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

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.