Intended for healthcare professionals


Africa's medical brain drain

BMJ 2005; 331 doi: (Published 29 September 2005) Cite this as: BMJ 2005;331:780

Why I want to stay in Africa

  1. Emmanuel Makasa, registrar in orthopaedics (emakasa{at}
  1. Department of Surgery (Ortho), University Teaching Hospital, PO Box 50110, Ridgeway 15101, Lusaka, Zambia

    EDITOR—The prevailing view is that all African trained health workers want to get out of their countries as soon as possible. I don't, for the following six reasons.

    • The experience I get in Africa is far richer than that in the United Kingdom or United States. My logbook shows the number of supervised operations I have performed, and the outcomes of these, and shows how I have rapidly and competently evolved to performing major surgery on my own. I have seen the logbooks of registrars of comparable seniority in the UK and elsewhere, and there is no comparison.

    • The colleagues I know who have gone abroad often develop low level depression. They are distanced from their families and culture, get sun deprivation, and may be subject to covert racism, often manifest in difficulty getting suitable jobs.

    • I live among my relatives, and am supported by them.

    • I can also easily relate to my rural home, some 450 km north east of Lusaka. Like so many of my local colleagues, I have a plot there where I can grow food, and build, if I feel so inclined, a house.

    • Although my pay is poor, I have enough money to live in a reasonable house in Lusaka, and with the support of my family and friends am sustained through the long hours I work.

    • I get much joy from serving my own community, and much gratitude from them. Given the shortage of doctors in Africa, the local people need my services, arguably more than peoples of privileged communities. I have also been helped through my education by the people, who through their taxes and community commitment support the public hospitals in which we are trained.

    These compelling reasons to stay in Africa do not argue against the need to resolve the issues of the skills drain. I strongly support the need to find ways of compensating Africa for the money spent on training health workers who leave Africa to work abroad.


    • Competing interests None declared.

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