On the wall over Dr. Rafael Grossmann’s desk at Eastern Maine Medical Center in Bangor hangs a framed photograph of the city of Caracas, Venezuela. Under a polished blue sky, the modern city of 5 million people, with its crowded streets, gleaming high-rises and spreading slums, is dwarfed by a spectacular mountain range.

“That one is called El Avila,” Grossmann says, pointing out the nearest peak, whose dark, forested flanks form a massive backdrop to the Venezuelan capital. The mountain, which separates Caracas from the humid shores of the Caribbean Sea, is a national park, he says, and its steep slopes are dear to his heart.

“I was up there every day, until I came here,” he says, a note of nostalgia in his voice.

Grossmann, 42, is among hundreds of foreign-born doctors now living and working in Maine, seasoning the state’s largely homogeneous culture with an international flavor. Some are here on a temporary basis, working off a requirement that they practice three years in a medically underserved area of the United States before applying for a permanent work visa.

Others, like Grossmann, have jumped through all the immigration hoops and have made Maine their home for the indefinite future, settling in to build a career, make friends, raise their children and live their lives.

Grossmann, a trauma surgeon at EMMC, lives now in the rolling hills of Holden. He and his journalist wife, Audrey, who is also Venezuelan, have been putting down roots in eastern Maine since March 2002, when they came for an initial interview at the hospital.

“It was cold and dark and ugly and gray,” he recalled, but he and Audrey had spent his seven-year surgical residency in Ann Arbor, Mich., and were steeled for the late-winter dreariness of the northern-tier states.

They came back in June for a second look, hoping to be charmed. They weren’t disappointed.

“Oh, it was all green and beautiful,” Grossmann said with an expansive smile. “The black flies weren’t out yet. We drove around and looked at schools and went down to the coast.” When the surgical position was offered, they accepted swiftly.

Grossmann, who returned to Caracas for two years after his residency, says the cumbersome, government-run medical system in Venezuela makes it impossible to practice at the level he was trained for.

“I had all this specialized training and potential,” he said. “But I couldn’t use it, and I couldn’t provide for my family there the way I wanted to.”

Despite having extended family in Caracas, he and Audrey found the current political turmoil and the growing crime rate intolerable, fueling their decision to return to the U.S.

“It was not the same place we grew up,” he said. “We decided we didn’t want to raise our children there.”

Nuclear family

Dr. Natalia Cherepnina, 29, was born in Kyrgyzstan and grew up during the Cold War in a secluded community in Kazakhstan. Both her parents worked in the Soviet Union’s nuclear weapons industry.

“It was a very secret town,” she said. “It didn’t exist on maps. No one from the family knew where we were or could come to visit.”

In school, Cherepnina excelled in sciences and was encouraged to study foreign languages – first German, then English. She went to medical school in Moscow, followed by a two-year residency. Her education could easily have stopped there, but Cherepnina wasn’t satisfied.

“In Moscow, I worked in a hospital where there were three antibiotics, and you couldn’t get an X-ray in the middle of the night,” she said. “I decided that if I really wanted to do medicine, I should go to the United States.”

When she arrived in New Haven, Conn., to take her residency exams, her English was rough, Cherepnina admitted. But within a few months she was comfortable with both medical terminology and social exchanges.

In the final year of the three-year internal medicine residency, she began looking for work.

“I wasn’t thinking about Maine at all,” she said. “I was just applying everywhere.” But EMMC invited Cherepnina to interview for a job as a hospitalist – a hospital-employed physician who takes over for inpatients’ primary-care doctors.

“I came up during my vacation,” she said. “I was hoping to find a job in Connecticut, but everything there just faded compared to here.”

Cherepnina, who started working in Bangor in July 2006, said EMMC’s status as a tertiary care hospital – one that accepts complex cases from smaller referring hospitals – provides her with a wide range of professional challenges.

“The hospitalists here are very thorough. There are a lot of people I can learn from. I enjoy working with them, and I trust them,” she said.

Cherepnina, who is single, said she has no plans to leave the Bangor area when her temporary visa expires in about three years.

“I like it here. I’m more of a nature and outdoor person,” she said. She enjoys snowboarding, hiking, camping, surfing and other outdoor activities. On vacations, she’s enjoyed backpacking in California and snowboarding at Lake Tahoe.

Although her family now lives in Moscow, Cherepnina said she probably won’t return to Russia except to visit. Her parents came to Bangor at Thanksgiving time and were having a fine visit.

“We don’t really celebrate Thanksgiving in Russia,” she pointed out. “But my mother’s at my apartment right now, cooking up some Russian foods for me.”

Think globally, live locally

As a child, Dr. Sylvana Atallah lived with her family in Nigeria, went to school in England and then attended medical school in Cairo, where she was born. She practiced in the cosmopolitan international city until 2004, when she arrived in Cleveland for a second residency in intensive medicine.

For the 36-year-old Atallah, an eventual move to the United States was a given. Her family had a green card while she was growing up, and they came every year to fulfill their immigration requirements with an eye to someday apply for full-time residency.

But when push came to shove, Atallah’s father, who is also a physician, was unwilling to give up his thriving practice in Nigeria and start over in this country. Her mother, a science writer, is an established journalist in Cairo.

When Atallah finished her one-year residency in Cleveland, she was faced with a choice. Because she was in the U.S. on what’s known as a J-1 visa – for her medical residency – she could either return to her own country for two years before applying for a regular U.S. work visa, or she could practice for three years in a medically underserved area of this country before finding a more permanent position.

Atallah said there was really no question of going back to Egypt. She and her Lebanese doctor-husband, Charbel Maskiny, whom she met during her Cleveland residency, were expecting a child, and since they both knew they eventually wanted to practice in this country, they started looking for a hospital or medical practice where they could both work.

“We looked in Pennsylvania, Ohio, Florida – there are underserved areas in most states,” she said. They came twice to Bangor to interview for jobs at EMMC, and they liked what they found.

“Salary-wise, the other places offered more,” she said. “But people are very friendly here.”

The hospital offered them both full-time jobs with the flexible scheduling they needed so one of them could always be home in Hampden with baby Joelle, now 2 months old.

And after they’ve finished their three-year commitment?

“We don’t know what we want to do,” she said. “So far, this seems like a very nice place to stay.”

From Beirut to Bangor

For infectious-disease specialist Dr. Mohamad Mooty, Lebanon, where he grew up, will always be home. But now, living in Hampden with his wife and two young children, Mooty, 36, says life is good in eastern Maine, outweighing the more sophisticated attractions of Brooklyn, N.Y., where he completed his degree in internal medicine at SUNY Downstate in 2005.

“In Brooklyn, there were lots of Lebanese people,” he said – whole neighborhoods of compatriots, and stores and restaurants selling familiar foods and other goods. Great restaurants, museums, Broadway shows and other attractions were all around. It was a terrific place to finish his medical training, he said, but no place to raise a family.

“I was married and the father of a newly born kid,” he said. “I needed a good place to raise my family, and a good academic environment. That’s why I came here.” It sweetened the deal, he added, that his sister is married to a rheumatologist who also practices in the Bangor area.

Practicing medicine in the U.S. is the realization of a lifetime dream, he said. In Lebanon, he said, doctors can earn a decent living, but it’s hard to find a challenging position. And, he added, the poor in Lebanon are routinely turned away from hospitals and clinics.

“If you don’t pay ahead with a certain deposit, they just won’t admit you,” he said. Though there are clear inequities in the U.S. health system as well, he noted, “at least here, there are some supports.”

Mooty was in New York on Sept. 11, 2001, when the World Trade Center was attacked, and said the attitude toward Middle Easterners like him changed dramatically overnight. Things are better there now, he said – but here in Maine, people have gone out of their way from the beginning to welcome his family to the community.

Noting his Arabic accent, patients and others he encounters often ask where he’s from, Mooty said, but he’s never encountered any animosity. Many have misconceptions about Lebanon. “They think we all live in the desert, that we all have camels in Beirut,” he said, grinning. He enjoys the opportunity to educate those who are interested, he said.

Mooty the family man enjoys spending time with his wife, Rouba, and their kids at local parks, the Maine Discovery Museum, swimming at the Bangor Y in the winter and at area lakes and rivers in the summer. When they need a shot of big-city culture, they head for Boston.

Mooty is working off a three-year obligation through the J-1 visa waiver program. Will he stay in the area?

“For sure,” he said. “I mean, no one can guarantee the future, but that’s my plan.”