Brain Drain: Africa’s Trainee Doctors Are (Barely) Holding Health Together – Health Policy Watch

A doctor in the DRC examines a patient. Working conditions for doctors are extremely challenging in many African countries.

As the Global North hunts down African doctors, health care falls to overworked and unmentored trainees, some of whom learn medical procedures from YouTube.

Fifteen of the richest (fiscally) countries in the world have more than 55,000 African doctors in their health systems, a new analysis of data from The continent shows These are doctors who have qualified before entering those countries.

The United Kingdom is the worst hit, followed by the United States, France, Canada, Germany and Ireland, in that order.

Of the African countries that are running out of doctors, an analysis of the latest data from the Organization for Economic Cooperation and Development shows that Egypt has lost the most, followed by Nigeria, South Africa, Algeria and Sudan.

These countries have therefore paid a significant price in the quality of health care they can offer their residents.

Egypt, for example, has the lowest doctor-patient ratio of its North African neighbors. In many of the drained countries, there are so few trained doctors that most health care falls to doctors in training: medical interns.

“Treat Like Nobody”

Research in Uganda and Kenya details the cost for those inside. The study entitled “We were treated like nobody” was published this month in the British Medical Journal for Global Health and is based on data on more than 700 medical interns in both countries, as well as on interviews with 54 junior doctors and 14 consulting doctors.

He found that medical interns suffer from burnout and stress because they work unreasonable hours and often have no superiors to train and supervise. Their working conditions continue to have the same challenges that lead more experienced doctors to seek greener pastures.

The research found that the lack of support and supervision also “threatened the well-being of individuals and the quality of care provided”.

“Many reported working unreasonable hours – up to 72 hours – due to lack of staff,” according to Yingxi Zhao, one of the researchers.

“Sometimes the interns were the only staff running the wards or they had to do certain procedures without supervision. These include cases where the interns had to learn how to do caesarean sections from YouTube.”

Threat to the lives of patients and doctors

Such conditions threaten not only the lives of patients, but also doctors in training. Research from the World Health Organization (WHO) found that people who worked 55 or more hours a week had a 35% higher risk of suffering a stroke and a 17% higher risk of dying from heart disease ischemic, compared to those who worked 35-40. hours

The results of Kenya and Uganda mirror those of a study in Nigeria published in May in the journal Public Library of Science.

Researchers interviewed 628 early career doctors and nearly 40% said they felt overwhelmed by their work. About 16% said they wanted to leave the profession and twice as many said they experienced anxiety.

Researchers in both studies recommend limiting the hours that medical interns and junior doctors work. But limited training facilities and continuous brain drain make the doctor-patient ratio so low that reducing working hours is almost impossible.

By a large margin, the best doctor-patient ratios are in Libya and Algeria – 22 and 17 doctors for every 10,000 residents respectively. But even Libya and Algeria compare poorly with the main importers of African doctors, the United Kingdom and the United States, which have between 32 and 37 doctors for every 10,000 people.

To a doctor looking for a work-life balance, going to the Global North is a no-brainer.

Lucy Nyokabi, a medical intern at a hospital in Nairobi, says her workload is overwhelming and she often does not have safety equipment or supplies to do the job properly, such as oxygen masks.

“My family supports me to get the things I need for work. I have to remind myself that I need this training to excel in the actual work,” he says.

This makes leaving attractive: “We all hope to work outside the country. I believe that the conditions are better out there.”

First published in The continent. Subscribe to this free weekly newspaper by emailing

Image credits: DNDi.

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