By Emil Mondoa, M.D.
If doctors are to be expected to make the requisite sacrifices, society must be fair and compensate the doctors enough so that they do not have to worry about the basics, about their families' needs. Sometimes Cameroon physicians have to do things that are less than honorable in order to survive.
Loss of physicians and other skilled people trained at very high expense is the worst of the drain of African resources that has been going on relentlessly for the past 500 years. Recently Monsieur, the plainspoken French interior minister of Hungarian extraction, stated that he would welcome immigrants (politically correct shorthand for Africans) as long as they spoke French fluently and had a skill that could be used to improve France. Wow! Talk about eating cake!
I was triggered to write this piece by an article on this blog which states that according to some experts, Cameroon will lose virtually all its remaining physicians by year 2009.
That is a tragedy that is being repeated to different degrees in countries all over the continent. As an expartriate physician of two decades, this led me to think why I shall not be going back - professionally - and have passed the point of regret.
Now, here goes:
1) Education- specialization
The education of doctors trained in Western-style medicine, such as I had at the University of Ibadan in Nigeria, does not end with their medical degree. Many of us do not consider our training complete until we have had some kind of specialty or subspecialty training. If good quality training is not available locally, many young doctors would leave to seek such training elsewhere.
The Cameroon medical establishment has never sought affiliation with the West African Colleges, such as the College of Surgery (of which our own VA Ngu is the founder) or the College of Physicians that provide standards and exams of world class quality. These colleges have enabled members to establish good quality training for doctors, reducing the need for doctors to go abroad for training. That is not enough, though, because tens of thousands of Nigerian doctors practice abroad.
2) Education - Medical degree
One medical school producing less than 70 graduates a year cannot supply the needs of a growing population of 14 million. Back in the day, with considerable self-sacrifice and dedication, my parents payed for my medical education at Ibadan. I could have stayed where I studied, and most people who go for primary medical degrees in Europe or America stay. There were 11 Cameroonian medical students in various classes when I was in Ibadan. Three of them are in UK; one in the US; one in Nigeria and the other six stayed in Cameroon. All of the five who left Cameroon have post graduate degrees. They were not better students. They had to leave to get what they wanted.
3) Doctors are human too!
I was 17 years old in CCAST Bambili when this truth struck me for the first time. Preparing for my 'A' levels was the first time that the full implications of the medical life struck me with full force. Doctors must sacrifice sleep, comfort, time and family in order to do their work well. Doctors muck around with cadavers in their training. Doctors bear an awesome amount of responsibility. Doctors have to live with the consequences of error and must shoot for zero error, the impossible! This was scary stuff! No, this was not for me, I thought. I had to do something else or nothing at all.
I worry if a prospective doctor has not gone through this kind of crisis, because it could mean that he or she has not been visited by the spirit of humility.
My entire educational arc from the time I was toddler was headed in that direction. We lived near the Victoria General Hospital and hung out with doctors. Ibadan medical students like Dr Nchinda and Dr Epanty spent their vacations at our house or visited. That was the only life I knew , lived and breathed and blithely went through childhood assuming I would assume fully when I grew up.
Cell phones then were only found in the fevered imaginings of sci-fi writers, so I wrote my thoughts in long hand and dropped a note in the post office to my mother. My mother, a tough woman, panicked. She called the principal, then Mr Livinus Niba and rushed up from Tiko. We sat down, and that was the first time she spoke to me like an equal. We discussed for about two hours, and she left me a nice motherly care package of miondo and other delicacies. Obviously, she succeeded in directing me back to the straight and narrow path of medicine.
The things that concerned me when I was 17 years old remain concerns today. Most doctors that I know have no desire to live in sybaritic luxury. Ease is certainly out of the question, given the nature of the profession. If doctors are to be expected to make the requisite sacrifices, society must be fair and compensate the doctors enough so that they do not have to worry about the basics, about their families' needs. Sometimes Cameroon physicians have to do things that are less than honorable in order to survive. Many of us cannot stomach such a situation and would move to a place where we would be able to live and practice honorably.
Is it true, as I read elsewhere in this blog, that beat cops with no command responsibility make more than physicians in that society? If that is so, the country does not deserve to keep a single doctor.
4) Time and Family
A young person without responsibility to a spouse and children can just pick up and leave. Once he or she settles in another society, marries, places the children in school and establishes a mature routine, it is disruptive and traumatic to the children especially, to start moving to a society they know little about. Within 5-7 years of moving to America or Europe, it becomes extremely difficult to return, because of the inertia of the new place. The best policy is to put into place those conditions (through positive conditions and not edicts) that make it desirable to stay in the home country.
5) Awful Work Conditions/Lack of Equipment
Western-trained doctors do not practice healing by the laying of the hands. They require certain basic equipment and medications. Enough has been said about the fraud, waste and abuse that I do not need to elaborate. A doctor is normally powerless to change such society-wide ills. I have avoided putting any kind of political spin to these problems that force physicians to make choices that are not favorable to their home country's needs. The answer to these problems is political and everyone's problem. The people must resist thugs in power and force changes that lift the society.
Emil I. Mondoa, M.D., is a practicing, board-certified pediatrician affiliated with Our Lady of Lourdes Medical Center in Camden, New Jersey; South Jersey Medical Center in Vineland, New Jersey; and the Alfred I. duPont Hospital for Children in Wilmington, Delaware. He also holds an MBA from the Wharton School, with a focus on health-care management. He is founder of the Glyconutrients Research Foundation.
Dr. Mondoa is the author of the highly-acclaimed Sugars That Heal: The New Healing Science of Glyconutrients.