August 19th, 2019
To poach and rely on highly skilled foreign workers from poor countries in the public sector is akin to the crime of theft.
- "Migration of Health Workers: An Unmanaged Crisis," The Lancet, May 28, 2005
What is striking about the tyranny of the medical industrial complex is not only its unconscionable oppression of the American working class, but also its assault on the health care systems of other countries. These acts of barbarity and pillage allow the Anglo-American elites to keep the countries of the global south in a state of backwardness and dependency, and one of the ways this is done is by enticing doctors from developing nations to abandon their countries and practice in the West.
One such example is India, a country with horrendous unmet health care needs. Snakebites are a serious problem and lead to the deaths of over 45,000 Indians each year, the overwhelming majority of whom are villagers in isolated rural communities. Following a snakebite, the afflicted person often has to travel vast distances to reach a medical facility, typically battling poor roads in the process. An unreliable power grid results in these remote areas having intermittent access to electricity, which exacerbates the problem as the anti-venom must be refrigerated.
So lax are India's ethics laws that her destitute masses are frequently used as clinical guinea pigs by powerful pharmaceutical companies in the testing of new drugs, which has resulted in tens of thousands of adverse reactions and thousands of fatalities. The number of clinical trials has risen dramatically following a relaxing of drug testing laws that was implemented in 2005, and many of these patients are unable to read the consent forms which are printed in English. India also has an egregious doctor-patient ratio, with less than one doctor for every thousand patients.
Speaking on the troubled state of Indian health care, Tatyarao P. Lahane, MD, said in an interview with The Times of India:
A skewed doctor-patient ratio in our country is the major cause of trouble. In almost all leading countries of the world a doctor in a government hospital checks a maximum of 30 patients a day. In India, any doctor on an average checks at least 150 patients a day.
Inadequate environmental regulations have led to extremely poor air quality, which has likewise contributed to unsatisfactory health outcomes. Furthermore, India's downtrodden masses continue to be oppressed by an inhuman multi-tier system. In an article titled "More Indians die of treatable diseases than lack of access to healthcare," Swagata Yadavar writes:
Poor care quality leads to more deaths than insufficient access to healthcare -1.6 million Indians died due to poor quality of care in 2016, nearly twice as many as due to non-utilisation of healthcare services (838,000 persons).
In addition to these problems that are a pox on Indian society, there are over 59,000 Indian physicians working in the United States, the United Kingdom, Canada and Australia, countries which have the resources to easily train their own doctors. Two thirds of that number work in the US. Lamenting the staggering number of Indian doctors that go abroad in "Doctors For The World: Indian Physician Emigration," Fitzhugh Mullan writes "that their clinical and political energies will never address the improvement of health care in India."
In an ironic twist, private hospitals that cater to affluent Indians are turning a profit through the peculiar phenomenon of "medical tourism," whereby uninsured and underinsured Americans can receive medical care for a minuscule fraction of what they would be billed in the US.
Significant numbers of African doctors, virtually all coming from countries with poor doctor-patient ratios, are lured to practice in the US, and are also beguiled by false promises of excellent training and superior working conditions. Many hail from countries with poor health indicators, such as Ghana, where life expectancy is 63. Moreover, as Jonathan Wolff writes in "Why America Steals Doctors From Poorer Countries":
If a doctor from Ghana is recruited to the US, not only does Ghana lose its doctor, it loses the money paid for the training. It may be that the doctor is likely to send a portion of earnings back home (known in the development business as "remittances"). But this is scant compensation. In sum, the US is receiving a massive subsidy from the developing world in training its medical staff.
Nigeria has a doctor-patient ratio of one doctor for every five thousand of her citizens, a life expectancy of 55 for men and 56 for women, and a maternal mortality rate of over 800 deaths per 100,000 live births. Over half of Nigeria's doctors practice abroad.
International medical graduates (IMGs) that hail from developing countries are often sent to work in rural areas where American physicians are reluctant to practice, and yet many never return to their native lands. In "U.S. Recruiting Africa's Doctors for Placements No One Wants," by Austin Drake Bryan writes:
The United States is recruiting the world's doctors - and from the very places that need MDs the most. Dubbed the "international brain drain," the United States leads the way in attracting international doctors, especially those from Africa.
The United States, with its high salaries, attracts more international doctors every year than Britain, Canada and Australia combined. However, for every 1000 people, Africa has only 2.3 health care workers, while the United States has almost 25.
IMGs are frequently brought into the US on guest worker visas, and can have their visa revoked if they complain. This bolsters the stranglehold of the health insurance companies, hospital executives, and pharmaceutical companies, and exacerbates the challenges of unionizing a newly proletarianized and increasingly dehumanized workforce. Indeed, foreign doctors on the J-1 visa are particularly vulnerable to abusive and exploitative working conditions. Decrying the exploitation of IMGs in Australia, Sue Douglas, MD, writes in The Australian "that international medical graduates are a vulnerable group that have been exploited by the government, abused by their own profession and ignored by the public."
In an interview with Pamela Wible, MD, and Corina Fratila, MD, Fratila, who is from Romania, speaks of training in the US and being forced to work 126 hours a week with minimal supervision, while also struggling with the danger of fatal miscommunications that can easily occur between doctors and nurses who are coming from different countries and do not share English as their native language.
Another disturbing trend is the growing number of American medical graduates that do not match into a residency position. In an article published on April 16th, 2019, titled "The National Resident Matching Program No Longer Meets Doctor Needs," Joe Guzzardi writes:
In the most recent match, which happened last month, 1,162 U.S. medical school seniors and 811 previous U.S. graduates did not match to a residency at a teaching hospital, so nearly 2,000 U.S. grads did not get residency. Without fulfilling residency requirements, doctors can't practice medicine. In last month's match as well, 4,028 non-U.S. citizen students/IMGs matched and were granted residency, bringing the total number of IMGs placed in U.S. residencies since 2011 to 31,894.
It is important to remember that residency positions are subsidized through Medicare funds, which are in turn subsidized by the American taxpayer. Passed over for a residency position and often saddled with terrible student loans, some unmatched medical school graduates have even taken their own lives, as exemplified by the tragedy of Robert Chu. The increasing reliance on foreign doctors is also curious, in light of the fact that vast numbers of American high school students are not receiving an education in basic math and science.
A ruthless war is being waged against universal health care, both at home and abroad. US military interventions in Iraq, Libya, Afghanistan (under the communists), and Yugoslavia brought about the destruction of comprehensive (and in the case of Afghanistan, burgeoning), single-payer health care systems. Juan Orlando Hernández, the US puppet overseeing the Honduran junta following the putsch that ousted the progressive government of Manuel Zelaya, has taken measures to privatize that country's health care system. Hence, "democracy has been restored."
The progressive governments in Cuba and Venezuela both offer free health care to their citizens. Consequently, they are "rogue" states. Syria has been ravaged by the US-NATO-Israel bombing campaigns and the "international community's" support for a generous array of barbarians and religious fanatics, yet still offers free health care to her citizens. This is also the case with the rebel government in the Donbass which even gives free health care to captured neo-Nazis.
The poaching of foreign doctors is consistent with the desire of the Western elites to keep the global south under the iron heel of subservience and destitution. This devilry has also played a role in transforming the American medical profession into a diabolical sweatshop devoid of unions and labor laws, with the deteriorating rates of infant mortality, life expectancy and maternal mortality that have inexorably followed. To borrow a phrase from Yeats: "anarchy is loosed upon the world." Unless we find a way to disenthrall ourselves from the despotism of the medical industrial complex, the health care oligarchs will continue to enslave us all.
David Penner has taught English and ESL within the City University of New York and at Fordham. His articles on politics and health care have appeared in CounterPunch, Dissident Voice, Dr. Linda and KevinMD; while his poetry has been published with Dissident Voice. Also a photographer, he is the author of three books: Faces of Manhattan Island, Faces of The New Economy, and Manhattan Pairs. He can be reached at: 321davidadam@gmail. Read other articles by David.