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Migration of Doctors from poor and reach Countries to reach English speaking Countries.
- Edoardo Cervoni, Wigan Road, Ormskirk, Lancashire. (4 July 2005)
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Poor countries must change the policy to stop the brain drain
- Dr.Satheesha Nayak (5 July 2005)
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Is Brain Drain not the fault of Developing Nations?
- girish chawla (6 July 2005)
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currency and purchasing power
- Akash Samtani (6 July 2005)
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Freedom to work, not economic exclusion.
- Anand Sharma (7 July 2005)
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Medical migration - a more equitable managment method?
- John A Dorward, Eyemouth, Berwickshire TD14 5DD (14 July 2005)
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Rich country, poor country, poor doctor
- ANTHONY O BELLA (25 July 2005)
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Edoardo Cervoni, GPwSI (ENT) West Lancashire PCT, Wigan Road, Ormskirk, Lancashire.
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Omar B Ahmad, while discussing the migration of skilled health professionals from poorer to richer countries, omitted to mention the existence of a counter-flow. Recognizing its existence and its reasons, together with whit the obstacles that make it more difficult, is of paramount importance. The migratory flow described by Ahmad is not simply a flow from poorer to richer countries, but, more precisely and correctly, from poor and reach countries to reach English speaking countries with a rather well developed recruitment system (Canada, US, UK, Australia, NZ). Language, by all means, mechanisms in place to make possible the achievement of equivalent professional titles, and recruitment systems appear to be key factors. Ahmad also mentions Italy among the Countries producing more health professionals than they can absorb. A recent bibliographic reference is missing. In fact, this statement deserves, at the least, a more accurate review. If it is true that in 2002 Italy, with 583 physicians per 100,000 population, had probably the highest level of medical staffing in the world, it must be emphasized that the overproduction of doctors occurred mainly in the decade 1974-84 (98 % more than in 1964). In the following decade this has been of the 41 % and, in the last decade, of the 5,4 % only (1). From the Academic Year 1988-89, the number of enrolments to the Italian Faculties of Medicine in is regulated according to the demand of doctors on the territory. However, this new regulation, is clearly likely to cause a shortage of doctors within the next 2 decades due to the retirement of those graduated in the ’70s. OOH services are already struggling in obtaining appropriate cover, especially by doctors with postgraduate qualification in Primary Care. Surprisingly, the physician/population ratio is lower in the Northern Italy, where the pro-capita GDP is much higher than in the Southern Italy. The feature evidences the importance of non-economic factors in shaping the geographic distribution of health workforce. 1 Calcopietro M. [Medical doctors in Italy: a situation analysis]. [French] [Journal Article] Cahiers de Sociologie et de Demographie Medicales. 42(1):113-48, 2002 Jan-Mar. Competing interests: None declared |
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Dr.Satheesha Nayak, Selection Grade Lecturer in Anatomy, Manipal Academy of Higher Education Manipal, Udupi District, Karnataka State, INDIA. 576104
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Editor – the article about the medical migration by Omar B Ahmad describes “why”, “what” and “how” aspects of migration of medics to the developed countries. As far as India is concerned, it is not only the medical drain but we must say that it is the “intellectual drain”. The main reason for migration is the policies of the country, the demand in the developed countries and attractive salaries offered in the developed countries. Actually, many of the youngsters in India, dream about visiting a developed country, working for there for a few years, make money and come back. For an Indian, if he works in USA or England, the money he will get is five to ten times more that he will get in India. So they like to go and work for a few years and come back to the motherland. Some of them settle there if they get a permanent residence ship. In India, first of all, it is difficult to get a good pay with a basic degree. It is very difficult to get a job in the first place. Here, most of the software engineers, doctors and PhD holders will be waiting to get a job in a developed country. They feel it is a shame on their part to work in India. Countries like India have to realize that “Only monkeys will stay if you give peanuts to eat”. They have to change the government policies and create job opportunities to the intelligent deserving people in order to stop the brain drain. Competing interests: None declared |
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girish chawla, SHO walsgrave hospita , coventry
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Dear Sir, I read this article by A. Omar.It was a very good article. The points highlighted reflected a great depth of thought in the matter. I personally feel that intellectual assets are going to developed countries not because the life there is very attractive but because they do not get enough support in their own country and they have to struggle through the beurocractic system for career development. It is very easy to blame developed countries for the brain drain but actually many talented people leave their homes even if it means staying away from their childhood friends, local pub and relatives but as things for them are made so difficult in their own country that they are not left with any option but to go to places where their talent would be recognised. Most of the scientist and research workers that migrate to developed countries say that the main reason for their desicion was perhaps because they were not able to have opportunites they wished in their own work practice. Some of them are very keen to come back but when they come they find there is no place for them in the system in their original birth place. In Summary I feel the main reason for the brain drain is that developing countries do not recognise the talent of their people and do not give opportunities that they deserve. Kind Regards
Competing interests: None declared |
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Akash Samtani, GP London N21 2PB
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One of the main reasons for migration from the 'developing' world to 'developed' world is the super strong currencies here. Compare India and the UK for example where 1 pound buys 80 or so rupees: The purchasing power of 80 rupees is however much greater than 1 pound by about 4 to 1 i.e. 1 pound buys as much as 20 rupees. Therefore any prospective doctor from India should divide any UK salary by about 4 to get a realistic idea of the true worth of his UK salary when comparing it to his Indian salary. If the aim is to save money and return home it makes sense. if staying in the UK is the goal the massive costs of living here should be taken into consideration. Competing interests: None declared |
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Anand Sharma, Consulatant Forensic Psychiatrist The Edenfield Centre, Manchester
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Sir, There may be nearly as many Ghanaian doctors in New York state as there are in Ghana [1] but these doctors are not the cause of poor health in their country of origin. Ahmad's article [2], although learned, fails to acknowledge the primary cause of ill health in developing nations: poverty. Public health initiatives would have a greater impact than any formal health care provision. I would argue that limiting recruitment from developing countries is well meaning but ultimately misguided. Migrant remittances to developing countries in 2002 have been estimated to be up to $200 billion. [3] This massive sum, representing a considerable proportion of poorer nation's GDP, exceeds the total amount of aid given to Africa in the past 40 years. It is my humble opinion that these talented men and women contribute more to the alleviation of poverty and hence improved health in developing nations than any national strategy for the migration of health workers. Richer countries should allow unfettered access to employment in their health care systems if they want to help imrove the lives of those in poorer countries. Yours etc., Anand Sharma [1]CBFC.org IRIN interview with the President of the Ghana Medical Association, Dr. Jacob Plange-Rhule,October 6, 2003. [2]Omar B Ahmad, Managing medical migration from poor countries BMJ 2005; 331: 43-45 [3]'Migrant remittances to developing countries', UK Department of International Development, by Cerston, Bannock Consulting, June 2003. Competing interests: None declared |
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John A Dorward, General Practitioner Eyemouth Medical Practice,, Eyemouth, Berwickshire TD14 5DD
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Editor, In his thoughtful article Ahmad (1) has explored many of the issues and dilemmas raised by medical migration, the need for "ethical recruitment" and freedom of movement. The goal is arguably not "to meet the legitimate labour needs of the developed countries", but to enable the development of the healthcare systems of the developing countries without their being damaged by the labour needs (legitimate or otherwise) of developed nations. At present the developing nation loses not only intellectual capital but also social capital in addition to the finance spent in training a health care professional (HCP). In any financial system this is not sustainable… The compensation strategy that Ahmad places last in his suggested list of solutions is the most important to tackle. One mechanism is to develop a clear and strong global framework whereby the receiving country replaces the lost capital of the developing country when a trained HCP moves to a developed country to train or work in a service-providing post in health care. Such a system could be administered by an international Trust and linked to professional registration in the receiving country. The receiving country would pay into the Trust as long as the HCP was professionally registered and the developing nation would receive a payment from the Trust to be channelled into health education. This system would be more just for all. It does not restrict the worker's rights to move freely, it enhances the value of the worker in the receiving nation, it makes the receing nation think more clearly about its personnel needs, and it gives the developing country an opportunity to retain its capital. There are a number of side issues that need further discussion but it provides a starting point for negotiation. John Dorward General Practitioner Eyemouth Medical Practice Berwickshire dorwards@fish.co.uk 1. Omar B Ahmad Managing medical migration from poor countries BMJ 2005; 331: 43-45 Competing interests: None declared |
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ANTHONY O BELLA, Foundation Year 2 SHO Ysbyty Gwynedd, Bangor LL57 2PW
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The article on managing medical migration barely avoids the trap of laying more blame for Third World problems at the door of developed nations rather than the afflicted countries themselves – a way of thinking that is at the heart of the wider debate about where the solutions to Africa’s problems lie. If America needs doctors and nurses it will, for we live in a free world, recruit from wherever it finds them. Awkward, artificial barriers to the movement of healthcare workers are as much an infringement of individuals’ rights as they are, in the long run, unfeasible. The most effective answer to a mass exodus of Poor Country’s doctors is to make Poor Country and its hospitals enjoyable to work in. Besides, the suggestion that the retention of doctors in their developing countries of origin would mean better healthcare in those places is a fallacy. Many of my colleagues back home are unemployed, underemployed or unable to undertake postgraduate training because of stagnant infrastructure and rudimentary healthcare delivery systems. And where they do begin hospital practice, they soon face the despondency of incessant strikes and an appallingly equipped workplace. This problem has moved from fresh young graduates to involve doctors at every level of specialist training. As a medical student and then house officer at the largest teaching hospital in Nigeria, I saw – among other departures – a professor of medicine leave for the UK to take the PLAB exam, while the chief resident in medicine and a consultant paediatrician set off to begin residency anew in America. It all served to rather extinguish what little hope I had of staying put to further my training in my own country. I came to realise that possibly the single most important factor driving the emigration of healthcare professionals is a lack of job satisfaction. It goes that bit beyond salaries, housing allowances and cars. As your editorial rightly pointed out, rich countries awash with vacancies will always pull professionals from the developing world. It really isn’t about right or wrong. If the developed world became self–sufficient in training people for its own manpower needs, all well and good. The outflow of expertise from developing countries would consequently halt, leaving them with trapped doctors who in turn would be left with little choice but to hope for the day when their patient won’t die for want of an urgent blood electrolyte investigation. Anthony Bella sesanbella@yahoo.com Competing interests: None declared |
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