Tie the doctors down and save an Ethiopian kid

Tie the doctors down and save an Ethiopian kid. Really? 

I respect Nicholas Kristof as a journalist who has all the good intention and courage to take on many of the pressing issues faced by the developing world.
But I was shocked when I read this:

'We should rethink the training of doctors in Africa. The problem now is that it’s very expensive to train these doctors, and then they move to Europe or America; it’s a form of aid from Africa to the West. I believe that African medical schools should shift to a system so that graduates end up with non-transferrable degrees (perhaps after just two or three years of training), so that they don’t have the option of practicing medicine in the West. It’s harsh, I know, but it’s even harsher to see Ethiopian kids dying in hospitals because the doctors have emigrated to Washington D.C.'-Nicholas D. Kristof, Nytimes (2008)

The argument here can be summarized as the title for this post: 'Tie the doctors down and save an Ethiopian kid'. I hope Mr. Kristof has rethought about this after 2008. Frist of all, there is not any established causal link between the 'brain drain' and the kid dying in a rural village in Ethiopia from a preventable cause. Chances are even if the doctor had not migrated away, the kid would died. Why? There are way too many other problems plaguing the health care in resource-poor settings. The kid could have died from the lack of medical supply, a counterfeit malaria drug, a power outage during a critical surgery, his mother not having the money to take him to a doctor, a local herbal/witch doctor who performed a ritual on him and sent him home. And the list goes on. Moreover, even with no brain drain, some poor parts of the developing world have as few as < 5 doctors per 100,000 people. There are so few trained and qualified doctors in Sub-Saharan Africa the first place (each country has <2 medical schools on average). Just for comparison, the average number of doctors per 100,000 people in the US is about 271. That translates to about one doctor per 370 people. If that is a reasonable estimate for the operational efficiency of an average physician, there are then 98150 (>98%) patients who will not be matched to a doctor in the poor regions that are of concern here, assuming doctors are distributed evenly geographically. Even with the more modest requirement that UN sets: one doctor per thousand people, about 95% of the patients are not likely to get a doctor. In other words, there is about 95% possibility that the Ethiopian kid will still die even if all doctors are retained in the country (if the child's death is caused by not seeing a physician as Mr. Kristof assumes).

What really shocked me about this Kristof article is how little he values the rights of the to-be-physicians involved given Kristof has been an ardent advocate for human rights. If well trained physicians do not want to stay at home, there are reasons. And many of these reasons can be summarized as a lack of incentives to stay. Before the proper infrastructure and supporting environment are in place, forcefully keeping the doctors around will not prevent the Ethiopian kid from dying. A study done by MIT Poverty Action Lab has focused on the subject of low nurse attendance rates in rural India. What they found is that without proper incentives, nurses do not show up at work. Many of the nurses interviewed during the study felt that their rural clinical facilities have neither the equipment nor the medical supply to enable them to put their skills to good use. As such, staying faithfully at work and watching the helpless patient suffer just adds on to the frustration. Now, if a doctor is forcefully retained in the rural part of his home country to help those in need, will he feel the same way? Probably so, unless there is a holistic effort on improving the whole rural health-care system in the country. Will the Ethiopian kid still die? Probably, because the frustrated doctor is showing up late for work or just taking a day off sitting at home on the day that the kid visits. The stakes at hand are the the well-being of the doctor as well as the health of the sick child. However, sacrificing the former does not guarantee the later. The "Tie the doctors down and save an Ethiopian kid' argument appeals to the emotions of the reader rather than his rational senses.


Responding to the shortage of physicians in poor rural parts, there are other solutions. One of the most successful is the training and deployment of community health workers. Local people from the community can be easily trained to make a difference to the health status of the people around them.Partners in Health has used this model in Haiti , Peru, Rwanda etc. with a lot of success. Other similar projects are now sprouting. I am not saying that a trained community worker can replace a doctor completely. No, he/she cannot. However, training more community workers who have volunteered to engage their own communities and who are committed to make changes happen is probably more feasible than revamping the medical education system in Africa to keep doctors locked up against their will. 


There are more pressing needs in global health and better solutions to address them than locking the doctors up with the unwarranted hope that doing so will save the sick child dying in Ethiopia tomorrow. 

Support ONE Act a week

http://one.org/blog/2011/06/24/one-act-a-week-send-a-message-of-encouragement-to-african-youth/
What is Act a week:

Courtesy to ONE.

Aid works

Whether aid works has been a great subject of debate amongst people in and out of the aids circle. For all the problems that aid has been criticized for, we cannot ignore the positive (sometimes life-changing) impact that aid has made on the poor.
One of the greatest physics superstars and a ex-instructor at MIT, Walter Lewin is know for his famous motto: "physics works!". Here I want to show you the living proof that says it out loud that aid works! Although it is no magic bullet as some would wish it to be, just like every other practical solution to problems in a world rife with complexities:
http://www.one.org/livingproof/en/

The journey of summer self-discovery-Part 2

From my second informational interview this summer--pure amazingness...especially useful for those with a background similar to me. 

1)  On what one should do as an undergraduate at MIT

Cross-register with Harvard to take some courses on global health

If necessary, one should contact people in Harvard to get course evaluations and syllabus.

Most Harvard classes have a heavy focus on reading, writing and verbal discussions. As such, one might be at a disadvantage as a MIT undergraduate. One relatively easy class in this aspect is Global Health Challenges ( refer to their website for the complete list ). Other classes to consider are those on statistics and data analysis, especially if one is not confident and familiar in these two areas).

Develop as extensive a network as possible as a student at MIT. Get to know administrators working in your department, faculty members, TAs, in and outside of the classroom.

Look into alternative career options if you have been focused sorely on academia/non-government agencies. Experiences such as consulting is likely to come to handy one day. It also increases your credibility when applying to future graduate programs and employment openings.

Really polish your communications skills. Take HASS classes and speak up in class. These skills are essential for the future prospect as a graduate student in global health and beyond.

Spend some time in MIT library and search for journals/course materials etc that are relevant. The medical journal Lancet sometimes has interesting articles about global health.

2)  On applying to graduate degrees in public health/global health

If you are thinking of doing any sort of graduate degree in global health, a Master of Science in public health is something good to start with. An alternative is a MPH (master in public health). However, MPH often requires previous working experience or a MD degree.

To be considered for admission, one should have some rudimentary skills in quantitative data analysis skills and a strong passion for global health. To gain a head start, one should contact the admission office for the particular program one is interested in and get to know the faculty members sitting on the admission committee. Another added advantage is working experience prior to applying. If you are not sure about going into global health or think you are lacking in the skills/assets other applicants might have, taking a gap year is a good option. Places to look for work include 1) Research Assistant openings in different  universities 2) Academic & government institutions like IHME 3) consulting opportunities.

If you are worried about money, most master’s degrees in global health are not funded, as you probably already know. However, there are ways around this! Harvard for example, offers funding for master’s degree candidates in environmental health. Although the content of the program isn’t strictly within the domain of global health, it still teaches some of the important skills that are transferable to global health studies. Degrees such as this one will serve as a good springboard for options in the future, for example, applying to a PHD degree in pubic health. 

Informational interview with Dr. Stefano Bertozzi

(Note: The responses are not direct quotes, just the main points I learned from Dr. Bertozzi's responses) 

Qn:   Describe a typical day of your work/ some of the projects you are currently involved in e.g. the trip to South Africa?

Ans:  Now, I am mostly in charge of doing a manager’s job:  10-12 hours of meetings focused on transformative  technology in global health e.g. vaccines etc., strategies surrounding regulatory issues of drugs and vaccines, negotiating with government officials. I am also responsible for working with PEPFAR and WHO in coordinating our responses to the global epidemic of AIDS and TB.

Qn:   What first drew you to global health? You did a bachelor degree in biology like I am doing now. But then got involved with health policy & impact evaluation of health projects? How did that happen?

Ans: I started in academic medicine. However, doctor’s degree is not critically important. Quantitative skills e.g. statistics, economics etc are important for future employment in the field of global health. Right now, we really need more talented young people coming in with those skill sets.

Qn:  Did your work experiences in global health turn out to be what you first expected in the early stage of your career? What do you enjoy most about working in this field?

Ans: I have done field work in Congo and Tanzania and worked 11 years in Mexico. I have also been employed by the World bank. I have been enjoying my work greatly. The sense of achievement and of you are actually helping people live a better life on the population scale is the greatest part of it all. 

Qn:  What are some important points to think about before deciding to go into the field of global health?

    Ans: you got to like different cultures, different people. And a lot of traveling. I have just flown to South African in 24 hours, stayed there for about that much time and come back to the United States.

Qn:   What skills do you think are important for one to gain at the undergraduate and graduate level in preparation for a career in global health?

Ans: Cross-register at Harvard. Learn things on a broader scale than a single cell or a single protein: take physiology, anatomy, immunology. And I wish you all the best in pursing global health!

My summer attempts to find a path in life-Part 1. Advice and thoughts will be appreciated.

Before I came to college, I have always lived the dream of becoming a biologist working on the front line of finding cures for the incurable diseases. However, things and circumstances have changed. As you can see from my introduction, I have taken a renewed passion in international development, especially global health. Ever since I was a young child growing up in the farms in the rice fields of southern China, I have felt a vague calling to get into the field of international development. But I have not been in the right environment for that thought to flourish. Now, in MIT ihouse, I feel it is finally the right time for me to pursue what I really love to do for the remaining years of my life.

Having said all that, I still knows little about what doing global health is like in the big real world. So this summer, I set off to talk to people who know more than me.

The first person I had the honor to talk to this summer is Dr. Stefano Bertozzi, the director for the AIDS/TB program at the Bill & Melinda Gates Foundation. (watch Dr. Bertozzi on the interview at AIDS 2013: http://www.aids2031.org/library/videos?videoid=42)

The interview details will be coming in the next post.

Some of the international development blogs that I enjoy

1) http://chrisblattman.com/
Blog by Chris Blattman, an assistant professor at Yale in the department of Political Science and Economics. He has some excellent pieces regarding the different aspects of international development. He also gives some very practical advice for students thinking about going into international development.
2) http://www.one.org/blog/
This is the official blog by ONE, one of the biggest and I think the greatest non-profit organization specialized in grass-root advocacy to pressure the congress into fighting global poverty. They have recently, in conjunction with GAVI (Global Alliance for Vaccination and Immunization) and others successfully pushed for an increase in budget that will go towards immunizing 4 million children worldwide from preventable diseases. So that is pretty awesome right?
3) http://www.owen.org/
The blog from the recently-returned-to-the US development economist Owen Barder who now works for the Center for CGD (center for global development). I greatly enjoyed his posts about aid transparency and his interesting experiences in Ethiopia.
4) http://practicalaction.org/blog/
Started by the famous economist E.F Schumacher, this non-profit organization has come a long way in its role of assisting the poor through the implementation of appropriate technological solutions. I am personally not a huge fan of appropriate technological solutions. I strongly recommend you check out their website. They also have excellent educational resources for those interested in learning how to build some of the things that they use to help make the lives of the poor easier.
5) http://aidontheedge.info/
Trained as a good biologist and a fan of Charles Darwin, I cannot help getting intrigued by some of the posts on this blog that bridges concepts in evolution to the incredibly complex business of international aid. If you enjoy this, you might also want to learn more about complex theories, which I find equally interesting although I still have to find more about it.

These are what I have currently on my RSS feed. You are greatly welcome to add to the list.