Brain Drain II -- The reGain

July 16, 2009 -- Dongfan Chung, a 73 yo former Boeing engineer took a look at his wife and daughter, and walked away. That was the end of a rather disinteresting trial in our age about a man who was convicted of transferring numerous trade secrets and boeing designs to the People’s Republic of China, a nation he proclaimed as his motherland. Perhaps the recession we are currently embroiled in reduced the hullaballoo that would naturally have met this news. Perhaps it’s the gentle hands of time healing the wounds of the yesteryears. You see in the years after World Wars, many nations went to extreme lengths to obtain technologies that would move their markets forward. This involved transfer of several patented technology across borders resulting especially in the 80s in rapid Japanese industrial development. More unconfirmed anecdotes include stories of professors becoming factory hands in order to study machines in the US economy. They did it for a variety of reasons. Love for country, money, notoriety, the thrill of it. For what they believed in, they sacrificed their luxuries in search of the upper hand. Of course it’s criminal and it infringes on intellectual property rights so don’t you go doing it. But at home, these people are considered heroes. Another form of espionage, the legal kind, is higher education. We leave our shores in droves for education in other countries and we head back with knowledge gained and skills built to develop ours’. But what drives us to leave and what, ultimately, takes us back?

I’ll start with the most controversial of the responses I’ve heard; “I just don't have the patience to deal with spoilt patients with an overdeveloped sense of entitlement”. Now I wouldn’t necessarily have put it that way but it is to be expected that in a country where healthcare is expensive and people are used to a certain standard of living superior to most around the world would by default expect a standard of care superior to what most around the world demand. In addition to this however, there is a more outspoken culture in developed countries with a belief in the presumed right of access to any service one’s money can buy. This is an inherent part of the medical practice in the US – patients who are proactive in their health maintenance and who can sometimes be a tad bit purposeful in their pursuit of one goal or the other. Compare this to Ghana where the average patient is only ever so grateful to be seen by the doctor, wears their Sunday best to go see her and are more willing to take anything the doctor says to take. They are forever grateful for the any respite they get from their care and are less wont to blame a physician for lapses in care. This might not necessarily be good for the patient in the long run or for the quality of healthcare delivery and providers for that matter. However, it remains a fact that draws the immigrant physician to her country.

Another reason the younger generation of Ghanaians want to practice in the country of Ghana is social responsibility. But what is social responsibility? Each individual being responsible for his community, which of course begs the question, ‘what is one’s community?’ Is it our country of birth, is it where we were raised until adolescence and where our formative years were spent – in a country where we were loved and raised where we felt we belonged and where we were beaten into or at least scared into studious little nerds or is it the country that opened its shores to us, gave us the opportunity to achieve high quality education often without paying a single dime and enables us to train at the highest levels known to man and arguably spends the biggest dollar value on our education. The answer is not an easy one and is as personal as they come. And those who go home in fact do not argue their choices along these lines. Of course a lot of Ghanaians are fiercely patriotic and believe it is and will forever be the best country on earth so not one of them is likely to tell you that they owe more of an allegiance to the US than to Ghana. More than this, however, there is a belief, born of years spent in close proximity to, if not in, poverty and experiences in the medical system to know that the marginal benefit of their services is higher in a resource deprived country like Ghana than it is in the US. Being a product of two cultures, they choose to give to the one that needs them more.

Given people care about what impact they can make though, one is tempted to ask if they might not be able to contribute more to their country by working in the US and helping back home in training and establishing health facilities or systems through the use of their income? This way, one could contribute effectively to Ghana, provide services in the US, and attain the comfortable life in terms of income for family and self that drove us to the lengths necessary to make it in school. On the surface, this seems a reasonable proposition. I was gently informed however that what impact one makes depends on the services her dollars provide, the importance of the services, their effect on the system one wants to change and of course how the provision of the services fits into the individual’s worldview of self attainment. In other words, one has to be happy not only practicing in the US but also with the decision to not practice at home. This is especially difficult for those of us who want to effect change on the ground and be a part of the movement towards equalizing access to healthcare in Ghana. Instead of money, what we need is hands on the ground; hands that work at shaping policy, lobbying for political will and heal disease. The hands might as well be ours’.

What really brings us home though, and why I made the argument in the first part of this piece that we are no heroes, is the fact the greatest thing pulling us home, is home itself. Many a Ghanaian is unable to break and more often than not, strengthens the bond she has with the country when she leaves. Family and friends are left behind and are missed by the hour. The unique hospitality of the country, the good nature of its people, the resilience they show and the food which can only be found in my mother’s kitchen and by the big gutters at the roadside appeal to our very makeup. Of course we know of the frustrations with work in Ghana. We know we cannot just transfer our knowledge into the country expecting success. We expect our lives would not be quite as glamorous as possible with practice in the US. We know this and yet, we are still heading back. Some have called us noble, others heroic. But above all, we are just creatures answering the call of the wild, heading home to the watering hole at which we first drank.

Prime

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This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
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