It worked — Manitoba scored its share of South African medical professionals — and I felt more than a little guilty. What business did we have enticing skilled professionals away from countries that had spent millions of scarce dollars training them and desperately needed their services, simply to fill our own needs, however pressing they might be?
Over a decade later, one could have hoped that poaching of the talented human resources of the perennially more desperate South and East by the powerful countries of the North and West would have been called off. It hasn’t. In a now-celebrated case, last fall newspaper reports alerted us that Shoppers Drug Mart had sent recruiters to aids-stricken South Africa to interview young pharmacists, and lure them to Canada with promises of $100,000 salaries. “We have a long history of helping pharmacists from other countries start new careers in Canada,” a Shoppers spokesperson said. Not everyone was content to let it pass. In January, an editorial in the Canadian Medical Association Journal blasted Shoppers, pronouncing such ventures “not just gauche [but] unethical. It amounts to a Canadian corporation taking advantage of South African taxpayers and [an] impoverished higher education system — truly foreign aid in reverse.”
Unfettered globalization, with its free flow of capital and investment, is increasingly being followed by the free movement of people with professional skills, and Canada and other wealthy countries have become landing spots for many of the best and brightest from the developing world. By doing little to discourage this and much to promote it — everything from word of mouth campaigns to targeted immigration approaches that identify skilled professionals — almost everybody in government and industry working on Canada’s skills shortage is complicit. Arguably, Shoppers Drug Mart was simply doing overtly what most governments from the North and West both allow and encourage more covertly every day.
While few would want to forbid people from moving to a better life, the fact remains that as we benefit, the other half of the world pays a hefty price. Clearly evident in engineering, agricultural technology, business, education — any number of fields, really — the effects of this outmigration are most dramatic in health care, and the place hardest hit is Africa. Across the continent, there are thirteen doctors for every 100,000 people, though for some countries, such as Ethiopia, that number is just two. (I have visited clinics in African countries that have not seen a doctor in years, and some only have a single nurse attempting to hold things together.) Meanwhile, in the US the ratio of doctors to citizens is 256 to 100,000; in Canada, it is 214 to 100,000.
According to the United Nations Conference on Trade and Development, 65 percent of newly qualified doctors in Bangladesh seek jobs abroad. As in Ethiopia, Bangladesh’s locally trained medical personnel depart for the greener pastures of the North and West. In particular, the health care systems of Canada, the UK, the US, and Australia have become heavily dependent on immigrant health care professionals. The Organisation for Economic Co-operation and Development (oecd) reports that 22 percent of practising doctors in Canada were trained elsewhere; in the UK, it is 33 percent. The US and Australia fall somewhere in between.
Such reports indicate that policy-makers and institutions have been aware of the issue for years. In 1999, the World Bank’s World Development Report declared that the brain drain from the Third World to the First would be “one of the major forces shaping the landscape of the 21st century.” But nearly a decade into this new century, all we’ve really done about “foreign aid in reverse” is take advantage of it.
Dr. Amir Attaran, the Canada Research Chair in Law, Population Health, and Global Development Policy at the University of Ottawa and co-author of the cmaj editorial, says that Shoppers Drug Mart–type recruiting would be much less likely today in Britain. In 2004, the British House of Commons International Development Committee issued a statement arguing that the migration of vast numbers of skilled workers contradicted the goals of the West’s development programs: “[It is] unfair, inefficient and incoherent for developed countries to provide aid to help developing countries to make progress towards the Millennium Development Goals on health and education, whilst helping themselves to the nurses, doctors, and teachers who have been trained in, and at the expense of, developing countries,” stated the parliamentarians. This is not to suggest that Britain has not, over the years, recruited from needy countries, as the oecd statistics reveal. Indeed, Manchester reputedly has more Malawian doctors than Malawi, and hospitals across Britain are heavily dependent on Zimbabwean and Zambian nurses. Nonetheless, also in 2004, the National Health Service decided as a matter of policy to cease active offshore recruitment from developing countries. “It didn’t require a law,” says Attaran, “just a change in behaviour. And after the nhs lead, the public culture changed.” “Boots [the British drug-store chain] would not do what Shoppers has done,” he continues — “go to a struggling country that has one of the world’s highest incidences of hiv/aids, and lure their pharmacists away.”
While chastising Shoppers, Attaran reserves equal scorn for Canadians as a whole. “Does anyone give them [Shoppers] a hard time about it? Not in this backward country,” he fumes. His point is that few ask what happens to the sending countries when they export their talent to Canada, and fewer still ask policy-makers to admit that domestic laws and practices amount to a jumble of contradictions and hypocrisy. Canada boasts about its refugee settlement programs — as the US does about opening its arms to “the huddled masses” of the world — but in the main, it is no longer the poor, unskilled, and uneducated who emigrate. While stories of overqualified immigrants driving cabs in Canadian cities are legend, it is our ability to put foreign-trained skill to use that we consider our real genius, and that is where the majority of our efforts get directed.
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