To get a sense of the challenges professional immigrants face when they arrive in the United States, listen to Damaris Perez-Ramirez.
"I am originally from Cuba," Perez-Ramirez said. "I graduated as a clinical psychologist in 1982 so 26 years ago. I worked in my country for 12 years at a medical school as a professor of medical psychology."
During those 12 years, Perez-Ramirez also earned her doctorate degree in Psychology, conducted research and published dozens of articles in Cuba's medical journals.
"However, when I came to the United States, I started from zero," she said.
Starting from scratch meant cleaning houses, working as a translator and coordinating parenting classes for Latinos in the Twin Cities. These weren't exactly the kind of jobs she had in mind when she arrived in Minnesota in 2001.
"It was difficult, very difficult, and sometimes even humiliating to be doing things that you were not expecting to do, when you were more well-educated than the people you were serving," she said.
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Perez-Ramirez is working as a clinical counselor now. But it was a hard climb back up the professional ladder, one that involved going back to school and re-learning everything in English, she said.
Starting from scratch is something millions of high-skilled immigrants have to do once in the U.S.
A recent report by the Migration Policy Institute shows that, nationally, more than 1.3 million college-educated immigrants are either unemployed or working in jobs such as dishwashers, taxi drivers or housecleaners.
"What we're seeing is that people will live in near poverty or actual poverty for long periods of time where it's really not necessary," said Michael Fix, the Institute's senior vice president and co-author of the report.
Underemployment affects one in every five immigrants with a bachelor's degree or higher, the report found.
"You've got people here with college-educations. You've got the talent. It's really, in many cases, not that heroic and not that expensive to unleash that talent."
"This is a readily remediable problem," Fix said. "You've got people here with college-educations. You've got the talent. It's really, in many cases, not that heroic and not that expensive to unleash that talent and to find an efficient and quick way to provide credentials that can result in people being full employed."
Fix suggests offering low-interest loans to immigrants to help them pay for their re-certification tests, as well as integrating language and workforce training to speed up the process.
That would help many of the immigrants Stephen Nguyagwa sees on a daily basis.
Nguyagwa is the program coordinator for the African & American Friendship Association For Cooperation & Development in St. Paul. He helps foreign trained doctors and nurses living in the Twin Cities obtain state licensing in their fields.
The study material and test for doctors alone costs up to $15,000, and that's tough to pay when a person's working a low-wage job, Nguyagwa said.
"I've got people who are working as parking lot attendants. I've got people who are working as security officers," Nguyagwa said. "These are people who are really on basic wage, so it's a bit tough for them."
No one knows this better than 34-year-old Yussuf Mohamed. He was trained as a registered nurse in Kenya and Australia. But when he first arrived in the U.S., he earned minimum wage loading trucks at a baking company in Fargo, N.D.
In 2007, he got a $1,000 grant from the African & American Friendship Association to pay for his test and preparation to become a nurse again.
"I did not have any money," Mohamed said. "I didn't have anything back then. Even if I was going to do it, it was going to take me long, long time." His life has changed for the better, Mohamed said. His salary is enough to prove that. In 2007, before his re-certification, he and his wife earned a combined $24,000. Now, with his salary as a registered nurse at the Hennepin County Medical Center and overtime pay, he more than tripled his salary.
"I started working as a nurse in February 2008, so between February 2008 and December 2008, those are 10 months, I made $80,000. Just me," Mohamed said. "My life changed for good. Now, you know, I'm doing exactly what I was trained to do."
But the process to get re-certified is not as easy for other professions. And that brings us back to Perez-Ramirez.
In the last few years, she received her Master's Degree in counseling and psychology from St. Mary's University in Minneapolis and passed her board exam.
"It's unbelievable," she said. "At the beginning I thought, 'It's not possible, It's too much.' And I thought, 'I'm never going to get there'."
But she has. And in four months, when she completes her 4,000 hours of required supervised work, she'll be able to -- at least officially -- call herself a psychologist again.