Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad

4 | The Damage Done

The Damage Done us reliance on foreign healthcare workers hurts not only the health of Americans but that of people in developing countries as well. The negative effects extend in a ripple effect beyond health and cause deleterious social and economic impacts around the world, destabilizing governments and even creating opportunities for terrorist groups. Apart from everything else, global healthcare is a national-security issue. Lucy, one of our first known human ancestors, lived out her life in a breathtakingly beautiful gorge in the Rift Valley of Ethiopia . Not much is known about Lucy’s life. We know that she walked upright, used tools, and had a humanlike pelvis. We don’t know what killed Lucy; perhaps she died in childbirth— which would make her very much like her Ethiopian sisters of today. Not a lot of progress in 3.2 million years! The healthcare-worker shortage is so acute in Ethiopia that only 6 percent of the women have a skilled midwife or doctor to assist them during childbirth. In the United States, where virtually all women have a medical professional present when they give birth, 15 women die of pregnancy-related complications per 100,000 live births. In Ethiopia, 720 women die of pregnancy-related complications per 100,000 live births.1 More than 99 percent of all maternal deaths occur in developing countries. Almost all of these deaths could be prevented with proper medical assistance. 4 92 I N S O U R C E D Nationwide, Ethiopia has an estimated shortage of 10,000 healthcare workers. Much of this shortage can be ascribed to the loss of healthcare workers who emigrated to developed countries . In a 2008 Georgetown University study, a group of recently graduated nurses and physicians in Ethiopia were asked about their career plans. The researchers were amazed to discover that 80 percent of the nurses and 60 percent of the doctors planned to emigrate. Many had already applied for visas. In 2009, I visited a healthcare clinic in the Rift Valley, Lucy’s old stomping grounds. The building was acceptable: It had concrete walls and floors, a sheet-metal roof, a functioning water pump, and a latrine. What it did not have was a doctor or nurse. The staff consisted solely of a sanitarian, whose training was in teaching families about basic hygiene, such as washing hands and how to build a latrine. He was doing what he could, but he had no training in the diagnosis and treatment of disease and only a basic understanding of the medicines and equipment in the clinic. And he was the only healthcare worker for a hundred miles. Where was the doctor? Most likely in Chicago, where there are more Ethiopian doctors than in all of Ethiopia. In Ghana, as a study conducted in 2009 for the World Bank showed, 60 percent of the doctors and nurses trained there since it became an independent country, in 1957, have emigrated to the United States or the United Kingdom.2 Some African countries , despite continually training doctors, have no more physicians now than they did when they attained independence, in the late 1950s or 1960s. There are more Malawian physicians in Manchester, England, than in Malawi. A small country in the heart of Africa, Malawi has never had a war or a famine, so these doctors are not refugees who fled for their lives. Nor does Britain lack students qual- The Damage Done 93 ified to enter medical school. It has the professors to teach them and enough world-class institutions in which they can learn. Like the United States, until recently Britain simply found it cheaper to import doctors than to train them. The Indian doctor is rapidly becoming the face of American medicine, from mind/body guru Dr. Deepak Chopra to medical novelist Dr. Abraham Verghese, from countless Indian doctors on popular television shows to the Indian doctors who practice in your town. Indians make up 25 percent of all foreign-trained doctors in the United States—the largest group of foreign-trained doctors here. So it may surprise you to learn that India has the biggest healthcare-worker deficit of any country in the world. To the casual observer, it may appear that there are plenty of physicians in India. It has some of the finest hospitals in the world. Indian hospital groups—such as the Apollo Hospital system (not related to the...