Helping the Brain Drain

If you're wondering if I got to help put a shunt into a child with hydrocephalus, nope. Instead of helping with cool surgical procedures, this type of brain drain that I find myself helping is much more serious. In the field of global health, the "brain drain" is the problem of many highly educated people (especially physicians) leaving their developing/ undeveloped country for more developed countries like the United States. As I learned about the brain drain issue in my global health classes in college, as I sat at round tables in the past year at conferences, I always took the mindset of how can we start fixing this problem? How can we get more doctors to stay put in the countries where they were born, the countries that need their expertise much more desperately than the US does? But another thing I continue to realize in my time in Haiti is that systems and people are two very separate, entities. And sometimes life is complicated and so you choose to help the person sitting in front of you, even if it hurts the system.

The doctors at HIC and I have compared lots of stories over the past few weeks. For example: There are frustrating days when nobody at the market will sell me a roll with peanut butter for less than $3 (normal price I pay in my subdivision market is 25 cents) because they see me as a white ATM machine. But I kept my complaints to a minimum when I realized that there are 2 prices in Haiti - a Haitian price and a blan price and local doctors are always charged the blan price. Hearing this made me flash back to my first day in Les Cayes - when Dr. Cleonas showed me the local beach and the restaurants there for my official tour of the city. I remembered that lots of little kids followed us and not because they wanted handouts from me. Instead they kept saying "hey dokte (doctor) gimme dollar." In a week and a half I can leave the constant requests everywhere I go. I can go back to a hospital where the air conditioners work all the time instead of 25% of the time. I will no longer have to feel like I am going to pass out mid-work day. The doctors here have worked their butts off studying and interning for 7 years of medical school, only to have this as their reward.

For all my fellow medical students out there, current doctors and medical professionals - do me a favor for a moment. Imagine that you spent 7 years learning and cramming all of the latest medical knowledge. You learned how to read MRI and CT scans, memorized the latest drugs and treatments, got to see all the possibilities of labs to order and tests to run and outcomes to provide for your future hypothetical patients. Then you start practicing and realize that your patients can't afford any of the labs or tests you want to order. The pharmacy is often "stock out" (running out of many needed medicines) so you have to hope the week is good enough for you to get your hands on the meds you want your patient to take and then hope your luck is extra good and your patient can actually afford the medicines when they're available. There is not governmental insurance system, no hospital agreeing to eat the cost if your patient is poverty level. You have to rely only on your physical exam and the patient's meager understanding of the human body for your diagnosis. You struggle with translation, because not only does the patient not speak the language of medicine, but often Creole from the rural mountain areas is as different from the Creole in town as it is from French. You spent all of medical school using French to describe health and disease, and now you struggle to find an appropriate translation in order to get the medical history you need. You have to explain what an antibiotic is to someone who hasn't taken medicine before or even attended kindergarten. Heck, this might be the first time they have even seen a clinic... I know somedays I leave the hospital so frustrated I want to give up, but this week whenever that feeling arose, I made myself try to imagine what the local physicians must feel like.

After the docs leave the hospital, their patients and locals ask them for money, handouts, rides home. They hear countless story after sad story about families unable to afford their medicines, food for their children, etc. And this is all after hours. Talk about never being able to take the white coat off. I recently had a doctor at HIC turn and look at me after one of these begging situations. They said "Kristen, I don't know what I am supposed to do anymore. I am just one person. I can't help everyone..." I have come home on several occasions and felt the same way. But the difference is I get to leave this life of overbearing demands in a week and half. And I question too if it's harder when it's your own people. I wonder how different it would be if the woman asking me for a handout wasn't just a random Haitian in my eyes, but if she was the woman who's house I walked by everyday on my way to school growing up. If the kids unable to afford their medicines were friends of a friend. Some hunch tells me that being fully immersed in the community here would make the burden of working in healthcare here that much heavier...

And so this week I helped a staff member at HIC with their visa application. Not because I don't want this person to keep working at HIC, I know HIC will be worse off without this medical professional. I don't want Haiti to continue to lose it's doctors to Canada and the states. But I also don't think it's fair for me to say: "Sorry. Even though you and I have worked equally hard on our medical degrees, you don't get to have the same opportunities as me. Why? Because for some random reason you and I were born in different countries." And so I hope by working slowly to improve healthcare systemically here, it will become more attractive for doctors to stay and work here. I hope that medical schools here (as I hope they begin to do so worldwide) begin to choose students who are very invested in their local communities. Students who don't come from well-resourced families and who feel so tied to their country they would never want to leave...

But in the meantime, the brain will continue to drain and I will find myself adding to the problem...

For anyone curious about the hospital were I am working/ studying at this summer. Here is a pic of the newest building in HIC's collection - a new ob/gyn ward in the making!