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Spare a thought for those struggling to become doctors in Africa

Whilst British university fees have been a heated and controversial subject in the last few years, how many of us have given a thought to the financial problems faced by medical students in Africa?

The continent has some of the poorest countries in the world and consequently some of the least well supplied with doctors and other health care workers. Poor living conditions and lack of resources form perfect conditions for appalling health statistics.

The Ebola outbreak in West Africa in 2014 underlined just how vulnerable many African countries are to new and evolving health threats.

Malawi is one of the most beautiful, but poorest countries in the world. It ranks 170th out of 174 in the World Health Organization lifespan tables; median life expectancy is 54 years. 62% of the population live below the international poverty line of less than US$1.25 per day.

Adult HIV prevalence is 10%. Most people in Malawi will never see a doctor. That is because there are only about 600 doctors, most of whom work in the large cities. That’s one for every 51,000 people. In the UK we have over 200,000 doctors; one per 325 people.

There are even fewer specialists. Two registered cardiologists cover the entire country. Only 8% of paediatrician and 9% of obstetrician posts are filled. But it is not just doctors. There are only 60 physiotherapists in Malawi and 33% of nurses’ posts are vacant.

This chronic shortage of health workers has led to Malawi to have some of the worst health outcomes globally. It is one of the most dangerous places in the world for a woman to give birth: one woman will die from childbirth for every 196 births. The equivalent in the UK is one maternal death per 8333 births.

The lifetime risk of childbirth (the cumulative loss of life due to childbearing over the course of a woman’s life) was one in 36 for a Malawian woman in 2008; in the UK, it was 1 in 4,700. It is the same for children’s health: for every 1000 children born in Malawi, 110 will die before they turn five.

One of the reasons for the shortage of doctors and other health workers is the cost of education. Although primary education is free in Malawi, secondary schooling is not and the cost is crippling for large families, especially in rural areas. Consequently children often drop out of school in order to support their families who have often lost the bread winner to ill health.

It is a vicious cycle of events that perpetuates poverty and despair.

The situation is much worse for those very few who have the opportunity for higher education. Although the government subsidises training, a large part of the cost of medical and nursing school has to be met by the families. Consequently many bright and capable students drop out of college and this often happens in their final years when the prospect of graduating is tantalizingly close.

The situation has recently been exacerbated by the government increasing the mandatory student annual contribution by over six-fold to the equivalent of £834, an astronomical amount for most families.

The UK based charity Medic to Medic works to alleviate this situation by financially supporting students who would otherwise abandon their studies. Started in 2007 by a British junior doctor, the organisation initially enlisted UK doctors to support Malawian medical students (hence its name). It now has donors from the general public and has grown to have over 50 student medics, nurses, physiotherapists, pharmacists and health assistants on its books.

Students are selected by interview and their progress carefully followed by written reports and visits from the charities staff. Here is the story of one:

Elizabeth was raised by her mother in a polygamous family following the death of her father. She has 17 siblings. She had multiple breaks in her education because her family could not afford to pay her secondary school fees. In order to register at the College of Medicine she worked as a housemaid and skipped meals to save money. But, despite all her efforts she was told that she would have to drop out of university and re-register the following year as she had not secured enough funds. Elizabeth was selected as a Medic to Medic student. Now she doesn’t need to worry about her tuition fees, she doesn’t have to skip meals and she can concentrate fully on her studies so that she can graduate as a doctor to help the people of Malawi.

Medic to Medic often continues its support after graduation and encourages graduates to work in rural areas where the need is greatest. One of its first graduates will complete her postgraduate training in neurology this year and become the first female Malawian neurologist. With one colleague they will have a catchment population of 18 million!

Global austerity has had its greatest effect on the people in the developing world. Small charities such as Medic to Medic can have an enormous impact on individuals and through them on families and whole communities.

If you would like to help, donate or just know more go to their website at www.medictomedic.org.uk

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