Sadly, the title quote could apply to any number of situations related to life in sub-Saharan Africa, but in this case is taken from a physician in this article in the New York Times Magazine, “America Is Stealing the World’s Doctors.”

The premise of the article: In a globalized economy, the countries that pay the most and offer the greatest chance for advancement tend to get the top talent. South America’s best soccer players generally migrate to Europe, where the salaries are high and the tournaments are glitzier than those in Brazil or Argentina. Many top high-tech workers from India and China move to the United States to work for American companies. And the United States, with its high salaries and technological innovation, is also the world’s most powerful magnet for doctors, attracting more every year than Britain, Canada and Australia — the next most popular destinations for migrating doctors — combined.

Just how extreme is the situation? In Zambia, 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.

There are some hints at plans to address the problem:

• There are 13 sub-Saharan medical schools receiving support from a United States-financed $130 million program; 
• The Global Fund to Fight AIDS, Tuberculosis and Malaria provided money to Zambia’s ministry of health (Zambia is featured prominently in the article) 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.”

And there are other circumstances: a friend of mine was in the Peace Corps in Niger about a decade ago. a Nigerien friend of hers wanted to go to nursing school, so we agreed to spend the $300 to cover all his expenses in the program. But he decided to go to mechanics school instead to become a bush taxi driver. Why? He’d have a more secure income; in Niger nurses are hired by the government which clearly had no funds – and no history – of paying public workers (when I visited in 1999 the school systems were closed as the teachers had been on strike for months, not having been paid for at least the prior 6 months). In the scheme of things it was a minor situation to be sure, but nonetheless strikes an important chord: medical providers, like everyone else, are part of an economic system, though unlike many others their presence has immediate has life or death consequences for the community. There are no easy solutions, either in the article or in real life, though the answers probably lie somewhere in the simple phrase that is the title of Nobel Prize for Economics recipient Amartya Sen’s major work, Development as Freedom.

It’s a well written article and a situation worth contemplating. Read more…