Punjab's medical colleges at Amritsar, Patiala and Faridkot trained doctors from the 1950s in numbers well beyond what the state's health system employed, and a large proportion emigrated.
Punjabi doctors were among the substantial cohort of South Asian doctors who staffed the British National Health Service from the 1960s, particularly in general practice and in hospitals outside London, and the same pattern followed in the United States, Canada and the Gulf.
The remittances and the return visits built a great many village hospitals, dispensaries and eye camps in Punjab, funded by doctors abroad.
The free eye camp, run by a visiting surgeon in a village gurdwara or school, is an institution in Punjab and is almost entirely diaspora-funded.
A state that cannot fill its rural medical posts trains doctors who staff another country's health service and then fund clinics back home. Every part of that arrangement is a symptom.
The National Health Service recruited Indian doctors heavily from the 1960s, and graduates of the Punjab medical colleges were a substantial part of that intake.
The pattern repeated in the United States after 1965 and in the Gulf from the 1970s, and the medical colleges in Punjab have functioned partly as export institutions for sixty years.
Punjabi doctors abroad have funded hospitals, dispensaries and equipment in their home villages on a large scale, which is among the least documented parts of the remittance economy.