Saturday, March 10, 2012

Developing World's Doctor Brain Drain

From the New York Times, an article by Matt McAllester about the United States' propensity for attracting young physicians from abroad and adding them to the American work force when they're far more needed at home.
The migration of doctors and nurses from poor countries to rich ones elicits some highly emotional responses, not to mention a great deal of ethical debate. Writing in the British medical journal The Lancet in 2008, a group of doctors, several of them from Africa, titled their paper “Should Active Recruitment of Health Workers From Sub-Saharan Africa Be Viewed as a Crime?” They concluded that it should. Other critics have used terms like “looting” and “theft.”

Some of the anger is directed toward the doctors who leave. The managing director of University Teaching Hospital in Lusaka, Lackson Kasonka, suggested to me that doctors who received government financing for their educations and then left exhibited “a show of dishonesty and betrayal.” ...Peter Mwaba, the most senior civil servant in Zambia’s ministry of health, said that doctors overseas should not “hold their country to ransom” by staying away until things, in their minds, sufficiently improve.

The public health challenges in Zambia are intimidating: life expectancy is 46, more than one million of Zambia’s 14 million people are living with H.I.V. or AIDS and more than 1 in 10 children will die before they reach 5. To cope with this, there are slightly more than 600 doctors working in the public sector, which is where most Zambians get their health care. That is 1 doctor for every 23,000 people, compared with about 1 for every 416 in the United States. If Desai decides to stay here, the world’s richest country will have gained a bright young doctor. The loss to Zambia will be much greater.
The author visits an understaffed Zambian hospital with plenty of donated equipment from Japan, making it clear that more doctors are needed there to put it to use. Yes, it's clear that with those new ventilators just sitting around, more doctors would make it a much better hospital. But not all hospitals in these doctors' home countries are even minimally equipped. In my opinion, he doesn't adequately examine the difficulties a doctor faces in running a facility with extremely severe equipment shortages, of which there are all too many in developing countries.

Low-resource medicine is a noble practice, but has its limits. Too few resources and a hospital becomes a hospice--with no IVs, sterile equipment, meds, or adequate staff, it becomes essentially impossible for caregivers to do their jobs. Patients either get better or they lie around and die. Hard to blame a doctor for not wanting to walk around, much less try to work, in a place like that. If you bring doctors back to such hospitals, will even the simplest of the tools they need somehow follow them there?