Buenos Aires hosted this year’s World Congress of Psychiatry and I had the opportunity to attend a seminar on Brain Drain by Dr. Afzal Javed, co-chair of the section on Psychiatry in Developing Countries of the World Psychiatric Association. I was impressed by what he had to say.
Here's a summary of the notes I took during his lecture:
- What is brain drain? In the medical field, brain drain is the migration of health professionals from developing countries to developed ones, especially the United States, the United Kingdom and Australia. This started around the 1950s and it has become a major problem since. Internal migration is responsible for brain drain also existing within the same country. Many doctors move from rural areas to the big cities, where there are better universities, job offers and living conditions.
- Why is it a problem? Because many developing countries have a shortage of health professionals to begin with, and the migration of doctors and nurses to foreign lands leaves their native country understaffed, thus increasing global inequities in access to health care. This means, in a nutshell, the wealthy keep getting healthier and the poor keep getting sicker.
- Why does brain drain exist in the first place? Because the general working and living conditions and salaries of health professionals in developing countries are inferior to those offered overseas. Also, since the cost of medical education is much lower in the developing world, it is cheaper for developed countries to import foreign doctors than to invest in educating native students and training local professionals. Some even go as far as to say that, by exporting physicians, the developing countries are actually subsidizing healthcare in the developed world.
- What can be done? Freedom of movement is a right and migration is inevitable. They key lies in its regulation and management. Both developing and developed countries have things to offer. These strengths can be further developed by working together in partnerships to improve education, training, infrastructure and employment opportunities. The ultimate goal of cooperation should be to provide more and better healthcare to every single person. After all, isn’t that what we all want?
I would like to thank Dr. Javed and Dr. Riese for their help and encouragement.
*This blog was updated on 15 November, 2011 to correct a typographical error.
7 comments
Saskatchewan in general and our rural areas in particular have major issues with this. Ironically, our solution is to hire international graduates.
I wonder if media, internet and publicly accessible data and knowledge can minimise the downside of brain drain in the affected setting? My point is that although experts emigrate, the remaining population can keep themselves updated with social media and stay in touch with emigrated experts, even though these experts have left the physical setting.
Adam: We have issues with this as well. Argentina is not a very federal country, so most resources are concentrated in Buenos Aires. This means there's a lot of competition here to get a job and very few doctors in the rest of the country. Also, we have a lot of students and young doctors coming from neighboring countries (education is free here).
Nermin: A very good idea! I believe many of today's issues can be helped by the democratization of knowledge and information... What about exchange programs? Experts from different fields travelling periodically back and forth to train and update younger doctors and to make information and expertise circulate? I think we have to think in terms of global health. Cooperation is key!
Natalia and Nermin: I live in Colombia. I keep myself updated with social media (especially twitter) and email. In my opinion the problem is having the equipment/resources to reproduce what has been done in research in other parts of the world. If all the major research is still produced in developed countries, that can't be reproduced in developing countries.
Should developed countries make some "donation" of resources to developing countries?
What if the major research breakthroughs were made in developing countries?
Mauricio, that's interesting. I think a possible answer to that is making "donations" as you say --- it would appear to be fair, since a big part of the health professionals working in developed countries were trained in the developing world. But governmental involvement and investment is necessary too, specially in developing countries. Until that happens, I don't think we will be seeing many scientific breakthroughs in this part of the world. We have the human resources for it, but we lack the funding.
The healthcare professional shortage is really critical in some countries . I also live in a latinoamerican country and personally I do not think ocasional interchange would be enough, I completely agree with you when saying by exporting physicians, the developing countries are actually subsidizing healthcare in the developed world so developed countries should pay at least the same amount that a qualified doctor training is worth in the developed world when hiring a doctor from a developing country. I heard some countries do not allow to fully graduate students until they have finished a minimal amount of time working in a rural area.
Gusther, having to work in rural areas before you graduate sounds quite fair to me. Otherwise, there would be hardly any medical presence in rural areas. People go where the opportunities are. I think governments in our part of the world are not doing enough to keep valuable human resources within their country and distributing them according to necessity. Also, our needs in terms of health care are changing: chronic diseases are becoming increasingly prevalent and we need to keep up with that. I wrote a blog about this situation in my country a while ago: http://www.thelancetstudent.com/blog/contrasts