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

LGBT Progress Overshadowed by Abuses

United Nations general assembly hall

United Nations general assembly hall

NEW YORK - The second report ever released by the United Nations on protecting LGBT rights was published today by the U.N. Office of the High Commissioner for Human Rights (OHCHR). The report outlines steps for governments to take in stopping LGBT discrimination.

There are 80 countries in the world today that criminalize consensual same-sex relations. The punishments vary, including prison sentences, torture, and the death penalty.

The report represents the gradual progress being made by governments in protecting LGBT people around the world. Since the first report released in 2011, 14 countries have adopted or strengthened laws that protect LGBT rights. These changes often extended protection of sexual orientation, gender identity and introduced legal protections for intersex persons.

But it is clear that the progress is overshadowed by abuse. The report states that “since 2011, hundreds of people have been killed and thousands more injured in brutal, violent attacks” because of their LGBT identity.

This violence is in part fueled by anti-LGBT rhetoric issued by regional, national, and international leaders.

In May the president of Gambia, Yahya Jammeh at a rally said that he would “slit the throats of gay men” in the West African nation. In 2014, the president of Uganda, Yoweri Museveni, said that gay people were “disgusting” after being asked if he personally disliked homosexuals in a BBC interview.

Even in 2012, the Nobel peace prize winner and president of Liberia, Ellen Johnson Sirleaf, defended the current law that criminalizes homosexual acts by saying, “We like ourselves just the way we are.”

Although these leaders have not changed their opinion on supporting legislation that criminalizes LGBT persons, the UN report published today is meant to outline international obligations that leaders like these have in protecting their LGBT citizens.

The report outlined five standards and obligations that every state has in protecting the human rights of LGBT persons.

The report calls on countries to protect LGBT individuals from violence, torture and ill-treatment. This includes condemning “conversion” therapy for LGBT persons, forced and otherwise involuntary sterilization and treatment performed on intersex children.

The report also demands states to “decriminalize homosexuality and to repeal other laws used to punish individuals on the basis of sexual orientation and gender identity.”

States also have the “obligation to address discrimination against children and young persons who identify or are perceived as LGBT or intersex.” This means that states are obligated to protect children in schools from harassment, bullying, and in addition to protecting all LGBT people from lack of access to health information and services.

The report also outlined the obligation that countries have to “protect the rights to freedom of expression, association and assembly and to take part in the conduct of public affairs.” This means that states must protect the rights of LGBT persons and LGBT allies to assemble and advocate for their rights.

In much of the world these standards and obligations are not followed and support for LGBT rights is often cited as a western construct meant to destroy autonomy and “traditional cultural values” that exist in sovereign nations.

However the United Nations has made it clear once again that this view is not acceptable.

The report states that “All human beings, irrespective of their sexual orientation and gender identity, are entitled to enjoy the protection of international human rights law.”

Contributing Editor: @AustinBryan
LinkedIn: Austin Drake Bryan

Despite Presidential Legacy Goals, Obama Agrees to Slow Afghanistan Troop Drawdown

U.S. Soldier in Afghanistan, Courtesy of the U.S. Army

U.S. Soldier in Afghanistan, Courtesy of the U.S. Army

AFGHANISTAN - In March, President Obama announced that troop levels in Afghanistan would not be reduced, despite the president's pledge to decrease the number by half. In the following weeks a flood of diplomatic engagements, press conferences and speculation by world leaders unraveled about what the bilateral relationship will look like in the coming months and years.

What has become clear is an already tense and fragile relationship has become increasingly volatile with the rise of ISIS, coupled with the lessons learned from Iraq’s draw downs. In Iraq, many think we withdrew too quickly, leaving the vulnerable Iraqi troops to fend for themselves against ISIS, who advanced quickly against the inexperienced resistance.

Despite these factors, amplified lobbying efforts by President Ashraf Ghani certainly doesn't bode well for Obama’s plan to get half of the troops remaining in Afghanistan out by the end of 2015. With these pressures accumulating for months, Obama has officially decided to slow his planned troop draw down by scratching the 50% reduction in troops he was planning for the end of 2015. Now, the plan is to keep 10,000 troops in Afghanistan through the end of 2015, when the timeline will be further evaluated and structured for 2016.

Regardless of this major decision, Obama is unyielding on his benchmark goal of ending the war in Afghanistan before his Presidency comes to an end. Therefore, while there may be 10,000 troops in Afghanistan in December, he plans to have only a few hundred troops at the U.S. Embassy in Kabul left in the country by the end of 2016. The pace of this drawdown, though, is yet to be situated.

No doubt the White House, Pentagon, CIA and others are weighing the pros and cons versus staying longer to establish peace and stability, a strong Afghan military, and a more robust response to ISIS advances – but there is the eternal reminder that this is already America’s longest war and it cannot drag on forever. And while Obama may be dogged about having troops out by the end of 2016, he may be outweighed by recommendations from senior advisers and officials in these agencies who are pushing for Americans to stay longer and lock in the progress made over the last 13-years. It remains to be seen who will win this fight.

Africa Correspondent: @JessamyNichols
LinkedIn: Jessamy Nichols

To Spite Obama Health Insurance Companies and Pharmaceuticals Choose to Kill Citizens

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WASHINGTON, D.C. – At midnight on December 31st the world retired 2014 to make way for 2015. For many it marked a night of festivities, parties, and insouciance. For others, like me, it was the day which marked the resetting of health insurance premiums, deductibles, and prescription coverages which would inevitably result in increased costs.

In the days prior, I frantically traveled to doctor's offices and pharmacies to get all of our prescriptions refilled before January 1st. In one instance, my son's pediatrician wouldn't authorize refills for his asthma medications without an appointment. Thankfully we were able to be seen by him on an emergency basis on the morning of December 31st. It was with grateful relief that he wrote all of the prescriptions needed and that I was able to get them filled before the pharmacy closed.

Unfortunately the insurance company would not authorize the refill of one of my son's most expensive medications until after the new year. One might think, with the figures I am about to report, that the medications to which I am referring are 'Brand Named' versus 'Generic.' However, this is not the case. In 2014, before I met my plan deductible, the generic version of one of his medications was $250 for a 30-day supply, while the cost for the brand name was $491. After I met my annual deductible, the costs of this medicine was reduced significantly to $50 for a 30-day supply of the generic which was a great costs savings for our household.

This reduction from my perspective directly correlated with the enactment of The Affordable Care Act (ACA) which was passed in 2010. The ACA, also known as 'Obamacare' made health coverage mandatory and also provided the means for the uninsured to purchase affordable insurance through exchanges which would help regulate the market prices. For me it was a blessing because it reduced my premiums and enabled me to purchase 'individual/self-pay' insurance without having to pay exorbitant premium fees because of 'preexisting' condition as defined by insurance companies such as Asthma, Cancer, Heart Disease, etc.

The cost to maintain this insurance is expensive, but compared to what I paid for COBRA Continuation Health Coverage in 2012, the 33 percent reduction in premium costs was a welcomed relief. I went from paying $1,660 per month to just over $550 per month for better coverage. The only catch was that my prescription costs increased significantly and thus the net/net was actually more like a 20 percent reduction in costs once this was factored in. However, providing the best healthcare for my son was non-negotiable and often meant that bills remain unpaid, and in some instances I didn't refill my medication or go to see the doctor when I needed.

Then, on November 14, 2014, The New York Times reported that "The Obama administration on Friday unveiled data showing that many Americans with health insurance bought under the Affordable Care Act could face substantial price increases next year — in some cases as much as 20 percent — unless they switch plans." Proponents of ACA asserted that this demonstrated that the legislation was working while Republican opponents pointed to these increases as proof that it is not.

As a parent and someone who is directly impacted by the ACA, I can categorically state that without it neither my son nor I would have insurance coverage. I couldn't have afforded to pay $3,000 a month in premiums and prescription costs because of 'preexisting conditions.' From my perspective the 2015 rate increases coupled with inflation in costs for generic medicines is a ploy devised by the insurance companies and pharmaceuticals to incite an already cash strapped American consumer to work against their own best interest. The premise that healthcare for average Americans was better prior to the passing of the ACA is ludicrous.

Me and millions of other Americans remember the heartache and pain of having to watch one's child suffer because an insurance company informed you that your child's healthcare costs would no longer be covered because of an "annual or lifetime" dollar limit. Other parents were faced with the necessity of mortgaging their homes, working several jobs, and making other sacrifices so that they could pay for expensive cancer or heart disease medicines. We all thought these days were behind us, but it turns out that 'we' have become collateral damage in what has been advertised as a war between the Republicans and President Obama.

In reality it is about greed. Providing access to affordable healthcare and prescriptions is not a luxury, it is a need. Parents like me are not 'lazy ne'er-do-wells' seeking to sponge off of the government. We are hard-working individuals who make difficult choices so that our children may live and grow up to be healthy contributors to society. The ACA provided us with hope for such a future, but insurance companies and pharmaceuticals have found a new way to game the system.

Anecdotally, it appears that since insurance companies are forced to insure people who may cost them money, they will make insurance available but the quality of that service is dependent on one's ability to pay for it. Thus, the better the insurance the greater the costs. However, this doesn't help them to recoup their losses (i.e. executives can't buy a new yacht, jet, exotic car, or mansion), so they turn to the pharmaceutical companies to further pressure consumers into lobbying for the dissolution of Obamacare.

When the media first began to report that generic medicine prices would increase substantially I worried but not much. Then, The Chicago Tribune reported on the rising cost of generic drug prices, and I became concerned but couldn't imagine an increase greater than a few percentage points. Then on January 3rd when I asked the pharmacists to fill the one prescription remaining from 2014, I was shocked to learn that the price increased from $50 for a 30-day supply to $391 for a 30-day supply. That was for GENERIC not brand name! I contacted my insurance company and was given a clearly ridiculous story that the cost of manufacturing the drug had increased.

Asthma can be a life-threatening condition and not taking his medication for a few days though not recommended, is not going to kill him. The same cannot be said of parents who have children with a terminal illness like cancer, in which treatment consists of multiple medications and a single prescription can cost upwards of $1,500 per month. Thus, the title of this article seeks not only to grab your attention, but also to help people understand that by taking away our ability to purchase life-saving medicine so that a pharmaceutical company can increase it's profit margin is immoral, reprehensible, and absolutely inhuman; and like it or not the choice to drastically increase the cost of generic drugs is tantamount to 'killing citizens.'

Follow Nahmias Cipher Report on Twitter Twitter: @nahmias_report Editor-in-Chief: @ayannanahmias

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Kim Jong-un Promises War

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HOLLYWOOD, California -- Could James Franco and Seth Rogen start a war? Until yesterday, that notion seemed absurd. But now, Kim Jong-un, the supreme leader of North Korea, has promised 'merciless' retribution if Columbia Pictures releases the film The Interview, which stars both Franco and Rogen.

In a nutshell, The Interview is a comedy in which the two superstar's characters team up in order to assassinate Kim Jong-un. After realizing that the press are given unparalleled access to international dignitaries during media ops and conferences, the two plan to murder the North Korean leader during an interview. Admittedly, the nature of the movie is combative, and should be expected to draw criticism, especially from the real-life man who is caricatured and assassinated in the film.

But, is the movie an "act of war," as Kim Jong-un alleges? Few think so. But for years, North Korea has inflated their international ego with empty [yet still terrifying] threats. In March 2013, Kim Jong-un warned that he would attack parts of South Korea using nuclear weaponry which he did not yet possess. Since then, Kim Jong-un has proudly planned nuclear attacks on Los Angeles and Washington, D.C.

Obviously, the film is controversial, even to many who do not sympathize with Kim Jong-un or his agenda. To me, The Interview is a more inflammatory version of Team America World Police, which featured marionette characters, including a crew of American special forces who penetrate North Korea in order to foil Kim Jong-il's fictitious attacks against America. A main difference between The Interview and its predecessor are that the new movie stars a Kim Jong-un lookalike, which is more provocative than a war between puppets. And also, the fictional plot in Team America is actually true-to-life today, where Kim Jong-un promises war against those who oppose or disrespect him, even Hollywood creatives.

Essentially, Kim Jong-un is playing a dangerous game of chicken with Columbia Pictures, which is almost certainly a lose-lose proposition for North Korea. Either Kim Jong-un engages the United States government in so-called catastrophic attacks, or Kim Jong-un will publicly undermine his brawny remarks with failure to follow through. Inaction, following such severe threats, will certainly show the limitations of Kim Jong-un, no matter his Herculean confidence. Both outcomes will augment doubts about Kim Jong-un's executive rationale and international image.

While I understand how the movie can be incendiary to a North Korea audience, I feel that making a movie, a piece of art, about assassinating a world leader is far less offensive than a national government guaranteeing nuclear warfare against the people of the world. Kim Jong-un has little room with which to point fingers, especially in terms of needless threats against oppositional nations.

It is unlikely that Columbia Pictures will withhold the release of The Interview. After all, the First Amendment protects free speech and those who practice it. But as human beings, I believe we should be promoting love and peace more than division and homicide, especially in the art we produce.

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

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International Volunteers Series: Caregiver in Cochabamba, Bolivia

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Olivia Elswick, Asia CorrespondentLast Modified: 08:07 a.m. DST, 24 June 2014

Imagen 419BOLIVIA, Cochabamba -- This week I spoke with Charlene Becicka, a caregiver at an orphanage in a rural pueblo outside of Cochabamba, Bolivia. Cochabamba is known as the “City of Eternal Sunshine” because of the beautiful weather year round. This orphanage offers a home to 50 girls from 3-17 years old.

Becicka attended Loras College in Dubuque, Iowa and studied English Literature, Secondary Education, and Theatre. “While my education has certainly aided in my work as a volunteer and missionary, it has been my faith that has really sustained me in my work,” she says.

What drew you to the site you decided to work in?

I was drawn to the site Hogar Maria Auxiliadora because of the role of the volunteers listed in its site description. The other sites listed teacher, tutor, nurse...the role for volunteers at Hogar Maria Auxiliadora: mother and friend. I’ve always loved children, so being in the role of mother and friend seemed like the perfect fit for me.

What is a day in the life like?

The role of the missionaries at Hogar Maria Auxiliadora is quite varied. We are responsible for caring for the girls in every aspect of their development. Daily our responsibilities include waking the girls, feeding them breakfast, ensuring they do their chores, helping with homework, accompanying them to doctor’s appointments, and just spending time with them. In a larger sense, though, our job is to be a caring friend and role model.

How are you able to handle all of your responsibilities while keeping a healthy work/life balance?

I take a half-hour to hour-long break every day in which time I usually read or write letters. Taking a little time every day to do something I enjoy is very refreshing.

What are the hardest parts about living there?

For me, the most difficult aspect of my work is the language barrier. I came to Bolivia without ever studying Spanish, so my first few months were a real struggle trying to build relationship and maintain authority with the children while learning the language. 9 months later, the language barrier has decreased, but can still be a challenge at times. However, being immersed in a different culture and learning a new language have also been some of the most rewarding aspects of my experience.

What is the most rewarding part about living there?

Seeing the girls make progress toward individual goals is incredibly rewarding. In my time volunteering here I’ve seen girls learn to read, learn to better manage emotions, and make progress toward other personal objectives. It’s wonderful to be a small part of helping the girls develop skills and habits that will aid them for the rest of their lives.

What are some of the most heartwarming experience you’ve had?

The most heartwarming moments are when the girls show their love and appreciation for the work I do with them. Surprise hugs and kisses, words of gratitude, and special notes and pictures from the girls are always touching.

And the most heartbreaking?

It’s heartbreaking to hear the girls wish for a healthy family. While some of the girls I work with are orphans, many have been abandoned, abused, or simply come from families that can’t afford to take care of them. Hearing girls ask why their parents don’t come visit them or why they have to live in Hogar is difficult.

What lessons will you take with you?

Living and working with a diverse group of children has certainly taught me to be patient.

What are the most critical problems faced by people in your area?

One of the most critical problems faced by people in rural Bolivia is illiteracy. Encountering people in Bolivia who can neither read nor write motivates me to help the girls I work with develop this fundamental skill.

What are your hopes for the people you’ve interacted with?

My hopes for the girls of Hogar Maria Auxiliadora are the same as the hopes I have for all the people I encounter: that they will use their unique gifts and talents to grow into the best people they can be and always face the world with a smile.

Anything else you’d like to add?

I am incredibly grateful for the opportunity I have been given to serve the girls and young women of Hogar Maria Auxiliadora in Cochabamba, Bolivia. However, service does not require quitting your job or moving to a foreign country. One of the lessons I'll take away from my mission experience is that propagating peace and justice can start with being present to the people around you, wherever you find yourself.

Follow Olivia on Twitter Twitter: @nahmias_report Asia Correspondent: @OCELswick

American Man Detained in North Korea

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Olivia Elswick, Asia CorrespondentLast Modified: 09:36 p.m. DST, 14 June 2014

"Kim Jong-un clapping" Photo by: Petersnoopy October 9, 2010 http://www.flickr.com/photos/54050720@N05/6549444309/

PYONGYANG--North Korea has detained an American man as he tried to leave the country following his tourist trip which began on 29 April 2014. State media identified the man as Jeffrey Edward Fowle, 56, of Maimisburg, Ohio and he is the third American citizen to be detained by Pyongyang in the past 18-months.

He was arrested for what they describe as activities inconsistent with his stated intent on his tourist visa. Japanese news agency Kyodo reports that he allegedly left a Bible in a hotel where he had been staying. North Korea has been promoting tourism in an effort to attain foreign currency, but the country is sensitive to how visitors act while in the country.

The State Department has warned against travel to North Korea, and being part of a tour group will not prevent possible arrest. State Department spokeswoman Marie Harf said there’s “no greater priority for us than the welfare and safety of U.S. citizens abroad,” though they cannot give any further information about specific details without consent from the individual.

Because the U.S. has no diplomatic presence in North Korea, the Swedish Embassy handles consular matters for Americans in North Korea and are working to return Fowle to his three children, ages 9,10, and 12, and his wife, Tatyana, a 40-year-old Russian immigrant.

The Swedish embassy has been in contact with one of the other two U.S. detainees, Kenneth Bae, 45, a Korean-American missionary from Lynwood, Washington who is serving 15 years of hard labor for alleged hostile acts against the state aimed at bringing down the regime of Kim Jong-un.

North Korea contains state-controlled churches but forbids independent religious activities. Bae is fearful for his health after he was returned to labor camp following a stay in the hospital. He told Swedish diplomat, Cecilia Anderberg, that he has likely lost 10 pounds since his return to the camp. Bae spends eight hours a day doing manual labor with his hands, and he suffers back and neck pain.

U.S. civil rights leader Jesse Jackson has offered to go to North Korea to help with Bae’s release. For a second time, North Korea has rescinded its invitation to Ambassador Robert King, with no explanation. Former U.S. ambassador to South Korea, Donald Gregg, has visited Pyongyang, but for matters unrelated to the 3 Americans held captive.

Matthew Miller, or Miller Matthew Todd, 24, is being detained for improper behavior after he entered North Korea on April 10th with a tourist visa, tore it up, and shouted that he wanted to seek asylum with North Korea “as a shelter.” Last year an 85-year-old veteran of the Korean War, Merrill Newman, was freed from Pyongyang, after being held for several weeks following an organized private tour in the country. He was released after involuntarily giving a videotaped confession apologizing for killing North Koreans during the war.

Follow Olivia on Twitter Twitter: @nahmias_report Asia Correspondent: @OCELswick