Tackling global shortages in health workersBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1971 (Published 21 October 2008) Cite this as: BMJ 2008;337:a1971
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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
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: No competing interests