One foreign-trained surgeon believes the medical system is biased against outsiders like him. Kathy Sheridan reports

Javaid and Sarah Butt had been in Galway for six months when they decided their long journey was over. "We said we're not crossing waters any more." After five years of surgical training in London Javaid knew what he didn't want. "I didn't feel that England was the place for me. I felt very much this obviously big discrimination against foreigners trying to settle in to the system. When my training was completed I felt consultants were giving me indirect signals that said, look, we have our own boys."

He took the hint. In 1992 he went home, to the Pakistani side of Kashmir, to serve his community and settle down. "Then trouble started. I was young, I wasn't married and I was offered a temporary job in an area that was very much a war zone. I stayed for nine months and couldn't settle for political reasons."

He was back in London, preparing to go to the US, when the Galway offer came along. "It was like going from a big city to a village. We loved it so much. People, particularly the consultants in the hospital, were very receptive, very warm, and that helped me to settle down. This is what we were aiming for: a place to make a home. Then our two children arrived, and within a year we felt so much a part of the attachment and intimacy within the community."

Sarah, also a doctor from Kashmir, began to work part time at the hospital. Javaid says: "We had a lot of family members coming over, particularly my father, my brothers, my wife's family. They loved the place so much they never asked us to come back [to Kashmir\]."

Would they have returned if their father had asked? "In our culture our elders have very strong influence. If they say they want us back we feel obliged to answer that and ignore everything else. We trust them."

His father observed how they had knitted in to the community, helped by what he perceived to be significant similarities between Irish and Muslim culture. "I saw a very family-oriented culture, particularly in Galway. I saw my consultants were very like that. They would mention their fathers and mothers frequently. I didn't see that in England.

"Another similarity was how they went to church on Sunday and had Mass inside their homes. Our parents would take us out for prayer on Friday and we also had hautam" - the Muslim equivalent of a Mass station - "where father would call all our relatives and make a feast and invite the orphans and the poor from the community."

Meanwhile they bought a pretty house near Salthill, and Javaid's training continued with all the support and encouragement he could have wished for from senior colleagues.

They moved to Dublin in 1998, to allow him to complete his surgical accreditation at the Adelaide & Meath Hospital, in Tallaght.

"After that I was supposed to become a consultant surgeon in this country. It was then that I noticed some problems in the system."

He hit a glass ceiling. Applying for consultant posts, there were times when he didn't even make the shortlist, although he believed himself to be the best-qualified candidate. He saw white doctors he had trained racing ahead to become consultants. At one stage, he says, people suggested that it would have been better if he had married an Irish girl.

Three years after taking up a temporary post as general and breast surgeon at University College Hospital Galway he remains temporary, despite the post being available as a permanent one. Appointments are centralised, under a national system.

He says of the system generally that he believes it is "still geared to pick up the choice of their own people, and as long as it picks the right people I don't mind.

"But when you see them appointing a white guy who is more junior, less experienced, I think they want to keep the system their own way, with the white boys out in front."

Is there inbuilt racism? He cannot believe there are people who are racists, he says diplomatically. "I don't think there is true racism on an individual basis. It's the system which is at fault," he says. "When it comes to consultants they believe \ need to see a white face."

There are 47 vacant surgery positions around the country, "and these are kept vacant because they are looking for white candidates to come forward".

All his friends who went to the US are consultants now, he notes. "There may be individual racists there, but the system is fair."

Meanwhile, he carries on seeing 200 patients a week and feeling baffled.

Sarah, who is trying to do her membership in paediatrics, produces an article by a hospital colleague, Dr Saud Bajwa, that claims: "The non-EU doctors are like good butlers who are paid well, dressed up nicely and can cook a fine meal, expected to serve it on the table but not supposed to dine with the elite class."

As a household it's a fascinating mix of East and West. Sarah is clothed in traditional Muslim dress, and as we lunch on traditional Indian dishes this reporter is transfixed by the sudden blast of a recorded call to prayer.

Meanwhile the boy's hurleys sit inside the door, their parents speak only English - not Urdu - to them and they reply with a pronounced Galway accent.

"We see no point in teaching them a language which is not spoken \ and is no use to them," says Javaid. "This is their country now. When I take them home to Pakistan they feel foreigners there. The language, culture, manners are all different. They feel like they're on holidays there."

In 10 years the Muslim population of Galway has grown from about 30 to 2,000, by Javaid's estimate. He seems relaxed about Sarah's recent adoption of the hijab - "She is not oppressed. What she does is of her own volition" - and the boys' education. "There is no need for them to go to specific schools. What they need to know about Islam can very easily be taught at home."

Sarah points out later, however, that they have spent a lot of money making sure the boys had an Islamic education. "I've made special arrangements, such as getting a nanny from Pakistan for two years, who taught them the Koran, and now my babysitter is a Muslim."

Her adoption of the hijab only a few months ago was in response to some difficulties in her life. "When I started studying religion," she says, "more and more I felt I had no option. Why do nuns wear that dress? Why did women wear headscarves to Mass? It's about respect. It's respect for Islam. I used to think that if I wore this it would make me out as a funny individual, but this world is a test for us."

She stoutly defends Muslim strictures on female behaviour. "We are just not allowed to mingle with men. Look at David Beckham." She admits that the ban on alcohol affects their socialising to some extent.

"I have been to pubs with Irish friends and would drink orange juice no problem. But you feel different - you are different."

The incentive, she says smiling, is that "in the hereafter there will be a river of wine, and it will not make you drunk but give you the lovely feeling of being drunk".

She has observed many changes in Ireland in 10 years. "Everything is different now. Everybody is rushing to pay the mortgage, and material needs are increasing. People have drifted away from each other. In the UK you just said hello to your neighbour when you were parking the car or going out in the morning. It's getting like that here now."

They both insist they have never encountered racism here. "What people call racism is actually people who feel uncomfortable, because some who are not asylum-seekers are coming to this country and abusing the system. I worked in the Rotunda and saw the pressure that was on staff and resources by people abusing the system, and that inflamed me, because we are taxpayers too."

But she has sympathy for women in that situation. "It's the economies of those countries. The rich are getting richer and the poor are poorer, but all the world cannot fit in to Ireland or theUK or the US, so things must be improved in their own countries. Without peace that cannot be achieved."

For all its faults they will not consider Ireland as anything but home, says Javaid. "I feel Irish by my actions, by my looks, what I wear, my home, my investments. I train my children to be good Irish citizens. I feel this is my country. If I didn't feel that I'd pack my bags and go and live somewhere else. But yes, I do think about where I was born, who are my parents.

"I feel similar to the Irish who settled in America. They're American-Irish. I'm Indian-Irish. My next generation will be Irish."