Bitter Pills:Medicines & The Third World Poor | Page 29
INAPPROPRIATE TRAINING
The chronic lack of trained health workers is one of the major obstacles to
providing basic health care to the majority of the rural poor. Most governments
recognise the urgent need to train paramedics and to develop referral systems to
support them. But in most cases demand far outstrips the number of health workers
successfully trained.
Meanwhile, large sums of money continue to be poured into training doctors who
emerge from medical schools with no intention of working in the rural areas.
Moreover, many of the skills the doctors acquire are not relevant to their country's
most pressing health needs. Dr. Mahler, Director General of the World Health
Organisation, underlines the deficiencies of conventional medical training: "Most
of the world's medical schools prepare doctors not to care for the health of the
people but to engage in a medical practice that is blind to anything but disease
and the technology for dealing with it." (17)
Doctors' training is very expensive. It rarely opens the students' eyes to their
country's major health problems or to an awareness of the social and economic
roots of ill-health. In Bangladesh medical students spend far longer than their
British counterparts studying subjects such as anatomy, at the expense of gaining
an understanding of disease prevention and common health problems. They are
encouraged to depend on medicines. For example, throughout five years' training,
not a single lecture is devoted to appropriate non-drug treatments for diarrhoea,
although diarrhoeal diseases account for over half the country's illness. |l8) It is
hardly surprising that these doctors prescribe expensive anti-diarrhoeal drugs and
rarely encourage oral rehydration, which would enable people to take advantage
of a safe and inexpensive means of saving lives.
Most Third World medical students come from wealthier families and many are
totally ignorant about the reality of life for the mass of the poor. Neither their
background nor their training motivate them to work in the rural areas where
conditions are primitive and health facilities very basic. Many opt for private
practice and specialised medicine. A Brazilian doctor sees the trend as so wellestablished that the first question invariably put to newly trained doctors is what
they plan to specialise in. He comments that "Specialisation is getting so far-fetched
that there will be specialists in the retina of the eye and the right hand".