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Brain
Down the Drain
Prof. Dr. Farakh A. Khan |
Articles by Professor Dr. Farakh A. Khan Dr. Farakh A. Khan is an eminent urologist of Pakistan with a thinking mind that does not limit itself to his immediate vocation. He is a free thinker who likes to explore other vistas around him - Music, Photography, traveling amongst other hobbies. He is a keen student of social and cultural dimensions of our society with a open and inquisitive perspective, that is in itself a rarity in our barren cultural landscape. Previous Articles: |
Migration of the best brains in the Third World countries on substantial scale to lucrative markets in the Developed World is a post World War II phenomena. This has been labeled as “Brain Drain” and condemned by the governments of the Third World countries. This “Brain Drain” has been cited as a reason for the backwardness of these poor countries. In the health sector we now have experience of more that 50 years of export of raw medical manpower and infusion of foreign qualified doctors back into Pakistan on a regular basis. These “Brains” came back to Pakistan for various reasons, personal or idealistic. We now have to examine what happened to these “Brains” in their native country? In the early part of our history many young doctors working abroad felt that “the country needs them”. Others had more personal reasons such as ageing parents or support to the family. Here was a group who was highly trained by the Western system in UK or USA. Entry into the chaos of the Pakistani system of medical practice was an acute cultural shock. I have been told by many doctors that it takes 3 to 6 months for the re-entry shock to wear off. Here was system, which was not innovative and blind to new ideas. The immediate superior was a major hurdle in bringing change. On the other hand the superior was instrumental in making or breaking a career. This is a closed system, which was not transparent and had no logic in decision making. Worst of all the major indicators of performance such as research and education was of no significance. The new “Brain” entered a monolith of bureaucratic red tape worm where every one had to agree with the superior. Some “Brains” soon realised that the there was a way towards rapid career enhancement and that was to get close to the power cable and grab it with all the means at ones disposal. We then saw a group emerge with close links with power. This required time and energy of a different kind. In the process these ‘Brains” used their talents in a direction where practice of medicine became secondary. We thus see good “Brains” loosing their original function. This was the final outcome of transfer of technology form the Developed World. For some odd reason many Third World countries are unable to sustain scholarship. Is the culture of these unfortunate countries? Is it the grinding poverty? Perhaps it is the totalitarian state structure, which cannot tolerate dissent. Any new idea or innovation is taken as a threat to the state structure to be suppressed by all means. This state of mind promotes loyalists rather than scholars. It curbs free debate to prevent perceived threat to the system and to maintain status co despite visions of impending disaster. In the late 80’s the government felt that by getting Pakistani “Brains” into the system of the Developed countries for PhD’s would some how improve matters when they get back to Pakistan, an experiment which had already failed in the health sector. Young talented “Brains” were selected and sent out at great expense. The masters of this scheme failed to ask simple questions. Why had PhD program in Pakistan not promoted before and today? What happened to the earlier PhD’s when they got back to Pakistan? The latter experiment has been ongoing in the health sector and shown to fail miserably in the government run institutions. Vast majority of doctors who left the country immediately after qualifying in the early 60’s are still working abroad. Those who have returned are now part of the system and some regret it. In the early 70’s the government placed a ban on doctors going abroad. After a few years it was realised that the ban had no effect on the movement of doctors out of Pakistan. How is it possible to train a doctor who has received poor undergraduate training in Pakistan to be able to fit or excel in a highly competitive Developed World? At the same time a highly trained doctor with number of foreign degrees is pushed into mediocre position in Pakistan? It is obvious that “the seed is good but the soil is bad”. Large number of foreign nationals from all over the world are functioning in the field of science and technology very well in the Developed World. Some of these are at the cutting edge in famous universities abroad and are an asset to these countries. On the other hand the pull of the native country is also great but they know that they do not have a place there under the prevailing conditions in the native country. Many feel that their qualifications are far ahead of the native country and hence would be of no use there. In resent years the migration of the “Brain” back to the native country has been occurring in China and India. In India the reverse migration has been in the field of Information Technology which has taken off combining the advanced technology of the foreign-trained manpower who also had the requisite funds and the cheap Indian labour market. It is estimated that by next year the export of software from India shall exceed $ 10 billion. The biggest influx of “Brain” has been in China where highly skilled Chinese are returning home and in the process boosted the economy. It is also clear that the new demands of Information Technology in the Developed World will result in accelerated migration of a skilled workforce under the prevailing circumstances in Pakistan. Globalisation has made labour force a commodity and with declining population in the Developed World the demand of even unskilled or semiskilled workers shall increase (Burki, SJ. The battle for the brain. DAWN. 12th September 2000). However the demand of doctors abroad has been kept in check by the strong lobby of the doctors representatives. Canada welcomes skilled immigrants but categorically denies access to doctors. Unlike as in past when doctors were encouraged to move to UK and USA from the Third World countries and were used as cheap labour to maintain their health facilities now the state has to incur a heavy expenditure for health care. With increase in the percentage of older population who need greater chunk of health care facilities the Developed World shall again need cheaper doctors form countries like Pakistan. The doctors in the Developed World of course will resist this. To cut costs USA has taken drastic measures, which have reduced the income of the doctors. UK is trying to make the hospitals autonomous to make them income-generating institutions but the full impact of the move on the lower income strata of UK is still not known. We know that the waiting list for a TURP is one year. Presently it is cheaper and quicker for the patients to come on holiday to Pakistan and undergo his surgery and enjoy his holiday as well. The final arbitrator shall be the prohibitive cost of health care in the Developed World. Pakistan has also had transfer of technology in the health sector in the form of opening of hospitals in Islamabad and Lahore. These institutions target service for the rich and hence are of limited value for the economy and made no contribution for the poor of the country. Nevertheless they have provided employment opportunities to small number of people in the country. It is thus obvious that unless we correct the “Soil” it is unlikely that the skilled Pakistani manpower will return home and those who stay back shall suffer. We are not experiencing “Brain Drain” but “Brain Down the Drain”. Prof.
Farakh A Khan Lahore March 2001 |