In an article from International Herald Tribune published last July 20, the rich nations were blamed for the shortage of doctors, not only in the Philippines, but in all poor countries. As much as 18,000 Filipino doctors leave the country, mostly going to the U.S. to undergo training and eventually, to stay there for good. Even Africa, where millions are afflicted with AIDS and very much in need of medical attention, is being drained of its doctors. It appears that monetary compensation is one obvious factor why a healthcare professional leaves his home country. Another less obvious one is career satisfaction, which some overzealous people think should be second priority to the god, Patriotism. In the end, it is the recruitment of foreign-educated doctors by rich nations that is blamed for this “brain-drain”.
I don’t believe it is the rich nations’ fault that a lot of doctors flock to their countries for training and medical practice. That is like blaming the bakery with the better-tasting bread for another bakery’s loss of loyal customers. Or blaming a more reputable, consistent university for having more incoming freshmen than a college who’s failed to improve itself. The rich nations are short of healthcare professionals and are willing to compensate well those who’d come to its shores to work, which is admirable really because it shows how much they care about their nation’s health and well-being that they’d spend for its survival and maintenance.
And now, contrast this with what is happening in our country.
The government allocates some money for healthcare but, clearly, it isn’t enough. It would rather spend money on aircraft than on ample supply of antibiotics and medical equipment in our government hospitals. Directors of these government hospitals are only left to having to make do with what are given to them. Dr. Rasalan’s tale of how more than one patient are squeezed into a rickety cot and recycled gloves and surgical needles are autoclaved are true horror stories. Every medical clerk who has been rotated to any government (or semi-private) hospital can attest to that. Even years after being rotated to such hospital, I still cannot forget the smell of such places. It’s like a mixture of the scents of menstrual blood and bleach. And if ever anyone would contemplate painting futility, the sight of relatives ambubagging dying relatives because of unavailability of ventilators would very much be appropriate subject.
Also, because of the lack of budget for healthcare, government doctors, nurses, and hospital employees are underpaid and overworked. Our residents-in-training are now no strangers to working 72-hours straight duties compared to those training abroad who’re working at most 30-hour shifts. Doctors abroad even perform research studies to analyze if their work shift schedules are humane, especially for those who’re still in training. In our country, these studies exist, as residents’ research papers, but nobody pays attention to the findings that even a 24-hour work shift is already too much. Instead, those who’re supposed to be concerned brush it aside and dismiss it as trivial or inapplicable, believing that what has been tradition should be followed, regardless of what new findings will come up. Nurses are also forced to have more workload but with no equivalent increase in pay. Ideally, there should only be 3 patients at most being handled by one nurse. But in our government hospitals and even in private hospitals, a nurse is forced to handle 20-30 patients because the hospital wouldn’t hire more nurses. And, of course, the hospital expects that the additional workload is only small and doesn’t deserve an increase in payment. This also happens to other hospital employees, especially the nurse aides and the orderlies.
And so it seems that both the government and the current medical system are at fault and are contributory to the nation’s deteriorating healthcare. But what if we take out the government from the equation, as suggested by one of this blog’s frequent readers?
I’d say, it would have been more helpful if the government officials are less idiotic than they are now. And even if the private aspect of medical care manages to give what is due (better wages and more humane duties and treatment of training doctors), a great part of health sector is public and thus, it would be like racing uphill with only one leg. It’s so romantic to hear “let’s not blame the government and just do it ourselves.” In reality, this is just simply unfair because it would not be just that only the private sector (a handful of private individuals) will act on a problem that is nationwide in scope.
My point here, after a lengthy exposition, is that we should look within the country for the solutions to our problem. We cannot order rich nations to stop what they’re doing because they’re doing it for their survival. We do not have the right to do that. One reason why I encourage doctors who’re unsatisfied with work here to leave because it’s the only way I see now to make the apathetic government and the rest of the nation see that there is a problem and by sacrificing doctors to the god, Patriotism, isn’t going to solve the problem. It would be very unfortunate indeed if this country runs out of sacrificial lambs and still not realize that the problem lies within its system.
July 26th, 2007 at 21:46
[...] Continue reading ‘We are Responsible For The Shortage of Doctors, Not the Rich Nations’ [...]
July 26th, 2007 at 22:54
Hi,
You might be interested in this piece about cooperative work on an AIDS test for CD4 count by two companies, one university and a research institute.
http://insideinnovation.wordpress.com/2007/07/26/aids-fighters-in-the-lab/
All the best,
Colin Stewart
Columnist
O.C. Register
July 27th, 2007 at 12:33
You’re right, it’s not their fault there is massive emigration of health care professionals and other high-skilled workers from developing countries to richer ones. But it is true that five countries, US, UK, Germany, Canada, Australia and (I forget the last one), have tweaked their immigration policies in the last few years to attract these people. It is true that they have aging populations in need of care. It is true that there is a global hunt for talent, with these richer countries competing with each other to get the world’s best and brightest.
A compromise has to be set somewhere. Our government needs to do something, but these receiving countries also have to offer some compensation. We’re losing human capital, our local resources have educated and trained them. Remittances are good…but dollars can’t cure the sick.
July 27th, 2007 at 14:17
I’m sure you know I’ll be saying that the let’s do it ourselves call is not romantic. It’s just as romantic as “a government that does its part.” That’s the romantic wishful thinking if you consider the reality of the situation, don’t you think?
My only point is that the government is not a “deus ex machina” that we can rely on. Sure they have to do their part, but, we have to do something to call their attention if they don’t.
Will it take a mass exodus of doctors? A nationwide medical strike? A boycott on government hospitals? Encouraging each and every doctor to go abroad might “up the ante” and trigger the crisis levels needed for the government to take serious notice?
Those are just some examples of people taking things into their own hands.
July 27th, 2007 at 18:19
to Jon Limjap: “let’s not blame the government and just do it ourselves.”
— That’s why I called it romantic…it’s an idea with no basis on facts. The citizenry can be mobilized but, if the government is not up to the task, chances are the task will not be fulfilled. The task to revise the current medical system cannot be done without the government. I said this because in the previous related article, you hinted that we should just do it ourselves, which should be quite impossible and unfair.
I do think it will take a mass exodus of health care professionals before this country will wake up and realize that, not only it has done nothing to stop it, it also has contributed to the faster deterioration of the situation.
But then, of course, waking up the government to take action, as done by the private sector, isn’t enough. The government has to take full action. That’s why I said we cannot take the government out of the equation that easily.
July 27th, 2007 at 18:22
to sparks: But we sure cannot expect the rich nations to stop taking in foreign-medical graduates just because there is shortage of doctors in the poor nations? That doesn’t sound reasonable. Also, it wouldn’t be reasonable if the government hinders the Filipino doctors from leaving. That would be impinging on the rights of the doctors as human beings who can choose how to live their life.
What the government must do is re-analyze the budget and allocate the proper allowance for healthcare. The current medical system should also be revised, taking into consideration that healthcare professionals are human beings, too.
July 27th, 2007 at 18:52
Tess,
“I said this because in the previous related article, you hinted that we should just do it ourselves, which should be quite impossible and unfair.”
I guess you misunderstood my point. Let me rephrase my question to its simplest possible form:
“What can we do?”
Ayan na lang. Assume “nothing” is a valid answer.
July 27th, 2007 at 18:53
Oops… Assume “nothing” is an *in*valid answer.
July 27th, 2007 at 22:03
to Jon Limjap: Sorry if I misunderstood what you’re trying to say.
What the current medical system could do is to analyze the studies regarding the medical residents workhours. I’m sure a lot of residents-in-training and fellows have done research related to this. If doctors in the U.S. cannot work more than 30 hours straight, why should it be different here in the Philippines? Does that mean that we work longer hours and never get tired? If reduction of continuity of care is the concern, a more efficient system of endorsement can be done. Also, an increase in wages would be beneficial to keep more of our doctors in the country.
Nonmedical people (people who are non-healthcare professionals) should understand that healthcare professionals are human beings too, and that they need the same basic needs and wants of an average person. Yes, seeing doctors as a sort of demigod is a hard habit to break. But it should be done, out of consideration for the humanity of doctors and other healthcare professionals.
I would also like to caution the government from trying to imitate the American system of medicine nowadays, which noticeably has been starting to incline towards socialist medicine. If doctors and other healthcare professionals will be treated as traders instead of commodities, then we’ll go a long way yet.
July 28th, 2007 at 5:32
Pru: the study of international labour migration and its impact on developing economies (as well as rich ones) is a relatively new area of research. But people are thinking about them. Migrants are no longer seen as simply people working leaving their home countries to look for opportunities abroad.
It makes sense to me to look at them as agents of economic development. Their remittances already dwarf official aid and foreign direct investments.
Think tanks, even the International Labour Org. are looking into this as a possible area where public policies might intervene to stop the brain hemorrhage, or at least minimise the costs. It can be seen as a public matter because the impacts are public.
July 28th, 2007 at 10:45
“Migrants are no longer seen as simply people working leaving their home countries to look for opportunities abroad.”
— Oh yes, people do still think that people leaving their home countries (especially doctors) are selfish and unpatriotic.
“…public policies might intervene to stop the brain hemorrhage, or at least minimise the costs. It can be seen as a public matter because the impacts are public.”
— But to hinder individuals from leaving the country if they want to? Force healthcare professionals to do mandatory public service before leaving the country? Preposterous! That’s only fair if the government sent these professionals to school, paid their tuition, bought their books, and gave them allowance. But individuals who paid for education on their own should be left to practice their profession as they see fit.
July 28th, 2007 at 15:52
Tess,
““Migrants are no longer seen as simply people working leaving their home countries to look for opportunities abroad.”
— Oh yes, people do still think that people leaving their home countries (especially doctors) are selfish and unpatriotic.”
Oh, no, sparks isn’t talking about patriotism. It has absolutely nothing to do with patriotism. Don’t take it too personally, even though I understand that this is a very deep and personal issue to you.
She’s talking political science. Migrant labor is now a socio-economic force that is directly affecting whole nations. As such nations *tend* to take actions that favor their government (not necessarily their people) vis-a-vis socio-economic forces, whether they be essentially good or bad for the people in question.
July 28th, 2007 at 16:43
Prudence,
I’m currently doing research on migrant Filipinos abroad. I thought I’d be depressed by the outcome, but most migrant workers still care about the Philippines. Most of them don’t want to give up their citizenship, most think they contribute to the welfare of the Filipino even when they’re so far away.
I don’t begrudge migrants of leaving. I have family abroad. I myself have felt the pressure just because everyone else I knew was leaving. Now I happen to think its inevitable, for certain key professions. Its the next step to globalisation. We might all argue that Labour is the last to freely circulate the globe (after production and capital that is), just because we hold different nationalities.
What I’m trying to point out is there should be ways to minimise costs on all parties. And there should be other ways where the home country can benefit from the Diaspora not just in monetary terms. I myself am in Australia, although only for a short period. If I look at myself as an agent of economic development, I am learning so many things - building up my social networks, my skills and know-how. I’m saving up money. I imagine its the same for all 8.2 million Filipinos scattered all over 193 countries and territories. Imagine the wealth of human capital accumulating out there. The key is how do we harness it?
I will post excerpts of our findings on my blog soon.
July 28th, 2007 at 17:19
to Jon Limjap: Yup, I do understand what she’s trying to say. I’m merely reacting to the statement as how an individual might interpret it. Not the government or as a nation. As an ordinary lone individual. You have to admit we’re not yet that mature, as a group of people, thinking that all our movements, as a nation, have global impact.
However, I do have to raise the point about public policies. What kind of public policies are going to be enforced? This is alarming because there’s a proposal to put all medical graduates and board passers under mandatory public service for some years, before letting them to leave the country, if they wish. Now, I am against that. Not because I’m someone who’s planning to leave. I’m against it because it is simply trampling upon rights of individuals to live their life as they see it fit. Imagine, you paid for your own education and you’ll be forced to do something that isn’t in your plans? This would only be absolutely okay for those who plan to practice here. But not for those who wanted to do training abroad. It’s a disadvantage, because most institutions abroad want as much as possible fresh graduates (more trainable, I think). So, if you’ve already lingered here for years because of the mandatory public service, then you’re decreasing your chance to get accepted for training abroad.
If the government wishes to enforce this kind of policy, it should apply only to the graduates of state universities, since taxpayers’ money were used to subsidize their education and it is fair that they should give some return to the taxpayers for such an investment.
July 28th, 2007 at 17:23
to sparks: I’ll be looking forward to reading the findings.
July 28th, 2007 at 17:28
Prudence,
I actually agree with you that those who acquired their degrees in private institutions shouldn’t be ordered to stay. I think maybe there should be policies to “over-produce” health professionals so at least some might decide not to leave. Those who choose to stay in the country should have incentives as well.
July 28th, 2007 at 17:37
to sparks: The idea of incentives is good. Yeah, I do agree on that. Also the medical system should be revised. The U.S. are spending appropriately on studying the effect of their current medical system on their training doctors. Just goes to show that they’re concerned that maybe their doctors are getting too tired, which in turn could affect the quality of healthcare. Yes, we do have these studies in the Philippines, but most training institutions choose to ignore it. I don’t understand why. Even with the exodus of doctors, there are still many applicants for residency and many are still turned down and yet institutions will complain they don’t have applicants?!?! Now, that’s a puzzle.
That’s why I said there should be changes both in the government and the current medical system. One without the other is futile.
July 29th, 2007 at 21:50
I think we *are* already overproducing nurses: thing is I don’t think the supply of doctors is that healthy. It’s just too much trouble for too little benefit, as what Tess here is saying all along. However the only way to “overproduce” doctors is for it to have greater demand abroad, than nursing does. That would certainly discourage doctors from training into nurses. I wonder how one could influence that demand.
The incentive system is a great idea, albeit again, frustratingly, a system that can only be implemented by the government.