Parts of southern Ohio, like other rural areas in our nation, suffer chronic shortages of qualified physicians, so Dr. Khayam Shaukat's services have been appreciated by his mostly low-income Adams County patients.

But not since February. The Pakistani-born doctor has been stranded in his native land, the victim of the kind of red-tape snarl that has become common as we try to balance security and liberty in post-Sept. 11 America.

As Dr. Shaukat explains in his "Your voice" column (below), he trained in this country for years before coming to work at Dunkin-Blanton Health Center in West Union last fall. When his mother fell seriously ill, he went to Pakistan to be at her side.

"Unfortunately, when he reapplied to come back to the U.S., he chose to seek a different visa," said Rep. Rob Portman, R-Ohio, whose district includes West Union. That choice triggered a new, intensive security check. "This is a good example of where there is a pull and tug in the new homeland security policy," said Portman, whose office is working to expedite Shaukat's return. "Anybody from Pakistan, particularly if applying for a new visa, has to go through a thorough background check."

Previously, Portman said, the State Department issued visas without consulting with law enforcement or intelligence. We even saw one 9-11 hijacker's visa approved months after the terrorist attacks. "Now, under the Patriot Act, they're talking together," Portman said. "It is a more effective way to keep hijackers from getting into our country. The problem is that from the perspective of a visa holder, it takes too long."

Meanwhile, Shaukat's patients are caught in the middle. Clinic officials say it's increasingly tough to cover for him as the weeks go by. "The clinic really needs him," Portman said. "It's tough to attract doctors to our rural areas, making this a particularly unfortunate situation."

There are no easy answers here; obviously, federal officials need a more efficient, responsive process to handle visa issues.

But Shaukat's story is one small example of the trade-offs, dilemmas and Catch-22s we face in this new era. Some have economic impact. As Portman pointed out, tightened visa policies have resulted in 40 percent fewer foreign graduate students nationwide than before Sept. 11. That means a tremendous loss of income for our universities.

"There's a balance there, but we haven't reached it yet," Portman said. America needs to keep pushing to reach it.