Running on hope

Just like Lakshmi (and, I am sure, many others), my summer research efforts came with a hefty dose of frustration. The lab samples I needed weren’t ready, there was no backup, everyone seemed to be on vacation, and, try as I might, I could not get across that, no, we couldn’t just put things off until tomorrow because I only had so many tomorrows left. A few days in, I was already panicking that my summer would be a waste, and nearly regretting not staying in Baltimore. With all the logistical, political and cultural issues that can make it so difficult to do global health work, why do we insist upon going halfway across the globe, not knowing whether our efforts will be worthwhile at all?

For me, the answer came, at least in part, towards the end of my stay in Morocco. My initial project was to run genotyping assays for a study of TB transmission, but as the obstacles piled up, I applied the first cardinal rule of global health: be flexible!!! I decided to devote my time instead to the logistics and patient recruitment aspects of the study and got the opportunity to meet with a group of migrants living in northern Morocco as they awaited an opportunity to cross the straits to Europe. They were the lucky ones. That very same week, 12 people had died of thirst in the desert, trying to reach northern Africa and a passage to Europe. Having lived an undeniably privileged life, one in which my daily worries and fears are pretty much limited to staying on the “P” side of Pass/Fail and taming my recurrent cravings for Chipotle, I could not imagine the depths of despair in which these men and women must be to take such tremendous risks, entrusting their lives to strangers and fate as they cross borders, deserts and seas.

The tragedy of the lives lost everyday in the deserts of North Africa and Central America, on the seas that separate Third World from First, reminds of just how important it is that we keep working towards better standards of living and human dignity for all, starting with better health. It is true that health is inextricably linked to issues of poverty, education, etc…, but it remains a critical starting point because of the powerful effects that it has on every aspect of the lives of people and societies; at its worst, disease not only debilitates the mind and the body, but also erodes the capacity for hope. When the death of relatives, friends, and colleagues become a fact of daily life, hope simply cannot be sustained, and neither can dignity. Societies in which disease and death abound will accord less value to human life loses its value, leading to the kind of social neglect, repression, and human rights violations that are the daily bread of so many in this world.

How, then, can we not justify going to the other end of the world and sparring with as many bureaucrats and corrupt officials as it takes to bring some measure of improvement? Bringing better health to every corner of the world is a daunting challenge and it may seem at times that we are fighting alone and for little reward, but it is a challenge well worth facing. For at the end of the road, lies the chance to restore not only health, but hope.

Think Local, Act Global: making domestic reform work for global health

I am no expert on domestic healthcare reform and am just beginning to understand better what it involves, but I was very interested in the Affordable Care Act’s efforts to shore up the National Health Service Corps (NHSC), which recruits and supports physicians and other health professionals to work in underserved areas, and expand residency spots in primary healthcare. If done right, the US’s efforts to increase its medical workforce in underserved areas could help to reduce its dependence on foreign medical professionals in these areas, many of whom come from developing countries where there are woefully few medical professionals.

Although the impact of “brain drain” (as opposed to training capacity, for example) is debatable, it is clear that there is a global and growing shortage of HCPs, which has incited enough concern for the WHO to adopt a Global Code of Practice for the international recruitment of health personnel during the last World Health Assembly in May. The code recognizes that international migration of HCPs has several benefits (e.g. professional development, increased income) for individuals and does not purport to halt such migration, but emphasizes that it should have a net positive balance on the health systems of developing countries such that they can retain a skilled health workforce. As we all know, it is veeeeery expensive to train a medical professional, and in most countries this burden falls on states rather than on individuals; thus, the departure of an HCP represents a significant economic loss for a poor country in addition to its effects on the attrition of the health workforce. With a fourth of its physician workforce coming from other countries, the US (as well as other major recruiters of medical personnel such as the UK and Australia), should take a leading role in adopting policies that respect the ideals of the WHO’s code.

There is already some push for the US to invest in workforce development abroad: Congresswoman Barbara Lee has sponsored a Global Health Act, which would support the training of HCPs in developing countries. A former Assistant Surgeon General has also suggested the creation of a Global Service Corps, which would function somewhat like the NHSC and send US medical professionals (including foreign-trained professionals) to developing countries to help facilitate workforce development and the strengthening of health systems. Of course, sending US HCPs abroad through the GSC means that the US will need more medical graduates to replace them. It seems only fair that the US should assume the burden of training the HCPs it will need to fulfill its commitments to domestic and global healthcare to ensure that, in its efforts to provide more equitable access to care, it does not accelerate the attrition of the medical workforce in developing countries. This of course depends not only on the government but also on professional and licensing organizations (e.g., AMA, AAMC) that can help promote domestic training capacity by licensing more medical schools and encouraging existing schools to admit more students.

It is a difficult balance to strike, but hopefully the current and future reform initiatives will allow the US to continue providing opportunities for foreign medical personnel via immigration while assuming its fair share of responsibility (and costs) for the training of its medical workforce.