Nepal, Feb. 21 -- He leaves his village with a borrowed dream - and borrowed money. A poor young man arrives in Kathmandu hoping to secure a job abroad. But before he ever boards a plane, he is compelled to spend nearly Rs 30,000 - including food and lodging - in the name of mandatory medical tests. When the promised job falls through, the debt does not.

This has become the quiet, crushing reality of thousands of Nepali workers. What should be a routine health check has, many allege, turned into an organized system of extraction - a "medical mafia" thriving in the shadows of foreign employment.

Medical tests are reportedly conducted on far more workers than destination countries actually require. Even before jobs and destinations are co...