As a medical oncologist who began my career in Kerala and later transitioned to the United Arab Emirates (UAE), I have had the unique opportunity to experience oncology practice in two very different healthcare environments. This article is a reflection of that journey - the differences, challenges, opportunities, and personal growth that came with it.

From God’s Own Country to the Gulf: The Transition

My medical journey began in Kerala, where I practised in a system known for its strong clinical acumen, patient trust, and ethical grounding. The decision to move to the UAE stemmed from a desire to explore international opportunities, expand my professional exposure, gain financial stability, and secure a more balanced lifestyle. While the transition brought new possibilities, it also came with logistical hurdles such as licensing, adapting to new clinical protocols, and adjusting to a multicultural healthcare environment.

Clinical Practice: Comparing Kerala and the UAE / Patient Demographics

Kerala patients are usually well-informed, often inquisitive, and deeply involved in treatment decisions. In contrast, the UAE presents a highly multicultural patient population comprising locals, South Asians, Arabs, Europeans, and Africans. Each group brings its own set of expectations, beliefs, and communication styles, making cultural competence an essential part of practice.

Disease Presentation

In the UAE, we often encounter a younger patient population. This may be attributed to the large number of expatriates and working-age individuals living in the country. A significant proportion – nearly 50% of our oncology patients are under 50 years of age. Consequently, we see a relatively higher frequency of cancers that are more common in younger individuals. This contrasts with the cancer demographic in Kerala, where the patient population tends to be older due to the higher proportion of retired and elderly individuals.

Access to Treatment and Medications

One major advantage of practising in the UAE is the availability of high-end medications. Many cutting-edge cancer therapies including targeted agents and immunotherapies are available and accessible due to robust insurance coverage. The UAE is also one of the few countries where new cancer drugs are approved relatively quickly, giving patients early access to potentially life-extending treatments.

In Kerala, while the public healthcare system offers affordable care, access to novel agents may be limited by cost constraints, especially in the absence of private insurance or funding mechanisms.

Palliative Care

The palliative care system shows a marked contrast between the two regions. In Kerala, palliative care is well-established, with a strong community-based model and wide accessibility, even in rural areas. The state has set an example globally in integrating palliative care into the public health system.

In the UAE, however, access to palliative care services can be limited, primarily due to insurance-related challenges. While major hospitals do offer palliative care, it is not uniformly accessible to all patients, especially those with limited or no insurance coverage. This remains an area with significant scope for improvement in the region.

Legal and Professional Safety

One of the most reassuring aspects of working in the UAE is the structured and impartial medico-legal framework. If a medico-legal issue arises, it is thoroughly reviewed by an expert panel from the Department of Health (DOH). The process is professional, objective, and focuses on determining negligence through a transparent evaluation.

This is in stark contrast to the increasingly volatile situation in parts of India, including Kerala, where doctors often face hostility or even physical assault following adverse outcomes irrespective of fault. The UAE’s strict laws ensure safety and dignity for healthcare professionals, creating an environment conducive to stress-free clinical decision-making.

Work-Life and Family Balance

Another often under-appreciated advantage of practising in the UAE is the quality of work-life balance. Fixed working hours, well-defined responsibilities, and fewer bureaucratic obstacles allow more time for family, rest, and professional development. For physicians with young children or ageing parents, the relatively structured lifestyle can be a game-changer. In contrast, long working hours, on-call duties, and administrative overload are common challenges in Kerala’s healthcare system.

Challenges and Adaptation

While the UAE offers many advantages, it comes with its own set of challenges:

• Licensing and Credentialing: The process is rigorous and documentation-heavy, requiring persistence.

• Language and Cultural Barriers: While English is the primary language of practice, dealing with patients speaking Arabic or other regional languages may require interpreters.

• Follow-up Issues: Some expat patients may leave the country, making long-term follow-up difficult, especially for cancers requiring chronic management.

Professional Growth and Opportunities

There are ample opportunities in the UAE for continuing medical education (CME), participation in international conferences, and collaborations with global pharmaceutical and academic institutions. While research opportunities may be more limited outside major centres, the overall environment supports skill advancement and specialisation.

Lessons across Borders

Kerala’s strengths lie in its grassroots-level oncology care, patient trust, and strong academic training. These can inspire improvements in community outreach and preventive oncology in the UAE. Conversely, Kerala can learn from the UAE’s efficient health systems, fast regulatory approvals, and emphasis on physician safety.

Final Thoughts

My journey from Kerala to the UAE has been both professionally enriching and personally fulfilling. Working in a system that values efficiency, safety, and innovation - while allowing time for family and reflection - has given me a broader perspective on what oncology care can look like. I remain deeply connected to my roots in Kerala and hope that sharing these experiences will help others considering a similar path, and perhaps spark ideas to improve healthcare delivery on both sides of the Arabian Sea.