Sunday, November 22, 2009

The long term costs of middle class flight from the Third World

The reality that many educated people are being drawn to the Western world from their home counties is an old and familiar topic. But there is a back side to this process that seems yet to be identified. This is to try to define some of the implications of the problem. The point: the “drain” of talent into the Western countries [I’m mainly thinking about the United States] means that the social and cultural capital of countries desperately in need of that talent is being lost. That loss could eventually cost not only those countries but also the Western world, which must deal with countries bereft of educated middle classes.

One of the most noticeable entailments in this process of educated middle class movement is a flow of trained physicians to this country from other countries. Many countries in fact pay for their citizens – usually the cream of the crop – to study medicine. So their graduates come out of medical school with no debt. At same time the developing countries have the usual problems of graft and administrative incompetence, so that some of the best medical graduates can become frustrated and jaded. And some of them discover that in the United States [or some other western country] medical practice can be more fulfilling and far more profitable. The barrier is the costs of entering a medical career in the West: usually there are exams to take that often require further study. But the incentive is huge: a life in safety, a comfortable way of life, often a superior income, and the opportunity to actually practice medicine and even excel in the profession.

So some of them come to the United States and qualify to practice medicine. What this means for them is that their lives are much improved; they have a good income – one that can enable them to support family members back home – and a comfortable, safe career. Without debt -- unlike almost every young physician trained in the United States, for doctors trained in this country pay for their own education, almost always by acquiring an astronomical debt. Doctors graduating from medical schools in this country have no other option than to work hard, charge the best fees possible, in order to pay off their debt. Doctors arriving from elsewhere, after qualifying to practice, begin in a position to develop their careers with much less concern about financial obligations.

So much for what happens inside the United States, for instance. But the implications for the countries that trained these physicians is a growing and costly loss. Countries that must have professional communities and a viable middle class are constantly having their middle class, their best citizens, siphoned away. I don’t know any numbers, but I fear that the long term consequences of this process are to undermine social and cultural processes that our country needs to take place in other countries. We have a national interest in seeing middle classes prosper all over the world, but the seductive power of the opportunities that our country offers those classes works against that interest.

That’s a problem we see happening in Afghanistan and Pakistan. In Afghanistan, after 2001, when the American military invaded the country in order to punish Al Qaeda, hundreds of Afghans who had been living abroad and had prospered in their respective professions returned to help develop the country. There was much excitement about finally developing their home country and they came, in many cases at their own expense.

As everyone knows, it hasn’t happened the way they had hoped. I fear that most of them – those for instance that I met at a 2002 conference on how to help the country, have given up. I wonder how many have stayed, continued trying to develop the country, despite the disappointing developments.

And what are the implications of losing that enthusiastic community of willing Afghans? Those who were ready to pay their own way, even to sacrifice, to serve the public interest of the country: doctors, bankers, hydrologists, engineers – educated, well trained professionals. What has been lost? It is easy to guess: A loss no one can assess. An opportunity lost that is unlikely ever to return.

For Afghanistan there is a huge need for them, but for reasons we can all appreciate I fear that most have gone back to the West.

I see the same problem in Pakistan. And there the loss may be just as catastrophic. And it is one many of us in this country can easily see in our own communities. The community I know includes many excellent physicians from Pakistan and other Third World countries. Our county in fact cannot do without them. But what does it do to Pakistan? Every day we read on the front page signs of the tragic failure of that country to develop the powerful and dominant middle class that must be established if it will ever establish a productive modern country. Pakistan’s loss, America’s gain. A gain scarcely appreciated in America; a loss scarcely recognized in Pakistan.

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