EDITORIAL NOTEBOOK | GLOBE EDITORIAL
The AIDS brain drain
BANGKOK, Thailand
The shortage of doctors and nurses in many of the countries most afflicted by HIV and AIDS was mentioned repeatedly at the AIDS conference as a hindrance to treating the 38 million infected. The emergence of the epidemic has put a harsh light on the inadequate health systems of developing countries, and Thailand is in better shape than other nations hard hit by AIDS. Under the dry term "absorptive capacity," the issue unites all sides in the battles of abstinence versus condoms and brand-name drugs versus generics. The US AIDS coordinator, Randall Tobias, said that Mozambique, with 18 million citizens, has just 500 doctors. Two factors contribute to the shortage: the toll that AIDS itself takes on health workers and a brain drain of nurses and doctors to industrialized countries where they can earn more and work under more favorable conditions. Tobias said an Ethiopian had told him there are more Ethiopian-trained physicians in Chicago than in all of Ethiopia. The lack of trained workers could impede treatment as much or more than lack of AIDS drugs. In a report presented at the conference, the group Physicians for Human Rights said a serious response to brain drain will require "significant new investments" directed at health systems. Dr. Lieve Fransen, the senior development official for the European Commission, said there would be an international meeting on the brain drain problem in December in Nigeria. "We don't think stopping people at borders is the solution," she said. A better approach is for industrialized countries to invest more in their own providers so hospitals do not have to depend so heavily on professionals from developing countries.
Both nation-to-nation assistance programs and the Global Fund for AIDS, TB and Malaria should provide salary enhancements to health professionals in developing countries. Tobias advocated pairing relationships between medical schools in the United States and in developing countries. Washington should ensure that foreign professionals working in the United States can return to their home countries for a stint of service without putting themselves at risk in the naturalization process. Developing countries badly need all their own health workers and should be helped by industrialized countries to keep them. DONALD MacGILLIS © Copyright 2004 Globe Newspaper Company.
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