Brain drain and brain gain

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Who are medical migrants? What causes them to move? What are the consequences of this movement? And how can the situation be corrected? Well, it depends on the angle you see it from.  Medical migration first has to be viewed from three unique perspectives: that of the source country, the destination country and that of the migrant.

According to the WHO Estimates of Health Personnel 2004, in 2000 Europe and the USA with 21 percent of the world’s population had 45 percent of the world’s doctors and 61 percent of the world’s nurses.

Africa, with 13 percent of the world’s population, had a mere three percent of the world’s doctors and five percent of the world’s nurses.

Medical migrants come from Africa, the Caribbean, South East and South Asia. The major destination countries are Australia, Belgium, Canada, France, New Zealand, UK and USA.

These are complex, and in many ways, relative. They are often referred to as factors that “push” from the sending country and factors that “pull” to the destination country. These are job satisfaction, skill utilization and professional development, income and standard of living, politics, government and administrative bureaucracy, personal safety, health safety and retirement safety.

Medical migration has positive and negative effects on the source country, the destination country and the migrant. Unfortunately, current literature, public forums and media attention appear more focused on two of the following possible major consequences: the negative effect on the sending country (its impact on healthcare delivery in Africa) and the positive effect on the destination country (the impact on their shortage of medical personnel).

There are positive effects on the sending country (knowledge and expertise gain on migrant’s return) albeit this cluster is very small. There are also negative effects on the destination country, again very small.

And then, to the surprise of many, there are significant negative consequences for the migrants as well, especially (racial) discrimination, social status and lack of recognition of the primary migrants, and the potential for loss of culture, language and identity of their children.

We need to address the factors in the sending country that favour migration, the circumstances of the destination country that encourage the in-migration movement, and the motivational factors that prompts the medical migrant to leave.

While we deal with the cause we must also rebalance the consequences. We should look at the positive and negative consequences like a playground see-saw.

For example: take the source country (or say Africa), list and evaluate the positive and negative impact of medical migration on it, then reverse this gradient (remember the see-saw) by decreasing negative effects and increasing positive effects.

All professionals, not just medical doctors, have the right to practice in any location or region of their legal choice. However, for the sake of World/Public Health, the inequities do need to be addressed.

The above was an article I published in an International Journal of Medical Science in October 2005. It is disheartening that it still applies today.

“Push” factors in 2016 now include the puzzling difficulty in passing residency exams in some specialties, difficulty getting desired placement for residency training, repeated clusters of strike action, and the falling international value of income.

There is also the “double drain” effect. These are doctors who have returned home with expertise gained abroad, but without the necessary support to integrate back into the health system, they are then forced to return abroad.

Some Asian Governments got this right a decade ago. They sent emissaries to the UK and USA and asked their nationals to return home.

They provided land and real estate, and loans at special rates and grace periods. They passed legislation that enabled easy transfer of equipment, drugs and medications, and technology for their returning physicians.

They facilitated building permits, import duty waivers and infrastructural support. They empowered these professionals. Today these countries have a booming medical tourism industry. They turned a brain drain into a brain gain.

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