The Ebola outbreak has shed light on a dearth of medical professionals in West Africa, especially in Liberia, a nation still reeling from a 14-year civil war. Fewer than 170 qualified doctors live there and qualified Liberian doctors and nurses around the world aren’t eager to return to their home country right now.
Since Liberian health officials reported the first case of Ebola in March, nearly 100 doctors have succumbed to the disease, scaring many of those on the front lines. In recent weeks, reports have surfaced of medical personnel deserting the Ebola-stricken at treatment units in Liberia.
Last week, doctors and nurses went on strike in demand of an adequate wage and a “risk bonus” for caring for patients. Reports stated that although government and global health organization officials promised up toward $750 in monthly wages for medical personnel, many said they received less than a third of that amount. That conflict shows promise of coming to an end; the chairman of Liberia’s national health workers’ union has expressed a willingness to negotiate with President Sirleaf.
But it will take more than a few dozen medical personnel to tackle a disease that has ravaged much of the region. Earlier this week, Sirleaf called for all hands on deck in an “open letter to the world” that BBC producers read on air. She said the current outbreak “requires a commitment from every nation that has the capacity to help — whether that is with emergency funds, medical supplies or clinical expertise.”
While the United States, some European countries, Cuba, and some global health organizations have sent help to the region, many Liberian doctors living around the world — including Dr. James Adama Sirleaf, the president’s son, who lives in Georgia — remain wary to return to their native land.
This reluctance among the most qualified Liberians to live and work in their country of birth, however, goes beyond the Ebola outbreak, or even West Africa for that matter. A 2013 report by the United Nations’ Department of Economic and Social Affairs showed that one out of nine Africans with a university degree migrate to one of 34 Organization for Economic Cooperation and Development member states — including the United States, Britain, France, Australia, Russia, and Spain.
The trend has created what some experts call a “brain drain,” defined as a gap in expertise caused by the emigration of talented, educated Africans to more developed nations. The brain drain has played a role in the devastation of health care infrastructures around the continent. According to data from online health workplace policy journal Human Resources for Health, one out of five African-born physicians and one-tenth of African-born nurses work overseas. Their reasons for relocating include better pay and the desire to raise families in more stable environments.
While African doctors make advancements in medical research elsewhere, their countries’ health care systems suffer. Liberia is no exception. Before the Ebola outbreak, there was just one doctor for nearly 90,000 people in the country. Many of those doctors take assignments in Monrovia, Liberia’s capital city, ultimately leaving the rural areas uncovered. The medical personnel shortage has forced senior government officials — including former Health Minister Dr. Peter Coleman and current Health Minister Walter Gwenigale — to moonlight as medical personnel.
Before the Ebola outbreak, experts said that post-war Liberia needed to increase its number of qualified medical personnel tenfold to provide adequate health care services to people living in the country. Gwenigale also suggested that doctors be paid $1,000, five times the average salary. That’s very unlikely, however, due to a host of factors including inadequate educational facilities that fail to attract the top professionals.
While Liberia has provided medical education in the post-civil war era, it hasn’t proven sufficient in convincing recent medical school graduates to pursue a career in the West African country. A 2011 survey of medical students and a physicians found that barriers to medical training included a “lack of clinical and basic science faculty.” Students at A.M. Deligotti College of Medicine, the country’s only medical school, recounted studying by candlelight in dormitories with no running water or electricity.
Those negative experiences most likely have taken a toll on many who graduate from that institution. Nearly all of the fewer than a dozen people who complete their studies at the medical school annually take their talents elsewhere.
“Most of Liberia’s best minds are in the Diaspora,” Edmund Zar-Zar Bargblor, the vice president of the Liberian Community Association of Rhode Island, argued in a piece on TLC Africa.com. “Present conditions in Liberia demand that Liberians with the requisite skills and talents need to be identified and encouraged to return home, to help with the economic recovery process.”
Bargblor’s words haven’t fallen on deaf ears. Liberian officials too have long recognized the brain drain as a problem that could threaten its future development. Shortly after she entered office, Sirleaf promised that the government would assist Deligotti in improving its facilities. In recent years, some people have also petitioned Liberian officials to follow the lead of other nations in awarding dual citizenship to the best and brightest Liberians who decide to travel while maintaining ties to their home country.