Tuesday, April 1, 2008

Window on Eurasia: Central Asia Losing Doctors to Russia

Paul Goble

Baku, April 1 – Despite widespread opposition among many Russians to guest workers from Central Asia, officials in some parts of the Russian Federation are actively recruiting medical professionals from that there, exacerbating health crises in that region and generating new tensions in and between Russia and governments there.
One reason Russian officials are taking this step is that salaries for doctors in many regions are very low– averaging 5,000 rubles (220 U.S. dollars) a month in Ryazan, and as a result, fewer than half of Russian MDs are working in their profession, Novyye izvestiya said yesterday (http://www.newizv.ru/news/2008-03-31/87453/).
But for Central Asians, these Russian salaries are far higher than they could ever hope to receive at home, and consequently, the paper said, more and more doctors from Central Asia and especially Tajikistan, a country where there are now only 680 family practitioners for its more than six million residents.
Not surprisingly, some officials in Central Asia are worried about this brain drain. On Saturday, President Emomali Rakhmon lashed out at his country’s medical profession, complaining that its members were not doing enough at home and were too willing to go abroad (http://www.centrasia.ru/news.php4?st=1206942420).
Because the doctors are leaving the country or choosing not to work at their profession – only 37 percent of Tajik medical graduates over the last three years are currently employed as doctors – Rakhmon said, Tajiks are forced to travel “from villages to the cities and even beyond the borders of the country” to get the treatment they need. Besides the inconvenience and expense involved and the tragic reality that many simply have to forego treatment as a result, Tajikistan’s shortage of medical practitioners puts at risk plans to cut maternal mortality by 75 percent and infant mortality by 67 percent over the next seven years, the Tajik leader said.
It is not surprising or even unusual that many Tajik doctors go to Russia. Indeed, as Sergei Kolesnikov of the Russian Academy of Medical Sciences told the Moscow paper this week, “England and the U.S. for a long time have sought to solve the problem of a deficit of medical cadres by attracting foreign specialists.”
But if what Russia is doing falls within a general pattern, there are several important differences. First, Russian officials are recruiting medical professionals from countries whose titular nationalities also are supplying many of the lower skilled guest workers many ethnic Russians do not like.
Second, because Russian medical salaries are so low, many Russian doctors now sell medications on the side to make ends meet, a practice that at least some of the “immigrant” doctors may fall into as well and generate even more antagonism to their ethnic group.
And third, as doctors leave Central Asia, the epidemiological situation there continues to deteriorate. As a result, ever more of the guest workers from there are bringing diseases with them, thus intensifying anti-immigrant attitudes among Russians (www.dpni.tv/varticles/pomoshh_/264/ and www.rg.ru/2008/03/28/reg-jugrossii/gastarbayter.html).
Consequently and as often happens, the strategy Russian officials have adopted to deal with one problem – a shortage of doctors – has simultaneously undermined healthcare in Central Asia, inflamed Russian public opinion, and complicated Moscow’s relationships with Central Asian leaders.
And there may be yet another problem ahead, Kolesnikov pointed out. If Central Asian doctors continue to arrive, that will depress medical salaries, likely leading to a situation in which fewer Russian doctors will work in their profession and even to one in which some Russian doctors will not be able to find jobs in their profession.

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