As coronavirus spreads, so does the brain drain

by Sasha Alyson

Colonialism has always been about those with power extracting whatever they want from those with less. Only the details change.

Once they wanted gold, spices, and human beings. They took them with guns. They still want certain human beings, but economic power has replaced guns. Two recent stories in the New York Times offer an example.

Samantha Power, former U.S. ambassador to the United Nations, writes:

Covid-19 is poised to tear through poor, displaced and conflict-affected communities around the world…. The U.S. health system is utterly overwhelmed — yet we have 26 doctors for every 10,000 Americans. In Africa, where 1.3 billion people live and the virus has arrived, countries average fewer than three doctors per 10,000.”(1)

Another story looks at the situation from a different angle:

Eight U.K. Doctors Died From Coronavirus. All Were Immigrants.

LONDON — The eight men moved to Britain from different corners of its former empire, all of them doctors or doctors-to-be…. Now their names have become stacked atop a grim list: the first, and so far only, doctors publicly reported to have died after catching the coronavirus in Britain’s aching National Health Service. For a country ripped apart in recent years by Brexit and the anti-immigrant movement that birthed it, the deaths of the eight doctors — from Egypt, India, Nigeria, Pakistan, Sri Lanka and Sudan — attest to the extraordinary dependence of Britain’s treasured health service on workers from abroad.

It is a story tinged with racism, as white, British doctors have largely dominated the prestigious disciplines while foreign doctors have typically found work in places and practices that are apparently putting them on the dangerous front lines of the coronavirus pandemic…. Britain is not the only country reckoning with its debt to foreign doctors…. In the United States, where immigrants make up more than a quarter of all doctors but often face long waits for green cards, New York and New Jersey have already cleared the way for graduates of overseas medical schools to suit up in the coronavirus response….

By recruiting foreign doctors, Britain saves the roughly $270,000 in taxpayer money that it costs to train doctors locally, a boon to a system that does not spend enough on medical education to staff its own hospitals. That effectively leaves Britain depending on the largess of countries with weaker health care systems to train its own work force. Even so, the doctors are hampered by thousands of dollars in annual visa fees and, on top of that, a $500 surcharge for using the very health service they work for.(2)

The doctors and health workers are often fleeing untenable conditions. It would be inhuman and unrealistic to insist that they should stay in situations with no infrastructure to support their work, while putting their families at risk. But the U.S. and the U.K. are not providing a safe haven for everyone who faces danger at home — only for those whose skills it wants, even as those skills are more desperately needed in the homeland.

Those home countries lose the very people they most need. One study found that skilled professionals emigrate from Africa at almost double the global rate.(3) Western powers should be helping their own youth to develop the skills that are needed, rather than raiding other countries in search of something cheaper.


1. This Won’t End for Anyone Until It Ends for Everyone, by Samantha Power, New York Times, 7 April 2020

2. Eight U.K. Doctors Died From Coronavirus. All Were Immigrants, by Benjamin Mueller, New York Times, 8 April 2020

3. Honest Accounts? The true story of Africa’s billion dollar losses, by Natalie Sharples, Tim Jones, and Catherine Martin. Curtis Research, Health Poverty Action et al., 2014. This extensively-documented report shows that what Africa loses to the West — through the brain drain, tax havens, illegal fishing and logging, and much else — is far greater than what it receives in aid.

Top photo: Doctor and patient in Madagascar by Docteur Ando (Creative Commons license CC-BY-SA-4.0)

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Dividing the World in Two

by Sasha Alyson

Developing, majority, or Global South?

Imagine two lists of countries. One list includes Honduras, Nepal, and Ghana. The other has the United States, France, and Japan. Which list would be most likely to include Sweden?

That’s easy. The more difficult question is: What heading do we put on these two lists? The United Nations calls them Developed and Developing, and it has another category called “Least Developed Countries.” In writing about the aid industry, I frequently need to refer to these various groups, so I’ve explored the issue. I flatly reject the U.N. term “Developed Countries,” but there are no well-established alternatives to the U.N. terminology. Here’s what I’ve found in use.

Third World. This term appeared during the Cold War, when countries allied with NATO were defined as First World; the Soviet Union sphere was Second World; and others – largely former colonies – were the Third World. In actual usage, however, Third World was largely used for poorer, non-European regions. Switzerland was non-aligned, but nobody called it a Third World country. With the end of the Cold War, the term came to be synonymous with what are more often now called developing countries, or the Global South.

Some considered “Third World” too arbitrary, but that charge could be leveled at any system that divides nearly 200 diverse nations into two or three categories. I think it fell from use for the same reason that bell-bottoms did: It just became associated with a past era.

Global South, Global North. These terms are widely used in recent years. The obvious objection is that geography is more complicated than that, but so what? It’s a common feature of language that new terminology acquires a different meaning from its literal meaning. The writers I most admire often use these terms. I’ve done so too.

The West. Again, once you get beyond the literal geographic meaning, this is understood, even if its exact boundaries aren’t always clear. It doesn’t have a good counterpart; William Easterly’s 2006 book was titled The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good. But “the Rest” doesn’t work as a stand-alone term.

The majority world. I haven’t been able to track down who first used this, for what was once called the Third World. It’s appealing, because it emphasizes that “the Rest” are actually most of the world, not some leftovers, and that those of us born in the West have a highly skewed view of what life is like for most of this planet. I’ve incorporated it into my writing on occasion. Because it’s new and not widely used, I don’t use it too often because that might draw attention to the term itself, rather than the subject matter. I hope it will catch on.

Developing countries. Every country is developing, some in a more promising direction than others. I’m developing a blog, Jack is developing an ulcer, and bacteria worldwide are developing resistance to antibiotics. The word is practically meaningless. And yet, we all, broadly speaking, understand the phrase “developing countries.” Because the choices are limited, I sometimes use it reluctantly, and will do my best to help develop (there we go again!) alternatives.

The lords and the hordes. I came up with this myself, after a couple of drinks. The idea was to show how each group, at least on some occasions, views the other. I’m not going to use it, if I can get people talking about international aid as “karma colonialism,” that’s enough for me. If you wish to write about the lords and the hordes, go ahead, but please don’t tell anybody where you got it.

I do draw the line at one noxious U.N. term – “developed countries” – with its implication that certain countries have reached a qualitatively different stage, one that all others should and do aspire to. Let’s hope not! The globe does not have the resources to supply those levels of consumption, nor do the atmosphere and seas have the capacity to absorb its exhausts.

Moreover, as the world gallops toward environmental disaster, many fundamental assumptions of Western society, including the push for ever more consumption, urgently need to be challenged. The wealthy countries need to genuinely learn from others – and this is an entirely different thing from saying, “We can all learn from one another” while taking a Thai cooking class. Calling themselves “developed” simply gives these countries a sense of moral superiority, which in turn becomes their permission to meddle in other societies as they wish. Instead of “civilizing” the uncivilized, they will now “develop” the undeveloped. We need to seek better ways to structure human societies, rather than suggesting some countries have it all figured out.

Notes and Sources

Majority world map: Ken Myers, in a map posted on Reddit, originally identified this circular area (now known as a Valeriepieris circle) containing a majority of the world’s population. Our image uses a map created by Strebe under a CC-BY-SA 3.0 license, onto which we’ve added the circle. This may be used under a Creative Commons CC-BY-SA 3.0 license.

The author: Sasha Alyson has been active in the literacy and education fields in Southeast Asia since 2006. He writes regularly about how development projects frequently undermine the countries they claim to help.

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