The issue that Dr Bernard Lown, visionary, founder and Chairman of ProCOR,
raises is of great importance in the battle to retain health professionals in
Africa and other developing areas. It will be interesting to see how ProCor
correspondents from these countries analyze their various situations. There are
many complexities. Above all, it is not possible to ignore political realties.
In some cases the political situation is truly desperate--for example, if I
were a medical graduate of the University of Zimbabwe, I would have an
extremely difficult decision in balancing idealism versus reality. I would have
to realize that Mugabe's regime, which I would find impossible to live under, is
there to stay for the foreseeable future as it is being propped up by South
Africa and China. I don't think I would have the courage to stay to fight
Mugabe's dictatorial system and personally I guess I might rather become a
political refugee and migrate to in South Africa, England or the USA.
In the case of emigration of South African doctors, the reasons are complex and
include inadequate facilities in government hospitals as well as fear of crime.
Please see the excellent letter written by Bridget Farham in The Lancet of July
16, entitled "Migration of health professionals". Key points are:
(1) Truly
dedicated doctors leave the public serve for posts overseas or for the private
sector because of poor working conditions in the government hospitals; I might
add that this is not for lack of Government money, South Africa is
contemplating shoring up Mugabe's regime in Zimbabwe to the tune of Rand 6.5
billion (about one billion US dollars) which if invested into the heath service
could dramatically improve conditions;
(2) Specifically, tertiary hospitals
have been run down. The world-famous Groote Schuur Hospital where I have
worked since 1971, has been run down from a staff of 200 specialists to 100 and
now there are further plans to reduce this to 50; thus the workload per doctor
remaining increases proportionately;
(3) conditions in primary care centers are little better and pharmacies may lack basics such as antihypertensives;
(4) What South African doctors need from government is not so much a commitment to
them as doctors, but a commitment to patients such that working conditions in
the public sector cannot fail to retain doctors.
Regarding South African nurses, their pay is pitiful in a country where the top
financial managers, many of them black, are pocketing enormous and sometimes
even grossly indecent salaries. Furthermore, nurses (and doctors) have to
tolerate the government's lack-luster policy against AIDS, and if in government
service, have to work among hospital or clinic patients many of whom have AIDS.
The patient load is so severe that it becomes difficult to take the time to
take all the precautions against AIDS. Due to undertreatment and false advice
(that nutrients can cure AIDS) there is no feeling of getting on top of the
AIDS crisis as Uganda has. Conditions and therapy of AIDS in the Western Cape
where I work are much better than in many other provinces, but overall the
situation is not likely to change in the near future.
One way forward is to focus on certain hand-picked future leaders, who are
highly committed to their own countries, come what may. These persons are then
given further training at a selected overseas center, such as that run by Dr
Lown in Boston, then to return to build up in their own country centers of
excellence in their area of expertise. The next challenge would be to become so
outstanding that doctors from other African countries would be attracted to
learn not only specialized techniques (such as those of current cardiology) how
to expand into epidemiology and community medicine so as to spread benefits into
the society. Doctors trained on these lines would combine high-tech cardiology
with high community concern.
In sum, it is often not a case of our professionals being 'poached' by rich
Northern countries, but of free choice driven by poor working conditions and
political considerations. Factors in South Africa include lack of imaginative
government policy towards tertiary hospitals, thus overworking doctors and
limiting the management of advanced disease in impoverished patients, together
with confusion regarding the management of AIDS. All this creates a very
negative atmosphere. As long as these conditions persist, so will continue the
hemorrhage of doctors and nurses from public service to the private sector and
to overseas.
Lionel Opie
-----------------
Why not "brain's robber" instead brain drain?
The G8 (they represent the political structure of the Wealthy First World)
are responsible in part for our world's poverty. They also contribute in some aspects to our brain drain or better said: "drain robber".
There are some points to develop the complexity:
Our minds are colonised by their beauty and glimsy speach and teaching.
We eat Disney, Hollywood, Play Boy and other marvelous things.
We couldn't live in our gray countries without their power, fame and
money. (all that our soul claim to being human).
In our pauper countries, our politics with the high class in the real
government, help us to live without money, good food, houses, education,
health and security.
One example:
In the Malbran Institute our scientistis earn less than u$s 400 monthly. Is
the same place where works the colleague who research in Chagas' genes
(with european) and other superb scientist.
They made a politic argue- demonstration against our health minister since
almost 2 month to improve their salary and to have other benefits and, of
course, nobody have interest to solve it.
The condition to leave our country is done:
We have good education with no money to have a decent life.
Dr.Alejandro Wajner
Buenos Aires
www.criticamedicina.blogia.com
