How African doctors can cure 'brain drain'
On a recent medical volunteer trip I was introduced to an elderly woman on the surgical wards. She had a growing tumor that had deformed her face and was threatening her life. For three months she was told a set of special equipment was needed to perform her surgery. As she waited for this equipment, her tumor grew larger and compromised her vision in one eye.
I reviewed her records with her local surgeons and formulated a plan to remove her tumor. Using instruments that were available, we successfully removed her tumor after a two-hour operation. Looking back, her case was complex but not unusual. I have volunteered as a surgeon in several African countries and unfortunately, the story of this African woman is common. Her story highlights the gap in medical and surgical expertise available in Africa.
Many highly skilled doctors and health professionals of African birth practice cutting-edge medicine and surgery in leading medical institutions outside Africa. They are valuable to the hospitals and countries they work in but their hearts are also at home in their native countries.
They are part of Africa's so-called "brain drain." A 2008 publication showed that, as of the year 2000, one fifth of all African-born physicians and one tenth of all African-born nurses were working overseas.
Global health policy experts and several world agencies have suggested a variety of measures to reverse this trend, but I have often wondered whether one piece to this puzzle is being overlooked. Perhaps African health professionals in the diaspora are actually helping on the home front, but in less overt and quantifiable ways.
African doctors and other health professionals working abroad may be living overseas but their hearts are in Africa. As the saying goes, home is where the heart is, but what if the heart is in more than one place?
African doctors living abroad have families back in Africa and are motivated to contribute to the improvement of healthcare delivery on the continent. While some are ready to return back to their native countries, others are not prepared to make a complete move, but their skills can still make an impact in developing healthcare expertise and delivery systems on the continent.
Beyond medical missions
African health professionals in the diaspora are giving back by participating in medical missions. They often recruit their colleagues to volunteer as well. Medical missions can be seen as first step in helping in the healthcare field.
These missions require investment of personal time, finances and other resources. Fitting mission trips into one's practice is always a challenge but the rewards of making a significant difference in lives makes it worthwhile. In a single mission, over 1,000 patients can be screened and treated and hundreds may receive vital surgery that may otherwise be unavailable.
Medical missions can have a longer-lasting significance if they are structured to emphasize teaching and training in order to build local capacity. An effective strategy is to identify a cadre of doctors and mid-level professionals who are interested in developing their expertise in a focused area. Pairing the local professionals with an expert over several mission trips can result in a long-term mentoring relationship that is extremely effective in passing on expertise. A multiplier effect is realized when the mentee becomes a mentor to other junior professionals.
Medical missions are not one-way streets. They require commitment from both the local staff and the visiting medical team. They should be seen as equally weighted mutually beneficial partnerships.
Generosity in teaching
African health professionals in the diaspora are transferring expertise back to the continent through educational seminars and training workshops.
African Partners Medical is a group of African doctors and nurses in North America and Europe who sponsor annual educational workshops around Africa. These seminars attract faculty who are leaders in their fields. Through didactic teaching, workshops and hands-on experiences, local physicians, nurses and other supporting staff are offered the opportunity to acquire new skills in a small group setting.
In 2009 a group of Johns Hopkins neurosurgeons visited the teaching hospitals in Benin, Nigeria and the Korle Bu hospital in Accra, Ghana. The emphasis was on hands-on training. At the end of the week-long training the U.S. neurosurgeons saw the potential in a young Ghanaian neurosurgeon who was just three years out of his residency training.
This neurosurgeon was interested in gaining specialized expertise in pediatric neurosurgery but no such training opportunity exists in Ghana. Because of the exposure gained during this teaching mission, this young surgeon was able to come to Johns Hopkins for a year of formal fellowship.
Telemedicine and medical second opinion
The rapid growth of information technology in Africa presents an opportunity for remote consultations and medical second opinions.
Telemedicine has the potential of effectively linking African health professional in the West with their counterparts in Africa. The greatest challenge to this potential has always been the high cost of telemedicine infrastructure and other related technical and organizational challenges. These challenges are rapidly fading.
Each week I spend approximately two to three hours on online consultations using technology that is readily available. Through remote-access capabilities I review imaging studies, test results and communicate directly with both patients and physicians around the globe, including several African countries. Pathologists and radiologists are reading slides and images remotely. Organizations of African doctors in the USA and Europe are establishing formalized channels that will allow patients and colleagues in Africa to tap into the expertise of their members. This already happens in informal ways.
Some of the leading clinician scientists in the fields of breast cancer, sickle cell anemia, viral hepatitis and liver cancer -- diseases with high prevalence in Africa -- are African health professionals working in research hospitals and institutions in the West.
These scientists partner with international agencies in directing resources and collaborative research projects back to Africa.
Recent years have seen a steady return of African doctors back home. Most returning doctors set up individual practices and establish their own mini-hospitals. These scattered practices are less likely to result in institutions that last beyond one generation or result in the degree of transformation necessary to narrow the gap in healthcare expertise.
Having trained at the Mayo Clinic in Rochester, Minnesota, I am keenly aware of how a small group practice can evolve beyond one generation into a world-renowned medical center. The Mayo Clinic developed gradually from the medical practice of a father and his two sons. From the beginning, innovation was their standard and as the demand for their services increased, they asked other doctors and researchers to join them in what became the world's first private integrated group practice.
Pooling the resources of knowledge and skills among several doctors is what resulted in the present day world-renowned clinic. As African health professionals mobilize to return home or contribute from across the pond, greater strides are bound to occur if they can emulate the example of the Mayo brothers.
Resources, skill sets and expertise should be pooled to establish viable private medical institutions that can survive their founders and expand beyond one generation.