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Global lack of medical doctors

by Eleonore von Bothmer
There is a shortage of qualified health staff all over the world. In Africa, the situation is worsening as trained medical doctors and nurses leave their countries of origin to work abroad. All too often, traditional healers, whose role is controversial, are the only ones left to care for the ill.

“One sees untreated people – mothers and children – dying, because doctors and nurses are leaving the country. That is very unjust,” says Lorna Muhirwe of the Ugandan Protestant Medical Bureau. Dorothy Ngoma of the National Organisation of Nurses and Midwives of Malawi (NONMM) calls this trend in the medical sector a “global problem”.

In fact, there is a shortage of medical staff and doctors everywhere, even in rich countries like Canada and Britain. Yet these countries have the ability and the means to lure experts from developing countries – worsening the situation in the latter. Poor nations invest in educating the doctors and nurses who later work abroad. Ngoma stresses that this is especially devastating for least developed countries like Malawi, which do not have the money to stop these people from leaving.

Today, more medical staff and physicians from Malawi are said to work in Manchester than in Malawi itself, where they are desperately needed. Malawi faces large problems with maternal mortality, HIV/Aids, malaria and tuberculosis, which has an annual infection rate of 30,000. The Malawian health system is unable to meet the demand.

In Malawi, there is one doctor for 65,000 people. In France or Germany, the ratio is one to 211, and even there staff shortage is increasingly being felt. “We have all been sleeping,” Ngoma said at a mid-February conference in Berlin, organised by the Foundation for World Population and Action for Global Health (AfGH), on how to facilitate access to primary health care (PHC) in developing countries.

Although the problem is evident, there is no simple solution. “One cannot educate doctors overnight,” Malawian expert Ngoma stressed. At the same time, health systems in poor countries are plagued with other problems. Insufficient funding, inappropriate allocation of funds, the often problematic “earmarking” of project resources, and poor governance of the sector were among the issues discussed in Berlin.

These factors help to explain the enduring popularity of traditional healers, especially in rural regions. In these areas, even the most basic health care is often not available. “It is nearly impossible to persuade doctors or nurses to work in the countryside,” says Betty Nakaszzi Kyaddondo of the Department for Family Health Care in the Ugandan Ministry of Finance. This is especially true where people with medical training are already scarce.

Kyaddondo explains that traditional healers are still highly respected by the people, and, in many cases, they are the only ones who care for the ill. The same goes for traditional birth attendants: although they come under constant critique and are viewed with distrust by the World Health Organisation (WHO), they play an important role. All too often, there simply is on alternative. And this discussion is not relevant only in the African context. (See Chowdhury and Chaudhury, D+C 02/09, p. 82f.)

“If we followed all international guidelines, we would not be helping our countries”, says Kyaddondo. (eli)