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EDITORIALS: Olivia Roberts Tackling global shortages in health workers BMJ 2008; 337: a1971 [Full text]

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Tackling Global Shortages of Health Workers

Geoffrey P McMullin   (4 November 2008)

Tackling Global Shortages of Health Workers 4 November 2008
Geoffrey P McMullin, Retired consultant paediatrician TN36 4EN Send response to journal: Re: Tackling Global Shortages of Health Workers	Your editorial of 21st October (BMJ 2008;337:a1971) and the related article by Karen McColl (Fighting the Brain Drain, BMJ2008;337:a1496) make much of the differences in pay between doctors in the developing world and those in affluent societies but pay scant attention to the opportunities to practise effective medicine. McColl talks of the "push" incentives for doctors in underdevoped countries to seek employment in developed countries and mentions working conditions among these. However, what needs to be given greater emphasis is that in many if not most underdeveloped countries the possibility of doing anything useful for most patients is very limited. If you do not have antimicrobials, antiepileptic drugs, insulin or other medications for diabetes mellitus, if you do not have the laboratory facilities for diagnosing common infections, common forms of anaemia or blood glucose levels, if you do not have facilities for sterilising surgical equipment, for taking or giving blood, if you do not have adequate washing facilities, then increasing the number of doctors in the hospital or surgery is not going to contribute much to the health of the people you are attempting to serve. Immunisation too is an aspect of medical services that deserves mention. Without adequate programmes of immunisation backed up by proper refrigeration services, child mortality is likely to remain very high, however many doctors are standing around waiiting to help. I think that it is conversely true that many of the doctors from underdeveloped countries who choose to stay in the developed world might well return to their country of origin if the facilities to practise modern medicine were available there. I appreciate that there is more to modern medicine than medication and equipment, but as things are in many "developing countries" conventional medicine has for many common and important conditions not much more to offer than has the witch doctor. Competing interests: None declared