Brain Drain in Sub-Saharan Africa: A Function of Doctor Poaching or of Education?

Today I read a research article (Hagopian et al., 2005: see http://www.arp.harvard.edu/AfricaHigherEducation/WAfricanDoctors.pdf ) which found that faculty and administrators at medical schools in Ghana and Nigeria were almost unanimously encouraging their students to migrate to wealthier countries to pursue better career opportunities and larger salaries. In the presentation of their qualitative research, the authors of this article did not report that any of the interviewed educators expressed even slight concern for the plight of the millions of ill and underserved citizens of their own countries. In fact, they reported that what they learned through their research amounted to essentially a culture of migration in which the immediate abandonment of one’s own country in the name of promoting one’s career is encouraged and even expected.

In my opinion, it is elitist and morally reprehensible for medical professors to influence their students this way. To even allude to the idea that the goal of a government-funded (as most are in this particular context) medical education should be one’s own personal gain, to the detriment of the country which provided the funding, is a deplorable position for any citizen, let alone an educator of hundreds of citizens, to take. To suggest that prestige and financial compensation should be the only goals to which these students aspire, even in the context of abject need in which their countries are situated, undermines the ethical core of the field of medicine. First do no harm. Is it not harming millions of your fellow citizens to encourage your students to choose personal prosperity over the well-being, nay, the very lives of the citizens that their government intended for them to help when it spent a not insignificant portion of its limited funds on their education and training?

In graduate institutions, socialization and acculturation are powerful forces. Students learn not only the actual substantive knowledge necessary to work in their chosen fields, but also how it is appropriate for them to behave as professionals in these fields. More often than not, students learn (whether it is the direct intention of their instructors to teach them this or not) what they, as members of their field, should value. Thus, as students learn throughout their tenure as medical students to value migration, prestige, financial gain, and the technological advancements of more developed countries above all else, this so-called culture of migration into which medical students in parts of West Africa are socialized assuredly undermines any effort by governments to incentivize practicing medicine in one’s home country. Even where West African governments may be able to address one of these valued areas in an attempt to retain doctors, they certainly cannot provide new graduates with all of these valued assets simultaneously. Thus, if faculty members at medical institutions continue to instill their progeny with these “values,” the problem of health provider shortages in West African countries will only continue to grow exponentially.

Professors and instructors in medical schools in these countries have a moral responsibility, as educators and socializers of the next generation of doctors, to replace the culture of migration with a culture of altruism, patriotism, and equity. They should remind students that they all (and especially those who received government funding to attend medical school) owe their own country a great debt. They should teach them that their personal rights to choose migration should not be exercised at the expense of the rights of millions to health and to life. They should bring the voices of the poor and the underserved to their classrooms. They should urge future doctors to think of issues larger than the depths of their own wallets or the make and model of the cars they will drive when preparing them to make their OWN decisions about whether or not migration is an appropriate choice. In their classrooms, they should represent (or at least consider) the voices of the poor and the underserved in their nations. Let them leave the presentation of the other side of the issue to the poaching strategies of recruiters from developed countries.

Fortunately, at least not all medical school faculty in all Sub-Saharan African countries subscribe to the culture of migration. This video ( http://www.youtube.com/watch?v=ME-ICeVKukA ) interviews a professor (at 18:18) in Malawi who seems to feel that the role of wealthy countries in strongly encouraging students to migrate is morally reprehensible. The video also interviews at least 2 health providers who have risen above the culture of migration and chosen to work where they are most needed, and a current medical student who never considered leaving his home country of Malawi. On the other hand, it provides support for the existence of a culture of migration or at least for a culture of self-interest among Malawian-trained doctors, as it includes interviews with plenty of doctors and medical students have chosen to migrate and who truly don’t seem to even be able to fathom a reason why they might have chosen otherwise (e.g. 14:45; 13:50; 16:43).

Leslie Williams

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