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Richard Feinmann on aid to Africa

13 May, 09 | by BMJ Group

Richard Feinmann Sitting here pondering as a VSO doctor in Uganda I wonder all the time is the aid money to Africa well spent. Uganda gets £70m from the Department for International Development (DFID) and Africa gets about £1.2 billion. I feel some of it could be spent differently.

Uganda’s maternal mortality rate is 50 times greater than in the UK, infant mortality rate 100 times greater and UK has 40 times more doctors per 100,000 population.

So, as Paul Collier says in his book, Uganda is definitely in the “bottom billion” of world population.

He argues that being landlocked, having corruption, governance problems and conflict etc make it almost impossible for Uganda to escape from this undesirable club. Presumably the credit crisis makes things worse.

I have tried to get a child to the UK for treatment. Getting past the passport, visa and cost of air flights barriers can be overcome, but then you come to the NHS and the barrier swings shut. NHS units have budgets which would mean a UK child would lose out if an African child was given priority treatment.

But there are heart patients, cancer patients, and kidney patients who cannot be treated in Uganda. The infrastructure and resources are just not there. Okay, malaria, AIDS and TB are the biggies, and reasonably funded, but does that mean if you get renal failure you have to die?

So might the UK redirect some of its zillions of aid on units in the UK where a child could be treated and African doctors and nurses trained?

It was one of the saddest episodes of my NHS life when the UK virtually stopped overseas doctors from working in the UK. Yes, we needed more UK trained doctors, but why not train Ugandan doctors alongside them?

They will want good salaries once they are trained and may not wish to go back to Uganda, but this could be dealt with.

Help the Ugandans to help themselves with well trained health care workers. At the same time the extra manpower in UK can be used to lift the barrier so that enlarged specialist units can treat complex Ugandan patients.

Richard Feinmann is a general and chest physician who retired early after a serious health scare. He felt he had more to give and jumped at the chance to work with his health visitor wife in Uganda.

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  • Mark Struthers

    Richard Feinmann said,

    “Yes, we needed more UK trained doctors, but why not train Ugandan doctors alongside them? They will want good salaries once they are trained and may not wish to go back to Uganda, but this could be dealt with.”

    How? How can you deal with the UK trained Ugandan doctor who does not want to return to the poverty, overwork and chaos of African medicine? What African countries like Uganda need is an army of capable clinical assistants and clinical officers – doctors in all but name – but not exportable to predatory and pampered countries in Europe and the US. I made this suggestion in a BMJ rapid response entitled, ‘The heroes of African medicine’ back in October 2005.

    http://www.bmj.com/cgi/eletters/331/7519/755#118176

    I had responded to the following paper, ‘Confronting Africa’s health crisis: more of the same will not be enough’ – and the case of Fred Zyinga, the African hero.

    http://www.bmj.com/cgi/content/full/331/7519/755

    PS. I was born on the top of Nakasero Hill, one of the seven hills of Kampala – in 1956. I am also proud to have reached the top of Margherita peak, the summit of Mount Stanley in the Ruwenzori, the fabled ‘Mountains of the Moon’ – on New Year’s Day 2003.

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