Doktorların göçünün maliyeti

medikritik Per, 12/12/2019 - 09:38

Yaşı uygun olanlar hatırlayacaktır, 1987 yılında, Afrikalı şarkıcı Mory Kante, “Yeke Yeke” adlı şarkısı ile meşhur olmuştu. Bu yanık sesli adam Gine’nin güneyindeki Kissidugu bölgesinden çıkmıştı.

Bugün, yaklaşık 200 bin nüfuslu Kissidugu’da sadece bir hastane ve sekiz sağlık ocağı var. Sağlık ocaklarının hiçbirinde doktor yok, hastanedekilerin sayısı ise yirmiyi bulmuyor. Al Jazeera televizyonunun 2017’de yaptığı bir haberde konuşan hemşire Benjamin, doktor açığını kapatmak için insan üstü bir çaba ile çalışan yerel sağlık personelinden biri. Sağlık ocağında elektrik olmadığı için ilaçları ve aşıları benzinle çalışan bir buzdolabında saklıyor, haftada bir kez köyleri ziyaret etmek için kullandığı motosikleti gerektiğinde bir ambulansa dönüşüyor. Kissidugu şehir merkezine ise günde sadece birkaç saat elektrik verilebiliyor. Hastanenin jeneratörü çok acil durumlarda ve doğumlarda kullanılıyor.

EN ÖNEMLİ SAĞLIK PROBLEMİ

Aslına bakarsanız Gine, komşuları Sierra Leone ve Liberya’ya göre çok daha iyi bir durumda. En azından ülkede bir terör sorunu yok. Ancak, doktor yetersizliği tüm Afrika’nın belini büküyor. Sağlık örgütleri, az gelişmiş ülkelerde salgın hastalıklara mücadelenin önündeki en büyük engelin doktor eksikliği olduğunu söylüyorlar. İlaç ve ekipman, uluslararası yardımlar yolu ile bir nebzeye kadar tedarik edilebiliyor. Ancak bunlar, kullanacak uzman personel bulunamadığı için ihtiyaç sahibi insanların bir işine yaramıyor. Kissidugu gibi ücra bölgelerde enerji temel bir sorun olduğundan, uygulayıcı personel gelene kadar uygun koşullarda saklanamayan ilaçların ve aşıların miadı doluyor.

2016’da yapılan bir araştırma, doktor sayısının azalmasının beklenen yaşam süresini doğrudan ve olumsuz olarak etkilediğini gösteriyor. Bununla beraber, tüm Afrika, Latin Amerika, Ortadoğu ve Uzak Asya ülkelerinde doktor sayısı olması gerekenin çok altında. Gelişmiş ülkelerde 10 bin kişiye 40’tan fazla doktor düşerken bu sayı Afrika gibi bölgelerde 1’e kadar düşüyor. Filipinler’den Uganda’ya, Romanya’dan El Salvador’a kadar yüzlerce ülke doktor eksikliğinin sıkıntısını yaşıyor. Bu ülkelerin tamamında tıp fakülteleri var, hatta bazılarındaki tıp eğitimi dünya ortalamasının üzerinde bir kaliteye sahip. Peki öyle ise buralardan yetişen doktorlar nereye gidiyor?

DOKTORLARIN GÖÇÜNÜN MALİYETİ

Geçtiğimiz Mart ayında Suudi Arabistan sağlık bakanlığından kalabalık bir heyet Nijerya’da idi. Suudi Arabistan’da çalışmak için başvuran Nijeryalı doktorlar arasından seçim yapmak için Başkent Abuja ve Lagos’taki iki otelde seçme sınavları yapıldı. Bu sınava giren doktorlar, birkaç hafta önce de İngiltere’ye gidebilmek için British Council’in PLAB dil sınavına girmişlerdi. Nijerya’nın 28 tıp fakültesi her yıl yüzlerce mezun veriyor, ancak ülkede hala 5 bin kişiye bir doktor düşüyor. Çünkü, Nijeryalı doktorlar çalışmak için başka ülkelere göç ediyor. Nijerya’da yetişen her dört doktordan biri Nijerya dışında çalışıyor. Nijerya ile benzer durumda başka ülkeler de var. Ganalı doktorların yüzde 40’ı, Liberyalıların yüzde 50’si, Romanyalıların yüzde 25’i, Bulgar doktorların yüzde 20’si gelişmiş ülkelerde çalışıyor.

Gelişmekte olan ülkelerden gelişmiş ülkelere yüksek nitelikli göçmen akışı, yoksul ülkelerin en önemli kaynağı olan insan sermayesini kaybetmesi anlamına geliyor. Bir bilim insanı, doktor veya mühendisin yetiştirilmesinin topluma maliyeti düşünülecek olursa, beyin göçünün yoksullardan zenginlere doğrudan kaynak transferi olduğu da görülebiliyor. Sadece Afrika’dan göç eden doktorların dünyanın bu en yoksul kıtasına maliyeti 50 milyar doları geçiyor.

Nitelikli beyin göçünün maliyetlerini göstermek için doktorlar örneğini özellikle seçtik. Çünkü bilim ve teknoloji alanındaki beyin göçünün olumsuz sonuçlarının ortaya çıkması yıllar alıyor. Tıp alanındaki beyin göçü ise göç veren ülkenin sağlık sistemindeki yıkıcı etkilerini hemen gösteriyor.

Gaffar YAKINCA

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“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Pt, 04/11/2024 - 02:17

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Sa, 05/11/2024 - 07:42

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Ct, 09/11/2024 - 07:05

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Pt, 11/11/2024 - 04:34

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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DanielSpola (doğrulanmamış) Çar, 13/11/2024 - 01:58

“You get some of me but not tomorrow as they want me in as soon as I can make it happen. This is the one time when they say jump and I ask how high due the financial gains the company could benefit from and it being important enough for the client to appear in person.”

“Well I get an extra night of you at least! I wonder what we could do with that? Meantime, what about food? I am starving and delicious as it was a second breakfast is not quite enough to replenish me!”

“Well get something on and we’ll sort that out first.”

We drove into town and decided that a daytime visit to Charlie’s was going to be the answer. I parked in the bar lot and Elise dashed in to change into something more appropriate, jeans and a t-shirt along with her biker jacket but keeping her Converses on.

Walking down to the restaurant was different from the middle of the night visits as the streets were bustling and all of the shops and outlets were open.

Reaching Charlie’s we entered the front door and sat in a booth near the window. A beautiful young American Chinese girl came,smiled and said hello to Elise and gave us menus and asked if we wanted drinks in the meantime.

"No thanks Lin just a pot of Jasmine tea for us please." Lin went back to the kitchen area. “No booze for me today as I will have to work in the bar so it is just tea for me.”

Not in a drinking mood either, I agreed with her."

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