Where There Are No Doctors

In western Uganda's Kyaka II refugee camp, as Laura wrote earlier this week, women are fashioning a living out of sanitary pads composed of waste paper and papyrus. It's a terrific exercise in ingenuity, if not necessarily one that begins to grapple with the bigger issues facing the camp -- like the fact that all of Kyaka II's 16,200 refugees are served by a single doctor.

And that imbalance, while shocking, is hardly unusual. Elsewhere, that ratio deteriorates further. In 2007, Rwanda had just one doctor for every 20,000 people. In Liberia, that figure was one doctor for every 50,000 people. (By way of easy contrast, the hospital I was born in -- in a city of 100,000 -- boasts 1,140 active physicians on staff.)

It's easy to think about global health challenges as principally those of tangible resources: lack of drugs, vaccines, et cetera. But in many regions, as we've previously written, one of the more basic challenges is a dearth of trained people.

What accounts for such a massive shortage? Part of it, as Leana Wen's written, is the global brain drain. Here in the U.S., one-third of practicing doctors were trained outside the U.S., and up to 75% of them come from lower-income countries. There's also the phenomenon of internal brain drain, which occurs when international NGOs recruit local physicians away from public hospitals by offering better salaries and benefits.

Lack of medical training facilities, too, is a major contributor. In Zambia, for example, there's just one medical school. In 2005, that was true of another 24 African countries.

Fortunately, there are a wealth of ways that this challenge can start to be reversed: allowing more resources for training, for one, increasing incentives for local doctors to stay, and assisting communities with medical curriculum (in partnership, for example, with groups like Hesperian, whose health manual inspired this title's post). To help with specialty training, Wen suggests that instead of recruiting Western doctors to go abroad and assist patients -- as is the common practice now -- a more useful ask would be to request that such volunteers train local doctors instead.

It's a good reminder of the fact that while we often look to new drugs and or gimmicks for hope in the global health field, it's the resources that go neglected that are also the more promising -- that is, people.

Photo Credit: US Army Africa