One of the big pushes these days, in both undergraduate and medical school settings, is global humanitarian effort. In particular, there is a lot of talk about doing clinical work for some time in developing nations, such as central African countries. Although this certainly makes a difference, I wonder if it is much of a long-term solution.
At a recent interview, I met an applicant who was originally from Cameroon, a country of sixteen million that seems (at least on the surface) to be relatively stable compared to other countries that have become notorious through recent political and economic disasters (see Wikipedia, etc.). I had asked him if he considered becoming a doctor in Cameroon, but he shook his head: the government, he said, treats outsiders with care and welcome, but its own citizens are treated like dirt. Entering the country, white doctors and visitors go to one line – a speedy, welcoming entrance – while citizens wait in a long line to pay taxes on everything they bring in. I commented on how unfair it was, and the applicant reprimanded me: “We don’t use the word unfair. To say that it is unfair would be an understatement.”
I recently went to a directory of medical schools in Africa (http://www.iime.org/database/africa/index.htm) and checked to see where you could even become a medical doctor in Cameroon. There is exactly one school – in the capital of Yaounde’ – that has a biomedical sciences department. For reference, Egypt has 11 schools, as does Algeria. The United States has 144. This does not even enter the realm of class sizes.
With all the talk about traveling the world, as an American, it’s easy to overlook the fact that, as with any other resource, the ultimate goal has to be self-sustainability. One cannot expect many doctors of American origin to want to permanently reside in a foreign country, developing or not; most doctors elect to practice where they trained or where they are familiar with the patient population. The imperative then is to focus education training efforts not only on early schooling and literacy, which of course are very important and definitely seem like the basic first step to take, but also on higher level training for those who do progress to the end of high school.