We in the third world are rarely willing to admit to our “third worldliness.” We aspire to first world standards, and the things we want more than anything else are hotels of international standard, a well reputed university, and, in particular, good medical and nursing schools. We are greatly gratified by the recognition of our graduates as being of international standard—“Our doctors and nurses are as good as any others”—but there are difficulties with this. As soon as a country produces graduates of an acceptable international standard then it is “fishing in the same pond” as first world countries for their services. It is inevitable that doctors and nurses will be attracted to countries where salaries or working conditions are seen as better.
Figure 1.
Where will they go?
The situation becomes aggravated when conditions at home deteriorate. Then even the most loyal professionals feel their attachment stretched to breaking point by the need to help their families and the natural desire to advance themselves. So it is that the hour of departure comes nearer and the country loses another skilled person. This is happening all over the third world. No one is to blame, and probably nothing can be done about it, but a variety of factors need to be considered.
Firstly, in our anxiety to be part of and recognised as first world we in the third world have produced professionals whose expectations we cannot meet, because outside a few centres we do not have the financial resources to compete. Was that sensible? Secondly, the first world has produced a compounding factor. It has allowed successive governments, in their meanness and penny pinching, to so under-fund the health services that few of its own young people want to go into nursing and the ancillary fields. Consequently many of its hospitals are desperate for staff and will recruit from anywhere they can. Salaries may seem inadequate locally, but to us in the third world they represent a glittering fortune, and no one can blame qualified people for going after them.
The northern hemisphere will continue to suck in qualified people from the third world
Is there a solution to this problem? Probably not—at least not in the short term. In the past we have modelled our teaching programmes and our output on the so called developed world because that seemed the right thing to do. Has this been a mistake? I remember saying many years ago, when a new medical school was about to be opened in another country, that it would be better for that country to produce graduates whose qualifications are not recognised abroad, then although they might be functioning at a lower standard than elsewhere at least they would be there and of some help to that country. Naturally this was greeted by stony silence, but it's the truth. It's a very difficult matter, because the third world does not have the money to pay well enough to hold the trained people and yet does not want to be seen to be producing a substandard (by first world estimations, at least) product. It is clear that there is no immediate answer. The first world is likely to go on underpaying staff, so that the professions will be unfilled, and we in the third world will be too proud to stop training top class people. Furthermore, while the home situation remains unattractive, compared with elsewhere, the void that is the northern hemisphere will continue to suck in qualified people from the third world in increasing numbers, and we will continue to finance it. At least the first world might consider setting our very considerable contribution to its health services against the third world's debts, otherwise it becomes just another form of colonialism. We produce the resource; the first world takes it. I admit that there is one benefit to us: a lot of money is sent home to support families. But that is a poor substitute for the absent skilled person.