Medical Journal Myopia Regarding Third World Health Care
If le style c’est l’homme meme (the style is the man), goodness knows what the authors of an editorial in the latest New England Journal of Medicine must be like; cyborgs, I should think. Here is a sample:
In addition, the guidelines attempt to democratize the governance process for global health by incorporating second reporting instrument enabling all other stakeholders to formally share relevant information.
The effect on the brain of reading a whole page of this stuff is like that of gross overeating. No one can come to the end of it and remain fully alert. One suspects that is it purpose: to bore the reader into acquiescence.
The editorial concerns the tendency of health workers -- doctors, nurses, and technicians -- to migrate from poor to rich countries, and assumes that something bureaucratic must be done about it.
It begins by pointing out that Zimbabwe trained 1200 physicians between 1990 and 2001, of whom fully 840 have emigrated. This is doubly unfortunate, since -- as every doctor who has ever worked in Africa knows -- a doctor can do more good there, from the point of view of saving human life, with a few simple tools, than he can in a rich country with a whole armamentarium of the most sophisticated equipment. And this is because the pattern of disease is different in rich and poor countries: in Africa, life-threatening but easily-treated infections are still very prevalent.
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.
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.