America Is Stealing the World’s Doctors

For a diabetic or someone with heart disease in rural Nebraska, this is unquestionably a good thing. They may be unaware, however, that their gain is a poor country’s loss. The migration of doctors and nurses from poor countries to rich ones elicits some highly emotional responses, not to mention a great deal of ethical debate. Writing in the British medical journal The Lancet in 2008, a group of doctors, several of them from Africa, titled their paper “ Should Active Recruitment of Health Workers From Sub-Saharan Africa Be Viewed as a Crime? ” (PDF) They concluded that it should. Other critics have used terms like “looting” and “theft.”       
Some of the anger is directed toward the doctors who leave. The managing director of University Teaching Hospital in Lusaka, Lackson Kasonka, suggested to me that doctors who received government financing for their educations and then left exhibited “a show of dishonesty and betrayal.” (Desai is not in this group; his parents, who immigrated to Zambia, paid for his medical education in India, where they were born.) Peter Mwaba, the most senior civil servant in Zambia’s ministry of health, said that doctors overseas should not “hold their country to ransom” by staying away until things, in their minds, sufficiently improve.       

The public health challenges in Zambia are intimidating: life expectancy is 46, more than one million of Zambia’s 14 million people are living with H.I.V. or AIDS and more than 1 in 10 children will die before they reach 5. To cope with this, there are slightly more than 600 doctors working in the public sector, which is where most Zambians get their health care. That is 1 doctor for every 23,000 people, compared with about 1 for every 416 in the United States. If Desai decides to stay here, the world’s richest country will have gained a bright young doctor. The loss to Zambia will be much greater.       
Salaries and working conditions in a country like Zambia are never going to match those in the United States, but there are other factors that influence a person’s decision to emigrate: family ties, the cost of living, language and the comforting sense of living in a familiar culture. Doctors from Ghana once fled to the United States almost as a matter of course. But its retention rates of doctors and nurses in recent years have greatly improved as salaries rose enough to weigh the scales in favor of staying.       

The public health challenges in Zambia are intimidating: life expectancy is 46, more than one million of Zambia’s 14 million people are living with H.I.V. or AIDS and more than 1 in 10 children will die before they reach 5.

let me repeat that

The medical brain drain from poor countries gets a fair amount of attention in international health circles, and initiatives both private and public are trying to resolve the shortage of doctors. The teaching hospital in Lusaka where Desai trained, for example, is one of 13 sub-Saharan medical schools receiving support from a United States-financed $130 million program to generate more and better graduates. The Global Fund to Fight AIDS, Tuberculosis and Malaria provided money to Zambia’s ministry of health to recruit and retain doctors. Western aid agencies, many financed by donors like Bill and Melinda Gates, have also hired local doctors at higher salaries. But apparent solutions can create further problems; many of the doctors hired by aid agencies are doing research. They don’t see patients. Frustrated public health officials in Zambia and other developing countries call this the “internal brain drain.”       

source

is that a highly regarded source