Little information exists on the career paths and destinations of graduates of medical schools from developing countries,1 in contrast with many such reports from the developed world.2,3 I present here perhaps the first report on career paths taken by graduates of Makerere Medical School in Uganda.
Participants, methods, and results
Twenty seven doctors who graduated from Makerere in 1984 participated in the study. A database was compiled from the graduation list. Information was obtained through a focus group discussion (three doctors), an email questionnaire (17, including the three focus group members), telephone interviews (six), and in-depth interviews (four).
Seventy seven doctors (58 men) graduated in 1984. Reliable information was obtained for 96% (74 (56 men), of whom 22 (19 men) are dead). Seven died between 1984 and 1989, six between 1990 and 1994, six between 1995 and 1999, and three since 2000. The presumed causes of death (death certificates were not available) were AIDS (11); suicide (six); road traffic injuries, hepatitis, and alcohol related disease (one each); and unknown (two). Five of the suicides were related to knowledge or fear of being HIV positive.
The table shows the country of residence, the form of employment and the nature of work for the 52 (37 men) surviving Makerere graduates about whom I had reliable information. Forty three have specialised—the most popular fields being public health (13), surgery (seven), paediatrics (four), internal medicine (four), and ophthalmology (four); in this group, 27 of the 51 additional qualifications were from Makerere, and 36 were obtained between 1984 and 1994. The graduates now include a commissioner and a principal planner at the Uganda Ministry of Health; 16 at senior consultant or consultant (or equivalent) level; 12 medical officers special grade (that is, specialists below consultant level); two directors in the military medical services; two directors at international agencies; two directors of district health services; five medical superintendents; three senior lecturers; a senior professor; and technical experts for international organisations.
Table 1.
Country of residence and type of employment in 2004 for surviving Makerere medical graduates of 1984
| No of graduates | |
|---|---|
| Country | |
| Uganda | 36 |
| Republic of South Africa | 6 |
| Kenya | 3 |
| Canada | 2 |
| United States | 1 |
| United Kingdom | 1 |
| Switzerland | 1 |
| Botswana | 1 |
| Zimbabwe | 1 |
| Employer, type of employment | |
| Ugandan Ministry of Health | 22 |
| Other government departments | 6 |
| Non-governmental organisations | 6 |
| World Health Organization | 4 |
| University sector | 4 |
| Private practice | 5 |
| Military | 3 |
| International organisations | 2 |
| Nature of work, type of appointment | |
| Clinical | 31 |
| Managerial or administrative | 8 |
| Public health | 6 |
| Academic | 4 |
| Other health care | 3 |
Comment
The high death rate (30%) of young doctors within 20 years of graduation is a cause for concern. The profile of presumed causes of death highlights the impact of HIV/AIDS on countries that have a high prevalance of HIV, such as Uganda. The declining deaths—seven between 1984 and 1989, compared with three between 2000 and 2004—may partly point to the effective AIDS prevention campaigns for which Uganda has become renowned. That only 30% of the surviving 1984 graduates work outside Uganda is encouraging and suggests that the brain drain is not as massive in Uganda as it is in other African countries. In Ghana, for example, more than 60% of a cohort of doctors graduating between 1986 and 1995 had left the country within 10 years of graduation.4 Death has been a bigger brain drain than emigration among the 1984 Ugandan graduates.
Given the high proportion of health professionals working in the private sector in many countries,5 it is interesting that only 10% of the Ugandan graduates work in Uganda in the public sector work primarily in private practice. This may be due partly to the fact that many Uganda based doctors in public employment are able to do part time private practice as well. The low numbers of these graduates in academia reflects the worldwide unpopularity of academic medicine.
What is already known on this topic
Little information exists on the career path and fate of African doctors
What this study adds
Thirty per cent of doctors who graduated from Makerere, Uganda, in 1984 have died (most as a result of AIDS related causes), and most surviving doctors
This study did not establish the reasons for the choices made, lacked documentary proof of cause of death, and obtained little information on the social lives of the graduates. Nevertheless, these findings should serve as a springboard for a detailed study on the career choices and paths (and reasons) of Makerere trained doctors and on the implications of such choices for the Ugandan health system.
Editorial by Ncayiyana
This article was posted on bmj.com on 5 August 2004: http://bmj.com/cgi/doi/10.1136/bmj.38134.524387.AE
I thank all those colleagues who provided me with information in the discussions, telephone interviews, and via email, particularly Drs I Ndifuna, F Mulwanyi, J Omagino, G Murindwa, J Amandua, A Khayinza, S Omoding, KK Owor, C Kyambadde, I Oluoch, D Bukenya, H Ndobo, S Kabanda, and C Mugero. I also thank N Sewankambo and the staff of the Academic Registrar's Office, Makerere University, for the graduation list. Irene Modipa and the BMJ reviewers made valuable comments on an earlier version of this manuscript.
Contributors: YMD is the sole contributor.
Funding: None.
Competing interests: YMD is one of the Makerere graduates of 1984.
Ethical approval: Not required.
References
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