The Wards and the Brain Drain

As a reminder, Edendale hospital is a 900-bed hospital -- 200 of which are dedicated to internal medicine patients and equally divided into 5 wards. An example of a ward is shown in the picture above. Basically it is 40 beds, stacked next to each other within one room with no dividers in between. As you can expect, patient's don't get very much privacy during physical exams of procedures. Even more concerning, however, is given the lack of isolation, very sick and immunocompromised patients are cohorted with those with contagious infectious diseases. Thus, if a patient does not have Tb or meningitis when they come in, they have a high risk of acquiring it by the time they leave.

In terms of medical education and training in South Africa, like most other countries, medical school and college are combined into a a 6-year program. After medical school, they have two years of training as an intern whereby they work in various medical specialities like surgery, Ob-gyn, internal medicine, anesthesia, etc. Once they have completed these two years of training, they are given the title of a "medical officer" and given posts throughout South Africa where they are required to work for a minimum of two years. As a medical officer, they are not specialized into any particular medical field but basically are surgeons, OB's, pediatricians, and internists all rolled into one! Once their two years of service are completed, they then have the option of specializing into a particular medical field or continuing their work as a general medical officer.

Having worked with a fair number of interns at Edendale, I learned that the majority of those who complete their training and 2-year service commitment end up leaving South Africa to practice medicine in greener pastures. Known as the "brain drain" of "human capital flight," newly trained physicians in which the government has invested considerable resources and money, emigrate to Australia, New Zealand, and Canada with the promise of better resources and lifestyles. A long recognized problem, one statistic I read estimated about $1.41 billion loss of returns from investment for all doctors emigrating out of South Africa.

-F