Views And Reviews

Dubious motives

BMJ 1994; 308 doi: (Published 01 January 1994) Cite this as: BMJ 1994;308:65
  1. D Curr

    So why do you want to work at our rural African hospital? Of course, it's a perfect career opportunity for you. There is such a wealth of clinical material, such gross pathology. As a budding surgeon, you will welcome the opportunity to practise your basic surgical skills. By the time you return to the United Kingdom, you will be relatively competent, and sufficiently skilled to start operating on British patients. And the obstetric experience is unique. With such terrible perinatal mortality at the best of times, the occasional error of judgment will probably pass completely unnoticed. How refreshing to work in an environment quite uncluttered by the risk of patient complaints or medicolegal threats. No meddlesome community health councils or family health services authority disciplinary hearings here. Just think how much you could save in defence society subscriptions.

    Or maybe you are not finding your niche in medicine in the United Kingdom. Seven years as an ENT registrar at a district general hospital is a long time, and your CV is looking rather jaded. Nobody in Britain seems to appreciate your old fashioned values and professional authority. These days the nursing staff are argumentative and always challenging your management decisions. How about a fresh start in a distant traditional country, where you will win instant respect? Here the patients still bow or curtsey, and the nurses will stand up whenever you go on to the ward. At last you will have the prestige which you deserve as a doctor. Nobody will mind whether you bother to listen to patients properly, there's no time in a busy African hospital for the niceties of empathy and reassurance. The doctor here has more important things to do.

    No, I know that you are not at all like that. You are still young and idealistic. You've always believed in primary health care, and you've heard of Alma-Alta. You've read about Third World debt and structural readjustment programmes, and you know your NGOs from your GDPs. But more than that, there's a little bit of Africa in your soul. You were there when Mandela came to Wembley, you still listen to your Graceland album, and you're rather fond of bananas. You've always got on well with Africans. That nurse on your ward even invited you to come and stay with her family in Togo, or was it Tobago? You understand Africans, after all, and you know what's good for them. You know they need your help.

    So now your many and various CVs arrive at the hospital, in all shapes and forms: typed and handwritten, legible and illegible, one inexplicably sent in a padded envelope. The task of identifying the best candidate seems impossible. How can we make any logical choice between so many different applicants? But perhaps it doesn't much matter. After all, these people should be thankful to have any doctors at all, shouldn't they?

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