Research Article: Why Pakistani Medical Graduates Must Remain Free to Emigrate

Date Published: January 29, 2008

Publisher: Public Library of Science

Author(s): Zarmeneh Aly, Fawad Taj

Abstract: What is forgotten in the debate on brain drain, say the authors, is that some doctors who emigrate to the West have every intention of returning after their higher-level training overseas.

Partial Text: The current debate about the brain drain of health professionals from low-income countries such as Pakistan to the rich world often demonizes medical graduates who choose to leave their countries. Such graduates are sometimes considered to be insensitive to the plight of their country’s struggling health sector. But what is forgotten in this debate is that some doctors who emigrate to the West have every intention of returning after their higher-level training overseas. And while the brain drain is often blamed for Pakistan’s difficulty in meeting its people’s health care needs, other factors play a major role, including the increasing demand for health care from the growing population and the adverse conditions that cause disease [1].

There are four main reasons why medical graduates of Pakistan emigrate to the West [5]:
The long-standing belief of young doctors and their parents that training outside their home country is superior and a mark of achievement.The expectation of bigger incomes.The lure of high-tech training and super-specialization.A reaction against the Pakistani government’s poor management of the education system, and the corruption associated with this management, in favor of what are perceived to be the more merit-based medical training systems of the West.

There have been repeated calls to restrict medical graduates from migrating from poor countries. Delanyo Dovlo, for example, a specialist in human resources for health based in Accra, Ghana, suggested that “moral arguments” must be used to “create policies that moderate the loss of trained health workers from poor countries and stop the medical training subsidies they make to rich countries” [7]. But the right of individuals to leave their country, and conversely their right not to be forced to leave, are generally recognized tenets of international law [8]. And forcing people against their will to serve in an environment that is unsuitable for them will drastically hinder their job satisfaction and performance. The challenge is to advance human health while protecting health workers’ rights to seek gainful employment [9].

The marked underinvestment in health at the national and state levels in Pakistan contributes to poor staffing and morale at government hospitals and clinics. Increased investment and modernization initiatives would create opportunities for physicians to work in their home country, promoting the repatriation of Pakistani medical graduates who undergo higher-level training overseas.

As medical students, our proposition to return to our homeland once we have satisfied our ambitions abroad is often met with mockery and outright disbelief by both friends and relatives. It is hard for them to understand why, once we are used to the environment of the developed world, we would return to share the benefits of our experiences. No one wants to give up the comfort of home and loved ones in exchange for living amongst strangers. But we realize that staying might make us susceptible to the mundane routine, devoid of intellectual stimulus, that comprises most of the postgraduates’ lives here. We realize that we’ll come back better equipped with the technical know-how and academic expertise synonymous with postgraduate training in the West, with new ideas and challenges, and with the immense task of adapting our expertise to the local environment of our homeland.