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37

So it is time to come back to the series on Globalization.

Human Capital Flight or Brain Drain is the migration of educated and skilled professionals from less developed places to more developed places. The usual reasons are going abroad for further education and settling there or taking jobs in developed countries for better salaries and living standards. While brain drain does result in financial profit for the persons migrating or their families they may remit money to, there are other less realized aspects of brain drain that also need to be considered.

Expense of education borne by less developed country, while fruits of the person's service are reaped by developed countries.  Today's outrage on Twitter was the government making it mandatory for doctors going abroad for further education to return to work in India after completing their education and reserves the right to enforce it by not issuing No Objection Certificates to doctors who don't comply. The government of India estimates some 3,000 doctors who studied in government subsidized hospitals have left the country in the last one year. The annual cost of each student is about 31.31 lakh rupees, while fees charged are Rs.850/- per annum. The government is paying the difference per student that results in no gain to the citizens. 939 crores is no amount to sneeze at. In a country with high poverty, scarcity of medical professionals and tight budgets, this money should be better utilized or recovered.

As far back as 2001, the UNDP had estimated that India loses about $2 billion a year from IT professionals taking up jobs in the US alone.

Some argue that those working abroad remit money. But a country's well being is not money alone. When 3000 doctors go abroad, there are supporting jobs that get reduced too. Less nurses, less ward boys, less patients treated, more losses due to ill health, less villages with access to healthcare... it is all interconnected - which is why governments subsidize - for development.

On a "for higher education" scale... a 2009 report by Associated Chambers of Commerce and Industry (Assocham) estimated that India lost around $10 billion annually in foreign exchange from an average 5 lakh students choosing to go abroad for further education every year and made a strong case for deregulating higher education. The concern of the Indian government that doctors going abroad for further education return to work in the country makes sense. But more is needed. here need to be more and better education facilities to keep the students in the country - which will also result in more jobs within the country. It is a cycle.

The government spends considerable money in education from basic schooling to subsidizing degrees that have costs well beyond the average man's capacity to spend. This expense is intended as an empowerment of citizens as well as raising the skill capital of the country. Brain drain delays the development of the country. In his essay on Globalizing Inequality, P. Sainath quotes statistics from Africa from the Economic times, and puts them in a context of national interest.

...today, according to the Financial Times, the entire continent of Africa has just 20,000 engineers and scientists to serve a continent of six hundred million people, because today, there are more African scientists and doctors and engineers working in the United States than in all of Africa and much of this drain of medical personnel has come from South Africa – the country facing the world’s largest AIDS pandemic.

Lower employment in developed countries. Migrant professionals increase competition to native professionals and often work at lower salaries, resulting in increased unemployment for the local population. UK's visa restrictions for professionals from 2010 came from rising unemployment in the country with hundreds of thousands unemployed IT professionals and engineers while 36,000 immigrated for jobs from outside the EU. As the economy tightens worldwide, these inequalities become more and more visible and resented.

But beyond this, there is also a social cost. When well educated people leave for more prosperous surroundings, their influence also leaves with them beyond their services. Educated minds lead to a more thinking society and increasing brain drain adds to the less developed areas remaining permanently mired in poverty and less world aware society.

Brain drain, or Human Capital Flight increases inequality and makes poorer countries poorer and richer countries richer. A few random examples come to mind. Michio Kaku, the scientist-activist calls the H1B America's secret weapon. It is the visa for professionals to immigrate. Over half of America's top professionals are non-Americans and they are driving the country's prosperity, because they change the ratio of educated and skilled professionals in society - making the country skill dense and thus with more opportunity too. On the other hand, if India has one doctor for 1700 people, Ghana has one for 6700 people. 305,000 Malaysians migrated overseas between March 2008 and August 2009 compared to 140,000 in 2007. According to the official Chinese media, 65,000 Chinese last year secured immigration or permanent resident status in the United States, 25,000 in Canada and 15,000 in Australia in 2007. A 2007 study of Chinese students found that 7 out of 10 students enrolling abroad never return. And while it is true that lack of opportunity or oppression drives or abundant opportunity pulls these people, these numbers of people moving to greener pastures is also making the pastures greener, and their loss is desertifying the pastures they leave.

Many have recommended deporting/encouraging return of Pakistani professionals back to Pakistan as a possible solution for dealing with extremism by increasing powerful, influential voices who have seen the merits of a developed and inclusive society. Obviously no one imagined them to pick up guns and fighting wars with the Taliban, but the influence of thoughts that were more broad minded would dilute the influence of extremism and provide alternative ways of thinking for people at large. In other words, they would strengthen the moderate voice. It is no coincidence that reversal of brain drain was suggested as a developmental intervention.

Needless to say, I support the government's decision to make it mandatory for doctors to serve in the country even if they go abroad for further education. In addition to doctors studying in government colleges, I think doctors studying in private colleges should also be required this, though for a shorter period. There are reasons - below.

  1. Whether a government or private educated doctor, the government still has made considerable contributions to making that education possible and in the cost that is possible in India. Consider, for example an Indian doctor and an American doctor working on similar jobs, paying off their education loans. Even if the Indian doctor gets paid less, guess who finds the payments easier? That is the difference in a developed and developing country, which makes a developing country more needy. I see nothing wrong in citizens with the capacity to pursue extensive education being expected to have a stake in helping develop the country.
  2. I think this should apply to all professionals, not only doctors, though doctors have more conspicuous investment and scarcity of professionals.
  3. This should not apply to those who do all their degree education abroad, since their investment is also in another country.

I got several significant comments, which I'd like to talk of here.

The medical students are already giving in a lot of effort for 7-8 years to go through a shabby education system. Give them adequate compensation/incentives to work in rural areas. Monetary/reduction in study term/preference in PG admission. ~ Raj Rambhia [1][2]

This, I think is a matter of education reform, and applicable to all students whether they continue working in India or abroad.

the question of how the students can "give back" is indeed a serious one. the number of students that manage to study medicine in India is largely due to government subsidized education. Two issues here 1. How do you get them to "pay us back" and 2. What about all who studied in private colleges.

1. Lets say, 4.5 years of studies and the avg. 10 lakh that the govt spends on a student can be reimbursed in 1 year of internship and 1 year of Bond. The bond already exists, and lasts 6 months long. Problem is, there is no enforcement. Is 6 months enough? will one year fix this? Difficult decisions to make. In the 6 months, of the docs who do it seriously, a large number of them see upwards of five hundred patients a week, many do twice as many. thats a few hundered thousand patients treated by the lot of them, does that cover the costs?

Now, they get to go abroad only after they finish the bond, and get a NOC. The new "law" adds a clause to the NOC, it says studies that you do on your own money, in your own time, also, now belong to the nation. Meaning, you come back, irrespective of how many years you have worked in India. and "given back"

2. What about all those who did not study in government colleges? Like me. My college made me do a bond, 2 years paid pittance and on call24x7, I enjoyed it, as did most others I know. Now, 3 years down the line i might want to go work in the US for 10 years, maybe my wife wants to do a PhD, but if I go by the j1 Visa, i cannot, my visa expires when I finish studying.

~ Uberschizo

I am not certain even in this instance the government is speaking of private colleges, though I support even if they are. Also, I am not certain the government means stints working in India for every higher education course. The impression I got was mandatory serving in India, which would be a one time deal. Let us see what clarifications emerge.

Additionally, I think for exceptional cases, there should be an alternative to reimburse the government for the money invested in their education in stead of working, though I hesitate to recommend this, because it isn't only about money, but a professional less in the country. Also, extremely specialized doctors would find it far cheaper to pay back than invest time, but our country needs the neurosurgeons more than the money.

I think some of this also ought to be in reforming education so that students form attachments in the country and genuinely care about the need of the country, which will go a long way toward making this easier for all.

Another comment referred to this as a "communist" choice. I disagree. It is about as communist as the country making the specialized education possible and affordable or people earning more also paying taxes at higher rates. On the other hand, it is capitalist in an exploitative way to the interests of people of both countries to get educated using resources of a poorer country, depriving someone of them, and then going abroad to undercut salaries for doctors who have invested far more money to get qualified there.

In my eyes, while specific solutions may be good for specific groups of people, governments being responsible for entire countries, have a responsibility to make decisions that will help all. The decision to enforce professionals to serve in the country impacts thousands of lives beyond that student alone.

6

Physicist Michio Kaku said in a video "If you have been exposed to Cesium 137 because you are an atomic worker, even after you are dead and buried your graveside will be radioactive. Your great grandkids can come with Geiger counters and see that great granddaddy still has radiation at his graveside"

It is a very big thought to compute. For a person dead and buried for years to still be radioactive. That also happens to be the reality of radiation. Today, every person in their thirties has been alive for two grade 7 nuclear disasters in our world. Considering that both have resulted in massive radiation and exclusion zones, it is easy to see how big a phenomenon nuclear contamination is.

But apart from these, there are hundreds smaller accidents that have happened. Fuel leaks, partial meltdowns, other contamination. Nuclear testing has deposited some nuclear contamination worldwide. Add to it nuclear contamination hidden by governments for economic or political reasons, like our Baloch friend describes in his interview. Our world is radioactive. The only difference between us and the nuclear exclusion zone is that our exposure is within what is called acceptable levels.

I can't help but wonder at the number of "radioactive people" we have. People who may be outside exclusion Zones, but their gravesides will still be radioactive.

Much has been written about prevention, treatment and harms of radiation. I think it is time for medicine to explore how people live with radiation along with how they die. Adapt better to it. A principle of Appreciative Inquiry is that we find what we seek and we can create positive change by seeking what we wish to see happening and enhancing it.

To me, it makes sense that along with learning how to "prevent and fix damage" of radiation, the time has come that we study what makes some people live long and healthy lives in spite of being exposed to radiation. Are there factors that can be duplicated to bring hope to others similarly contaminated?

Much information on increasing incidence of cancers and such. And I definitely don't deny it. Radiation must be avoided. Exposure to radiation must be avoided and treated as far as possible. Yet, we don't have enough resources to do it at times, it seems.

TULGOVICHI, BELARUS: The only villagers of the deserted Belarussian village of Tulgovichi, 370 km southeast of Minsk, inside the 30-km exclusion zone around the Chernobyl nuclear reactor, cellebrate the Orthodox Annunciation, 07 April 2006.

Not even half of those displaced by Chernobyl are properly rehabilitated yet. The ones from Fukushima are still in a limbo till more is known of their fate. Researchers state that 0.2% of all aid is targetted at the elderly. Yet, we have people who refused to leave and Samosely who moved into abandoned homes - living lonely, but largely healthy lives within exclusion zones. Eating contaminated food, drinking contaminated water, rearing contaminated livestock.

Many say that the Samosely fake health so that they aren't forced to leave exclusion zones. Yet, it is quite difficult to fake being alive if you aren't. It is quite difficult to live alone in your 80s unless you are reasonably healthy. Farming own food, working to sustain livestock... And they are invariably old. And many among them have died. That is more health than what many elderly people in cities have.

Then, there are the Baloch, who claim that Pakistan's nuclear testing in the Chagai region, that turned Raskoh mountain black released radiation that is killing the Baloch population and causing inexplicable defects. The truth of this is very difficult to ascertain considering that Pakistan doesn't allow independent media into Balochistan, but the photos and information these people have put up on the net is compelling and rather difficult to explain without the white elephant of nuclear testing in the room. Yet there certainly are enough Baloch to fight an enduring war against the Pakistani state. They grew up in this environment and they seem to be fine in a physical sense, if not politically, nationally or in human rights.

Other studies describe mixed opinions on the wildlife in the Chernobyl exclusion zone. Some say it thrives without human interference, others say the diversity is decreasing and worrisome mutations are happening. Dotted among these are stories of natural adaptation. Mice that had left the region after the humans left seem to be back and better able to deal with radiation. Species develop mutations, but there are also animals thriving.

Scientists experimenting with mice have been able to medically assist them to survive lethal doses of ingested radiation by treating them with drugs.

In the Emmy Award winning NOVA - Inside Chernobyl's Sarcophagus, scientists who have worked at Chernobyl for a long time are giving interviews in their old age. They speak of colleagues dead from heart failure but not Acute Radiation Sickness. Whatever precautions they took seemed to have protected them from coming to unimaginable harm working as they were directly at ground zero.

Yet, the common factor is also neglect. Whether it is the Baloch, the Liquidators, the scientists, the people of Pripiyat who lived in deadly doses of radiation for days before being evacuated, the people of Fukushima who claim they aren't provided enough information to protect themselves, the workers in Fukushima who didn't have personal dossimeters for the initial months of the crisis... the common thread running through is that they are left largely to their own devices. The resulting guesses born of need for information and lack of it are dismissed for being ignorant.

We may not have cures for Radiation exposure, but we do have cures for malnutrition, lack of safety gear, prompt information, for heart problems, for adequate testing and prompt prevention, and many problems plaguing these people.

Research into centenarians has been conducted to study longevity. Is it possible to study longevity among people exposed to radiation? There is an astonishing pool of neglected people who could serve to create answers.

A person had commented on some site, that these people seem to live in defiance if what we know as science, but it is possible that while they get a lot of radiation, the otherwise clean air and lack of other pollutants allows their bodies to compensate and remain healthy. While this may not be true, an interview of one such person describes the alternative accommodation provided by the Ukranian government as damp and emotionally unsatisfying, sharing a home with strangers. This accommodation was still difficult to get... Possibly a contaminated person wouldn't thrive like that, but might in an area of less radiation, but otherwise healthy life? We don't know. But we ought to find out. Research guides wise choices. Otherwise it is only paranoia - however scientific sounding.

Health is not a singular, linear thing. Also, if we are surrounded by loads of ambient radiation, and we have exposures we deem safe, is it a matter of degree rather than absolutes? And if so, is there a way to research how we can enhance our tolerance so that we are less susceptible to increases in radiation? Is there a way for more people exposed to radiation live functionally fit like the Samosely?

I think that these people have something that could be studied for the benefit of mankind. They ought to be supported better for this information they could provide us and possibly create better lives for others who have been exposed to large amounts of radiation, which currently includes populations of at least two cities and hundreds of villages already. It is not a small number.

As long as nuclear power continues to be used, we can't count on these numbers reducing. We can't even count on knowledge prevailing over political priorities or economic cutting of corners or plain indifference to potential consequences.

Now there are farmers in Fukushima who are unwilling to leave. As long as we continue to use nuclear power for electricity, as long as we fight wars, the possibility of exposure of people to radiation can never be ruled out, and it is too late to begin research after a disaster.

Recently, a researcher said that the radiation exposure after Fukushima could have been drastically less if people had used masks in the days immediately after the accident. Simple pollen masks eliminated almost all the inhaled cesium and two thirds of ingested iodine. The only thing is that it was published nine months after the accident.

Is there a way to create a cohesive system of guidance aiming at maximum functionality and effective practices that will lead to it? I am talking of a world standard that governments can simply duplicate across their countries for effective responses and better management of survivors. IAEA, are you listening?

Disclaimer: I am not recommending keeping people exposed to radiation, but using people living with radiation already to learn how they live long anyway.

Disclaimer2: I am aware that popular view holds anything less than outright condemnation and paranoia of radiation as inadequate. That doesn't bother me, obviously.