This article is a response to the article entitled “How The Brain Drain To The West Worsens Africa’s Public Health Crisis” (http://www.pambazuka.org/en/category/comment/37062), Jacqueline Tanaka argues that although the Gates Foundation has dedicated a significant fraction of its resources to improving the African healthcare system, what the Foundation ought to be doing in addition is to provide funding to train the African physicians.

I recently came across an article entitled “How the Brain Drain to the West Worsens Africa’s Public Health Crisis”, published on Pambazuka News 9/14/06. Many of the facts and ideas presented in the article resonated with me as I, too, have been thinking about quality of life issues in Africa. Let me introduce myself. I am an Associate Professor of Biology at Temple University in Philadelphia, PA, USA. I have become aware of some of the issues facing African countries through my students at Temple who are African or are of recent African descent as well as friends who are African or who have close ties to Africa. And perhaps because I am a biologist, I see things through a somewhat different lens than the author of the article.

The author, Rotimi Sankore, writes: “Resolving Africa’s public healthcare crisis will resolve most of the other issues and be a step towards isolating AIDS which can then be tackled more easily. The first step must be resolving the health worker shortages, which includes dealing with the ‘brain drain’.”

Tackling the health care issues of Africans goes beyond providing health care. To me, the issue is a larger one dealing with ‘quality of life’ that includes access to clean water, adequate nutritious food, education, and access to means of support for one’s family. These issues require political integrity and environmental restoration. The environmental restoration will, in turn, pay back by providing ecosystem services such as clean water and fertile soil, reduction of erosion and reduction of desertification. Since much of the environmental destruction is done in the name of ‘economic development’ and done by foreign ‘investors’, beating back this ‘progress’ will take vision and political will in addition to the political integrity.

But how does all this relate to the topic of “brain drain” raised by Sankore? Well, I see first-hand some of the “brain drain” - African students who come to Temple University for their undergraduate degree in the hope of returning to Africa as medical doctors. In my experience, these students have been the brightest, most talented students I have seen in my six years at Temple. Some carry a perfect 4.0 GPA through their entire four years. They conduct research with faculty often publishing in peer-reviewed scientific journals as undergraduates. Clearly they are Africa’s best and brightest.

And they want to go back. So what happens? Well, if they are lucky, they get accepted into a US or British medical school as an international student. This alone requires some luck as well as a perfect academic record. But here is the rub. They will not qualify for the loans and aid that American students depend on. The African students have few resources to pay the huge tuition bills for medical school so those who manage to attend have enormous debts to pay at the end of four years. How can they possibly go back to their country and pay even a fraction of their debts on an African salary? They can’t. So, many continue through their residency, barely making a dent in their debt burden. They accept positions practicing medicine here not because they don’t want to return home but because they can’t afford not to practice here.

As for those physicians who are trained in Africa, why not ask them why they came here to practice? Chances are you will find out what the infrastructure is like for them in their country. One of my students described a clinic in her personal statement (which each student writes in their medical school application). In her words,

“The hospital was like a war zone, if not, a crowded arena wherein the medical staff had to sprint to save precarious lives. People swarmed the hospital from all walks of life and lay sprawled even on the hospital floors. The Nigerian health narrative is ugly. Glutted with poorly trained medical personnel and failing health systems, the medical environment consistently breeds short, unhealthy lives.

Death by “natural causes” frequently implies death by preventable, controllable, treatable maladies-malaria, typhoid, tuberculosis etc. In addition, the government’s nonchalance frequently necessitates that doctors go on strike just to get paid. It remains a gloomy fact that it is very easy to lose a life in Nigeria. The reality is simple and crushing – the government will not fund basic care, the people cannot afford basic care, and the medical personnel are dangerously incompetent in providing basic care.

Medical incompetence in Nigeria is a direct result of shoddy medical training. Medical schools lack adequate facilities while maintenance is permanently deferred. The faculty: student ratio is unbelievable, even then, a significant number of the instructors are inexperienced and unqualified to teach medical students. Endemic corruption in the country has permeated medical schools such that admissions into the schools can be gained through “connections”. Success in medical school can likewise be procured through financial and sexual inducements. Could it then be a surprise that patients have to plead for pre-treatment medical tests else, the “doctor” would “forget” to do so? Misdiagnoses and malpractice certainly contribute to the rampant deaths that are but signatures of Nigerian hospitals.”

Sankore argues that: “The problem seems to be that acknowledging, prioritizing and acting on the “brain drain” problem means that governments of countries that have benefited from the “brain drain” have to take responsibility, and cease their recruitment of healthcare workers from Africa.” While I agree completely with your statement that developed countries must cease recruiting health care workers from African countries, I think we need to do much more in terms of training health care workers. We need to devote some of our international aid funds to educate and train health care workers and then send them back.

This initial wave will form the backbone of an emerging African healthcare infrastructure. They will have knowledge and training in modern medical techniques in addition to the cultural knowledge indispensable for dealing with African medical problems. And if these students are given the opportunity to participate in the elite MD/PhD programs at the top medical schools (for which they are eminently qualified), they will be prepared to conduct cutting-edge research on diseases including some of the very same infectious diseases long ignored by the West.

There is plenty of work for all to deal with these complex issues. What must Africans do? They must commit resources to build a strong health-care infrastructure and they must recognize the links between health care, quality of life and environmental restoration. They must, in some cases, wrestle resources from corrupt leaders. They must demand that the resources of their motherland be shared with the people. These resources are necessary to provide the tools for health care workers to address the staggering quality of life issues in Africa.

What must the rest of the world do? We must care about the quality of life for everyone sharing the planet. And if you don’t care for the same reasons I care, you must care because you can’t run away. Whether you live in the rural sub-Saharan countryside or on a crowded block in Queens, NY you can’t escape environmental contaminants and airborne microbes. The recent recognition of extreme drug-resistant forms of TB should remind us all that we have no immunity against the rapid evolution of microbes. And guess who provided the incubator for this rapid evolution of the TB microbes? An AIDS patient with a weakened immune system. This new form of TB cannot be treated with any of our existing TB medicines, all of which are at least 40 years old. Ask yourself: how long does it take for these microbes to travel across an ocean?

Is there hope? You bet there is…all $57 billion worth in the form of the Bill and Melinda Gates Foundation, as well as other organizations. The Gates Foundation has dedicated a significant fraction of its resources to some of the issues discussed above. But in my opinion, they have missed the biggest factor of all. They haven’t provided funding to train the physicians. Africa needs physicians and health care workers who understand the culture…who are from the culture. We must provide this education for Africa’s best and brightest. Not because we support the “brain drain”, but because it is part of the solution. So we need to find ways to draw the attention of the Gates Foundation to the human capacity building that is required to meet the challenges all poor countries face. Healthcare is part of the problem and we can begin there but ultimately, we must deal with all of the issues: food and water, political integrity, economic development, environmental restoration and education.

• Jacqueline Tanaka, PhD, is an Associate Professor of Biology at Temple University.
• Please send comments to or comment online at http://www.pambazuka.org

'Kubatana Blogs' - (http://kubatanablogs.net/kubatana/?p=19) points to an article by Zimbabwean cartoonist, Tony Namate on the Zimbabwean Domestic Violence Bill. Namate wants a bill that covers all violence - not just domestic violence - that would include baby dumping, abortion, and failing to report violence. He also believes “that women engaging in indecent exposure should be arrested”.

“And then there are some forms of violence that are touted as women’s rights. Once upon a time I remember hearing that women had a right to wear what they wanted. Fair and fine, but when they deliberately and indecently violate other people’s sensibilities by “wearing what we want”, then surely they are committing the crime of indecent exposure and should be arrested “on sight”? Or perhaps indecent exposure is a male-only crime?”

Mr Namate misses the point about “indecent exposure” as applied to men exposing their genitals in public, since this is also sexual assault if it is directed at another person. If women were to expose their genitals in a similar way then, of course, this would be indecent exposure.

Malawian blog, 'Afrika-Aphuki' - Afrika-Aphuki comments on the adoption of an 18 month old Malawian child, David Banda by mega celebrity, Madonna. The child has left Malawi for London but the debate around the adoption in Malawi and elsewhere rages on. In Malawi the debate has centred around two issues – firstly the way the Malawian government and Madonna have bypassed Malawian law to allow the adoption to be fast-tracked, and secondly on whether the child would be better off growing up in Malawi with support from outsiders such as Madonna, or growing up in the home of a high powered celebrity white European celebrity. Afrika writes…

“Although their actions have been interpreted as jealousy and anachronism, the Malawian lawyers and activists who have drawn our attention to the way in which Malawian law has been compromised for the sake of a celebrity adoption have shown that not every African has been sold on the white supremacist bandwagon. Granted that there are NGOs who thrive on foreign money which they misuse and enrich themselves with, there are Malawians who are genuinely concerned about Malawi’s problems, and are working both inside Malawi itself and outside, to help ease the problems. The very Malawians who are making accusations of jealousy and archaic laws would be the first ones to blame the Malawian legal system the moment child traffickers learned of the power and influence of money and fame, and began targeting Malawian children. Hopefully this debate has alerted us to such a possibility, and we are embarking on a process to make sure it does not happen.”

Zimbabwean blog, 'Enough is Enough' - Enough is Enough (http://enoughzimbabwe.org/eddie-cross-the-farm-situation-today) reports on the situation of farming in Zimbabwe, particularly that of white farmers and the seizure of farm equipment by the police and army. The seizures were declared illegal by the court but by the time the equipment was returned to the owners, it had been vandalised. Zim Pundit posts a letter sent to Zimbabwean political activist Eddie Cross and comments

“The campaign is carried out on an ethnic basis - white farmers are the targets. It is completely illegal and destructive. Farms taken over in this way quickly become derelict and unproductive.”

'Redeem Ethiopia' - Redeem Ethiopia (http://redeemethiopia.blogspot.com/2006/10/lures-of-war.html) commenting on the threat of war between Ethiopia and Somalia, believes that Meles Zenawi provoked the Somalis into declaring “war on Ethiopia”, something he believes Meles learned from his predecessor, former Ethiopian leader, Mengistu Hailemariam.

“It seems that Meles has been a good student of history. He has done all that is in his power to provoke the Somalis to declare war on Ethiopia with the same hopes of gaining domestic legitimacy and external military support. The fact that there is no formidable Somali government, military or immediate threat to Ethiopia has made his job much harder than Mengistu’s. He has literally had to partially invade Somalia to get mostly empty threats from Somali Islamists, who can at best remove his soldiers from some Somali territory.”

However, unlike during Mengistu’s rule, Ethiopians of today are not ready to go to war and believe the threat from Somalia to be non-existent.

'Mental Acrobatics'Mental Acrobatics writes a moving tribute to the late Dr Dr.Wanjiru Kihoro of Kenya who passed away last Thursday following a long coma. Mental Acrobatics describes Dr Kihoro as

“a true patriot, a strong daughter of Kenya, highly principled in an age where people’s convictions change with the direction of the wind……….. In Kenya, where she took on the Moi regime on human rights abuses when most were to scared to speak out, she showed patriotism and courage. Refusing to be broken by the arrest and detention of her husband, Wanyiri Kihoro, and colleagues by Moi’s notorious security forces, she showed patriotism and courage. As the founder and director of ABANTU for Development, an international development agency, Dr. Kihoro’s vision, inspiration and direction touched and changed the lives of many.”

'African Shirts' - African Shirts (http://africanshirts.blogspot.com/2006/10/lifting-veil.html)
comments on the debate around comments made by Jack Straw about Muslim women wearing the Niqab during his MP surgery. He stated that he asked the women to remove their veils which he sees as a “visible statement of difference” and one that infringes on the communication experience, since one cannot see the face of the woman. African Shirts however points out that in an interview with Jack Straw, he let slip the real motivation behind his statement

“in an interview with the Today programme, he lets slips his actual motivation. He's worried about "community relations". In other words, the people in a community cannot communicate with a woman who covers her face, in this instance at the behest of her religion. The veil here, acts as a barrier, just as 18-year-old boys in hoodies are intimidating. And if non-Muslim and Muslims who are trying to live harmoniously alongside each other cannot interact, "parallel communities" start to develop.”

The debate around the Niqab is an Islamic debate and should not be of concern to non-Muslims. From a Muslim point of view it is yet another attack against Islam and interference in the way people choose to practice their religion.

'Black Looks' - Black Looks (http://www.blacklooks.org/2006/10/5_days_in_south_africa.html) is in South Africa and writes a piece on her first 5 days

"The most annoying thing for me is not the fences, locks and gates but having to take taxis everywhere after 7pm in the evening. Everyone keeps telling me not to go out even in Melville at night, not to carry my laptop on the Kombi bus - basically not to go anywhere at night without a taxi. A Cameroonian colleague who lives in downtown Joburg takes a taxi to a bar 10 minutes away from his apartment and back! Coming from sleepy Granada where no one even goes out before 10pm and you can walk home on your own at 4am in complete safety, this takes some getting used to. I realise I no longer have a sense of personal security."

• Sokari Ekine produces the blog Black Looks, www.blacklooks.org
• Please send comments to [email protected] or comment online at www.pambazuka.org

The Gates Foundation has joined with the Rockefeller Foundation in promoting a new "Green Revolution" in Africa. But will the new effort learn from the mistakes of earlier "Green Revolution" initiatives? Sceptics say that the new proposals still disregard the interests of small farmers and the environment.

President Levy Mwanawasa is reasserting his authority to ensure that Zambia's hangover from the bitterly contested elections does not become a permanent state of affairs. In the wake of the country's fourth multiparty elections since 1991, when it emerged from 27 years of one-party rule, wide-scale rioting broke out amid allegations of voter rigging, with presidential runner-up Michael Sata, of the Patriotic Front, threatening to impose his party's policies in areas where they had an overwhelming majority.

An opposition leader has been denied entry into Madagascar to register for the December presidential election but the United Nations (UN) is confident that the country's ability to hold a credible poll remains intact. Officials closed the airport to international flights in the eastern city of Toamasina on Saturday, preventing former Deputy Prime Minister Pierrot Rajaonarivelo from returning from exile in France.

An international think-tank has recommended targeted sanctions against key figures in the Sudanese government and designating the western region of Darfur as a no-fly zone to pressure Khartoum into allowing a United Nations peacekeeping force into the troubled area. A UN Security Council resolution passed on 31 August called for a 20,000-strong UN peacekeeping force in Darfur, which would be expanded from the existing African Union Mission in Sudan (AMIS).

African Union (AU) Health Ministers adopted a Continental Policy Framework for Sexual and Reproductive Health and Rights last week in Maputo Mozambique, but failed to agree on how to tackle the issue of unsafe abortions as a united force and opted to take it up separately.

The impasse over deploying a major UN peacekeeping force to Darfur results directly from the international community's three-year failure to apply effective diplomatic and economic pressure on Sudan's government and its senior officials.

Guinness World Records have officially verified that the first ever world record has been set for the most number of people to Stand Up against poverty in multiple locations over 24 hours. On 15-16 October, 23,542,614 people, in over eighty countries around the world set a new Guinness World Record for the largest number of people to "STAND UP AGAINST POVERTY". The Stand Up record attempt, an initiative of the United Nations Millennium Campaign in partnership with the Global Call to Action Against Poverty (GCAP) was set in time for the United Nations International Day for Poverty Eradication on 17 October.

The United Nations on Monday marked World Food Day to call attention to the 850 million hungry people around the world, almost half of them children who are locked in a cycle of malnutrition and disease. Led by the Food and Agriculture Organisation (FAO), the theme for this year is investing in agriculture for food security. The semi-arid Sahel region of West Africa is amongst the most food insecure regions in the world.

Most countries in sub-Saharan Africa are not on track to meet the millennium development goal of eradicating extreme poverty by 2015, the International Monetary Fund (IMF) said in its regional economic outlook for Africa, released in Dakar on Tuesday. The IMF has estimated that Africa needs to accelerate annual GDP growth to seven percent to attain the goal of reducing by half the proportion of people living on less than one dollar a day by 2015.

I agree that this is a problem not only in Angola but in all of Africa. Poverty is the one major issue that has to be addressed. I agree that the business community that controls the oil and other resources that Africa provides should and must take care of the people that provide the labour force. They must develop the country such that all enjoy the fruits of the land. Merely raping the continent will only lead to all the anti-social problems that one sees prevalent in all parts of Africa.

The international community must play an integral role in empowering the people of the continent so that they could control their own destinies.

Education is the most crucial component of the formula for success. Health care is next in line that is needed to stem the growing pandemic of HIV and AIDS. Full employment will definitely add to the growth of the economies.

Another phenomenon is the idea of the African Renaissance that is being touted by the S.A. leadership. One has to be very skeptical of this idea. Remember that Africa is a continent filled with people of all stripes, colours and religions and one cannot forget that all are part and parcel of the success of the continent. If the African Renaissance were to succeed then one will only ‘Balkanize’ Africa once again for more exploitation by the external forces.

Hopefully some of these ideas have been uttered by others but I felt that I should also add to the list.

Prof Soyinka's eloquent discourse on the collective failure of the world, Black Africa included, is a damning indictment of those who have the power to stop and prevent the first genocide of this century. The UN has been prevaricating, the AU has been silent (in spite of the weakly mandated Peace keeping Forces in Darfur), and the Arab League does not believe there is a problem in the first place. Against this backdrop, it is heartening to see Black intellectuals taking the lead on this issue. This offers little comfort to those who are raped, killed, tortured and rendered destitute in their own backyard. The words "never again" mean nothing when it comes to that continent.

The challenge has been issued by Soyinka to African leaders to show even a token response: expel Sudanese diplomats from African capitols to show that we are serious about Darfur.

The fate of Darfur is the fate of all people of colour. Neither the USA nor Europe care about what happens to us. If Nigerians keep quiet today, the Arabs will come for them tomorrow. I can see it very clearly. So let other black people keep quiet today so that they can die tomorrow. Or let us fight this insult on our continent now, even if it is to the last drop of our blood. We must not allow history to record us as having kept quiet in the face of tyranny: enough is enough.

The article entitled “The Psychosis of Denial” contains inaccurate statements. The problem in Zimbabwe is caused by the current majority ZANU PF government. What has MDC got to do with the problems? Is it the MDC that has failed the land reform, or embarked on operation cleanup or caused the shortage of food and fuel? The authors of this article clearly benefit from the current situation in Zimbabwe. Those that are benefiting from the current misrule are known to be corrupt and nothing is done to them. There are many laws, e.g. the Public Order and Security Act [POSA] which benefit ZANU PF and not the general public. They say there is a rule of law but there is selective application of this, especially where corruption is involved. It is who you are, and your loyalty to Mugabe that matters in Zimbabwe. Too many laws are passed to keep the status quo intact. Zanu PF is worse than the apartheid regime considering that it is a Black government mistreating its people yet blames Blair and Bush. How are Blair and Bush responsible for the oppression of ordinary people in Zimbabwe? Are they responsible for plundering the country's economy?

The Mugabe regime has run short of what to say and they don't want to accept responsibility for their mistakes. Instead they pass endless laws that are retrogressive to the building of a country.

It is a power struggle issue in Zimbabwe. Someone thinks because they fought a war therefore no one else should rule the country except them. If you look for example at Mozambique, Malawi, Zambia, South Africa, Kenya and Tanzania, they have changed political leaders, but what has Zimbabwe done, and why? There is more to it than blaming other people and the opposition.

Zimbabweans are tired of the ZANU PF propaganda. The country is run on propaganda. Zimbabweans are just fed up. And we are waiting to see where this propaganda will take ZANU PF. The truth is ZANU PF is not committed to change or to the development of Zimbabweans at large. Look at who benefited from farm invasions, and what is coming out of those farms? Nothing. If your loyalty is questionable the farm is simply taken away from you.

A pro-democracy group is threatening protest action against sub-Saharan Africa's last absolute monarch if steps are not taken to start meaningful constitutional reform. The National Constitutional Assembly (NCA), an ad-hoc pro-democracy alliance of trade unions, human rights and legal support and advocacy groups, has given the Swazi government until early next week to respond to their concerns or face what they said would be a "peaceful march" to King Mswati III's Lozitha Palace, 20km southeast of the capital, Mbabane.

The Lord's Resistance Army (LRA) suggested on Wednesday the country adopt a federalist system as a way of ensuring peace after 20 years of conflict in northern Uganda. In the revised LRA proposals, made under the talks’ second agenda on comprehensive solutions, the rebels say Uganda should be governed under a federal system of government, insisting that this would ease tensions and ensure general stability.

Uganda is widely cited for its participatory orientation and strong commitment to implementation with regard to its decentralisation reforms. The implementation and outcomes of Uganda’s decentralisation reforms are examined to test the assumption that when decision-making powers over the environment are devolved to locally elected representatives, this increases participation and leads to better environmental outcomes.

50th Anniversary of the First International Congress of Black Writers and Artists MOTION ON THE DARFUR CRISIS Presented by Professor Wole Soyinka, President of the Communauté Africaine de culture

We deplore and condemn in the strongest terms the conduct of the Janjaweed units of sectarian terrorism against the African indigenes of Darfur and demand international intervention through the authority of the United Nations without delay.

We welcome the decision of the Africa Union to extend the mandate of its peace-keeping forces to the end of the year and urge the international community to support those forces by all means necessary, including a deployment of U.N. peacekeeping forces, since from all evidence, the Sudanese Government has demonstrated that it lacks the will or means, or both, to control the genocidal activities of the Janjaweed marauders.

We demand an end to the greatest international refugee crisis that the world has ever known, an end that will be meaningful only when the refugees are returned to their legitimate homes and placed under the protection of international forces until they are empowered to protect themselves, and peace is firmly established in the Sudan.

We demand an international commission of enquiry into strong allegations of complicity by the Sudanese Government in the activities of the Janjaweed. In the meantime, we call on the international organisations and governments to take strong action and sanctions including expulsion, against the Sudanese Government until it agrees to abide by the UN resolutions on Darfur and cease to place obstacles in the way of United Nations presence in Darfur.

Passed in Paris Friday 22nd September 2006

FEATURE: Wole Soyinka sounds an urgent warning bell against criminal silence on Darfur
COMMENT AND ANALYSIS:
- Assis Malaquias suggests that it is premature to suggest that positive peace is a reality in Cabinda
- Manuel Paulo points out that for a successful consolidation of long-term sustainable peace to exist in Angola, the economy would need to be diversified first.
- Kwanisai Mafa and Netfa Freeman caution that all Africans at home and in the diaspora must unite against real live enemies and beware of any diagnoses with a psychosis of denial that neglects the most pertinent aspects our anatomical problems.
PODCASTS: Pambazuka News publishes two further podcasts: African slaves fight for land rights, and Tajudeen Abdul Raheem gives voice to his reasons for giving up smoking.
LETTERS: Ranting is not Progress
PAN AFRICAN POSTCARD: Tajudeen Abdul-Raheem writes that we should ‘Stand Up Against Poverty’ and stand up for the MDG’s
BLOGGING AFRICA: Sokari Ekine continues her blog round up: "You don’t have to be an ‘intellectual’ to know what’s going on in Zimbabwe, you just need to live there."
CONFLICT AND EMERGENCIES: Links to news on Sudan, Somalia, Uganda and COTE D'IVOIRE
HUMAN RIGHTS: Human rights report on illegal detentions
WOMEN AND GENDER: Our girls stay home and india, china scoop the science prizes
REFUGEES AND FORCED MIGRATION: Fleeing war, Somalis are targets of violence in adopted home
ELECTIONS AND GOVERNANCE: Government sets up ministry for war veterans
DEVELOPMENT: Africans lash out at chinese employers
CORRUPTION: “Corrupt culture" revealed among African diplomats
HEALTH AND HIV/AIDS: New battle lines for hiv/aids war drawn
EDUCATION: Teachers go back to school in southern sudan
ENVIRONMENT: UN agency issues warning over untreated sewage
MEDIA AND FREEDOM OF EXPRESSION: FXI concerned about growing "climate of fear" at UKZN
INTERNET AND TECHNOLOGY: Keyboard caters for all official sa languages
PLUS: e-Newsletters and Mailings Lists; Fundraising and Useful Resources; Courses, Seminars and Workshops; Jobs.