Global Surgery & Anesthesia

Here's the article. Very sobering indeed.

I wish indeed that improving infrastructure in LMICs could do something about it, but my last 8 years in SSA showed me that the docs mostly follow the money - and LMICs simply can't afford HIC salaries. This may be overly simplistic and of course there are many other reasons for physician migration such as security and opportunities, but economics plays a major role.

I tend to think that the main avenue open to us at GHD is the lobby with HIC providers for legislation discouraging poaching...

Maybe this is an argument for helping augment training programs in SSA for non-physician healthcare providers such as clinical officers and medical officers. They already provide much of the healthcare, specially in rural areas. They are much more likely to remain in their own country.

There is great potential indeed in surgeon extenders, yet it seems that many (most?) LMIC governments prefer to insist on surgeons, and these other practitioners' roles are being shrunk rather than expanded...

Overview of surgery at district hospital in Uganda, Tanzania & Mozambique, Galukande et al in PLoS 2010. AMOs involvement in surgery varies by country, more in Malawi, Tz, less in Kenya, Uganda. It will take along time to train MD surgeons or cover all district and regional hospitals. In my opinion AMO training is a good investment.

The issues about docs in SSA following the money- I think economics drives the distrubtion of docs pretty much anywhere in the world, including in HIC. Docs, in general, will tend to work mostly where they'll make a decent amount of money. While asking HIC to develop policies that discourage "poaching," I think more should be done to create more incentives for docs to stay working in their countries. I may be too idealistic, but I believe many LMIC could very well afford ,at the very least, attractive incentives to retain their docs.

Must say, i dont really agree with the conclusions, but as my experience and knowledge are anecdotal, I'd refer you to the work of Michael Clemens, Senior Fellow at the Center for Global Development. He has a great blog post titled "People are not property: Please stop saying that countries “steal” doctors from Africa"

The link is here: http://chrisblattman.com/2011/04/06/people-are-not-property-please-stop-sayin...

I was very struck by Adam's comment and reference to a Center for Global Development paper by Michael Clemens which questions the standard view that emigration by skilled workers impedes development. So I read "most" of this paper. My take on Clemens's position is that he strongly equates freedom with development (uses Amartya Sen's definition here), so that restricting the freedom of movement of skilled workers becomes a strong negative to development, etc. To me this is typical free market rhetoric which justifies the end result - more inequality - on the basis of freedom for some. It should be pointed out that not everyone in developing countries has the same freedom of movement - that is dependent on rich country immigration policy and of course Canada is awash with skilled workers, unable to practice their skill but who presumably find an improvement in their post emigration status despite this. That being said, I found on of the "best practices" which Clemens support: "Match subsidized skills to local needs" to be in accordance with Dan and Robin's support for subsidized training of acute medical officers rather than doctors. The reality is that as long as medical doctors are trained ...

I was very struck by Adam's comment and reference to a Center for Global Development paper by Michael Clemens which questions the standard view that emigration by skilled workers impedes development. So I read "most" of this paper. My take on Clemens's position is that he strongly equates freedom with development (uses Amartya Sen's definition here), so that restricting the freedom of movement of skilled workers becomes a strong negative to development, etc. To me this is typical free market rhetoric which justifies the end result - more inequality - on the basis of freedom for some. It should be pointed out that not everyone in developing countries has the same freedom of movement - that is dependent on rich country immigration policy and of course Canada is awash with skilled workers, unable to practice their skill but who presumably find an improvement in their post emigration status despite this. That being said, I found on of the "best practices" which Clemens support: "Match subsidized skills to local needs" to be in accordance with Dan and Robin's support for subsidized training of acute medical officers rather than doctors. The reality is that as long as medical doctors are trained to use rich country approaches, as long as income disparities exist in the world and as long as global movement of doctors is allowed then there will be a shortage in poor countries. Publically- funded training of health care workers should focus on those who will remain in country and provide benefits to its citizens. I work in Guyana which highs the highest percentage, 89%, of skilled workers who have emigrated to OECD countries. Interestingly the smallest countries suffer the greatest percentage loss.

Excellent comments Brian, I am in full agreement that global justice and equity occasionally needs to limit our individual freedoms.

I also wish to clarify that my comment about "following the money" indeed applies to all doctors, both from LMICs and HICs... It is simply an observation of human nature and not a negative or derogatory comment.

Espero que los expertos , es decir los neurocirujanos expliquen las
indicaciones precisa del uso del dreno, para que en estos pasises
subdesarrollados , tengamos la oportunidad de utilizarlos bien
<<<<<<<<<sin mas a hacer referencia

Dr Juan Jose Guadamuz vado

Dan, Brian and all --I agree that doctors follow the money, but so does everyone else. It appears to me that a fruitful line of inquiry is what does it take for people to be happy in the place that they chose to live. It is not just the money. It is the money, the educational opportunities for self and family, the freedom to design one's career and satisfaction in it, the personal safety and other factors. Part of what brings people home, or keeps them there despite otherwise less than ideal circumstances includes family, social empowerment and a strong professional network. We have been working hard to build strength in networks so that our colleagues don't feel so isolated, and although I have not done a formal survey, I believe that it is working, though not sufficient in itself.

esdtimados colegas estoy pidiendo guidelines o protocolo de actuacion,
adecuado al tercer mundo, me podrian citar algunas direcciones electronicas

Dr. Guadamuz,

Esta conversación y el término "brain drain" se refieren no a un dreno ni
un procedimiento que se puede utilizar en condiciones clínicas, sino al
fenómeno de la "fuga de cerebros," la realidad que muchos médicos,
científicos, y personas con buena formación académica y profesional
salen de países subdesarrollados para irse a países donde encuentran
trabajo más lucrativo.

Saludos cordiales.

Amy, thanks for clarifying so eloquently. Your Spanish is much better than mine.
Catherine

I thought the notice below from HHS (Health and Human Services, the US government agency that oversees NIH and a bunch of other programs), would be of interest to those who followed this discussion:

The HHS Office of Global Affairs and the Health Resources and Services Administration are holding a public meeting/webinar regarding the U.S. implementation of the WHO Global Code of Practice on International Recruitment of Health Personnel on Wednesday, December 14th, 9:00-10:30 a.m. The meeting will be at the Hubert H. Humphrey Building of the U.S. Department of Health and Human Services, Conference Room 405A, 200 Independence Ave S.W., Washington, DC 20201. Interested parties can also participate via webinar. Interested persons should contact <> for more information.