Brain drain destroying Nepal's health prospects, says pioneer

By agency reporter
March 31, 2011

Competition for cheap doctors from health-rich nations, including Britain, is threatening the future of one of the world’s poorest countries - writes Chine Mbubaegbu for Lapido Media.

Around 50 per cent of the 1,000 that graduate in medicine in poverty-stricken Nepal each year leave to work abroad – permanently.

Now a new academy in the Florida-sized Himalayan nation is set to revolutionise the way medicine is taught in a bid to improve healthcare for the rural poor.

As the first intake at the Patan Academy of Health Sciences (PAHS) in the capital Kathmandu complete their first year of studies, they could begin to buck the trend.

PAHS launched its first training programme in August last year. It aims to prepare doctors to stay in Nepal, practising among the poverty-stricken villages – where 80 per cent of the 29 million population live.

PAHS founder Dr Arjun Karki said rural élites are not able to understand the effects of rural poverty on health and hygiene – even if they do stay. But training doctors who themselves are from rural areas, and consulting with villagers on medical solutions to their specific problems as part of the course, could help.

‘We’re committed to producing healthcare personnel who have the necessary skills, competence, attitude and motivation to stay and serve in the rural areas’ said Karki, a Hindu who works with an international board of advisors.

The Academy offers preferential places on further training courses as an incentive to practise in rural areas post-graduation. This way they hope to stave off the allure of the US, UK and Canada.

Funding for the $2million-a-year academy has come from tuition fees, and local government sponsorship. But more will be needed if it is to provide sufficient student subsidy.

Said Karki: "If people do not have income, they can’t get adequate nutrition to build houses, to build latrines, to install tap water in their homes, even if the water sources are available.

"This issue is not under the jurisdiction of a traditional physician. He is trained just to cure a sick patient. But we need people who can go beyond this."

John Dickinson, a 71-year-old former worker in Nepal with Christian mission agency Interserve, who was the first Fellow of the Royal College of Physicians to practise medicine once Nepal opened to the West, now funds himself to teach gene medicine there each year.

He said family pressures to go abroad were almost irresistible. "The training is very expensive. Parents sell their ancestral lands to fund their children who must then earn good money abroad to be able to buy them back."

Life expectancy in the Nepal countryside is around twenty years lower than in urban areas like Kathmandu – which is itself 14 years lower than in the UK, according to 2008 World Bank figures.

In 2009, the UK’s Department of Health launched the Medical Training Initiative (MTI) scheme, which fosters exchanges between the NHS and other institutions around the world.

The scheme makes two-year places available to international medical graduates on condition that they return to their home country.

However, just one of the 437 candidates in the 2010 UK intake was from Nepal.

Dr Karki said: "Current policies of the developed world are very tempting for our young doctors to go, receive training and get lost there."

He added: "‘I don’t think this is fair. It threatens the future of our country."


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