Medical Journal Myopia Regarding Third World Health Care
The authors of the editorial suggest that people like the Zimbabwean physicians migrate because of “push and pull” factors, or carrot and stick. With the mealy-mouthed delicacy of the politically-correct diplomat and careerist bureaucrat, they delicately refrain from describing the stick in any detail. The nearest they come to doing so is the following: “unstable working environments.” This reminds me a little of the Emperor Hirohito description of the dropping of the atom bombs: “The war has developed not necessarily to Japan’s advantage.”
With regard to Zimbabwe, the authors see reason for optimism:
In a draft national policy currently awaiting parliamentary approval, Zimbabwe addresses factors contributing to health workforce shortages; supports mechanisms and processes for stakeholder coordination and collaboration; and defines stakeholders’ roles and responsibilities in ensuring timely financing, implementation, and monitoring of national human resources for health and in promoting the development and retention of the health workforce.
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Have the authors ever been to Africa in general, and Zimbabwe in particular? And if they have, did they ever see anything from anywhere other than through the tinted windows of an air-conditioned official car? Here again one cannot help but think in analogies, this time with Beatrice and Sidney Webb, who read the Stalin Constitution for the Soviet Union with minute attention (coming to the conclusion that it was the most democratic in the world), and every official statistic ever to emerge from Moscow, and then wrote a vast tome about the Soviet Union including everything they had read, missing only the twenty or thirty million deaths that were taking place there while they read it.
The authors of the editorial in the New England Journal are in this great tradition of polysyllabic blindness: the march of folly never ceases, not even in the most respected medical journal in the world.
Working in healthcare myself, I’m used to reading articles like this. I find that its mostly used as a way to make the author seem vastly smarter than they are. The gyst of this article I take it is that Zimbabwe is trying to find a way to force health care providers to stay in country. I’m a tad confused who is the “stakeholder” I guess I have to read the article myself. I’ll do it right before I go to sleep.
“New England Journal–the most respected medical journal in the world.” Started to immediately dispose in the trash during med school. Reminds me of that other great journalistic rag in New York.
Ditto with “moron”‘s comments. The NEJM may be the most recognized medical journal in the world, but it is hardly the most respected. It is highly recognized because it markets itself to the lay public and mass media, not just to medical personnel.
I, too, learned to take the agenda-driven NEJM with a huge grain of salt as a graduate student in the medical-related sciences. The other “well known” medical journal is the anecdote-driven “The Lancet”, which we commonly referred to as “the comic book of the medical field”.
NEMJ only reflects the world around it. Von Mises’ books “Human Action” and “Bureaucracy” describe the life cycle of all human undertakings, from quilting bees to a world wars.
When we block processes of “creative destruction” during a downturn of any venture’s life cycle, we artificially prolong and expand the useless and negative components of the project while cannibalizing it’s useful and positive elements.
Thus the dense bureaucratese of the useless drones in academia, guilds, governments, courts, officials and wannabe officials.
This new approach to healthcare in the US – - Obamacare – - will no doubt add to the emigration of ‘trained’ Drs. from 3rd world countries. It has been happening for several years now, and with the medical school graduates from US schools dropping out of healthcare and taking another pathway because they are being ‘transformed’ into soviet style physicians, with little pay, no respect and not much future.
Now I am sure I will be deemed ‘racist’ or zenophobic or whatever the hell else for stating the obvious, but training in 3rd World Countries and office shore medical schools does not even come close to comparison of US medical school training. Wealthy leaders from all over the world come to the US for those specialists that we train…. in fact the medical schools give them special priority and care because they are wealthy. The ‘drs.’ trained in medical schools that are inferior to ours will be flooding the health care system …. thanks to Obamacare. We are sacrificing our future and our very lives.
Doctors with third world qualifications already have established government-sponsored practices in the US.
They provide medical care in prisons, for medicaid, and, IIRC, in Veterans Administration facilities.
The pay and conditions are much better than their homelands.
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If I’d just graduated from a medical school in the Third World, and grew up surrounded by abject poverty, economic survival would trump altruistic guilt sourced in not staying behind to help my desperate countrymen. Witness the growing large number of Central Asian doctors in America.
It’s a Sisyphian struggle remaining behind attempting to fight massive disease. The M.D. degree is a ticket out. Dr Schweitzer was the rare exception, and he was a European missionary going in the opposite direction.
“…and monitoring of national human resources for health…” That’s a scary phrase. One thinks of faceless bureaucrats pronouncing edicts by day, and goons coming around by night to enforce them.
“I’m sorry, Doctor, but we can’t seem to locate your passport. I believe that it would be wise for you to reconsider your travel plans.”
All these people who write, and publish, such obfuscatory tripe as you cite…don’t they have any inkling of how stupid they sound ?
Are they that far gone ?
Yes, they are.
They really believe that this nonsense is evidence of their vast intelligence.
I have worked with several American docs who spent a good portion of their careers in impoverished areas in Africa. One guy spent most of the time there and would come back to work double shifts in ER to make enough money to support what he was doing.
Finest people on earth. As physicians they knew how to diagnose with simple tools. Old school medicine stuff like actual taking a history and physical exam. I worked with one radiologist in convincing a company to donate a portable ultrasound to his missionary hospital which he carried himself on the plane because such things tend to get ‘lost’ in standard shipping.
Hopefully some docs from there who have trained or emigrated elsewhere will go back to bring new technology home.
People writing articles like this in NEJM maybe they have experience or not, but they are not addressing ground level medical concerns. This is fluff targeted to posh Bostonian or west coast liberal leaning types who would like to think that they have done something by reading and supporting an article couched in pseudo intellectual terms.
Impact of these sorts of editorial articles is near zero. Achievable preventive or treatment for malaria, dehydration, or AIDS is where focus needs to be.
I understand that it is frustrating when your best leave to seek better opportunity elsewhere. So maybe there are economic and political issues to keep more of them. That is outside the scope of medicine.
It seems to me that unless you are Mother Teresa, you are not going to stay in a Zimbabwe ruled by thugs and slipping ever more quickly in barbarity (if not already there) and, reading between the lines, it seems that the contemplated solution–covered up by all of the gobbledy gook and politically correct, camouflaging terminology–is to just intimidate or blackmail Zimbabwean doctors into staying in Zimbabwe.
I am reminded of the advice I read years ago (and I have no reason to believe that advice would not be the same given today) in an official U.S. State Department “Post Report” for our diplomatic staff on what to do in one of the countries in Africa–it may, indeed, have been Zimbabwe–if you were very sick or severely injured and had to rely on local treatment.
You had to head for the capitol city for treatment, but were warned that, even there–in a country in which AIDS and every conceivable kind to disease and infection were at epidemic levels–they routinely reused steel needles over and over again on multiple patients without ever sterilizing them.
There’s a reason that actual working docs (not the northeastern academic elite types) call it the New England Urinal of Medicine…
The entire editorial staff of that “respected journal” is composed of the most politically slimy, agenda driven, mealy mouthed socialists in the “esteemed” institutions of New England (and there are a lot of those types up there).
They will be the ones in charge of the death panels. I mean “Health Benefits Advisory Committee”…
We all want to publish in NEJM. It gains us mega-points in the all important publish or perish rat race. Because it has something like a trizillion points in citation-weighted scoring for promotion or retention, every piece of drivel in NEJM counts. Dr. Dalrymple (Dickens and I know his real name is Smith) knows that perfectly well.
Of course Zimbabwe exports docs, nurses, lawyers, high school graduates, auto mechanics, and peasants. Who would stay? Why act like docs are special?