Since private medical university fees are too expensive for the average Indian, the dream of becoming a doctor was only within the reach of the well-off that is, until 2003, when Chinese universities touting low tuition threw open their doors to them.

Thousands of made-in-China Indian doctor hopefuls enrolled in Chinese medical universities eager to take advantage of this deal, which seemed too good to be true and, as they are finding out, might actually be.

Soon after enrolling, these students discovered something that troubles them.

"Our futures depend on luck now," said one 21-year-old second-year student studying at Tianjin Medical University (TMU) who declined to give his name for fear of getting "in big trouble" with the school.

"We can't stop now; it's too late. We're just hoping for the best, that by the time we graduate, the Medical Council of India (MCI) will recognize our degrees."

The Indian Embassy in Beijing estimates between 4,000 and 10,000 Indians study medicine at Chinese universities but said it is impossible to know the exact number because not all of them register with the embassy.

In 2004, more than 20 medical universities began aggressively recruiting Indian students, promising low tuition and English-language instruction. With 263 Indians enrolled in its medical programme, TMU has one of the largest Indian medical student populations in China, said Guo Fenglin, director of the school's International Exchange Department.

"This university provided us a guarantee that we could get a reliable deal so we would be allowed to practice medicine when we go home," said Prokash Kumar, 18, a second-year TMU student from Tamil Nadu. "The promise the university gives us, we believe they'll follow."

Kumar said he believes that as long as he passes the MCI Screening Test, he will be allowed to practise medicine in India because MCI will recognize the degree he will have earned. The university's syllabus, he pointed out, is nearly identical to those of India's universities, so he says he should be prepared for the test.

"It would be the university's responsibility to help us out because we have relied on the university and would have relied on them for five or six years. We have followed the rules," he said. "If the degree is not recognized, that would mean we just wasted five years of our lives. That is not a trivial thing."

A chief officer with MCI did not respond to questions sent and re-sent over a week-long period by fax and e-mail.

His classmate, 18-year-old R.S. Ramya, of Kanyakumari, also said she is confident she will be allowed to practise medicine in India after she graduates from TMU and passes the test.

"The senior students we knew, they thought it was safe coming here, so if they are coming here, we know it's OK," Ramya said.

Many Indian medical students came to Chinese universities at the recommendation of educational agents, who assured them their certification would be recognized when they return home.

The agents also tell prospective students the courses will be taught in English, but the students at TMU don't agree how well their teachers speak it.

"Our teachers know English very well," Kumar said. "If we have some problem, we can explain in English, and they understand very well."

However, another TMU student who refused to give his name for fear of expulsion said he has serious problems understanding his instructors.

"You can hardly understand their pronunciation," he said. "Some teachers are good, our teachers are really co-operative and everything; it's not their fault they can't speak English, but it's also not our fault that we can't understand them. We told them to bring teachers from India, and they promised a couple of times that they would, but they haven't."

Gourangalal Das, first secretary at the Indian Embassy in Beijing, said that complaints about the English proficiency of instructors come from many universities across China, but added: "All of the students say that they've gotten better faculty and over time, the language ability of the instructors has improved. Many universities are bringing in foreign teachers, who are easier for students to understand."

Recognition is the key

Kumar and Ramya agreed that the appeal of studying at a Chinese university is the low tuition.

"A normal Indian cannot afford to attend a private medical college," Ramya said. "Coming here offers us a reasonable education at a reasonable cost."

TMU's five-year medical training programme is more or less typical of those offered in China. Critics in India say that the aggressive recruitment of Indian medical students is motivated by nothing less than money, and they offer as evidence that the minimum score on high school final exams required for admission at these schools is 70 per cent.

Guo confirmed the 70 per cent minimum score requirement at TMU but said the school always seeks better-qualified students.

Regarding money, TMU charges Indian students US$3,300 a year for tuition, which is near the top of the scale for Chinese universities. Last year, it was US$2,300, and next year it is expected to jump to US$4,100. Some medical universities in China charge as little as US$1,600 a year; the national average is US$2,000, Guo said.

That tuition fee is substantially less than Indian universities' charge, but if MCI does not recognize the degrees, getting them in China is worthless at any price.

"The problem is that China has degree and diploma recognition agreements with many countries maybe 50 or 60, especially in Europe but there are no bilateral agreements between China and India right now," Guo said. "For other countries, it is no problem. Even Americans study here, and their degrees are recognized."

He said the Ministry of Education and the Scholarship Committee of China are working to establish bilateral degree recognition agreements with their Indian counterparts.

Any Indian student who receives a medical graduate degree from a foreign country must meet three conditions to be a registered medical practitioner in India, Das said.

First, the students must pass MCI's Screening Test. Second, they must earn a medical degree from an institute listed in the World Directory of Medical Schools, published by the World Health Organization. Third, they must obtain the Eligibility Certificate from MCI according to the Eligibility Requirement for Taking Admission in an Undergraduate Medical Course in a Foreign Medical Institution Regulations, 2002.

Han Rui, a co-ordinating professor in TMU's International Exchange Department, said because MCI issues Eligibility Certificates to students before they go to China, "we believe MCI will honour their degrees. Otherwise, they would be going back on their promise. How could they face their students?"

The eligibility requirement was passed to avoid a repeat of the nightmare faced by Indian medical students who invested several years of study in inexpensive but dubious educations at Russian and Eastern European universities in the 1990s, Indian media reports say. Because the English-language instruction the students received there was of such poor quality, most failed the Screening Test when they returned. Some later petitioned the Supreme Court to overturn the MCI's decision and won a one-time waiver.

Concern has arisen that the China experience would repeat the European one eligibility certificates or not.

"No batch of Indian medical students in China has yet taken the MCI test, and it is difficult to predict," Das said. "Most universities claim that their syllabi conform to the MCI requirements."

Keeping track

He said the Indian Embassy has responded to students' complaints with visits to various universities.

"Most of the complaints are from individual students and pertain to micro-level issues," Das said. "Macro-issues like curriculum, internship and practice, et cetera, the Embassy is proactively pursuing with the concerned authorities in India and the Chinese Ministry of Education."

But specifics of the dialogues are "not in the public domain," he said.

Guo confirmed the Embassy's visits to TMU to conduct investigations and regularly sends e-mails and faxes requesting information about its students.

He said that he also receives occasional complaints from Indian students, and the university tries to ensure quality instruction by using a two-pronged approach. First, teachers are scrutinized by a supervisory group of foreign and Chinese professors who visit their classes and evaluate their performance. Second, students submit written evaluations of their instructors.

"If the teachers aren't teaching very well, the students will come to my office and make complaints, and we replace the teachers," Guo said.

The first batch of Indian students will graduate in 2008. Then they will find out if their faith that their Chinese degrees will qualify them to practise medicine in India was justified.

For Ramya, it's not only a matter of career, but also of family.

"My parents are doctors," she said. "They are working at the hospital, and they are waiting for me to come and join them."