Medical staff export: A crime against humanity

Government officials entered into a private arrangement to transfer 283 medical specialists to the service of the government of Trinidad and Tobago.

The list and capacity includes 15 internal medicine specialists, 15 obstetricians and gynaecologists, 15 paediatricians, four ear, nose and throat specialists, four anaesthetists, four ophthalmologists, four pathologists, four senior psychiatrists, 15 surgeons, four urologists, 15 orthopaedics specialists, 20 radiologists, 40 public health nurses and 100 midwives.

This transfer of health workforce represents 11 per cent of obstetrics and gynaecology capacity, 16 per cent of internal medicine, 15 per cent in paediatrics, 25 per cent in neurosurgery, 27 per cent in pathology, 37 per cent in psychiatry, 53 per cent in orthopaedics, 67 per cent in urology and 71 per cent of radiology.

The justification is that the export is necessary to “accelerate excellent bilateral relations and strengthen the health sector” of Trinidad and Tobago. The officials further claim that medical brain drain curbs human trafficking and prevents “doctors from drowning in the Mediterranean Sea”.

The tragedy of the public narrative is the false assumption that this arrangement is authorised by government. In truth, a few officials not only violate the Constitution, international law and public service standing orders but undermine a sacrosanct pillar of government policy – health system strengthening.

The Institute of Public Policy Research has brought a public interest legal petition on facilitated medical brain drain. We plead that it is illegitimate, illegal, irrational and an abuse of power for unelected officials to hurt patients by diverting medical resources to a foreign country.

Shortlist published
The shortlist of doctors and nurses bound for Trinidad and Tobago has been published. Despite all appeals, officials have not bothered to recruit replacements. We know who is leaving our hospitals to serve the government and people of Trinidad and Tobago, but not who will fill the gap in patient care.

This must enter the book of records for being the most surprising decision in the history of public policy.

We have a doctor to patient ratio of 1:24,725 against a World Health Organisation recommendation of 1:1,000 a nurse to patient ratio of 1:11,000 against a recommendation of 1:500.

Yet, this does not take into account regional disparities in the distribution of health workers. About 80 per cent are concentrated in Kampala which caters for five per cent of the population. In most districts, the doctor to patient ratio is more than 1:150,000.Overall, 42 per cent of positions are vacant.

In comparison, Trinidad and Tobago has 10 times as many doctors, three times as many nurses, 22 times the per capita health spending, 32 times the per capita GDP and universal health insurance.

They have a population of 1.3 million compared to 35 million Ugandans. Only 42 per cent of expectant Ugandan mothers compared to 98 per cent of Trinidadians have access to skilled maternal health services. Our mothers are four times more likely to die during child birth.
Three times as many Ugandan children die before the age of five. If we know this, why should we provide technical assistance and subsidies to this developed country?

The effects
To export 100 midwives has the effect of withdrawing maternal health services from 900,000 mothers. The transfer of specialists deprives care to 1.2 million patients. This crime against humanity is committed by some official’s intentional deprivation of medical services, calculated to cause fatal consequences to the lives of thousands of Ugandans.

The specialists should have departed three months ago. The public outcry and petition only provided temporary reprieve. Unfortunately, the court ruling has been indefinitely postponed.
This legal uncertainty and insistence by officials on implementing the scheme provoked the withdrawal of Shs34 billion in donor aid to the health sector. The sum represents annual health spending on 1.2 million people.

This issue will not abate for it is not as simplistic as wages and human trafficking. Medical brain drain invokes deep ethical, moral, legal, political, economic and national security questions, all of which shall be explored in subsequent articles.

For now, let us recall the experience of our mothers and children. It is that pain and loss which compels us to act with urgency.

In the interests of full disclosure, the author took leave from the Foreign Service to challenge the legality, logic and consequence of transferring public health workers to the service of a foreign country.

The writer is the acting executive director Institute of Public Policy Research

SOURCE: Daily Monitor

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