Dr John Baptist Mukasa, or JB Neuro, as his colleagues referred to as him, “was all the time on the beck and name of everybody who wanted neurosurgical care”, in keeping with his colleague Dr Sabrina Kitaka. Mukasa’s demise from COVID on June 29, in the course of Uganda’s most deadly wave to date, robbed the nation’s medical fellowship of a pal and a mentor.
It additionally reduce the overall variety of neurosurgeons in Uganda by 25%.
Solely three neurosurgeons stay in Uganda, a rustic of 44 million individuals (though some estimates put the workforce as excessive as ten). By comparability, Canada, with a inhabitants of 35 million, has over 150 neurosurgeons. New York Metropolis’s Columbia Presbyterian Hospital, the place I did my residency, has 17 neurosurgeons in a single division alone – a number of instances bigger than the complete neurosurgical workforce of Uganda.
There are various causes for this disparity, together with an absence of coaching services and hospitals able to supporting advanced surgical care. After which there’s the mind drain – the migration of skilled professionals out of a rustic to different, typically wealthier, places.
Mind drain is taxation
There are various causes docs depart. A better wage, entry to schooling, steady political situations, improved requirements of residing, elevated perceived high quality of life, and better private security all draw docs away from their houses and sometimes to international locations that beforehand colonised theirs.
It’s a multi-billion–greenback business. Just lately, my colleagues and I revealed an estimate of the financial impact of the migration of docs (we didn’t have sufficient info to take a look at the migration of nurses or different well being professionals). We discovered that international locations lose someplace between US$3.5 billion and US$38 billion a 12 months because of the surplus deaths that mind drain causes. The international locations exporting the best variety of docs incur the most important prices: India, Nigeria, Pakistan and South Africa.
In different phrases, not solely do the international locations to which docs migrate profit from an inflow of skilled, skilled professionals, additionally they inflict what is actually a tax on the economies of supply international locations — all for the privilege of attracting away their scientific workers.
Saluja, Rudolfson, Massenburg, Meara, Shrime/BMJ International Well being, CC BY-NC
Mind drain and COVID
In 2010, the World Well being Group agreed the International Code of Follow on the Worldwide Recruitment of Well being Personnel. This settlement inspired supply international locations to carry onto their healthcare workforce by enhancing schooling, residing requirements and dealing situations (it didn’t tackle how this could possibly be achieved within the face of restricted assets). The settlement additionally required vacation spot international locations to cease recruiting from international locations with a scarcity of healthcare employees.
However that by no means occurred. In truth, at the start of the COVID pandemic, lively recruitment of docs from these supply international locations stepped up as the dimensions of the disaster turned clear.
COVID initially hit developed international locations exhausting, pummelling Italy, Spain and New York Metropolis, and leaving international locations in Africa comparatively unscathed. It appeared fairly miraculous, prompting commentators to supply causes for Africa’s relative success.
Calls rose for medical professionals from resource-constrained areas to assist shoulder the burden of the pandemic in developed international locations — flying within the face of the WHO settlement. These calls went past easy recruitment. Some supplied further incentives to entice docs to remain: for instance, the UK quick tracked registration of docs skilled outdoors the nation.
Now that the pandemic has swung again to ravage Africa, India and different components of the creating world, this can be a favour that creating international locations haven’t returned.
Since I started scripting this piece, Uganda additionally misplaced a 36-year-old ENT surgeon, Dr Ian Bwete Apuuli. Through the pandemic, he carried out tracheotomies on COVID sufferers, permitting them the prospect to breathe with out air flow. However tracheotomies generate aerosols, and aerosols carry an infection. Apuuli succumbed to the illness, leaving Uganda with just one surgeon skilled to take away tumours from the pinnacle and neck.
The mind drain of healthcare employees from international locations that may scarcely afford to lose them just isn’t an impassive, financial dialogue. After we actively entice docs not simply to return and assist, however to and are available and keep, the impact is greater than momentary. It’s greater than financial. It undermines the complete well being techniques of the international locations these docs depart behind.