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Matiram Pun: Obama wins – a pretty optimistic outlook for the world

11 Nov, 08 | by BMJ

Matiram PunKenya’s people have shown an enthusiasm bordering on fanaticism over the US presidential election and declared a national holiday after Barack Obama’s win. But it was not only Kenya and the whole of Africa that showed an interest in the election. The whole world did, because Obama was the outsider’s choice. In Iran, Turkey, and the Arab countries Obama’s victory has been celebrated as win that will bring difference and change. The same is true for Asia.


Everyone is interested in the world’s superpower leaders, but why are people so extraordinarily interested this time? What do people expect from Obama’s presidency? What is so special about his policies? Will he be able to meet the expectations of all these people and countries?

What about the long term impact of Obama’s win on the healthcare systems of Asia, Africa, and other developing countries? Many health professionals in the US and others who are preparing to move there are particularly happy about Obama’s win.

The medical “brain drain” has been causing much debate in the developing word. Analysts have often blamed policies in developed and Western countries that have allowed the latter to import qualified staff from the former. BMJ editorialist James Johnson wrote “The rich countries of the North must stop looting doctors and nurses from developing countries“. Countries such as the US, UK, Canada, and Australia have attracted huge numbers of qualified doctors and nurses from the developing world (Mullan F. The metrics of the physician brain drain. N Engl J Med 2005;353:1810-1818). Even more worrying is the fact that most of them are there to work – not to try to gain higher degrees, doing research, and return to their home countries with better qualifications. Foreign medical graduates are recruited to community and service oriented hospitals in the US rather than university and academically oriented hospitals.

The developed world is flexible about the migration of health professionals from the developing world into their countries. They welcome qualified staff in whom they have not had to make any investment. Will flexibility about healthcare workers’ migration be one of Obama’s policies? We will have to wait and see. When Tony Blair became the UK prime minister in 1997, similar ideas prevailed, but later on EU policy meant that Asian doctors looked towards Australia and the US. Even now, US hospitals prefer American medical graduates, making it difficult for foreigners to apply for residency programmes. Are developed countries producing fewer health professionals than they need, or too many of all their graduates working in research and universities rather than providing everyday medical services to their fellow citizens?

With an Obama presidency, there might be changes in laws on abortion, contraception, and research – particularly stem cell research. People have high expectations as a result of Obama’s win. I believe his win will inspire similar enthusiasm, expectation, and participation around the whole world.

Matiram Pun is a junior doctor from Nepal and is working in Kathmandu. He has a special interest in mountain medicine and high altitude physiology.

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  • Joseph W. Blackston, MD, JD

    Dr. Pun is grossly misguided in his assessment of the US healthcare staff. While many outside of the “states” are ecstatic over the election of Barack Hussein Obama as President, almost NO-ONE employed in the Healthcare services (yes, that is Doctors, Nurses, and everyone else) supports Obama or his policies.

    The reason is that most of the individuals who work in US healthcare do not desire a move toward even more “socialization” of the US healthcare system. The US system is far from perfect but strangely, as Dr. Pun points out, doctors and nurses from everywhere else in the world seem to want to come to the US. Why would this be??

    The US Healthcare system is successful today because of free enterprise. Nurse and physician satisfaction is directly correlated to greater professional independence, and freedom to practice good medicine. When government intervenes with controls, restrictions, and bureaucracy, patients suffer and the practice of medicine suffers.

    Obama will NOT make this condition better, he will absolutely make this worse.

    I would respectfully request that Dr. Pun limit his opinions to medical issues in areas of his specialty, and not opine on US political issues on which he is woefully un-informed.

  • Matiram Pun

    Dear Dr Joseph W. Blackston,

    Thank you very much for your comments to this blog. I really appreciate your time and highly value your points here.

    There will be hardly any difference on who will provide a better picture about Obama and his policies other than American citizen who are living there and closely following him. Of course, it will vary individually, with political polarization, personal preference leaving any biased views behind. It is extremely exciting that you are coming here to give your views on the issues which makes the blog complete. Otherwise, it would remain unilateral and presumably accepted by all!

    Obviously, we are lacking statistics on how many from US Healthcare services support Obama or don’t! However, I still strongly believe that there is significant portion of Healthcare services in US that support Obama or his policies. Here I am trying to give an outsiders view on Obama’s win and long term impact on health professionals’ migration to Developed world (UK, Australia and of course US) from Developing countries in the background they are ecstatic with this win. It is rather my observational and analytic view than my personal opinion or feeling.

    I agree with Dr Joseph that the US Healthcare system is far from perfect. I wonder if there is any perfect that exists. But there are ample evidences that the Doctors and Nurses are moving to US. I wonder what is inside view from US general public, Doctors and Nurses!

    I again reiterate my conclusion on that (condition), we will have to wait and see what will exactly happen with Obama.

    Thank you Dr Blakston for your sincere request about not to opine on US political issues! Yes I’m neither interested nor right person to do that. Here I have given a scenario of medical brain drain and health professionals’ attitude from developing country in the perspective of Obama’s win. Therefore, the blog on itself is far away from US Political issues and Healtcare system.

    Best wishes,
    Matiram Pun
    Junior Doctor
    Nepal

  • Sanju Lama

    A plausible and personal opinion from Dr. Pun; and may touch many unspoken thoughts from the medicos of the developing world. Although it seems like asking for or expecting a bit too much from president elect Obama at this point, as everyone knows, the world and people do not seem to stop speculating his moves in all major aspects-economics, immigration, defense/security, science and medicine. The list goes on.
    Dr. Blakston does sound correct and clear in his opinion regarding the direction the US healthcare may take under Obama in future and why it may be so popular among the health care workers worldwide, yet why the politicians make it a major issue in each election time, and even come close to winning because of it! It’s true that the competitive market based health care system is the main factor behind it, giving more freedom within the law to practise ethical medicine.
    So where does it stand from the physicians’ and nurses point of view/ from the politicians/policy makers’ point of view, and most importantly from the people/patients’ point of view?
    The bottomline is “what has worked so far will still work in future too; until and unless somebody wants to drastically “change” the whole set up, which was the very argument/vision that the Obama campaign started with and pulled through so far; and hence inviting the worldwide speculations and expectations!” As responsible individuals, we are allowed our personal yet well informed opinions on matters around the world. With the consideration that the US still holding the topmost position in world politics and its presidency still being called the world’s highest office position (i put it on the media though), only time will tell where this whole scenario moves from here, with or without Mr. Obama’s take on the controversial yet seemingly successful health care system. Optimism remains the name of the game.

    (There is no conflict of interest.)
    Sanju Lama
    (MBBS,Nepal)
    Currently, Mountain medicine and high altitude program,
    Faculty of Medicine,
    University of Calgary, Canada.

  • Rajib

    hi sanju,

    so you are in canada!!
    i just found you in the course of surfing the web.

    Rajib

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