No doctors in the house

The rocket attack nearly killed them, spraying shards of glass through the basement hideout where 9-year-old Nagina Khudaynazar and her family had sought refuge from the Taliban in the summer of 1998. But when Afghan forces warned they could no longer withstand the Taliban attacks, the family took a desperate step: They set off on a days-long trek through the mountains of Afghanistan, traveling by bus, donkey, and foot into Pakistan — all while Khudaynazar’s mother was nine months pregnant.

So began a years-long odyssey that would eventually lead them to a cramped South Boston apartment, where Khudaynazar would rise to become the 2007 valedictorian at City on a Hill Charter Public School, harboring an audacious ambition. “I wanted to become a physician,” said Khudaynazar, who spoke little English when she arrived as a refugee in 2001. “I knew my ABCs through the refugee program.”

If medical training is partly a test of perseverance, people like Khudaynazar ought to have an edge. How hard is an 80-hour workweek compared with fleeing the murderous Taliban? Indeed, many Boston valedictorians have shown similarly hard-won tenacity, overcoming poverty, violence, and worse to become top students with dreams of medical school. And yet, when it comes to medicine, Boston’s best public school scholars are failing.

Nearly a quarter of more than 90 Boston valedictorians from 2005 to 2007 told the Globe they wanted to be doctors. Yet today, not one holds a medical degree — a bruising legacy of the school system’s striking failure to provide solid science instruction and a paradox in a city that boasts some of the finest teaching hospitals in the country.

Khudaynazar has come the closest: She’s one of just two Boston valedictorians interviewed by the Globe who have reached medical school.

By comparison, the valedictorian-to-doctor pipeline is well established in the cities and towns that surround Boston — and not just in the most affluent communities. Among suburban eastern Massachusetts valedictorians from 2005 to 2007, the Globe found doctors from East Bridgewater, Billerica, and Stoughton, all towns with incomes near the state average.

In all, eight of the 65 suburban valedictorians contacted by the Globe — more than 12 percent — have become doctors, including a surgery resident at Beth Israel Deaconess Medical Center and a chief resident at Tufts Medical Center.

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Boston’s valedictorians fared somewhat better in their pursuit of careers in the broader fields of science, technology, engineering, and math, a constellation of disciplines known as STEM that today drive the fastest-growing area of Boston’s economy. While more than a third of Boston valedictorians interviewed by the Globe entered college intent on pursuing STEM-related degrees, less than a quarter now work in an affiliated field. Among them are Tony Wen, who, after a childhood spent dreaming of designing buildings, works as an architectural designer, and Theo Dyshniku, who graduated from Wentworth Institute of Technology and now works as an electrical engineer.

Many who persisted now fill support-level positions. Others switched tracks after struggling in introductory science classes — painful decisions that effectively closed the door on some of the city’s most lucrative careers. For graduates such as Shalese Ford, the 2005 valedictorian at Snowden International School, that meant giving up her dream of becoming a veterinarian after running aground during introductory college chemistry.

“It was very sobering,” said Ford, client services coordinator at Thompson Island Outward Bound Education Center. “I really had to come to terms with what I wanted to do with my life.”

If ever a student embodied the promise of the American dream, it was Abadur Rahman the day he graduated as the 2006 valedictorian of East Boston High School. Rahman had spent his first decade in Bangladesh, where his grandfather was an influential imam. Rahman spoke only limited English when he arrived in Boston in 1998, and he would come to struggle with his Muslim identity in the aftermath of the terror attacks of September 11, 2001. He adopted a chameleon-like persona and was often content to let people think he was Latino.

Rahman nevertheless became a standout student, taking a number of STEM-related Advanced Placement courses to prepare for the pre-med track ahead. Just eight years after arriving in the United States, he earned a full academic scholarship to Northeastern University.

“My specific goal was to serve,” said Rahman, who was deeply influenced by his grandfather’s example and the extreme health disparities he witnessed in Bangladesh. “My focus was to go back home, more than likely to be a pediatrician.”

But then came the classes: Calculus. Biology. Chemistry. “I was massively unprepared,” said Rahman, who was dismayed to learn that many classmates had covered much of the material in high school. “Folks were at a different quintile than we were in terms of how much material they had [already] comprehended and internalized.”

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Rahman quickly discovered that it was impossible to juggle all of his STEM classes at once. “I fell behind in chemistry,” he said. “I was getting burnt out, and I didn’t put as much energy into biology. By the time we got to week eight, calculus was just a disaster.”

George DeGregorio, one of Rahman’s science teachers at East Boston, said he was astonished to learn his star student had struggled in college-level science. “His abilities were there,” said DeGregorio, who’s taught at East Boston for 20 years. “I am surprised that he would have felt ill equipped. … He achieved at such a high level.”

Maybe DeGregorio shouldn’t have been surprised. Students at East Boston have long scored well below statewide averages on the math and science MCAS, and Rahman felt as if teaching was geared toward the slower learners.

“The issue was the content and the pace,” said Rahman, who was also working part time at the CVS where his father was the head cashier. In high school chemistry, “we wouldn’t move to the next section until everyone understood the chapter we were on.” In college, he said, there was no waiting. “We were expected to learn two to three chapters a week.”

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Shalese Ford said chemistry at Snowden International was similarly “watered down,” which helped set her up for failure when she took the subject at Ohio’s Denison University. “Our teacher in high school would give us tests, but she wasn’t so stern with us having to remember the equations,” said Ford, who tried unsuccessfully to pass college chemistry on three separate occasions. “I knew roughly what equations I needed in the college class, but I couldn’t remember the whole equations.”

Rahman was placed on academic probation after his first semester and was later forced to withdraw from the honors program. Meanwhile, life at home was also spiraling out of control. His parents, who speak limited English, were struggling with his younger brother who would eventually be diagnosed with autism. His sisters were being bullied for wearing the hijab. And his father, whose job provided the bulk of the family’s income, was hospitalized with an array of serious health issues.

In Bangladesh, “there were a lot of support systems,” said Rahman. “We didn’t have that. It was just me, my parents, my siblings, and my aunt and her family. That was it.”

Rahman increased his hours at CVS to help his family cover expenses. His grades remained disappointing, and by the time summer rolled around, he was in jeopardy of losing his scholarship altogether. He considered dropping out and getting a construction job.

“For the first time, it fazed me,” he said. “Maybe you’re not who you think you are. Maybe you’re not good enough. Maybe you’re not meant to be in school.”

His father, who’d never been to college, urged him to stay in pre-med, offering to sell the family home to pay for his son’s education should he lose the scholarship. Rahman’s uncle, meanwhile, counseled a less drastic course: Why not shift to a less challenging field?

His uncle prevailed, and during his third semester at Northeastern, Rahman abandoned his dream, switching to economics. “That was a tough moment,” Rahman recalled of the day he filed the paperwork to change majors. “I felt like I had failed. I felt like I wasn’t good enough.”

The trials faced by Boston’s valedictorians, more than half of whom are black or Latino, mirror discouraging national trends in STEM-related fields. Although blacks and Latinos account for more than 30 percent of the US population, a recent report by the National Science Foundation found they filled just 11 percent of all science and engineering jobs in 2015.

It’s a sobering lack of success that can become self-reinforcing, resulting in fewer people of color at the top of science and medicine who could become role models for the next generation. Among the 93 Boston valedictorians interviewed by the Globe, not one has gone on to earn a PhD or an MD. And of the roughly 25 Bostonians who have earned advanced degrees, just seven were in STEM-related fields.

By contrast, the suburban valedictorians have steeped themselves in higher education, especially in science and technology. Two-thirds have gone on to earn advanced degrees, nearly half of them in STEM-related fields. All those advanced degrees (including eight PhDs) help explain why suburban valedictorians outearn their Boston counterparts: They are about three times as likely to earn $100,000 or more, holding positions that include a software engineer for Amazon Web Services and an immunologist for a pharmaceutical company.

At Boston public schools, for every valedictorian like Rahman, there are many more graduates who’ve performed so poorly in school — and been served so poorly by Boston’s schools — that they’ve been locked out of the STEM economy altogether. In spring 2018, just 53 percent of BPS 10th-graders scored proficient or higher on the science MCAS, well below the statewide average of 74 percent.

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The Boston public schools official in charge of academics acknowledged the school system is failing to prepare students for college-level science. In fact, the school system only recently decided to hire an administrator to lead efforts to improve STEM instruction.

“This is not something that comes as a surprise to us,” said Charles Grandson, chief academic officer at BPS. “It’s very valid, the experience of a student going to higher education and feeling unprepared. We know that’s something we certainly need to do a better job at.”

Although the district has made major investments in STEM education in recent years — such as securing a $25 million commitment from GE and opening the $73 million Dearborn STEM Academy in Roxbury — Grandson said the district needs to work more closely with area colleges to ensure its graduates are ready for classes ahead.

“That’s one stream of work that has not been an area of focus,” said Grandson. “Science is sort of like the next thing people are focusing on in terms of making sure their students have access to high-quality instruction.”

BPS’s lack of focus frustrates advocates who see Boston’s young people being left out of a blossoming economy largely built around STEM. Only about 30 percent of 2017 graduates met state-recommended MassCore standards, which include three science and four math courses. Statewide, roughly 80 percent of students met the requirements, with more than 160 schools reaching 100 percent compliance.

Boston school officials say the district lags in MassCore compliance in part because some of the small schools they created in the early 2000s had specialized curricula that didn’t emphasize those standards. “We haven’t yet had a full conversation about how we walk that back,” said Mary Driscoll, the district’s associate superintendent of elementary and middle schools.

But the problem was different for top students like Rahman, who took several of East Boston’s most challenging AP math and science courses, only to find they weren’t rigorous enough to prepare him for college. At Northeastern, Rahman’s grades rebounded almost immediately after he switched to economics, ultimately double majoring with political science. And although he was initially lukewarm about the material, his focus intensified following an encounter with Bangladeshi Nobel laureate Muhammad Yunus, whose work in microfinancing revealed the power to “uplift people through economics.”

“I was excited again because I could contribute,” said Rahman, who went on to earn a master’s degree and today is economic development director for the Codman Square Neighborhood Development Corp. “Not the way I [originally] wanted to, but another way. I was reenergized.”

Boston students who persist in chasing their medical dreams face daunting odds in a process that favors the affluent — students whose families can foot the bill for expensive test prep courses, say, or offer them the freedom to study or take summer enrichment programs without having to work. In fact, more than half of all medical school seats go to students from families in the top 20 percent of household income, compared with just 5 percent that go to students from the poorest 20 percent.

Those were the odds facing Nagina Khudaynazar when she arrived in Boston as a refugee from Afghanistan.

Khudaynazar’s father had been an attorney back home, but in Boston he supported his five children as a factory worker at General Mills and later as a parking lot attendant. The family lived in the West Broadway projects in South Boston, while her mother worked at T.J. Maxx before breast cancer forced her to stay home.

Good grades came easily to Khudaynazar, but she didn’t think much about getting recognition for it. “I think it was my principal that pulled me aside to tell me I was valedictorian,” she recalled. “I honestly didn’t know what it meant.”

Then, like other Boston valedictorians who studied science in college, Khudaynazar received C’s in her first semester. “Does this mean I’m not smart enough for medical school?” she recalled worrying as a freshman at Mount Holyoke College.

A mentor might have helped, someone to advise her to pace herself with difficult classes, recommend study groups, and help with study habits. “I didn’t have structure,” said Khudaynazar. “In high school you had assignments. In college … you study your notes. You study for exams. You don’t have weekly assignments that force you to go into the book and study. It’s on you.”

In sophomore year, she found an academic adviser who helped her chart a path to med school. Her grades improved. She began working in a virology lab during the summer and later traveled to her native Afghanistan for a medical internship.

Nevertheless, those early courses weighed down her GPA. Khudaynazar moved home after college to burnish her credentials at a clinical research lab while studying for the MCAT, the grueling standardized test used for medical school admissions.

“It was definitely a blow: Like, oh God, I’m probably not going to get in,” recalled Khudaynazar, who graduated from college in 2011. “I struggled, so I was like, I’m going to take my time.” She spent the next three years studying, sitting for the exam twice. She sent applications to 20 US medical schools but was rejected across the board.

Undaunted, Khudaynazar applied to St. George’s University in Grenada, one of many medical schools in the Caribbean that often take students who didn’t get into US programs. She’s now on track to graduate in 2020, but the road ahead remains difficult. She’s had to live with friends while studying for the boards, and she’s constantly on the lookout for scholarships, hoping to make a dent in the $340,000 debt she expects to accrue.

And that’s to say nothing of the years-long residency ahead — yet another leg in a journey that, she hopes, will one day lead to a career as a physician, perhaps with a clinic of her own in Afghanistan.

Just like she dreamed in high school.

Malcolm Gay can be reached at [email protected]. Follow him on Twitter @malcolmgay. Meghan Irons can be reached at [email protected]. Follow her on Twitter on @MeghanIrons. Follow Eric Moskowitz on Twitter @elmoskowitz.