United States Leads in Stealing Africa's Doctors

Pediatric doctors at Donka Hospital in Conakry, Guinea

Pediatric doctors at Donka Hospital in Conakry, Guinea

The United States is stealing the world’s doctors — and from the very places that need doctors the most. Dubbed the “international brain drain,” the United States leads the way in attracting international doctors, especially those from Africa.

The United States, with its high salaries, attracts more international doctors every year than Britain, Canada and Australia combined. However, for every 1000 people, Africa has only 2.3 health care workers, while the United States has almost 25. Doctors emigrating in droves from developing countries for “greener pastures” are making an already critical health worker shortage ever more dire.

But this brain drain is not new. In countries like Ghana, some 61% of doctors produced in the country between 1986 and 1994 had already left the country by 1999. The financial loss from emigration like this has been extremely detrimental. The loss from this period of emigration in Ghana alone is estimated at over 5.9 million dollars.

Foreign MDs
Foreign MDs

Not surprising, foreign medical doctors make up a substantial proportion of the doctors workforce in some of the most affluent countries in the world. More than 34% of doctors practicing in New Zealand were from overseas in 2000.  And according to a 2010 report in the Economie Internationale other developed countries have extremely high proportions of foreign doctors, including the United-Kingdom with 31%, the United-States with 26%, and Australia and Canada with more than 20%.

This is in part the result of initiatives like the 1994 U.S. legislation proposed to allow foreign doctors on student visas access to stay in the U.S. if they agreed to work in some of the poorest places in the United States. Since then, over 8,500 African doctors have left Africa and gained jobs at American hospitals that were in short supply.

A sneaky initiative. It looks great from the outside from its ability to give African medical students the chance to work in the U.S. for higher wages but it does nothing but continue to keep those living in “periphery” countries ever more dependent on “core” countries.

This is described by most scholars as the dependency theory — an economic model that became popular in the 1960s as a critic of the way the United States, along with many western countries, exploits those in the “periphery” for their own gain.

Poor countries provide resources, in the form of raw materials, cheap labor, and a market to those countries in the core. While wealthy countries in the core perpetuate their dependence in every way possible — through control of the media, economic politics, banks and finance insinuations like the International Monetary Fund (IMF) and the World Bank, educational initiatives, cultural exploitation, and even sporting events like the World Cup.

Indeed, this exploitation is clearly exemplified by the emigration policies facilitating the exodus of medical doctors from Africa over the past decade. Of the 12 African countries producing the most medical graduates, 8 have seen a 50% increase from 2002 - 2011 in all graduates appearing in the U.S. physician workforce. Cameroon, Sudan, and Ethiopia each had over a 100% increase since 2002.

These policies in place, that are sucking up some of Africa’s greatest doctors, are just further methods of perpetuating the poorest country’s dependence on the wealthiest.

It becomes clear then that while the United States benefits, Africa only appears to benefit. The U.S. gains excess doctors, while Africa looses the few it barely has.

While the United Sates grows its ratio of 2.45 doctors for every 1000 people, countries like Mozambique see a decrease in the already alarming rate of .04 doctors for every 1000 people.

Health professionals around the world agree that human resources is the most key component to solving problems in global health. But it is often one of the most neglected components, with much more emphasis focused on managing disease outbreaks and not the people actually preventing diseases.

Oliver Bakewel, of the International Migration Institute, agrees with this logic in writing that “development practice has commonly seen a reduction in migration as either an (implicit or explicit) aim of intervention or an indicator of a programme’s success" in an 2007 report.

However some scholars at the World Bank disagree with the notion that migration is inversely proportional to success in African development. A 2014 article in The Atlantic headlined "Why the brain drain can actually benefit African countries," outlined their findings that suggest "one additional migrant creates about 2,100 dollars a year in additional exports for his/her country of origin.”

However, this argument does not look closely enough at the brain drain for specifically medical doctors.

The brain drain intersects more than just the medial field — it cross cuts every highly skilled profession. But the effects of the brain drain on the status of health care in Africa is much more harmful than that of the brain drain of — for example — African professors. The average increase of 2,100 dollars in exports will do nothing to solve the critical and immediate lack of medical doctors in almost every African country.

The time is here more than ever for the international community to play a more proactive role in addressing the international medical brain drain. Affluent countries like the United States should be held accountable for exploiting Africa for its doctors, while international policies should be put in place to help African governments increase wages for health workers and retain their much needed doctors.

Contributing Editor: @AustinBryan
LinkedIn: Austin Drake Bryan

Heroin in the Hills

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Michael Ransom, Contributing EditorLast Modified: 07:45 p.m. DST, 11 June 2014

High School Photography, Photo by Nadja RootCINCINNATI, Ohio -- While drug abuse is a long-standing problem in the Appalachia region of the United States, the surge in heroin usage has only been recently documented and is a relatively new phenomena. Most officials attribute the influx of heroin into be rural black-market to be a response to the crackdown on the easy accessibility to prescription pain pills such as OxyContin and Percocet, which rule the drug markets in Appalachia a few years ago.

In any case, heroin usage in the region is increasing at an alarming rate. To address this shift in society, police officers, caretakers and addicts have recently started carrying Naloxone. Could this overdose antidote be the answer?

Naloxone was first introduced in the 1960s, but was often written off as a taboo idea. In the War on Drugs, often addiction is not treated as a disease, and efforts to help people with life-threatening dependencies are not seen as legitimate. Lawmakers often claim that with increased access to clean needles and overdose antidotes, people will be more likely to use the drugs in the first place.

That logic is flawed, as heroin and other serious opiate addictions are fueled by growing issues in society and the personal lives of addicts. I believe that no one in their right mind would start down the path of heroin abuse simply because free needles were offered at a clinic down the road.

Data has shown that Naloxone is very effective in saving lives that are on the brink of overdose. Just last week, two police officers were able to revive a woman who was overdosing on the Staten Island bridge in New York. Examples of the drug's effectiveness are seen nationwide. It is an important tool in the fight against heroin and morphine related deaths.

Al Jazeera is now reporting about an interesting dynamic within the small-town America plight of heroin abuse. Cincinnati, Ohio has long been a hub of powerful painkillers, previously pills and now heroin. Neighboring Kentucky is home to some of the highest opiate overdose rates in America. Both of these Appalachian states are passing laws to help those afflicted with drug dependency. Kentucky has increased pedestrian access to Naloxone and offered amnesty to those who need medical treatment after a heroin overdose. Ohio has gone one step further, allowing those people are not users themselves to carry Naloxone, in the hopes they can administer to loved ones in a time of need. Other people distribute the antidote to churches or other religious networks in order to address the growing problem.

Approximately five people die from opiate overdoses every day in Ohio. The problem in Kentucky is slightly worse, with an estimated three overdoses overdose fatalities each day. The problem spans from cities such as Dayton and Cincinnati, to some of the most rural areas in modern America including many communities in Kentucky.

In the last 20 years, approximately 10,000 people have been brought back to life using the prescription Naloxone. While Ohio's efforts seem to be helping many people living with drug dependency, the difference in laws between Ohio and Kentucky are also encouraging people to cross over the Ohio river in order to score drugs in Ohio. Kentucky will often hold alleged heroin users in jail for months before their trial, while Ohio does not. Therefore, the Ohio initiative has created a dynamic where nearby addicts flock to cities like Cincinnati.

There is hope for the growing problem of heroin trafficking and addiction. Project Lazarus, for instance, is a multi-faceted nonprofit organization that is challenging the growing virus. Using a multifaceted approach that reaches out to those people at high risk of overdose, overdose survivors, various community organizations, doctors, nurses, police, and policymakers, Project Lazarus educates communities and healthcare workers, and helps users practice damage control by giving them the antidotes and tools they need in order to live a healthier life. The issues of heroin dependency throughout the country are indisputable, and I believe that it is both cynical and defeatist to condemn those who are trying to help people in need.

Follow Michael on Twitter Twitter: @nahmias_report Contributing Editor: @MAndrewRansom

Food Insecurity Affects Genetics of Newborns

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Michael Ransom, Contributing EditorLast Modified: 00:25 a.m. DST, 18 May 2014

"Providing information for mothers" Photo by: DFID--UK Department of International Development

WEST KIANG, Gambia -- The nature versus nurture debate is a compelling and enduring question. Are humans resigned to their instinct and biology, or can their experiences and influences negotiate basic psychology?

While the best answers to this dilemma are generally rooted in theory, a new study published in Nature Communications journal offers valuable quantitative insight. Headed by Paula Dominguez-Salas, a team of London School of Hygiene and Tropical Medicine scientists working in The Gambia researched 2,040 women to examine the effect of pre-pregnancy diet on the health of their children.

According to the study, mothers can in a sense "nurture" the nature of their child, before their youngster is even conceived. Maternal nutrition at conception modulates DNA methylation of human metastable epialleles concludes that in the years and months leading up to conception, the maternal diet can alter both the health and DNA of the baby.

Operating from a Medical Research Council outpost in West Kiang, Gambia, researchers observed women in 34 villages throughout rural parts of the east African nation. Women participants were pre-menopausal, not expecting, and had committed to live in West Kiang for the trial period of July 2009 to July 2011.

Monthly pregnancy testing enabled scientists to place the women into three categories--a non-pregnant control group, women who became pregnant in the rainy season (July-September 2009), and mothers who conceived in the dry months (February-April 2010). Experts then compared hair and blood samples of the Gambian infants to better understand the relationship between foodstuffs and newborn health. 

Typically, the rainy season offers vegetables such as leafy greens, eggplant and pumpkin. These are extremely rich in vitamins and minerals, but may provide less substantial caloric benefits. In contrast, Gambians eat more hearty meals during their dry season, including yams, peas and maize. Generally fresh fruits and vegetables are limited during this time of year, and nutrition may be lacking as a result. 

As opposed to their original hypothesis, the team found that the rainy season created optimal conditions for a soon-to-be mother. Researchers denote this time of high precipitation as the "hungry" time of the year. Despite annual food insecurity during this period, vegetable offerings are concentrated with essential nutrients. 

Nutrient-rich food is seemingly the most important component of a mother's diet--even more significant than a higher-protein, higher-calorie analog. In scientific terms, the seasonal foods typical of July to September promoted DNA methylation during pregnancy, which impacts the expression of an individual's genetic code. Whether the methylation process thrived or not, the consequences of this molecular activity are lifelong. 

The findings imply another example of the way that inequality so-often turns cyclical, perpetuating through bloodlines. Not only do women in developing economies have more difficulty gaining prenatal care and pediatric support during the early months of pregnancy and the pivotal years of child development, but we now know that the resources available to the mother help to define the child's genetic makeup, long before pregnancy. This makes education and food security all the more necessary.

A child's very "nature" is indeed impacted by the "nurture" he or she receives in the form of macrominerals, and essential vitamins B and D. Scientists are using this study and others like it to identify the ideal diet for expectant mothers. Future studies will determine the most beneficial diet for the maximized health of the baby. Until then, newborns in The Gambia and other food-insecure regions will be fundamentally at-risk for micronutrient deficiency and the genetic repercussions.

Follow Michael on Twitter Twitter: @nahmias_report Contributing Editor: @MAndrewRansom

Liara's Campaign | Beauty in its True Form

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UNITED KINGDOM - In a dialogue between acid burn activist, Liara, and the photographer, Julian Holtom, an amazing and inspirational synergy occurred and resulted in a series of portraits which are breathtaking. Liara's story, her bravery, and her passion are self-evident, but best summed up in her own words.

"As an artist my aim is to portray beauty in its imperfect form that can evoke new meaning to the beholder’s eyes. My work is dedicated to the Burn survivor community around the world; not only to represent all other burn survivors but to encourage and inspire greater self-esteem. To prove scars are not something to be ashamed of but they can become one’s identity, they should never obscure a person’s perception of themselves nor hinder them from living life to the full.

It is possible to overcome the emotional turmoil that comes with scars and that is our aim. There are organisations in support of burn survivors; such as the Katie Piper foundation, Phoenix Burns Society , Burn Victim Survivors group on Facebook and Burn survivors through the world whom I represent for example.

I approached Julian with whom I was able to work on the concept of portraying the scars as part of character and personality, with the aim to achieve something genuine yet beautiful in its true form. To prove that scars do not change a person, they make that person who they become.

Julian, thank you so much. I have not only had a relaxing and fun shoot but for first time as a model have felt confident with my body" ~ Liara

"Liara's closing comment pretty much sums up my desire to shoot her. She approached me via a modelling site where she will have faced relentless prejudice from photographers only wanting to shoot pneumatic breasted orange sex dolls. We met and talked, instantly I wanted to help her through this medium. Boy does she light up the room with her inner spirit when she's smiling. Which with her giggling most of the afternoon was very often. Really enjoyed shooting her, and have some really great shots for the time we spent together. More to come..." ~ Julian Holtom

Copyright Julian Holtom Photography ©2012. All rights reserved.

 

Editor-in-Chief: @AyannaNahmias
LinkedIn: Ayanna Nahmias

Kiss Me, Kiss Me. Kiss Me Not!

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Ayanna Nahmias, Editor-in-ChiefLast Modified: 02:17 a.m. DST, 22 January 2014

Indigo Lips, Photo by Florry One When I came back to the States from Africa in the late 70's, I was thrown into a school system and culture with which, like many people from different cultures and backgrounds, I was quite unfamiliar.

There was the usual lack of cultural sensitivity that routinely resulted in children asking me if I saw tigers walking down the middle of the street, or if I "put a glass up under all those naked, exposed breast, to get my milk."

It was offensive, but not necessarily hurtful. What did become painful were the taunts about my physical appearance. All children face ridicule at some point in their school careers. For some, the taunting, the desire to fit into whatever standard of 'cool' or 'beauty' of the day, and the incessant bullying, causes them to resort to harmful and often tragic measures in search of relief.

I made it through, but not unscathed, as nearly 30-years later, I still recall how hurtful it was when classmates would point out that my lips were 'liver lips', 'big, ugly gorilla lips,' and that my mouth, like the vacuum cleaning brand Hoover, was a dangerous weapon capable of rearranging the face of any boy foolish enough to kiss me.

So, with the recent trend in the entertainment industry, and in America as a whole, to achieve a mythical standard of beauty that now includes large lips, I bemusedly thought back to my childhood days and wondered if any of the girls who once taunted me, were now through some strange karmic leading, pumping, plumping, and outlining their lips to achieve an industry contrived standard of 'today's perfection.'

We all have things that we would like to change about ourselves. I have mine. However, I have come to appreciate my lips, but even more than this, I have come to appreciate my healthy lips, body, mind, and spirit. That said, this post does not pass judgement on those who desire to change something about themselves, but only seeks to encourage due diligence, introspection, and self-awareness before embarking on a journey that can result in Don Quixote's madness of chasing down enemies that do not exist.

We begin aging the moment we take our first breath, to do so with dignity is the greatest testament to a well-lived life. The video below should serve as a cautionary tale.

[youtube=https://www.youtube.com/watch?v=hL0CClIzgEU]

 
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Twitter: @nahmias_report Editor: @ayannanahmias

Central African Republic's Tragic Conditions

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Jessamy Nichols, Africa CorrespondentLast Modified: 21:41 p.m. DST, 12 September 2013

CAR Malaria Victim Helped by Aid Victim, Photo by Merlin-Frédéric Courbet-PanosCENTRAL AFRICAN REPUBLIC, Africa - A few United Nations agencies have released new reports that disclose the dire statistics of the current status of the Central African Republic (CAR). Although a peace agreement was reached in January between the national government and the Séléka rebel coalition, the rebels soon reclaimed the capital of Bangui and have since repeatedly stirred up violence and lawlessness through the volatile country.

The newest UN reports reveal that villages are still being burned to the ground by armed militants which has forced thousands to flee their homes and seek basic human necessities. It is has been calculated that over a third of the country's population of 4.6 million people are in desperate need of food, shelter, healthcare, water, protection and sanitation.

This is clearly a huge humanitarian crisis, and poses a threat to the ever-increasing unstable region. The DRC to the south has its own civil conflict raging on, and refugees from the CAR are fleeing into neighboring Chad and Cameroon daily.

As torture, looting, kidnapping, assaults and extortion continue through the country, UN agencies are trying to provide all of the assistance they can, but it is imperative that the central government regain control of the country and put an end to the rebels' stronghold on power. As long as the rebels have unchecked power, they will continue to ravage the countryside for food, supplies, and potential human capital.

Follow Jessamy on Twitter Twitter: @nahmias_report Africa Correspondent: @JessamyNichols

Emotional Health – Surviving the Maelstrom

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Julie Rowley, Contributing AuthorLast Modified: 00:10 a.m. EDT, 15 August 2013

Being healthy is about more than just keeping physically fit and maintaining a good work/life ratio. With all that life throws at us: the small troubles we encounter and have to resolve each day; the monumental tribulations that arrive on our doorsteps unannounced; and the vagaries of our bodies, we ride an emotional roller-coaster that can take its toll on us.

Our Bodies

From the time we hit our menses, we are subject to the ever fluctuating chemical balance of our bodies. We may experience anxiety about our menstruation, both anticipating it and dreading its arrival. For some women their monthly cycle is a time of intense pain, with cramps which can affect not just the abdomen, but circle around to the back as well.

For women with heavy menstrual flow there is the additional concern throughout this time of keeping clean and the fear that the telltale signs will appear on our clothing. Another common fear that women face is the absence of their menses, which may indicate an unwanted pregnancy. With the best will in the world and the use of birth control, slips can sometimes occur. At the other end of this scale are the women for whom the appearance of their menses means the conception they are trying to attain has not happened – yet again.

This comes with the corresponding disappointment and when this becomes a long term occurrence, depression and anxiety, as well as feelings of failure can set in.

Pregnancy is for most women a strange mixture of joy and misery: from the morning sickness (who ever coined that phrase has a lot to answer for…), through the dizzy spells; water retention; and cravings for foods we would normally not look at once, let alone twice; to the discomfort of the baby taking up so much room that all our normal body functions are disrupted. This is seasoned liberally with the awe and wonder of this little being growing inside us; the swelling abdomen; the first noticeable flutter of movement and we become completely and compellingly absorbed in this process.

Our hormones are wildly out of control during this time and although usually rational and reasonable people, we become emotional and volatile. Things which normally we would shrug off hurt or anger us instead. Some women find that their desire for a normal, intimate relationship with their partner dwindles or vanishes altogether during their pregnancy. This can be frustrating for the partner and a source of concern that the relationship is not as close as it was beforehand.

The diminution or complete loss of desire during pregnancy may come as a surprise, but in actual fact it is quite common and a normal feature of pregnancy. Nonetheless it can cause tension and stress between partners. Added to this already complex bundle of changing needs and emotions is the ongoing concern about the baby: the fear of miscarriage during the first 16 weeks; the waiting for the first movement and worrying if it does not happen at what we are told is the “right time”, even though it varies from one pregnancy to another; then dealing with all the odd twinges and aches which occur through the later part of pregnancy.

The birth itself can be a source of anxiety and fear, particularly if it is the first; and this is mingled with a sense of anticipation and excitement that the moment has finally arrived and very soon the “bump” will be gone and we will be able to hold our son or daughter.

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Published: 15 August 2013 (Page 2 of 2)

Further along the line, when we reach the end of our childbearing years, we have the looming specter of menopause. Not only do we have to deal with the regrets and feelings of loss as we leave behind the prospect of fertility and release our past identity to embrace the new phase we are entering, which in itself can be difficult and prolonged; but we have to deal with any physical symptoms which can accompany menopause.

Some women are lucky enough to sail through, while at the other end of the spectrum are those who experience every unpleasant physical side effect in the book, having to deal with the embarrassment of: sweats; mood swings; sleeping problems; and palpitations; to name but a few.  We may have to deal with depression, anxiety and feelings of loss of identity or alienation as we struggle to find new meaning to our lives.

Dealing with the Emotional Fallout

The emotional and mental experiences of these phases of our lives would be enough by themselves to live through and come out the other side in one piece. However, this is only, as women know only too well, a small part of the picture. We can add to this the many milestones and events, both large and small, in our life which can cause stress, anxiety and depression; the negatives can often seem to outweigh the positive, especially when we are dealing with bereavement and loss.

We now recognize that grief follows a natural cycle, whether that grief is related to losing a job or perhaps a divorce; anything which takes something out of our lives will trigger the grief cycle. This is composed of around 5 different stages, although there are different interpretations and some include 7 stages.

The first stage is of shock and denial, when it is difficult to grasp or to accept what has happened. As the reality of our loss becomes more real, the initial shock can turn to anger, which can be directed inwards at us or outwards at the world.

Following this we may enter a stage of trying to change the situation by altering our position in relation to it, by bargaining for the return of what or who we have lost.This passes and we then enter a phase of deep sorrow and depression, where life can lose its meaning for us and everything becomes a struggle. Finally we reach a level of acceptance of what has happened and our lives start to move forward again. It can take several years on average to work through this process, although everyone re-adjusts at their own pace and may take longer to pass through some stages than others.

Occasionally our own internal emotional processes become unable to complete the grief cycle and we can become stuck in one of the stages. At times like this, where our own resources and inner strength are not enough to find resolution to our problems, we depend on those close to us to understand and be there for us.

Sometimes though they are unable to give us the help we need to move on through the grieving process and it is at times like this where counseling can be invaluable; to be able to release our thoughts and emotions around our loss to someone who can understand and empathize, as well as helping us to see things from a different perspective and facilitate our moving forward once more.

When we think of the toll that a lifetime of such emotions can take on us, it is truly amazing that not only do we manage to survive this wild ride, but is a tribute to women everywhere that we emerge as such profound and inspiring human beings.

Follow Julie Rowley on Twitter Twitter: @nahmias_report

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