So, with 2 blogs to contribute to, I had to decide which one to blog on first, which, apart from laziness, is one of the reasons I've procrastinated for so long. For some reason, I've found it so much easier to write from a global health and development perspective, as opposed to the more reader friendly and general blog about my experiences interning in Niger. And, while I'm not gifted at story telling, spewing out my thoughts is certainly something I can do (perhaps to the dismay of those who read/listen!).
I've been in Niger for over a month now, on a 6 month CIDA (Canadian International Development Agency) sponsored internship with Samaritan's Purse Canada (SPC). Though I was sad to leave my SUNSIH duties early (including working with such an incredible committee on the Western Regional Global Health Conference in Edmonton this past weekend :) ), I feel truly lucky for this opportunity. As a "Water for Life Intern," I am working on the SP Household Water Program (HWP), which largely entails the specific use of the Biosand Water Filter (BSF) technology in areas of the world where a clean water source is not an option for those living there. Alongside my partner and national staff, I am to conduct monitioring and evaluation of previously installed filters (and if needed, maintenance and repair), work on the building and installation of new filters, as well as help in facilitating accompanying health and hygiene education for the beneficiaries and the youngs girls who live in the villages where Samaritan's Purse Niger work (SPN). By the end of this year, SPN will have installed 900 new filters, totalling 1800 over the past 3 years, in households averaging 8-12 people.
One of the major draws for me in working on this internship was the opportunity for hands-on experience in the field, and working alongside nationals towards participatory community development in the area of public health. I had always admired the work of SPC: their ability to appropriately respond to international crises, as well as to implement sustainable community development. In particular, my research on the effectiveness of the BSF in reducing the incidence of diarrheal diseases got me more interested in this internship and the SP HWP in general. While I was no expert on water, nor am I one now, the statistics on diarrheal diseases grasp my full attention: 90% of all diarrheal deaths are seen in children under the age of 5, and that 4, 500 children die every day from diseases associated with lack of safe water, sanitation, and hygiene. Not only that, but, as many of you already know, without clean water, in general, health is poor. School attendance decreases. Potential to work is lessened. Without generating income, the cycle continues. To me, addressing the issue of water is part of community development 101. It's an initial step towards any kind of social, economic, and cultural change. I wanted to learn first-hand what sustainable development could look like.
Niger is truly a country one could gain an understanding of development. Niger is no stranger to foreign aid and involvment. Approximately 50 % of the goverment budget is attributed to foreign aid (from the World Bank, the International Monetary Fund, France, the European Union, among others). In the past 3 years, Niger has ranked as one of the bottom 3 nations on the UNDP Human Development Index (HDI). In 2006, it was ranked number 177 out of 177 nations, shortly following the Food Crisis (Niger famine) of 2005. The poverty is apparent, especially in the villages. Garbage and animal waste litter the sandy ground. Many children run around with tattered or no clothes on. Many children have distended bellies, because they're malnutrioned (and may also have bellies full of worms). The river water where many bathe, wash dishes and clothing, and use for drinking and giving their animals is the colour of mud. In the capital city of Niamey, driving down the road, sign after sign is for another NGO. I often wonder if any of these organizations are creating change. Are they doing anyone any good? Am I?
While SPN is a great organization to work with (not to mention with fantastic staff) and I have already learned much in the way of development, I think one of the most important things I've discovered is that development is hard. I have to keep reminding myself that it is a process. I have always been an admirer of African women. In Niger, the women are no exception. They carry babies on their backs, have heavy things they're carrying on their heads, take care of the children (sometimes, they're doing these 3 things all at once!), cook, clean, work the farms, fetch the water...essentially everything. Many of their male counterparts, on the other hand, don't do so much...Much of the day is spent sitting under trees, talking to one another and drinking tea. They recognize that the women suffer, yet do nothing about it (of course, not true about everyone!!! I have met many hard-working men). Not only that, but while the children suffer from malnutrition, like many countries in the global south, everyone has a cellphone. Where are your priorities?! Alas, the frustrations of development. While all of these things are certainly not black and white, and things are far more complicated when you bring in the issues of culture, religion, the history of colonialism, neo-colonialism and poor policy making of the past, you can't help but wonder...what now?? How can we bring about change together when so many factors are just slowing it down? Can we make a difference? While one can usually keep light about the challenges of this work, with sayings like TIA (This is Africa), or WAWA (West Africa Wins Again), it's still so difficult not to feel frustrated sometimes, especially when you see things that break your heart.
But, after all this frustration, I still can't help but love the work and the people. There have been changes in people's lives because of the filters. For some families, their kids don't get sick anymore. People are so proud to show you how well they remember their training for maintaining their filters. People actually want latrines and fight off neighbours from using theirs. They love their children and want the best for them. Even with all the struggles I've faced looking at development, I try to keep in mind all the things I appreciate about Niger and Nigeriens. They've only shown me kindness, generosity, patience (mostly with my French and Zarma), and a friendly demeanor (especially now that the month of fasting for Ramadan has just ended). And, of course, there is truly nothing like going into a village and and everyone making fun of you because of your bad Zarma. But, at the same time it's that bad Zarma that helps people connect with you :)
But, I still have lots more to learn...Back to the villages tomorrow. I'm hoping to learn how to ride a camel!
Note: I will add pictures when I figure out how to do so...
Wednesday, October 1, 2008
Monday, September 29, 2008
Health for all- Is it really possible?
I recently returned home from a global health and social justice conference we hosted in Edmonton this weekend with our colleagues from the University of Alberta's Rural Economic Student's Association (REGSA) and the Student's International Health Association (SIHA).
Like many of you I'm sure, I usually come away from interdisciplinary conferences feeling a mixture of exhaustion and inspiration. This time around was no exception. I feel especially compelled to bring up the topic of universal access to health care- a topic that transpired through many of this year's panels and sessions. We of course are the privileged few in the world who don't have to think twice about medical care- but what about the billions of people who are not so fortunate? What do multilateral policies, development initiatives, and international projects really mean to those living in poverty? What about hidden populations? And what about those who are predisposed to a lower quality of life? Are the social determinants of health really taken into account when designing health and social outreach programs?
So many questions! Questions that mostly bring up even further inquiry. But the fact is that all around the world people from a diversity of disciplines and backgrounds, young people especially, are asking these questions, challenging current paradigms, and holding those in charge of our systems of governance accountable. That was the main message I took home after two days of debate and discussion at the SUNSIH/REGSA/SIHA 1st annual Western Conference.
Are you passionate about global health? Do you have answers to these questions?
Send us your thoughts and project ideas at general@sunsih.ca.
Before signing off I wanted to share an article with you that I came across about a month ago. I think that it is especially relevant to global health as it draws on the importance of the social determinants of health. It is also very topical considering that the Alma Ata Convention, which established the importance of social determinants of health and championed the concept of "health for all", is celebrating it's 30th anniversary this year. Look for related events, such as the Canadian Conference on International Health's review of Alma Ata (Checking In: Health for All or Health for Some?", hosted by the CSIH, October 26th-29th,2008 in Ottawa), which will be taking place throughout the year to celebrate and evaluate this landmark in global health.
And now for the article- hope you enjoy it.
Source: http://www.economist.com/world/international/displaystory.cfm?story_id=12009974
The price of being well
“SOCIAL justice is a matter of life and death.” Thus begins a long, provocative report released on August 28th by a group of grandees with an impressive range of expertise in health and development. The pundits, who include Amartya Sen, an Indian-born economist and Nobel laureate, were asked by the World Health Organisation (WHO) to take a broad look at the question of inequality and health. After more than two years’ work, the panel has issued a call to arms with a sonorous title: “Closing the gap in a generation”.
Like many of you I'm sure, I usually come away from interdisciplinary conferences feeling a mixture of exhaustion and inspiration. This time around was no exception. I feel especially compelled to bring up the topic of universal access to health care- a topic that transpired through many of this year's panels and sessions. We of course are the privileged few in the world who don't have to think twice about medical care- but what about the billions of people who are not so fortunate? What do multilateral policies, development initiatives, and international projects really mean to those living in poverty? What about hidden populations? And what about those who are predisposed to a lower quality of life? Are the social determinants of health really taken into account when designing health and social outreach programs?
So many questions! Questions that mostly bring up even further inquiry. But the fact is that all around the world people from a diversity of disciplines and backgrounds, young people especially, are asking these questions, challenging current paradigms, and holding those in charge of our systems of governance accountable. That was the main message I took home after two days of debate and discussion at the SUNSIH/REGSA/SIHA 1st annual Western Conference.
Are you passionate about global health? Do you have answers to these questions?
Send us your thoughts and project ideas at general@sunsih.ca.
Before signing off I wanted to share an article with you that I came across about a month ago. I think that it is especially relevant to global health as it draws on the importance of the social determinants of health. It is also very topical considering that the Alma Ata Convention, which established the importance of social determinants of health and championed the concept of "health for all", is celebrating it's 30th anniversary this year. Look for related events, such as the Canadian Conference on International Health's review of Alma Ata (Checking In: Health for All or Health for Some?", hosted by the CSIH, October 26th-29th,2008 in Ottawa), which will be taking place throughout the year to celebrate and evaluate this landmark in global health.
And now for the article- hope you enjoy it.
Source: http://www.economist.com/world/international/displaystory.cfm?story_id=12009974
The price of being well
Aug 28th 2008 | NEW YORK | From The Economist print edition
Is it time for a new paradigm for health and development? A heavyweight panel with an egalitarian ideology claims to have found one
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Which gap, exactly? That the life of a slum dweller in Caracas is generally shorter, nastier and more brutish than the earthly span of a rich person in Cologne or Chicago is hardly surprising. But why, asks the panel, do men born in Calton, a rough part of Glasgow, tend to die more than two decades sooner (see chart below) than men from the dormitory town of Lenzie a few miles away? Why do America’s Asian females live, on average, to 87, while the life expectancy of black males is only 69? The explanation, according to the WHO’s Commission on Social Determinants of Health, is not merely a matter of income. Nor can it be reduced to the varying capacities of health systems. In addition to those factors, says the report, there are social, political and economic forces that ostensibly have little to do with health but can still end up determining “whether a child can grow up and develop to its full potential and live a flourishing life, or whether its life will be blighted.”
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To reduce the risk of the latter, the experts have drawn up a long wish list. They call on governments to improve the quality of everyday life, particularly for women and girls in poor countries, through investment in child care and education, and by insisting on better working conditions. They stress the need to “tackle the inequitable distribution of power, money and resources”—through better governance, support for civil society, and more equitable economic policies. A final element in their proposal to make the world a fairer and healthier place is transparency, and better measurement of progress in tackling inequities in health. The manifesto is a new paradigm for development, claims Sir Michael Marmot, a professor at University College London, who chaired the panel.
Sweeping the proposal certainly is, and the idea of ending health inequality in one generation is ambitious, to put it mildly. But does it amount to anything more than a pious expression of worthy hopes?
At least on a first reading, there are good reasons to take the report with a fistful of salt. First, the authors exaggerate the originality of their ideas; theirs is not an entirely new paradigm. Second, by stressing the “social determinants” of health they may have gone too far to one extreme and underplayed the more obvious link between health and income. And finally, railing against the distribution of power and money may not be much help to anyone who faces practical decisions about how to allocate scarce medical resources.
But for anyone who is willing to look past the report’s ideological slant, there are plenty of things in it that deserve to be taken seriously. Ruth Levine of the Centre for Global Development, an American think-tank, describes the manifesto as imperfect but still useful. On one hand, she notes, the report fails to provide any ranking for its laundry list of laudable aims. But it makes a worthwhile point, in her view, by urging a rediscovery of an earlier view of global health that was more prevalent before 2000. That was the year when a different WHO-inspired panel—convened by Jeffrey Sachs of Columbia University—put a controversial emphasis on the way in which poor health leads to bad economic performances by individuals and nations.
With the latest report, says Ms Levine, “we can see the pendulum swinging back.” In other words, there is renewed stress on the way that poverty and inequality lead to worse health. Julio Frenk, a former Mexican health minister now working with the Gates Foundation, a charity, says the new report offers a way out of a “sterile debate” about whether poor health causes poverty, or vice
versa. What about the other possible flaw in the new report—that it downplays the link between income (as opposed to inequality) and health? Adam Wagstaff, a World Bank economist, says he still believes income “is causal” when it comes to health—so that faster economic growth is likely to benefit the health of society as a whole, even if income inequality is constant. As an example of the benign effects of money, he cites data from South Africa, where the health of older people improved after they started receiving pensions at the age of 65.
Still, Mr Wagstaff credits the reports’ authors with making a nuanced contribution to global-health debates. The authors don’t dismiss the role of growth—which they describe as “without question important”—though they do say it can lead to greater inequity unless there are policies specifically designed to improve public health.
One of the points that emerge from the report has been the subject of a lifetime’s research by the panel’s chairman. Sir Michael argues that even in rich societies people get healthier as they climb the social gradient in ways that cannot be explained by wealth alone. Hence his interest, and the report’s focus, on “social determinants” of health that are non-monetary.
One example: job insecurity, and the resulting stress, have a proven link with mental health (see chart). So does the immunisation of children, even in countries with free and universal access to vaccines. The report lists many reforms—ranging from the extension of social safety-nets to the education of girls and better public information about nutrition—that might boost the chances of better health.
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The structure of a country’s health services plainly matters too. The commission points out that societies with universal medical coverage enjoy better health than places of comparable wealth that choose a different approach. That gives the citizens of, say, Costa Rica an advantage which many uninsured Americans lack.
But whether people are well or sick also depends on factors and policies that lie far beyond the remit of any health minister. For example, a health ministry may try to get villagers to wash their hands before preparing food, but that is unlikely to happen unless there is running water, something the ministry cannot control.
The report may be right to look at the full range of causes, broad and narrow, that determine people’s physical condition. But it seems, at times, to be baying at the moon when it attacks global imbalances in the distribution of power and money. Especially when you recall that health ministers are often weak figures in a cabinet; they can’t hope to change everything.
One other niggle. Amid the report’s musings on the social causes of health problems, what about individual choice? A fat glutton can hardly blame a cruel society, or liberal trade policies, for his predicament—yet the report says too little about people’s responsibility to look after themselves.
Still, Dr Frenk for one believes it is possible to welcome the report without endorsing the nanny state. He recalls that as Mexico’s health minister he successfully made the argument that raising taxes on the sort of cigarettes smoked by the poor would in the long run help the worst off. As he sees it, such a tax need not imply a rejection of choice: diehard smokers can still puff away, but they must pay a price that reflects the cost to society of their habit.
Some people might quibble with his economics. But as Dr Frenk implies, it would be a pity if the new report’s saner ideas were obscured by the authors’ quixotic determination to achieve perfect political, economic and social equity.
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| Copyright © 2008 The Economist Newspaper and The Economist Group. All rights reserved. |
Saturday, August 2, 2008
Canada & The Brain Drain
A recent article I found in The Walrus, June 2008 issue.
It worked — Manitoba scored its share of South African medical professionals — and I felt more than a little guilty. What business did we have enticing skilled professionals away from countries that had spent millions of scarce dollars training them and desperately needed their services, simply to fill our own needs, however pressing they might be?
Over a decade later, one could have hoped that poaching of the talented human resources of the perennially more desperate South and East by the powerful countries of the North and West would have been called off. It hasn’t. In a now-celebrated case, last fall newspaper reports alerted us that Shoppers Drug Mart had sent recruiters to aids-stricken South Africa to interview young pharmacists, and lure them to Canada with promises of $100,000 salaries. “We have a long history of helping pharmacists from other countries start new careers in Canada,” a Shoppers spokesperson said. Not everyone was content to let it pass. In January, an editorial in the Canadian Medical Association Journal blasted Shoppers, pronouncing such ventures “not just gauche [but] unethical. It amounts to a Canadian corporation taking advantage of South African taxpayers and [an] impoverished higher education system — truly foreign aid in reverse.”
A fight was on, I thought. But sober realities quickly intruded to overwhelm the debate. Finger pointing about outright poaching aside, even the cma would have to acknowledge that our economy and the provision of public services depend mightily on more subtle forms of this phenomenon. Professor Ronald Labonté has watched the situation develop for a number of years — with no small amount of dismay. As the Canada Research Chair in Globalization and Health Equity at the University of Ottawa, and until recently adjunct professor in the Department of Community Health and Epidemiology at the University of Saskatchewan, he observes that active recruiting efforts are not even necessary: “All you have to do is post your needs on your website and let word of mouth take care of the rest.”
Unfettered globalization, with its free flow of capital and investment, is increasingly being followed by the free movement of people with professional skills, and Canada and other wealthy countries have become landing spots for many of the best and brightest from the developing world. By doing little to discourage this and much to promote it — everything from word of mouth campaigns to targeted immigration approaches that identify skilled professionals — almost everybody in government and industry working on Canada’s skills shortage is complicit. Arguably, Shoppers Drug Mart was simply doing overtly what most governments from the North and West both allow and encourage more covertly every day.
While few would want to forbid people from moving to a better life, the fact remains that as we benefit, the other half of the world pays a hefty price. Clearly evident in engineering, agricultural technology, business, education — any number of fields, really — the effects of this outmigration are most dramatic in health care, and the place hardest hit is Africa. Across the continent, there are thirteen doctors for every 100,000 people, though for some countries, such as Ethiopia, that number is just two. (I have visited clinics in African countries that have not seen a doctor in years, and some only have a single nurse attempting to hold things together.) Meanwhile, in the US the ratio of doctors to citizens is 256 to 100,000; in Canada, it is 214 to 100,000.
According to the United Nations Conference on Trade and Development, 65 percent of newly qualified doctors in Bangladesh seek jobs abroad. As in Ethiopia, Bangladesh’s locally trained medical personnel depart for the greener pastures of the North and West. In particular, the health care systems of Canada, the UK, the US, and Australia have become heavily dependent on immigrant health care professionals. The Organisation for Economic Co-operation and Development (oecd) reports that 22 percent of practising doctors in Canada were trained elsewhere; in the UK, it is 33 percent. The US and Australia fall somewhere in between.
Such reports indicate that policy-makers and institutions have been aware of the issue for years. In 1999, the World Bank’s World Development Report declared that the brain drain from the Third World to the First would be “one of the major forces shaping the landscape of the 21st century.” But nearly a decade into this new century, all we’ve really done about “foreign aid in reverse” is take advantage of it.
Dr. Amir Attaran, the Canada Research Chair in Law, Population Health, and Global Development Policy at the University of Ottawa and co-author of the cmaj editorial, says that Shoppers Drug Mart–type recruiting would be much less likely today in Britain. In 2004, the British House of Commons International Development Committee issued a statement arguing that the migration of vast numbers of skilled workers contradicted the goals of the West’s development programs: “[It is] unfair, inefficient and incoherent for developed countries to provide aid to help developing countries to make progress towards the Millennium Development Goals on health and education, whilst helping themselves to the nurses, doctors, and teachers who have been trained in, and at the expense of, developing countries,” stated the parliamentarians. This is not to suggest that Britain has not, over the years, recruited from needy countries, as the oecd statistics reveal. Indeed, Manchester reputedly has more Malawian doctors than Malawi, and hospitals across Britain are heavily dependent on Zimbabwean and Zambian nurses. Nonetheless, also in 2004, the National Health Service decided as a matter of policy to cease active offshore recruitment from developing countries. “It didn’t require a law,” says Attaran, “just a change in behaviour. And after the nhs lead, the public culture changed.” “Boots [the British drug-store chain] would not do what Shoppers has done,” he continues — “go to a struggling country that has one of the world’s highest incidences of hiv/aids, and lure their pharmacists away.”
While chastising Shoppers, Attaran reserves equal scorn for Canadians as a whole. “Does anyone give them [Shoppers] a hard time about it? Not in this backward country,” he fumes. His point is that few ask what happens to the sending countries when they export their talent to Canada, and fewer still ask policy-makers to admit that domestic laws and practices amount to a jumble of contradictions and hypocrisy. Canada boasts about its refugee settlement programs — as the US does about opening its arms to “the huddled masses” of the world — but in the main, it is no longer the poor, unskilled, and uneducated who emigrate. While stories of overqualified immigrants driving cabs in Canadian cities are legend, it is our ability to put foreign-trained skill to use that we consider our real genius, and that is where the majority of our efforts get directed.
Forty-nine percent of Canada’s Ph.D.s were born elsewhere, and the rules and regulations outlined in our immigration statutes — particularly the points system — tilt strongly toward enticing more foreign nationals with money, skills, and education. According to the minister for citizenship and immigration, Diane Finley, this is precisely what Canada must do — it’s a global competition, after all — and the Harper government’s March budget implementation bill included a provision giving the minister discretion in hand-picking certain immigrant applicants from the large backlog and accelerating their passage into Canada. Identify the need, and then fill it; so much the better that the people come relatively free of charge because their education was obtained elsewhere. Critics argue that this politicizes the immigration and refugee system, but few have raised concerns about the effects of talent recruiting on the developing world.
South of the border, the situation is similar. When the poor spill over the borders into America, as they do from Mexico, alarm bells go off. But, less noticeably, the US has become home to 30 percent of Mexico’s doctoral graduates; and over 60 percent of immigrants from the British Commonwealth Caribbean arrive in America with college or university degrees. In 2005, reporting for the UN, Arno Tanner, visiting Fulbright Scholar at the Migration Policy Institute in Washington, DC, determined that 88 percent of immigrants from non-industrial countries to oecd countries have at minimum secondary school education, and that “global labour migration is increasingly becoming a movement of the educated with their families, which means that, at least initially, the sending country loses a considerable part of its vocational elite upon emigration.” While this global migration creates a temporary vacuum for giants like India and China, it is “more permanent and occasionally life threatening in sub-Saharan Africa or in politically and demographically more vulnerable countries, such as Pakistan and Turkey.” Africa, Tanner states, “has lost a third of its skilled professionals in recent decades, and has had to replace them with 100,000 expatriates from the West, at a cost of $4 billion [US] a year.”
Cited in the Tanner report, Philip Emeagwali — a renowned Nigerian computer scientist who now lives in the US — says that this out-migration makes it nearly impossible for most African countries to build a middle class. He describes Africa as having “a massive underclass that is largely unemployed and very poor, and a few very rich people that are mostly corrupt military and government officials.” This slow but inexorable strangulation of the continent is doubly ironic, given Western leaders’ embrace of the “African renaissance,” and their commitment to helping the continent find “African solutions to African problems.”
Siphokazi Phillip, international relations coordinator for denosa, the professional association of South Africa’s nurses, told me that the recruitment of “all categories of health workers, with nursing being the most affected” continues apace in South Africa. He emphasized that Western health care associations recruit overtly through regular newspaper and magazine advertising campaigns. The biggest offenders, he says, are the US, Canada, Saudi Arabia, and the UK — apparently notwithstanding the efforts of the nhs and Britain’s parliament — and such actions have dire “implications for the country, because they further deepen the staff shortages we have had for many years. The gap is getting wider.” When I ask him about the mitigating effects of remittances, he is skeptical.
On a wall of the Odette Cancer Centre at Toronto’s Sunnybrook Health Sciences Centre, a large world map identifies the countries of origin of the 140-member radiation therapy staff. Doctors, radiologists, and counsellors speak thirty-one languages, the display says, and have come from such diverse places as India, Iran, Tanzania, and Taiwan. This, you might say, is a picture of modern Canada, of multiculturalism in practice, and in many respects it is.
Twenty years ago, Khama Hanson moved from Jamaica to London, England, to study to become a radiation therapist. She returned to Jamaica, which had given her scholarship monies, for a three-year stint to repay her obligation, but packed her bags again, this time for Ottawa and then Toronto. She now works at Sunnybrook. “I always wanted to travel,” she says, “and with this profession you can get a job anywhere in the world.” She tries to believe that some good derives from Jamaicans being one of “the best in the world when it comes to sending remittances,” but cannot deny that one of the Caribbean’s major exports is its workforce.
Sheila Robson, a Brit, came to Canada in 1977. “Princess Margaret Hospital in Toronto was experiencing a desperate shortage of radiation therapists,” she says. “They advertised in the UK, and nineteen of us answered the call.” For Robson, it was both an adventure and a serendipitous financial move: her salary quintupled instantly. Still, like many back then, she intended to stay in Canada only a short time; thirty years later, she’s still here, now as head of radiation therapy at Sunnybrook. In the early days, international recruitment as a strategy to address labour shortages tended to be from one First World country to another — Robson was trained in Newcastle, England — and for Canada, Australia, and England, significant immigration also occurred within the Commonwealth, which explains how Khama Hanson moved easily from Jamaica to England and then here. In the 1990s, as globalization knocked down walls, developing nations became fair game in the hunt.
During that hyper decade, for instance, Robson’s own department at Sunnybrook participated in two mad scrambles to address shortages, both times sending officials on worldwide searches with the full support of two levels of government. Cancer Care Ontario, the provincially funded umbrella organization that oversees strategies to address cancer treatment needs, mounted the overseas campaign of advertisements and interviews. The federal immigration department recognized the campaign and “made us a desired profession,” Robson says. On both occasions, the Canadian delegations found themselves in hot competition with other countries on the prowl for skilled personnel, especially the UK and the US. The Americans, Robson says, always offered great bonuses and higher salaries.
Today, while medical school enrolments are back to their pre-1993 levels, the pressure on Canada to take advantage of the developing world’s skills is enormous. With our population aging rapidly and baby boomers starting to retire, medical needs and costs are rising dramatically. Provincial and territorial health care budgets in 1993 accounted for 32.7 percent of total expenditures. By 2006, they were soaking up nearly 40 percent. The trend lines and expectations are clear. Extended wait times remain a major problem — and private health care, everything from hip replacement clinics in Montreal to the new for-profit hospital in Vancouver, is stepping in to fill the breach. But a major part of the strategy is to go for the foreign trained. In Ontario, for instance, the Liberal government says that it has “doubled the number of international medical graduates to improve access to health care,” and Michael Decter, former chair of the Health Council of Canada, confirms that the province has programs in place to speed up the process of accreditation for foreign-trained medical professionals already here. The question, of course, is whether such efforts simply amount to giving the green light to those wanting to leave their Third World situations.
Many health services across Canada fear that foreign-trained professionals are the only staff they are going to get. In the Yukon, for instance, keeping medical staff is a perpetual challenge, according to Stuart Whitley, the territory’s deputy minister of health and social services. In no small measure, it manages by attracting young international medical graduates (imgs). “We have arrangements for them to practise here,” says Whitley. “Special licences allow doctors who have come from other countries to practise, subject to such conditions as our medical council imposes. Sometimes those are supervisory — shadowing and so on.” The territory has recently licensed doctors from Pakistan, Britain, and South Africa, but, Whitley acknowledges, the problem remains, and “we can never get enough nurses.”
Too often, the Yukon — geographically isolated, with a population of just 31,000, and with few career advancement opportunities — is merely a portal for young medicos to move through on their way to metropolitan Canada. “We are constantly getting raided,” says Whitley. “The bigger medical centres in the South come up and say, ‘Here’s what we can offer you.’ imgs come here, qualify, and then move on to some other part of the country.” The result is a chain reaction, internal to Canada: outlying regions experience perennial shortages and are always in recruitment mode. Still, Whitley says that the Yukon government does not actively recruit overseas, sticking strictly to health fairs across Canada. “Everyone is aware of the complexity of the moral issues around the autonomy of doctors and other medical people to choose where they want to live and work,” he says. “And if we poach the best and brightest [from developing countries], are we obliged to compensate in some way?”
Whitley’s concerns don’t seem to bother the Saskatoon Health Region. In March, the Saskatoon StarPhoenix published a column by the region’s vice-president of human resources, Bonnie Blakely. Just back from a nurse recruiting trip to the Philippines, she was attempting to refute charges that offshore recruiting in poor countries was unethical. Not so, she argued; such efforts “enrich both communities.” Nowhere did she acknowledge that Canada’s ratio of nurses to population is 10 to 1,000, while in the Philippines it is 1.7 to 1,000. Rather, Blakely stuck to her guns, citing the Philippine government’s support for the venture, claiming that the nurses would earn good salaries and send money back home, and pointing out that if Saskatchewan didn’t scoop them, somebody else would.
Professor Labonté, who co-authored the book Health for Some: Death, Disease and Disparity in a Globalizing Era, explains that gross inequality of resources has given momentum to the movement of health care professionals. “The poorest countries are going through a collapse of their public health systems, often the result of dual crises in both financing and management,” he says. “Meanwhile, globally, there is a brisk labour market for highly skilled professionals in many fields, but notably in health care. In that competition, the poor countries can’t possibly compete.” Health training, he says, is widely seen as a passport to a better life, a difficult trend to deal with for well-meaning organizations fighting “unethical recruiting.”
Margaret Zondo, a Zimbabwean who works for the Presbyterian Church in Canada, confirms that skills migration is particularly devastating for African health care, “with [the loss of] teachers, engineers, and scientists close behind. It costs $200,000 [US] to train a doctor in Zimbabwe or South Africa,” she says, “and they end up in places like Manitoba, where one in three rural doctors is from Africa.” Zondo herself personifies the migration. Ten years ago, armed with an mba from Edith Cowan University in Australia, she became the permanent secretary of Zimbabwe’s Public Service Commission, a high-ranking job that left her in ultimate charge of 170,000 civil servants. It was a difficult time. In the mid-1990s, the International Monetary Fund compelled Zimbabwe to reduce its public service by 25 percent in order to qualify for continued foreign loans and aid. The effect, Zondo says, was that skilled and educated people were cut loose, and many of those who kept their jobs were underemployed and forced to moonlight. (Zondo described a close friend, a linguistics professor, who double-shifts as a chauffeur for a wealthy businessman.) In 2001, with Zimbabwe spinning out of control, she bailed and came to Canada.
“These days, when South Africans leave to go to North America and Europe, Zimbabweans and Malawians move into South Africa to fill the gap,” Zondo says. The hole left in Zimbabwe is partially filled by Cubans, who, having been recruited by the Zimbabwean government, are paid more and in foreign dollars, two facts that cause considerable resentment. (Remittances, Zondo adds in an aside and with obvious frustration, are fine for family and friends, but they don’t stimulate local economies, and, worse, they “hold down unrest, helping governments survive that shouldn’t.”)
Another absurdity was pointed out three years ago by the Commission for Africa, convened by then British prime minister Tony Blair. It argued that the number of foreign technical experts recruited by Africa far exceeded the number of skilled migrants leaving the continent. That is, for every educated African national making an exit, the developed world responds by sending more than one medical professional, engineer, lawyer, teacher, government analyst, or environmental planner. It’s madness, Zondo says: “The very least the West could do is use more of that [foreign aid] money to employ our skills.” Indeed, estimates vary, but as much as 35 percent of the total foreign aid sent to Africa each year goes to pay the salaries of foreign professionals.
In an attempt to address one aspect of the issue, the United Nations Educational, Scientific, and Cultural Organization (unesco) and Hewlett-Packard have engineered a unique partnership called Piloting Solutions for Reversing Brain Drain into Brain Gain for Africa. It provides grid-computing technology to universities in Algeria, Ghana, Nigeria, Senegal, and Zimbabwe, and aims to establish information-sharing links between researchers who have stayed in their home countries and those who have left. Without access to top-flight research in the North and West, the strength of African universities diminishes, which in turn makes it increasingly difficult for them to attract the best and brightest. The University and College Union in the UK, which devoted itself to an in-depth study of the issue two years ago, is now advocating the development of programs “aimed at encouraging African higher education unions to organise and develop such that they can themselves argue for capacity building work in the education sector in their home countries.”
These are noteworthy efforts, but ultimately long-term solutions require the contributions of a very broad circle on both sides of the divide. In a recent press release, Dr. Danielle Grondin, director of the migration and health department for the Geneva-based International Organization for Migration, argues that “international migration of health human resources is not a good or a bad thing, per se. Its effects depend on the policies and flanking measures put in place to guarantee equity, access, and quality of services in accordance with the particular national situation.” While allowing that “pull factors, especially the promotion and enforcement of ethical recruitment practices,” should be addressed, the iom stresses that “retaining health care workers in sending countries means addressing factors that often push them to leave, including difficult working conditions, low salaries, excessive workloads, and lack of career prospects or training opportunities.” The iom, that is, places at least as much responsibility on the sending countries.
Labonté notes that “as much as we rich countries have obligations to stem this, the so-called source countries have responsibilities themselves.” Kenya is a case in point, he says. It is home to thousands of trained nurses it desperately needs but cannot employ, due to a lack of money to pay them, and a lack of money or means to set up clinics — all the organizational and management shortfalls that paralyze a country. “The Philippines,” he says, “deliberately trains nurses for export, hoping for the remittances they will send back to the country, while enduring shortages at home. What are you supposed to do about that?”
While any road to a long-term and equitable solution is fraught with pitfalls, Keith Martin, the federal Liberal critic for international development and a medical doctor who has visited Africa twenty-six times, laments that Canada isn’t doing much of anything. He points to the Commonwealth Code of Practice for the International Recruitment of Health Workers, a 2003 proposal in which the signatory countries agreed not to recruit actively; Canada wouldn’t sign on. Instead, in 2005 the Liberal government adopted measures to speed the training and certification of foreign health care professionals already resident in Canada, so we could use them here more expeditiously and effectively. “If we’re going to do that,” Martin says, “we’re obliged morally to help on the other side.” His prescription? “For every international health care worker we take on here, we should train two in their country of origin . . . The present government could do it, [but this] would mean big changes at the Canadian International Development Agency, where getting anything through is like pushing sand uphill,” Martin says.
Canada provided $3.7 billion in foreign aid in 2005–2006, mostly through cida. It is a far cry from the 0.7% of gdp that Prime Minister Pearson long ago established as our goal, but what is equally lamentable is the hypocrisy of one arm of government, cida, sending aid for medical purposes to Third World countries, while another arm, Citizenship and Immigration Canada, encourages the skilled health care professionals from those countries to emigrate to Canada.
The choice for Canada appears clear: recruit more foreign health care professionals, or train more of our own. Given that the per-student cost to governments of undergraduate medical school education is upwards of half a million dollars, it would appear unlikely that there will be a dramatic increase in class sizes. As some have asked, what is the point of expensive training if you can get somebody else to do it for you?
The global choice is either to find ways to reduce the drain of medical professions from strapped Third World countries, or watch as half the world continues to become much worse off than it already is. In order to reduce foreign recruiting, Ronald Labonté believes Canada needs to follow Britain’s lead: ensure it is training its own supply of health care professionals. In the meantime, on the issue of compensation he agrees with Keith Martin. The problem, however, is that such compensation systems would only truly work under multilateral agreements — of which, presently, there are none. If Canada, for instance, paid for the training of two doctors in South Africa in return for receiving a fully trained South African doctor, what guarantee would it have that its new doctor would stay here, or that the two doctors trained in South Africa wouldn’t move elsewhere? Thus, while Labonté asks rhetorically, “Could Canada play a role?” and answers, “Well, somebody needs to start,” ultimately only a multinational approach will solve the vexing problem of foreign aid in reverse as it pertains to health care.
Poaching Foreign Doctors
Do our development and immigration policies amount to foreign aid in reverse?
by Larry Krotz
In the mid-1990s, I had a job making a film for the Manitoba agency charged with finding doctors and nurses to staff the province’s more remote health clinics. On behalf of the J. A. Hildes Northern Medical Unit, off I went with cameras and crew to make such obscure places as Norway House and Churchill look as appealing as possible — emphasizing their well-equipped clinics, comfy living quarters, hunting and fishing just outside the back door. The film was destined for faraway places like South Africa, and when physicians there saw it we wanted them to eagerly pull up stakes and come to Canada’s North.It worked — Manitoba scored its share of South African medical professionals — and I felt more than a little guilty. What business did we have enticing skilled professionals away from countries that had spent millions of scarce dollars training them and desperately needed their services, simply to fill our own needs, however pressing they might be?
Over a decade later, one could have hoped that poaching of the talented human resources of the perennially more desperate South and East by the powerful countries of the North and West would have been called off. It hasn’t. In a now-celebrated case, last fall newspaper reports alerted us that Shoppers Drug Mart had sent recruiters to aids-stricken South Africa to interview young pharmacists, and lure them to Canada with promises of $100,000 salaries. “We have a long history of helping pharmacists from other countries start new careers in Canada,” a Shoppers spokesperson said. Not everyone was content to let it pass. In January, an editorial in the Canadian Medical Association Journal blasted Shoppers, pronouncing such ventures “not just gauche [but] unethical. It amounts to a Canadian corporation taking advantage of South African taxpayers and [an] impoverished higher education system — truly foreign aid in reverse.”
A fight was on, I thought. But sober realities quickly intruded to overwhelm the debate. Finger pointing about outright poaching aside, even the cma would have to acknowledge that our economy and the provision of public services depend mightily on more subtle forms of this phenomenon. Professor Ronald Labonté has watched the situation develop for a number of years — with no small amount of dismay. As the Canada Research Chair in Globalization and Health Equity at the University of Ottawa, and until recently adjunct professor in the Department of Community Health and Epidemiology at the University of Saskatchewan, he observes that active recruiting efforts are not even necessary: “All you have to do is post your needs on your website and let word of mouth take care of the rest.”
Unfettered globalization, with its free flow of capital and investment, is increasingly being followed by the free movement of people with professional skills, and Canada and other wealthy countries have become landing spots for many of the best and brightest from the developing world. By doing little to discourage this and much to promote it — everything from word of mouth campaigns to targeted immigration approaches that identify skilled professionals — almost everybody in government and industry working on Canada’s skills shortage is complicit. Arguably, Shoppers Drug Mart was simply doing overtly what most governments from the North and West both allow and encourage more covertly every day.
While few would want to forbid people from moving to a better life, the fact remains that as we benefit, the other half of the world pays a hefty price. Clearly evident in engineering, agricultural technology, business, education — any number of fields, really — the effects of this outmigration are most dramatic in health care, and the place hardest hit is Africa. Across the continent, there are thirteen doctors for every 100,000 people, though for some countries, such as Ethiopia, that number is just two. (I have visited clinics in African countries that have not seen a doctor in years, and some only have a single nurse attempting to hold things together.) Meanwhile, in the US the ratio of doctors to citizens is 256 to 100,000; in Canada, it is 214 to 100,000.
According to the United Nations Conference on Trade and Development, 65 percent of newly qualified doctors in Bangladesh seek jobs abroad. As in Ethiopia, Bangladesh’s locally trained medical personnel depart for the greener pastures of the North and West. In particular, the health care systems of Canada, the UK, the US, and Australia have become heavily dependent on immigrant health care professionals. The Organisation for Economic Co-operation and Development (oecd) reports that 22 percent of practising doctors in Canada were trained elsewhere; in the UK, it is 33 percent. The US and Australia fall somewhere in between.
Such reports indicate that policy-makers and institutions have been aware of the issue for years. In 1999, the World Bank’s World Development Report declared that the brain drain from the Third World to the First would be “one of the major forces shaping the landscape of the 21st century.” But nearly a decade into this new century, all we’ve really done about “foreign aid in reverse” is take advantage of it.
Dr. Amir Attaran, the Canada Research Chair in Law, Population Health, and Global Development Policy at the University of Ottawa and co-author of the cmaj editorial, says that Shoppers Drug Mart–type recruiting would be much less likely today in Britain. In 2004, the British House of Commons International Development Committee issued a statement arguing that the migration of vast numbers of skilled workers contradicted the goals of the West’s development programs: “[It is] unfair, inefficient and incoherent for developed countries to provide aid to help developing countries to make progress towards the Millennium Development Goals on health and education, whilst helping themselves to the nurses, doctors, and teachers who have been trained in, and at the expense of, developing countries,” stated the parliamentarians. This is not to suggest that Britain has not, over the years, recruited from needy countries, as the oecd statistics reveal. Indeed, Manchester reputedly has more Malawian doctors than Malawi, and hospitals across Britain are heavily dependent on Zimbabwean and Zambian nurses. Nonetheless, also in 2004, the National Health Service decided as a matter of policy to cease active offshore recruitment from developing countries. “It didn’t require a law,” says Attaran, “just a change in behaviour. And after the nhs lead, the public culture changed.” “Boots [the British drug-store chain] would not do what Shoppers has done,” he continues — “go to a struggling country that has one of the world’s highest incidences of hiv/aids, and lure their pharmacists away.”
While chastising Shoppers, Attaran reserves equal scorn for Canadians as a whole. “Does anyone give them [Shoppers] a hard time about it? Not in this backward country,” he fumes. His point is that few ask what happens to the sending countries when they export their talent to Canada, and fewer still ask policy-makers to admit that domestic laws and practices amount to a jumble of contradictions and hypocrisy. Canada boasts about its refugee settlement programs — as the US does about opening its arms to “the huddled masses” of the world — but in the main, it is no longer the poor, unskilled, and uneducated who emigrate. While stories of overqualified immigrants driving cabs in Canadian cities are legend, it is our ability to put foreign-trained skill to use that we consider our real genius, and that is where the majority of our efforts get directed.
Forty-nine percent of Canada’s Ph.D.s were born elsewhere, and the rules and regulations outlined in our immigration statutes — particularly the points system — tilt strongly toward enticing more foreign nationals with money, skills, and education. According to the minister for citizenship and immigration, Diane Finley, this is precisely what Canada must do — it’s a global competition, after all — and the Harper government’s March budget implementation bill included a provision giving the minister discretion in hand-picking certain immigrant applicants from the large backlog and accelerating their passage into Canada. Identify the need, and then fill it; so much the better that the people come relatively free of charge because their education was obtained elsewhere. Critics argue that this politicizes the immigration and refugee system, but few have raised concerns about the effects of talent recruiting on the developing world.
South of the border, the situation is similar. When the poor spill over the borders into America, as they do from Mexico, alarm bells go off. But, less noticeably, the US has become home to 30 percent of Mexico’s doctoral graduates; and over 60 percent of immigrants from the British Commonwealth Caribbean arrive in America with college or university degrees. In 2005, reporting for the UN, Arno Tanner, visiting Fulbright Scholar at the Migration Policy Institute in Washington, DC, determined that 88 percent of immigrants from non-industrial countries to oecd countries have at minimum secondary school education, and that “global labour migration is increasingly becoming a movement of the educated with their families, which means that, at least initially, the sending country loses a considerable part of its vocational elite upon emigration.” While this global migration creates a temporary vacuum for giants like India and China, it is “more permanent and occasionally life threatening in sub-Saharan Africa or in politically and demographically more vulnerable countries, such as Pakistan and Turkey.” Africa, Tanner states, “has lost a third of its skilled professionals in recent decades, and has had to replace them with 100,000 expatriates from the West, at a cost of $4 billion [US] a year.”
Cited in the Tanner report, Philip Emeagwali — a renowned Nigerian computer scientist who now lives in the US — says that this out-migration makes it nearly impossible for most African countries to build a middle class. He describes Africa as having “a massive underclass that is largely unemployed and very poor, and a few very rich people that are mostly corrupt military and government officials.” This slow but inexorable strangulation of the continent is doubly ironic, given Western leaders’ embrace of the “African renaissance,” and their commitment to helping the continent find “African solutions to African problems.”
Siphokazi Phillip, international relations coordinator for denosa, the professional association of South Africa’s nurses, told me that the recruitment of “all categories of health workers, with nursing being the most affected” continues apace in South Africa. He emphasized that Western health care associations recruit overtly through regular newspaper and magazine advertising campaigns. The biggest offenders, he says, are the US, Canada, Saudi Arabia, and the UK — apparently notwithstanding the efforts of the nhs and Britain’s parliament — and such actions have dire “implications for the country, because they further deepen the staff shortages we have had for many years. The gap is getting wider.” When I ask him about the mitigating effects of remittances, he is skeptical.
On a wall of the Odette Cancer Centre at Toronto’s Sunnybrook Health Sciences Centre, a large world map identifies the countries of origin of the 140-member radiation therapy staff. Doctors, radiologists, and counsellors speak thirty-one languages, the display says, and have come from such diverse places as India, Iran, Tanzania, and Taiwan. This, you might say, is a picture of modern Canada, of multiculturalism in practice, and in many respects it is.
Twenty years ago, Khama Hanson moved from Jamaica to London, England, to study to become a radiation therapist. She returned to Jamaica, which had given her scholarship monies, for a three-year stint to repay her obligation, but packed her bags again, this time for Ottawa and then Toronto. She now works at Sunnybrook. “I always wanted to travel,” she says, “and with this profession you can get a job anywhere in the world.” She tries to believe that some good derives from Jamaicans being one of “the best in the world when it comes to sending remittances,” but cannot deny that one of the Caribbean’s major exports is its workforce.
Sheila Robson, a Brit, came to Canada in 1977. “Princess Margaret Hospital in Toronto was experiencing a desperate shortage of radiation therapists,” she says. “They advertised in the UK, and nineteen of us answered the call.” For Robson, it was both an adventure and a serendipitous financial move: her salary quintupled instantly. Still, like many back then, she intended to stay in Canada only a short time; thirty years later, she’s still here, now as head of radiation therapy at Sunnybrook. In the early days, international recruitment as a strategy to address labour shortages tended to be from one First World country to another — Robson was trained in Newcastle, England — and for Canada, Australia, and England, significant immigration also occurred within the Commonwealth, which explains how Khama Hanson moved easily from Jamaica to England and then here. In the 1990s, as globalization knocked down walls, developing nations became fair game in the hunt.
During that hyper decade, for instance, Robson’s own department at Sunnybrook participated in two mad scrambles to address shortages, both times sending officials on worldwide searches with the full support of two levels of government. Cancer Care Ontario, the provincially funded umbrella organization that oversees strategies to address cancer treatment needs, mounted the overseas campaign of advertisements and interviews. The federal immigration department recognized the campaign and “made us a desired profession,” Robson says. On both occasions, the Canadian delegations found themselves in hot competition with other countries on the prowl for skilled personnel, especially the UK and the US. The Americans, Robson says, always offered great bonuses and higher salaries.
Today, while medical school enrolments are back to their pre-1993 levels, the pressure on Canada to take advantage of the developing world’s skills is enormous. With our population aging rapidly and baby boomers starting to retire, medical needs and costs are rising dramatically. Provincial and territorial health care budgets in 1993 accounted for 32.7 percent of total expenditures. By 2006, they were soaking up nearly 40 percent. The trend lines and expectations are clear. Extended wait times remain a major problem — and private health care, everything from hip replacement clinics in Montreal to the new for-profit hospital in Vancouver, is stepping in to fill the breach. But a major part of the strategy is to go for the foreign trained. In Ontario, for instance, the Liberal government says that it has “doubled the number of international medical graduates to improve access to health care,” and Michael Decter, former chair of the Health Council of Canada, confirms that the province has programs in place to speed up the process of accreditation for foreign-trained medical professionals already here. The question, of course, is whether such efforts simply amount to giving the green light to those wanting to leave their Third World situations.
Many health services across Canada fear that foreign-trained professionals are the only staff they are going to get. In the Yukon, for instance, keeping medical staff is a perpetual challenge, according to Stuart Whitley, the territory’s deputy minister of health and social services. In no small measure, it manages by attracting young international medical graduates (imgs). “We have arrangements for them to practise here,” says Whitley. “Special licences allow doctors who have come from other countries to practise, subject to such conditions as our medical council imposes. Sometimes those are supervisory — shadowing and so on.” The territory has recently licensed doctors from Pakistan, Britain, and South Africa, but, Whitley acknowledges, the problem remains, and “we can never get enough nurses.”
Too often, the Yukon — geographically isolated, with a population of just 31,000, and with few career advancement opportunities — is merely a portal for young medicos to move through on their way to metropolitan Canada. “We are constantly getting raided,” says Whitley. “The bigger medical centres in the South come up and say, ‘Here’s what we can offer you.’ imgs come here, qualify, and then move on to some other part of the country.” The result is a chain reaction, internal to Canada: outlying regions experience perennial shortages and are always in recruitment mode. Still, Whitley says that the Yukon government does not actively recruit overseas, sticking strictly to health fairs across Canada. “Everyone is aware of the complexity of the moral issues around the autonomy of doctors and other medical people to choose where they want to live and work,” he says. “And if we poach the best and brightest [from developing countries], are we obliged to compensate in some way?”
Whitley’s concerns don’t seem to bother the Saskatoon Health Region. In March, the Saskatoon StarPhoenix published a column by the region’s vice-president of human resources, Bonnie Blakely. Just back from a nurse recruiting trip to the Philippines, she was attempting to refute charges that offshore recruiting in poor countries was unethical. Not so, she argued; such efforts “enrich both communities.” Nowhere did she acknowledge that Canada’s ratio of nurses to population is 10 to 1,000, while in the Philippines it is 1.7 to 1,000. Rather, Blakely stuck to her guns, citing the Philippine government’s support for the venture, claiming that the nurses would earn good salaries and send money back home, and pointing out that if Saskatchewan didn’t scoop them, somebody else would.
Professor Labonté, who co-authored the book Health for Some: Death, Disease and Disparity in a Globalizing Era, explains that gross inequality of resources has given momentum to the movement of health care professionals. “The poorest countries are going through a collapse of their public health systems, often the result of dual crises in both financing and management,” he says. “Meanwhile, globally, there is a brisk labour market for highly skilled professionals in many fields, but notably in health care. In that competition, the poor countries can’t possibly compete.” Health training, he says, is widely seen as a passport to a better life, a difficult trend to deal with for well-meaning organizations fighting “unethical recruiting.”
Margaret Zondo, a Zimbabwean who works for the Presbyterian Church in Canada, confirms that skills migration is particularly devastating for African health care, “with [the loss of] teachers, engineers, and scientists close behind. It costs $200,000 [US] to train a doctor in Zimbabwe or South Africa,” she says, “and they end up in places like Manitoba, where one in three rural doctors is from Africa.” Zondo herself personifies the migration. Ten years ago, armed with an mba from Edith Cowan University in Australia, she became the permanent secretary of Zimbabwe’s Public Service Commission, a high-ranking job that left her in ultimate charge of 170,000 civil servants. It was a difficult time. In the mid-1990s, the International Monetary Fund compelled Zimbabwe to reduce its public service by 25 percent in order to qualify for continued foreign loans and aid. The effect, Zondo says, was that skilled and educated people were cut loose, and many of those who kept their jobs were underemployed and forced to moonlight. (Zondo described a close friend, a linguistics professor, who double-shifts as a chauffeur for a wealthy businessman.) In 2001, with Zimbabwe spinning out of control, she bailed and came to Canada.
“These days, when South Africans leave to go to North America and Europe, Zimbabweans and Malawians move into South Africa to fill the gap,” Zondo says. The hole left in Zimbabwe is partially filled by Cubans, who, having been recruited by the Zimbabwean government, are paid more and in foreign dollars, two facts that cause considerable resentment. (Remittances, Zondo adds in an aside and with obvious frustration, are fine for family and friends, but they don’t stimulate local economies, and, worse, they “hold down unrest, helping governments survive that shouldn’t.”)
Another absurdity was pointed out three years ago by the Commission for Africa, convened by then British prime minister Tony Blair. It argued that the number of foreign technical experts recruited by Africa far exceeded the number of skilled migrants leaving the continent. That is, for every educated African national making an exit, the developed world responds by sending more than one medical professional, engineer, lawyer, teacher, government analyst, or environmental planner. It’s madness, Zondo says: “The very least the West could do is use more of that [foreign aid] money to employ our skills.” Indeed, estimates vary, but as much as 35 percent of the total foreign aid sent to Africa each year goes to pay the salaries of foreign professionals.
In an attempt to address one aspect of the issue, the United Nations Educational, Scientific, and Cultural Organization (unesco) and Hewlett-Packard have engineered a unique partnership called Piloting Solutions for Reversing Brain Drain into Brain Gain for Africa. It provides grid-computing technology to universities in Algeria, Ghana, Nigeria, Senegal, and Zimbabwe, and aims to establish information-sharing links between researchers who have stayed in their home countries and those who have left. Without access to top-flight research in the North and West, the strength of African universities diminishes, which in turn makes it increasingly difficult for them to attract the best and brightest. The University and College Union in the UK, which devoted itself to an in-depth study of the issue two years ago, is now advocating the development of programs “aimed at encouraging African higher education unions to organise and develop such that they can themselves argue for capacity building work in the education sector in their home countries.”
These are noteworthy efforts, but ultimately long-term solutions require the contributions of a very broad circle on both sides of the divide. In a recent press release, Dr. Danielle Grondin, director of the migration and health department for the Geneva-based International Organization for Migration, argues that “international migration of health human resources is not a good or a bad thing, per se. Its effects depend on the policies and flanking measures put in place to guarantee equity, access, and quality of services in accordance with the particular national situation.” While allowing that “pull factors, especially the promotion and enforcement of ethical recruitment practices,” should be addressed, the iom stresses that “retaining health care workers in sending countries means addressing factors that often push them to leave, including difficult working conditions, low salaries, excessive workloads, and lack of career prospects or training opportunities.” The iom, that is, places at least as much responsibility on the sending countries.
Labonté notes that “as much as we rich countries have obligations to stem this, the so-called source countries have responsibilities themselves.” Kenya is a case in point, he says. It is home to thousands of trained nurses it desperately needs but cannot employ, due to a lack of money to pay them, and a lack of money or means to set up clinics — all the organizational and management shortfalls that paralyze a country. “The Philippines,” he says, “deliberately trains nurses for export, hoping for the remittances they will send back to the country, while enduring shortages at home. What are you supposed to do about that?”
While any road to a long-term and equitable solution is fraught with pitfalls, Keith Martin, the federal Liberal critic for international development and a medical doctor who has visited Africa twenty-six times, laments that Canada isn’t doing much of anything. He points to the Commonwealth Code of Practice for the International Recruitment of Health Workers, a 2003 proposal in which the signatory countries agreed not to recruit actively; Canada wouldn’t sign on. Instead, in 2005 the Liberal government adopted measures to speed the training and certification of foreign health care professionals already resident in Canada, so we could use them here more expeditiously and effectively. “If we’re going to do that,” Martin says, “we’re obliged morally to help on the other side.” His prescription? “For every international health care worker we take on here, we should train two in their country of origin . . . The present government could do it, [but this] would mean big changes at the Canadian International Development Agency, where getting anything through is like pushing sand uphill,” Martin says.
Canada provided $3.7 billion in foreign aid in 2005–2006, mostly through cida. It is a far cry from the 0.7% of gdp that Prime Minister Pearson long ago established as our goal, but what is equally lamentable is the hypocrisy of one arm of government, cida, sending aid for medical purposes to Third World countries, while another arm, Citizenship and Immigration Canada, encourages the skilled health care professionals from those countries to emigrate to Canada.
The choice for Canada appears clear: recruit more foreign health care professionals, or train more of our own. Given that the per-student cost to governments of undergraduate medical school education is upwards of half a million dollars, it would appear unlikely that there will be a dramatic increase in class sizes. As some have asked, what is the point of expensive training if you can get somebody else to do it for you?
The global choice is either to find ways to reduce the drain of medical professions from strapped Third World countries, or watch as half the world continues to become much worse off than it already is. In order to reduce foreign recruiting, Ronald Labonté believes Canada needs to follow Britain’s lead: ensure it is training its own supply of health care professionals. In the meantime, on the issue of compensation he agrees with Keith Martin. The problem, however, is that such compensation systems would only truly work under multilateral agreements — of which, presently, there are none. If Canada, for instance, paid for the training of two doctors in South Africa in return for receiving a fully trained South African doctor, what guarantee would it have that its new doctor would stay here, or that the two doctors trained in South Africa wouldn’t move elsewhere? Thus, while Labonté asks rhetorically, “Could Canada play a role?” and answers, “Well, somebody needs to start,” ultimately only a multinational approach will solve the vexing problem of foreign aid in reverse as it pertains to health care.
Tuesday, July 15, 2008
The Beauty of Networks
I have been thinking about networks lately. And seeing them everywhere!
Oftentimes in the global health arena or perhaps more broadly in the non-profit sector, there seems to be a lot of overlap in interests and resources. The corporate world is moving towards mergers and consolidations, even community health services are being pared down to increase efficiency. Of course examples from the corporate and public sector are bound to raise controversial issues, however it can be argued that these organizations are working toward greater effectiveness.
Naturally, we should all be focusing on mutual collaboration and partnership. That's where SUNSIH comes in! We are here to help you facilitate knowledge and information sharing with other organizations or to help you access the wealth of information available through on-line resources and through collaboration with associated networks.
Here are the top 5 ways (and in no particular order) that you can plug into the SUNSIH/REUSSI network:
5. If you're part of a group who is working on or advocating for global health issues then we want to hear from you! We partner with organization who share our values and vision- contact us to learn more- general@sunsih.ca.
4. Browse our "Links" webpage for great resources that suit your own interests.
3. Want to receive local event information and global health updates? Our listserv may be the thing for you! Or even better, if you have a global health/local health event you'd like to publicize we would be happy to post the details to our listserv. In either case send us an email with your request!
2. Have you got something to say? Well then step up on our soap box and lay it out for us on our blog. Or just scope out the latest posts.
1. Apply to be a campus rep or regional rep to connect global health group working throughout your region.
Looking forward to hearing from you!
Mira Mehes
SUNSIH VP and networking fan
Oftentimes in the global health arena or perhaps more broadly in the non-profit sector, there seems to be a lot of overlap in interests and resources. The corporate world is moving towards mergers and consolidations, even community health services are being pared down to increase efficiency. Of course examples from the corporate and public sector are bound to raise controversial issues, however it can be argued that these organizations are working toward greater effectiveness.
Naturally, we should all be focusing on mutual collaboration and partnership. That's where SUNSIH comes in! We are here to help you facilitate knowledge and information sharing with other organizations or to help you access the wealth of information available through on-line resources and through collaboration with associated networks.
Here are the top 5 ways (and in no particular order) that you can plug into the SUNSIH/REUSSI network:
5. If you're part of a group who is working on or advocating for global health issues then we want to hear from you! We partner with organization who share our values and vision- contact us to learn more- general@sunsih.ca.
4. Browse our "Links" webpage for great resources that suit your own interests.
3. Want to receive local event information and global health updates? Our listserv may be the thing for you! Or even better, if you have a global health/local health event you'd like to publicize we would be happy to post the details to our listserv. In either case send us an email with your request!
2. Have you got something to say? Well then step up on our soap box and lay it out for us on our blog. Or just scope out the latest posts.
1. Apply to be a campus rep or regional rep to connect global health group working throughout your region.
Looking forward to hearing from you!
Mira Mehes
SUNSIH VP and networking fan
Chronic Poverty- A Global Concern
For all of you who receive dozens of global/public health emails each day (or more!) this blog is for you.
I was just pondering about the effectiveness of mass mailings and more importantly multiple mailings from the same organizations. I'm certain that at some point SUNSIH's been guilty of this activity, although we are conscious of the benefits of consolidating relevant information in a single communication. Perhaps what I think of most is whether there is a better way to share news and information without overwhelming you. I know we can all scan through our emails and draw out the important data, but wouldn't it be nice to have it come to you completely sorted out? If you have any suggestions for a more accessible way for us to share event information please do let us know! Also if you would like to suggest the type of content you would like to receive we would like to hear from you. general@sunsih.ca
Anyway, once in a while you do come across a great gem which is what I would like to share with you today. This report actually showed up in my inbox a few weeks ago but I've recently shared it with a colleague and so I thought I would share it with you as well. Of course as always, I do urge you to take it with a grain of salt.
I was just pondering about the effectiveness of mass mailings and more importantly multiple mailings from the same organizations. I'm certain that at some point SUNSIH's been guilty of this activity, although we are conscious of the benefits of consolidating relevant information in a single communication. Perhaps what I think of most is whether there is a better way to share news and information without overwhelming you. I know we can all scan through our emails and draw out the important data, but wouldn't it be nice to have it come to you completely sorted out? If you have any suggestions for a more accessible way for us to share event information please do let us know! Also if you would like to suggest the type of content you would like to receive we would like to hear from you. general@sunsih.ca
Anyway, once in a while you do come across a great gem which is what I would like to share with you today. This report actually showed up in my inbox a few weeks ago but I've recently shared it with a colleague and so I thought I would share it with you as well. Of course as always, I do urge you to take it with a grain of salt.
Chronic Poverty Research Centre CPRC - UK’s Department for International Development (DFID)
July 2008
Available online PDF [164p.] at: http://www.chronicpoverty.org
‘…..Over the last five years, in an era of unprecedented global wealth creation, the number of people living in chronic poverty has increased. Between 320 and 443 million people are now trapped in poverty that lasts for many years, often for their entire lifetime. Their children frequently inherit chronic poverty, if they survive infancy. Many chronically poor people die prematurely from easily preventable health problems.
For the chronically poor, poverty is not simply about having a very low income: it is about multidimensional deprivation – hunger, undernutrition, illiteracy, unsafe drinking water, lack of access to basic health services, social discrimination, physical insecurity and political exclusion. Whichever way one frames the problem of chronic poverty – as human suffering, as vulnerability, as a basic needs failure, as the abrogation of human rights, as degraded citizenship – one thing is clear.
Widespread chronic poverty occurs in a world that has the knowledge and resources to eradicate it.
This report argues that tackling chronic poverty is the global priority for our generation. There are robust ethical grounds for arguing that chronically poor people merit the greatest international, national and personal attention and effort. Tackling chronic poverty is vital if our world is to achieve an acceptable level of justice and fairness.
There are also strong pragmatic reasons for doing so. Addressing chronic poverty sooner rather than later will achieve much greater results at a dramatically lower cost. More broadly, reducing chronic poverty provides global public benefits, in terms of political and economic stability and public health….”
“….Priority goes to two policy areas – social protection (Chapter 3) and public services for the hard to reach (Chapter 5) – that can spearhead the assault on chronic poverty. Alongside these are anti-discrimination and gender empowerment (Chapter 5), building individual and collective assets (Chapters 3, 4 and 6) and strategic urbanisation and migration (Chapters 4 and 5). Working together, these policies reduce chronic poverty directly and create and maintain a just social compact that will underpin long-term efforts to eradicate chronic poverty (Chapter 6). Such social compacts ensure a distribution of public goods and services that contributes to justice and fairness….”
Content:
PART A – Chronic poverty as a key policy issue
Chapter 1 – Foundations for understanding and challenging chronic poverty
A. Chronic poverty and justice
B. The nature and extent of chronic poverty
C. Why address chronic poverty?
D: How to address chronic poverty?
E. Chronically Deprived Countries and Consistent Improvers
F. Conclusion
Chapter 2 – The policy and political challenge
A. Introduction
B. Where are the chronically poor in PRSs?
C. Policy responses/policy choices in PRSs
D. Political systems and ownership
E. Institutional mainstreaming and participation of the poor
F. Implementation
Obstacles to implementation
G. Conclusion
PART B – Four sets of policies for poverty eradication
Chapter 3 – Addressing insecurity through social protection
A. Introduction
B. The central role of vulnerability
C. The importance of social protection
D. Lessons from existing social protection programmes and policies
E. Country context
F. Conclusion
Chapter 4 – Economic growth and chronic poverty
A. Introduction
B. Poor people and the growth process
C. Disaggregation matters for policy
D. Transformative growth
E. Growth and strategic choices
F. Social protection as a policy lever for growth in Chronically Deprived Countries
G. Conclusion
Chapter 5 – Transformative social change
A. Introduction
B. Gender equality, social inclusion and increased ‘agency’: social goals to end chronic poverty
C. Politics
D. Policy contexts
E. Conclusion
Chapter 6 – Ending violent conflict and building a social compact
A. Introduction
B. Violent conflict and impoverishment
C. Redefining the fragile state
D. Towards a social compact
E. Financing the social compact
F. Conclusion
PART C – Conclusion
Chapter 7 – Eradicating chronic poverty
A. Eradicating chronic poverty
B. Five key poverty traps 1
C. Policy reponses to chronic poverty traps
D. Country context
E. Regaining the promise of poverty reduction
References
Background Papers :
http://www.chronicpoverty.org
Tuesday, July 8, 2008
New GHEC website
Dear friends and colleagues,
It was recently brought to my attention that GHEC has updated their website: www.globalhealthedu.org
Please take a look under RESOURCES especially in the PRIMARILY FOR STUDENTS & RESIDENTS section. It provides very useful information including Global Health:Career Options & Specialization (http://globalhealthedu.org/Pages/GlobalHealthCareer.aspx), newer topics such as "Establishing a Research Career in Global Health" and a Guidebook on Developing Residency Training in Global Health. http://globalhealthedu.org/Pages/Resource.aspx
GHEC also has developed educational modules for students to review either on their own or in instructor-led courses. They are great and very useful for your local student groups on campus! Please pass on this information to others who may be interested. http://globalhealthedu.org/Modules/Default.aspx
Sincerely,
Eugene Lam
President
Student University Network for Social and International Health
SUNSIH/REUSSI
It was recently brought to my attention that GHEC has updated their website: www.globalhealthedu.org
Please take a look under RESOURCES especially in the PRIMARILY FOR STUDENTS & RESIDENTS section. It provides very useful information including Global Health:Career Options & Specialization (http://globalhealthedu.org/Pages/GlobalHealthCareer.aspx), newer topics such as "Establishing a Research Career in Global Health" and a Guidebook on Developing Residency Training in Global Health. http://globalhealthedu.org/Pages/Resource.aspx
GHEC also has developed educational modules for students to review either on their own or in instructor-led courses. They are great and very useful for your local student groups on campus! Please pass on this information to others who may be interested. http://globalhealthedu.org/Modules/Default.aspx
Sincerely,
Eugene Lam
President
Student University Network for Social and International Health
SUNSIH/REUSSI
Tuesday, June 24, 2008
Public Health in Crisis-Affected Populations
Dear Friends,
A professor from the London School of Hygiene and Tropical Medicine has written a paper on public health in crises, meant mainly as a didactic tool for non-epidemiologists, and intended for people at all levels (donors, NGOs, UN, government, media, students etc.). It's open-access so please feel free to distribute to others who may be interested.
This is the link:
His info is below:
Francesco Checchi
Lecturer
Disease Control and Vector Biology Unit
Department of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
Room 51G6, 49-51 Bedford Square
London WC1B 3DP, United Kingdom
office +44 (0)20 7927 2336
mobile +44 (0)79 0671 9637
fax +44 (0)20 7927 2918
e-mail francesco.checchi@lshtm.ac.uk
Department of Infectious and Tropical Diseases
London School of Hygiene and Tropical Medicine
Room 51G6, 49-51 Bedford Square
London WC1B 3DP, United Kingdom
office +44 (0)20 7927 2336
mobile +44 (0)79 0671 9637
fax +44 (0)20 7927 2918
e-mail francesco.checchi@lshtm.ac.uk
Monday, June 16, 2008
International Day of the African Child
June 16th is the International Day of the African Child
I was just listening to a CBC report on the status of education in South Africa.
This program was particularly relevant because it brought up the 1976 Soweto uprising.
Schoolchildren protesting for their right to equal education were shot at by police officers.
At the time, the apartheid government established a school system that discriminated against all black students. Learning was made less accessible through the Afrikaans Medium Decree of 1974 which stated that lessons would be split between Afrikaans and English. Indigenous languages were excluded, except for physical, religious and musical instruction.
Imagine being a 7th grader and suddenly being told that you were no longer allowed to learn mathematics, socials studies and science in your own language! Students were required to learn in a language that was unfamiliar for many and oppressive for all.
The original Soweto rioting led to weeks of protesting that resulted in hundreds of deaths and thousands of injuries. Although it took nearly 20 more years for national change, this event inspired the internationally recognized day of the African Child initiated by the Organization of African Unity in 1991.
The theme this year is “Right to Participation: Let Children be Seen and Heard”.
I was just listening to a CBC report on the status of education in South Africa.
This program was particularly relevant because it brought up the 1976 Soweto uprising.
Schoolchildren protesting for their right to equal education were shot at by police officers.
At the time, the apartheid government established a school system that discriminated against all black students. Learning was made less accessible through the Afrikaans Medium Decree of 1974 which stated that lessons would be split between Afrikaans and English. Indigenous languages were excluded, except for physical, religious and musical instruction.
Imagine being a 7th grader and suddenly being told that you were no longer allowed to learn mathematics, socials studies and science in your own language! Students were required to learn in a language that was unfamiliar for many and oppressive for all.
The original Soweto rioting led to weeks of protesting that resulted in hundreds of deaths and thousands of injuries. Although it took nearly 20 more years for national change, this event inspired the internationally recognized day of the African Child initiated by the Organization of African Unity in 1991.
The theme this year is “Right to Participation: Let Children be Seen and Heard”.
Wednesday, June 11, 2008
Sexual Exploitation at the Hands of UN Peacekeepers and NGO Aid Workers: Perpetuating the Power Imbalance, and the Poverty of Rights
The UK branch of Save the Children International released a report at the end of May 2008 detailing the extent of a problem that was first identified in 2002. It was meant not to be a technically rigorous expose of the perpetrators and the victims, but more a 'snapshot' of the current situation, and the ineffectiveness of the policies put in place by the international community in response to this problem in 2002.
I was shocked and dismayed to learn of these gross offenses, and disappointed to realize that even those with good intentions at heart are subject to the evils of the human form. Or, perhaps the very call to work in a supposedly glorified and distinguished position, as is often seen within these already decimated and impoverished communities, appeals to the sociopathic tendencies that would then permit them to avail of the inherent power-imbalance that the aid and NGO industry exacerbates.
The data was collected through field visits, focus groups, and interviews in locations where Save the Children International have projects: Haiti, Cote d'Ivoire, and Sudan. The interviews would reveal very explicit stories of abuse at the hands of foreign aid workers, peacekeepers, and local staff of NGOs. The whole spectrum of sexual abuse, from verbal sexual harassment, to forced/coerced sexual assault was revealed, often with the exchange for money, material goods, perceived promise of protection and security, or the basics of human subsistence, food and clean water.
Naturally, children are the most vulnerable in any population, and this study revealed that children displaced from their home communities, children from especially poor families, and children whose families are dependent on humanitarian aid. Orphans were also particularly susceptible, suffering the double offense of sexual exploitation, and then the absence of a parental figure to advocate for the child, to seek redress.
The perpetrators were found to be members of 23 humanitarian, peacekeeping, and security organizations, with a particular source being the UN Department of Peacekeeping Organizations. Outside the scope of this report, it is difficult to quantify to extent of the abuses, given the undereporting by victim, and the absence of a reporting system within each of these organizations.
It isn't hard to imagine the reasons for under-reporting, when these children come to understand that sex can be used as a survival tactic. And, the risk of losing the protection and security of much needed resources is enough to suspend the need for one's physical integrity. This only speaks to the double failure of the aid community, to subject these already disadvantaged population to further affronts to their security, and that aid is insufficient in sustaining those most in need, and instead further deepens this power differential. Stigmatisation is a powerful social element, as womanhood and purity are integral to a girl's identity and perception within her community, which also can cause negative economic ramifications for the family, who cannot marry out their daughter for the gain of a dowry. Even if a victim summoned the strength to step forward, there is a general lack of confidence in the system, for both reporting and for discipline, of those who perpetrate the abuse.
What should the international community do about this?
Below is some proposed solutions put forth by Save the Children
I was shocked and dismayed to learn of these gross offenses, and disappointed to realize that even those with good intentions at heart are subject to the evils of the human form. Or, perhaps the very call to work in a supposedly glorified and distinguished position, as is often seen within these already decimated and impoverished communities, appeals to the sociopathic tendencies that would then permit them to avail of the inherent power-imbalance that the aid and NGO industry exacerbates.
The data was collected through field visits, focus groups, and interviews in locations where Save the Children International have projects: Haiti, Cote d'Ivoire, and Sudan. The interviews would reveal very explicit stories of abuse at the hands of foreign aid workers, peacekeepers, and local staff of NGOs. The whole spectrum of sexual abuse, from verbal sexual harassment, to forced/coerced sexual assault was revealed, often with the exchange for money, material goods, perceived promise of protection and security, or the basics of human subsistence, food and clean water.
Naturally, children are the most vulnerable in any population, and this study revealed that children displaced from their home communities, children from especially poor families, and children whose families are dependent on humanitarian aid. Orphans were also particularly susceptible, suffering the double offense of sexual exploitation, and then the absence of a parental figure to advocate for the child, to seek redress.
The perpetrators were found to be members of 23 humanitarian, peacekeeping, and security organizations, with a particular source being the UN Department of Peacekeeping Organizations. Outside the scope of this report, it is difficult to quantify to extent of the abuses, given the undereporting by victim, and the absence of a reporting system within each of these organizations.
It isn't hard to imagine the reasons for under-reporting, when these children come to understand that sex can be used as a survival tactic. And, the risk of losing the protection and security of much needed resources is enough to suspend the need for one's physical integrity. This only speaks to the double failure of the aid community, to subject these already disadvantaged population to further affronts to their security, and that aid is insufficient in sustaining those most in need, and instead further deepens this power differential. Stigmatisation is a powerful social element, as womanhood and purity are integral to a girl's identity and perception within her community, which also can cause negative economic ramifications for the family, who cannot marry out their daughter for the gain of a dowry. Even if a victim summoned the strength to step forward, there is a general lack of confidence in the system, for both reporting and for discipline, of those who perpetrate the abuse.
What should the international community do about this?
Below is some proposed solutions put forth by Save the Children
- Formation of interagency bodies that then provide evaluation and policing of the NGO agencies
- NGOs developing internal standards of conduct
- Implementing effective local complaints mechanisms for reporting abuse
- Formation of a new global watchdog
- Tackling the root causes or drivers of abuse: this goes beyond monitoring and reprimanding individuals within aid and peacekeeping agencies, but looking at the systematic failures of child protection services within the communities.
The only other thing I would like to see added is an ongoing evaluation mechanism for the effectiveness of these 'interventions'. Since this problem was identified in 2002, the extent of child sexual exploitation has not diminished, but has indeed increased. Are we to wait another 6, 12, 20 years for another field-based qualitative review of the issue, revealing that yet more years of child abuse have occurred?
Global Survey on Pediatric Curricula - We Want You!
What is this?
The Global Survey on Pediatric Curricula is an official trans-national project of International Federation on Medical Students' Association (IFMSA) in collaboration with WHO Department of Child and Adolescent Health and Development. The survey is being conducted by IFMSA SCOME from October 2007- May 2008 and extended until June 2008.
The Aim and Objectives
The aim of this project is to create a Map and Database of Paediatric Curricula around the world which enables us to get the information about the Paediatric Curricula. It is intended as a tool to gather and consolidate information on what medical students learn and understand, and also what skills they have in paediatric.
The main objectives of this project are to : (1) describe what medical students learn during their paediatric curricula, (2) describe clinical skills taught in Paediatric Curricula, and (3) find out what medical students know and learn about IMCI in their paediatric curricula.
Target Audience
We need your help to promote this survey in your home country and encourage medical students who had finished paediatric clerkship/clerkship to participate. We need at least 1387 responses, with at minimum three minimum students from each medical school taking part. We also extended the target audience to freshly graduated doctors (not exceeded by 6 month after graduation).
Link
The on-line survey can be accessed through:
http://tools.ifmsa.org/surveys
Username: pediatrics
Password: pediatrics
Current Response
So far, we have received 543 responses from people in 61 countries
What do we need you to ?
Fill in the survey if you have completed paediatric clinical rotation or clerkship
Send the link to your peers in your own language, add the link to your national and local medical student websites
What do you get in return?
In addition to the reward of knowing that you are contributing to an important piece of research, you'll be the lucky recipients of a free copy of the Pocket book
http://www.who.int/child
In addition, all those who participate in the survey will receive summary of the final results.
Final Extended Deadline
June 16, 2008 at 24.00 (Geneva time)
On behalf of GSPC team,
Fina Hidayati Tams, B.Med
International Project Coordinator
Global Survey on Pediatric Curricula
Faculty of Medicine
Gadjah Mada University, Indonesia
Intern CAH Dept. WHO HQ, Geneva, Switzerland
Period : May-June 2008
Monday, June 9, 2008
UN Letter Advocating Against Travel Restrictions for PLWHA
Please read about PLWHA travel restrictions.
You can sign a petition and perhaps forward to your own networks.
SUNSIH/REUSSI has signed on as one of the petitioners.
Call on governments to lift HIV travel restrictions
Introduction
In advance of the United Nations High Level Meeting on AIDS in New York from June 10- 11, the World AIDS Campaign and the Ecumenical Advocacy Alliance urge organizations to sign onto a letter from civil society to the UN missions and Heads of State of countries that impose travel restrictions on people living with HIV.
We join with other members of civil society in condemning such restrictions as discriminatory and in contradiction to the commitments made through the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration. We urge governments that continue to impose travel restriction on people living with HIV to lift these, whether short or long-term.
Signatures will be collected via email until June 5. To sign on, email the name of your organization and country to universalaccess2010@icaso.org. Signatures will also be collected during the civil-society pre-meeting taking place the day before (June 9) of the High Level Meeting in New York.
Background
When the HIV and AIDS epidemic was identified in the early 1980s and little was
understood about the disease, many countries established travel restrictions in an effort to prevent the virus from entering their borders. Such measures included mandatory HIV testing for persons seeking entry to the country and negative HIV status declarations by would-be entrants. Based on these mandatory tests and declarations, a number of countries have excluded from entry people living with HIV or people suspected of being infected.
Despite the medical advances that have made HIV a manageable disease, and a general consensus from the public health community that travel restrictions are inappropriate and discriminatory in nature, over 70 countries still impose some form of restrictions, citing two main reasons - to protect the national public health and to avoid the economic costs of providing health care and social assistance to people affected by HIV and AIDS.
These travel restrictions can take on different forms, including restrictions on people wishing to enter or remain in a country for a short stay such as business, personal visits or tourism; or for longer periods, such as labour migration, employment, asylum or refugee resettlement, or study. Of the countries with restrictions in place, some 10 countries bar people living with HIV from entering or staying in their country for any reason or length of time.[1] Countries
requiring special attention include: Burnei, China, Iraq, Qatar, South Korea, Libya,
Oman, Saudi Arabia, Singapore, Sudan, Yemen, United Arab Emirates and the United
States.
The 2001 Declaration of Commitments on HIV/AIDS saw governments agreeing to "enact, strengthen or enforce as appropriate legislation, regulations and other measures to
eliminate all forms of discrimination against, and to ensure the full enjoyment of all human rights and fundamental freedoms by people living with HIV/AIDS", and in the 2006 Political Declaration on HIV/AIDS governments committed to intensifying efforts to eliminate all forms of discrimination directed towards people living with HIV and AIDS. Also, the report of the consultation on international travel and HIV infection of the WHO, April 1987 states "HIV-related travel restrict ions have no valid public health rationale and may in fact undermine HIV prevention and other efforts to stop the epidemic".
Unfortunately, these commitments are not being kept.
What can YOU Do?
As part of a wide coalition of civil society organizations, we encourage you to sign on to letter below and take other steps as an individual or as an organization to join the call to countries to lift any form of HIV- related travel restrictions policies and/or laws.
Sign on to the letter below by sending your organization's name and
country to universalaccess2010@icaso.org no later than June 5.
Find out the status of any travel restrictions imposed by your country.
The list of countries with HIV-related travel restrictions is always changing. Check
up-do-date information before you advocate with a specific government. (For more
detailed information country-by country, visit http://www.eatg.org/hivtravel
www.eatg.org/hivtravel or www.aidshilfe.de)
Use the upcoming 2008 UN High Level Meeting on AIDS as a moment to press for new commitments (and action) by your own government and others to remove travel restrictions. This could be a very positive example of progress.
Use the 2008 UN High Level Meeting on AIDS to begin to strategize about national level action to oppose HIV-related travel restrictions.
Inform the media about the issue and the discriminatory practices of many countries.
Do not hold international conferences in countries with HIV-related travel restrictions. Future UN High Level Meetings or Reviews on AIDS should not be held in countries with such restrictions.
Raise awareness among your networks and constituency about the travel restrictions.
Many people are not even aware that such restrictions exist.
Advocate with others: Create a letter writing campaign to officials in your government. You can advocate at all levels of government: from your local representatives all the way up the President or Prime Minister. Work together with other religious communities, civil society organizations and networks of people living with HIV. Make sure you let the media know about your plans.
Lobby your government officials to speak out against HIV-related travel restrictions at 2008 UN High Level Meeting on AIDS.
Text of the Letter:
Civil Society Letter on HIV-related Travel Restrictions Addressed to the UN Missions and Heads of State in Countries with Restrictions
Dear Excellency,
As we approach the 2008 UN high-level meeting on AIDS, all governments and the global
community are called to review the progress and performance in achieving universal access to treatment, care, support and prevention by 2010.
As leaders within civil society, we are writing to ask for your urgent attention and leadership in removing your country's travel restrictions (short or long-term) that restrict access to people, based solely on their HIV status. These restrictions are discriminatory and are contrary to the commitments made through the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration.
We are asking you to consider announcing in New York, plans to lift your country's restrictions. This is the right thing to do. It does not create financial or other burdens. And as civil society, we are ready to stand with you in making and implementing such a commitment. This would be a noteworthy step and a sign of real leadership at the high-level meeting on June 10 -11 in New York.
Overview
HIV-related travel restrictions are not something new. They have existed since the beginning of the epidemic, but are increasingly obsolete and discriminatory in a world with more access to treatment and ever-increasing mobility.
Today, there are more than 70 countries that still impose some form of HIV- specific restrictions on the entry and residence of positive people. Of these, some 10 countries bar HIV positive people from entering or staying in their country for any reason or length of time. There are close to 30 countries that deport people once their HIV infection is discovered. More than 70 countries do not have HIV specific travel restrictions. For the remaining 49 countries, the information is either contradictory or unavailable.[2]
The most visible impact is when HIV positive people-against the principle of the greater involvement of people living with HIV-are denied entry into countries where major conferences or meetings on HIV are being held. This robs people living with HIV from opportunities to contribute their experience and expertise, while also diminishing the credibility and accomplishment of the conference or meeting. This situation is very problematic at UN high-level meetings on AIDS held in the United States, which has a complete ban on the entry of people living with HIV (HIV positive delegates, civil society representatives, UN staff, religious leaders, media, trade union members, and business people). In order to enter the United States
legally to attend such meetings, people living with HIV must disclose their status in a discriminatory and humiliating waiver process. The often lengthy and intrusive process to receive a visa waiver is all the more stigmatizing and discriminatory, when a mark is placed in a person's passport, indicating the waiver and its purpose.
However, in terms of largest impact and numbers of people affected, HIV- related travel restrictions are felt most by labour migrants. Prospective migrants are either barred from entering a country when determined to be HIV positive through a mandatory pre-departure HIV test, or are deported when required to take a periodic HIV test during their residence abroad, and test positively. Rarely is this type of HIV-testing confidential or linked to any other services, either in a person's country of origin or destination. This exposes to and places people who are already highly vulnerable in situations of great discrimination and economic
devastation. Similarly, people living with HIV, who want to cross borders for the
purposes of family reunification, suffer from the same restrictions.
Fulfilling existing commitments
The 2001 Declaration of Commitment on HIV/AIDS saw governments agree to "enact, strengthen or enforce as appropriate legislation, regulations and other measures to eliminate all forms of discrimination against, and to ensure the full enjoyment of all human rights and fundamental freedoms by people living with HIV/AIDS" (para.58).
The 2006 Political Declaration on HIV/AIDS saw governments commit to intensifying efforts towards these ends (para.29). These commitments are not being kept.
The realities are: HIV-related travel restrictions have no valid public health rationale and may in fact undermine HIV prevention and other efforts to stop the epidemic. This has been definitively stated by the World Health Organization and the World Health Assembly on several occasions. [3] HIV-specific travel restrictions are discriminatory and contribute to the stigmatization of people living with HIV. HIV-related travel restrictions are anachronisms, and highly inappropriate in the age of globalization, increased travel, treatment for HIV, and national and
international commitments to universal access to HIV prevention, treatment, care and
support. There is no demonstrated proof that the spectre of a huge negative economic impact on countries without travel restrictions is valid. In fact, the evidence points to the opposite in a country like Brazil, where there is universal access to treatment and there are no travel restrictions. There has been no flood of HIV positive travellers (short or long-term) streaming across the borders to claim treatment, placing a burden on Brazilian society. Long-term travel restrictions that single out HIV, as opposed to comparable conditions, are also discriminatory. Any restriction based on fear of costs must be based on an individual determination that such costs will actually be incurred. Any human rights or humanitarian concerns, such as need for asylum, should always trump economic considerations. The commitment of organizations
and governments to the GIPA principle (Greater Involvement of People Living with HIV or AIDS) is regularly undermined by HIV-related travel restrictions, when HIV positive speakers, resource people and leaders, cannot enter countries to take part in meetings, programs or planning.
UNAIDS and The Global Fund to Fight AIDS, Tuberculosis and Malaria are working together against such restrictions and have created an International Task Team on HIV-related Travel Restrictions, which comprises representatives of governments, UN agencies and civil society, including people living with HIV. They will be issuing their report and recommendations later this year, as well as providing tools to support governments in taking the steps to remove their restrictions. The Global Fund decided that it would not hold Board Meetings in countries that restrict short-term entry of people living with HIV or require prospective HIV-positive visitors to
declare their HIV status on entry.
What you can do We ask you to rescind HIV-specific travel restrictions and instead, take steps to ensure access to HIV prevention, treatment, care and support for mobile populations, both nationals and non-nationals. We are asking you to use the upcoming 2008 UN high-level meeting on AIDS as a moment to announce the elimination of these restrictions by your government. We are asking you to take up the issue of travel restrictions with other governments where they are applied to your citizens seeking to travel or migrate. We are asking you to meet with people living with HIV, who will be in New York at the high-level meeting to hear first-hand their experience of discrimination and stigmatization caused by travel restrictions. We implore you to not hold international conferences that are relevant to the response to HIV and AIDS in countries with HIV-related travel restrictions. Future UN high-level meetings or Reviews on AIDS should not be held in countries with such restrictions.
Yours respectfully,
[list of organizations]
This letter can also be downloaded at:
http://www.e-alliance.ch/media
For more information, please visit:
EATG website: http://www.eatg.org/hivtravel www.eatg.org/hivtravel
Deutsche AIDS Hilfe website: www.aidshilfe.de
Keep the Promise Campaign Bulletin of the EAA: The EAA website:
http://www.e-alliance.ch/media
Ua2010.org:
http://www.ua2010.org/en
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For past Action Alerts and Bulletins from the HIV and AIDS Campaign,
see http://www.e-alliance.ch
The Ecumenical Advocacy Alliance is a broad international network of
churches and
Christian organizations cooperating in advocacy on global trade and HIV
and AIDS. The
Alliance is based in Geneva, Switzerland. For more information, see
http://www.e-alliance.ch/
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[1] This information is taken from the web site of the European AIDS
Treatment Group,
and based on a survey which was originally done by the German AIDS
Federation in 1999
and has been continually updated. The information has not been independently
verified. See http://www.eatg.org/hivtravel/
[2] This information is taken from the web site of the European AIDS
Treatment Group,
and based on a survey which was originally done by the German AIDS
Federation in 1999
and has been continually updated. The information has not been independently
verified. See http://www.eatg.org/hivtravel/
[3] Report of the consultation on international travel and HIV infection.
Geneva,
World Health Organization, April 1987; WHO/SPA/GLO/787.1.
http://whqlibdoc.who.int/hq
screening of
international travellers for infection with Human Immunodeficiency Virus,
WHO,
WHO/GPA/INF/88.3 (1988).; WHA Resolution 41.24 Avoidance of discrimination
in relation
to HIV-infected people and people with AIDS (1988)
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