Friday 14 September 2012

Brain Drain-1

(Published in The Friday Times on 14-09-2012)

,703 candidates appeared in the entry test for medical colleges in Punjab last year, competing for 5,271 seats in 40 public and private medical and dental colleges. Nearly 3,500 seats are available in 15 medical and 3 dental colleges in the public sector, while 1,850 seats are available in private medical and dental colleges. This suggests that the top 3,000 candidates would be able to secure admission in the public sector and around 2,000 more will get admission in Private Medical Institutes.

These figures raise the question: What about the rest of the 28,000 students who passed FSc (Pre-Medical) with more than 60% marks but were deemed not good enough to get admission into a medical college, either due to merit or financial issues, as Private Medical Colleges charge almost half a million rupees every year only in tuition fee? 

As the saying goes: where there is a will, there is a way. And that's another way of saying that students who want to become doctors should make use of opportunities to study medicine abroad.

Medical education in developed countries such as USA,UK, Australia and Canada is much more expensive than in Pakistan, so the options for most Pakistani students are either China or the ex-Soviet states such as Kazakhstan or Kyrgyzstan. Medical Education in these countries is imparted in English, so there's no worry about language barriers. Browse through any English or Urdu daily in Pakistan and you'll see advertisements for institutes in these countries. 

This trend of going abroad to get a degree in medicine started in the 1990s when Central Asian colleges became a destination for students who lacked good marks. It should be pointed out that the minimum eligibility criteria for the Medical Colleges Admission Test (MCAT) is 60% marks in FSc. Initially, students with marks as low as 35-40% were able to secure admissions in Central Asian colleges. It was a dream come true, a shortcut bypassing the system in Pakistan. Chinese medical institutes offering medical courses in English started in the last decade.

At present, around 2,000 Pakistanis are studying medicine in
various medical schools across Kyrgyzstan. According to the
United Nations, a July 2006 survey of medical students at nine
institutions in Kyrgyzstan rated their level of knowledge
between 2 and 2.6 on a five-point scale. In China, there are 6
 medical colleges and 1 dental college recognized by the
Pakistan Medical and Dental Council (PMDC). Each of these
medical schools has around 150-200 Pakistani students per
session. Nine hundred Pakistani medical students are presently
studying medicine in Cuba on scholarships awarded by the
Cuban government after the 2005 earthquake. But PMDC does
not recognize Cuba's medical colleges and the living conditions
of our students there are pathetic. Around 100 Pakistani
students are studying medicine in Bangladesh.

Vulnerable students are duped into some of these places with
fancy titles like 'WHO Recognized Medical Institute'. The fact
remains that WHO (World Health Organization) "has no
authority to grant any form of recognition or accreditation to
schools of medicine or other training institutions. Such a
procedure remains the exclusive prerogative of the national
government concerned." (This is WHO's own clarification.)

The Pakistani state has done little to stall this "business".
Pakistan's embassies in the respective countries do not own
the students if they face any difficulties regarding the whole
process. In Cuba, students live 15 Kilometres away from the
city in which their college is located. In China, many
universities which are not officially recognized enroll students
using paid agents in Pakistan. Every admission gets the agent a
fixed amount of money and the unsuspecting student can't get
out of this maze easily.

The big problem facing Pakistan's health system is the influx
of these Foreign Educated Doctors and their integration into
the system. These medical graduates are not at par with their
counterparts from Pakistan-based institutes and that creates a
chasm in their ability levels. In almost all the foreign
universities, clinical training, the backbone of undergraduate
programs, is seriously lacking because of obvious language
constraints. You can teach students in English but you can't
teach them all the required nuances of the local language in
such a short period of time. Without the necessary knowledge
of the local language, how can anyone get a good medical
history from a patient? (Around 70% of clinical diagnoses are
based on a patient's medical history.)

PMDC has made it compulsory for all international medical
graduates to pass a specially designed test to practice medicine
in Pakistan. This is the only intervention done on a
governmental level for these doctors. A lot of those who can't
pass the test end up working for private hospitals, as they
can't get jobs in the public sector. This alternate pathway for
medical education is going to flood Pakistan with a lot of
substandard doctors very soon.

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