Will Bill Gates’ Millions Save Us?

This article is a response to the article entitled “How The Brain Drain To The West Worsens Africa’s Public Health Crisis” (http://www.pambazuka.org/en/category/comment/37062), Jacqueline Tanaka argues that although the Gates Foundation has dedicated a significant fraction of its resources to improving the African healthcare system, what the Foundation ought to be doing in addition is to provide funding to train the African physicians.

I recently came across an article entitled “How the Brain Drain to the West Worsens Africa’s Public Health Crisis”, published on Pambazuka News 9/14/06. Many of the facts and ideas presented in the article resonated with me as I, too, have been thinking about quality of life issues in Africa. Let me introduce myself. I am an Associate Professor of Biology at Temple University in Philadelphia, PA, USA. I have become aware of some of the issues facing African countries through my students at Temple who are African or are of recent African descent as well as friends who are African or who have close ties to Africa. And perhaps because I am a biologist, I see things through a somewhat different lens than the author of the article.

The author, Rotimi Sankore, writes: “Resolving Africa’s public healthcare crisis will resolve most of the other issues and be a step towards isolating AIDS which can then be tackled more easily. The first step must be resolving the health worker shortages, which includes dealing with the ‘brain drain’.”

Tackling the health care issues of Africans goes beyond providing health care. To me, the issue is a larger one dealing with ‘quality of life’ that includes access to clean water, adequate nutritious food, education, and access to means of support for one’s family. These issues require political integrity and environmental restoration. The environmental restoration will, in turn, pay back by providing ecosystem services such as clean water and fertile soil, reduction of erosion and reduction of desertification. Since much of the environmental destruction is done in the name of ‘economic development’ and done by foreign ‘investors’, beating back this ‘progress’ will take vision and political will in addition to the political integrity.

But how does all this relate to the topic of “brain drain” raised by Sankore? Well, I see first-hand some of the “brain drain” - African students who come to Temple University for their undergraduate degree in the hope of returning to Africa as medical doctors. In my experience, these students have been the brightest, most talented students I have seen in my six years at Temple. Some carry a perfect 4.0 GPA through their entire four years. They conduct research with faculty often publishing in peer-reviewed scientific journals as undergraduates. Clearly they are Africa’s best and brightest.

And they want to go back. So what happens? Well, if they are lucky, they get accepted into a US or British medical school as an international student. This alone requires some luck as well as a perfect academic record. But here is the rub. They will not qualify for the loans and aid that American students depend on. The African students have few resources to pay the huge tuition bills for medical school so those who manage to attend have enormous debts to pay at the end of four years. How can they possibly go back to their country and pay even a fraction of their debts on an African salary? They can’t. So, many continue through their residency, barely making a dent in their debt burden. They accept positions practicing medicine here not because they don’t want to return home but because they can’t afford not to practice here.

As for those physicians who are trained in Africa, why not ask them why they came here to practice? Chances are you will find out what the infrastructure is like for them in their country. One of my students described a clinic in her personal statement (which each student writes in their medical school application). In her words,

“The hospital was like a war zone, if not, a crowded arena wherein the medical staff had to sprint to save precarious lives. People swarmed the hospital from all walks of life and lay sprawled even on the hospital floors. The Nigerian health narrative is ugly. Glutted with poorly trained medical personnel and failing health systems, the medical environment consistently breeds short, unhealthy lives.

Death by “natural causes” frequently implies death by preventable, controllable, treatable maladies-malaria, typhoid, tuberculosis etc. In addition, the government’s nonchalance frequently necessitates that doctors go on strike just to get paid. It remains a gloomy fact that it is very easy to lose a life in Nigeria. The reality is simple and crushing – the government will not fund basic care, the people cannot afford basic care, and the medical personnel are dangerously incompetent in providing basic care.

Medical incompetence in Nigeria is a direct result of shoddy medical training. Medical schools lack adequate facilities while maintenance is permanently deferred. The faculty: student ratio is unbelievable, even then, a significant number of the instructors are inexperienced and unqualified to teach medical students. Endemic corruption in the country has permeated medical schools such that admissions into the schools can be gained through “connections”. Success in medical school can likewise be procured through financial and sexual inducements. Could it then be a surprise that patients have to plead for pre-treatment medical tests else, the “doctor” would “forget” to do so? Misdiagnoses and malpractice certainly contribute to the rampant deaths that are but signatures of Nigerian hospitals.”

Sankore argues that: “The problem seems to be that acknowledging, prioritizing and acting on the “brain drain” problem means that governments of countries that have benefited from the “brain drain” have to take responsibility, and cease their recruitment of healthcare workers from Africa.” While I agree completely with your statement that developed countries must cease recruiting health care workers from African countries, I think we need to do much more in terms of training health care workers. We need to devote some of our international aid funds to educate and train health care workers and then send them back.

This initial wave will form the backbone of an emerging African healthcare infrastructure. They will have knowledge and training in modern medical techniques in addition to the cultural knowledge indispensable for dealing with African medical problems. And if these students are given the opportunity to participate in the elite MD/PhD programs at the top medical schools (for which they are eminently qualified), they will be prepared to conduct cutting-edge research on diseases including some of the very same infectious diseases long ignored by the West.

There is plenty of work for all to deal with these complex issues. What must Africans do? They must commit resources to build a strong health-care infrastructure and they must recognize the links between health care, quality of life and environmental restoration. They must, in some cases, wrestle resources from corrupt leaders. They must demand that the resources of their motherland be shared with the people. These resources are necessary to provide the tools for health care workers to address the staggering quality of life issues in Africa.

What must the rest of the world do? We must care about the quality of life for everyone sharing the planet. And if you don’t care for the same reasons I care, you must care because you can’t run away. Whether you live in the rural sub-Saharan countryside or on a crowded block in Queens, NY you can’t escape environmental contaminants and airborne microbes. The recent recognition of extreme drug-resistant forms of TB should remind us all that we have no immunity against the rapid evolution of microbes. And guess who provided the incubator for this rapid evolution of the TB microbes? An AIDS patient with a weakened immune system. This new form of TB cannot be treated with any of our existing TB medicines, all of which are at least 40 years old. Ask yourself: how long does it take for these microbes to travel across an ocean?

Is there hope? You bet there is…all $57 billion worth in the form of the Bill and Melinda Gates Foundation, as well as other organizations. The Gates Foundation has dedicated a significant fraction of its resources to some of the issues discussed above. But in my opinion, they have missed the biggest factor of all. They haven’t provided funding to train the physicians. Africa needs physicians and health care workers who understand the culture…who are from the culture. We must provide this education for Africa’s best and brightest. Not because we support the “brain drain”, but because it is part of the solution. So we need to find ways to draw the attention of the Gates Foundation to the human capacity building that is required to meet the challenges all poor countries face. Healthcare is part of the problem and we can begin there but ultimately, we must deal with all of the issues: food and water, political integrity, economic development, environmental restoration and education.

• Jacqueline Tanaka, PhD, is an Associate Professor of Biology at Temple University.
• Please send comments to or comment online at http://www.pambazuka.org