America Is Stealing the World’s Doctors

George Ofori-Amanfo, a Ghanaian associate professor of pediatric cardiology at Duke Children’s Hospital in Durham, N.C., is involved with the Ghana Physicians and Surgeons Foundation, whose members, based in the United States, work to improve graduate education in Ghana’s four medical schools. He makes three trips a year to Ghana to teach young doctors. “I do feel guilty sometimes,” said Ofori-Amanfo, who came to the United States in 1995, when he was 30. About 530 Ghanaian doctors practiced in the United States in 2006, which amounted to about 20 percent of the doctors left in Ghana, according to an article in The New England Journal of Medicine. Ofori-Amanfo, for one, doesn’t think he’ll ever return for good.       

“Particularly when I look at the investment that the nation had put in me to give me my basic training and what the nation would have expected me to contribute,” Ofori-Amanfo said. “There’s a lot of guilt in that. Some cocoa farmer worked very hard to pay his taxes so I can go to school.”       

Had Kunj Desai stayed in Zambia, his experience might have looked like that of his old friend Emmanuel Makasa. An orthopedic surgeon, Makasa is 38 and earns about $24,000 a year. He does some work in private clinics for extra money. Makasa is something of an authority on the emigration of doctors. “The human-resource crisis in Zambia has reached a disastrous stage with the health system at breaking point,” Makasa wrote in a 2008 paper in The Medical Journal of Zambia (PDF), though he has no harsh words for his colleagues who left. He studied at the University of Alabama, Birmingham, on a Fulbright scholarship and also took and passed the first of two exams the British require of international medical graduates seeking jobs there. He told me that he had been tempted to emigrate permanently.       

But during his time living in the United States and visiting Britain, he felt subtle racism. He hated the weather in Britain and found Zambian doctor friends living stressful lives in undesirable parts of the country. And he knew the difference a single surgeon in Zambia could make. So his American wife and their two daughters moved to Zambia at the end of 2010.       
“There are very few doctors in this part of the world,” Makasa told me, “and if you left, yeah, it means you have a better life. Yes, you get more money. Yes, but you can’t enjoy a meal when you know your mother is hungry.”       
In 2005, Makasa and his colleagues set up Doctors Outreach Care International, which provides medical care to underprivileged communities and is financed by corporate sponsors. “I don’t stay in Zambia because of lack of opportunities to go,” Makasa said. “I stay in Zambia because of what I think I can do in Zambia.”       

I wanted to tell Desai what it would be like to practice in his old hospital, so I observed Makasa and a colleague fix a man’s broken leg. In the operating theater, there was a dirty-looking scalpel blade on the floor. The assisting staff ambled in late, causing the operation to start 30 minutes behind schedule. The air-conditioner was broken. A nurse took two personal cellphone calls in the operating room. When it came time for the surgeon to drill holes in the patient’s bones, a nurse produced a case containing a Bosch power drill. By way of sterilization, she wrapped it in a green cloth, binding it tight with a strip of muslin.       
Doctors at University Teaching Hospital do their best to improvise, as Desai once did, to make sick people well again, even if it is with an off-the-shelf power tool. And there have been some significant material improvements at the hospital since Desai left. Makasa took me to the intensive-care unit, where a doctor from Uzbekistan was supervising the installation of monitors, ventilators and electrically operated beds that any modern hospital would be happy to own, all donated by the Japanese government. Much of the equipment in the operating theaters was new, and the theaters themselves were being renovated. The hospital had a new M.R.I. machine, a new CT scanner and new dialysis machines. What it does not have — what can’t be donated — is enough doctors.       
I stopped by the neonatal-intensive-care unit, which many years earlier drove Kunj Desai to tears. Desai stayed up all night manually pumping air into a baby’s lungs, because there was no available ventilator. The next night, he returned to find that the baby had disappeared from the ward. He did not ask about the boy’s fate, but surmised that the doctor who followed him on duty had not been able to continue ventilating the boy by hand. I looked around at the dozens of babies in the unit. There were three new ventilators, also donated by the Japanese, but none were plugged in; the staff had not yet been trained to use them. I asked Jackie Banda, the doctor in charge of the unit that day, how long the unit had been without ventilators. “We’ve had none for the last two to three years,” she said.       

Kasonka, the managing director of the hospital, said that he didn’t blame Desai for leaving to pursue his surgical education. As we spoke in his office, I told him that Desai wanted to become a laparoscopic surgeon. At that, Kasonka sat forward in his chair with interest. Zambia, he said, had no surgeons performing this less-invasive surgery, though the Netherlands had recently donated a laparoscope.
“If I have to say something to Dr. Desai, it is: ‘Hey, Dr. Desai, I know you have now acquired extra skills in surgery including laparoscopy,’ ” Kasonka said. “I have got a state-of-the-art laparoscope — please come back and practice.’ You see, he will pack up his bags and come back.”