Reasons for Doctor Migration from South Africa

Background: The migration of doctors from their home countries is not a new phenomenon. Apart from voluntary migration due to various reasons; medical professionals; often from sub-Saharan Africa; are actively recruited by developed countries. Doctors in South Africa are esteemed for the high standard of training they receive locally; a quality which renders them prime candidates for employment. Various factors are involved in the push-pull theory of migration. It has; however; been reported extensively that push factors usually play a much greater role in doctors' decision to leave their countries of origin; than the pull factors in the host or recipient country. Push factors motivating migration most frequently include dissatisfaction with remuneration packages and working conditions; high levels of crime and violence; political instability; lack of future prospects; HIV/AIDS; and a decline in education systems. In addition to a depletion of intellectual resources through losing highly qualified and skilled individuals; source countries also face substantial monetary implications caused by the migration of doctors. The cost of training medical students is subsidised by the government; and could be regarded as a lost investment when young graduates seek permanent employment abroad. The aim of the study was to investigate the profile of South African qualified physicians who emigrated from South Africa. Methods: The investigation was conducted in 2005 as a descriptive study where the participants were primarily found by the snowball sampling method. The initial group of participants were known to the researcher. Participants had to be graduates from South African medical schools/faculties; living abroad and in possession of a permanent work permit in the countries where they were employed. Short-term locum doctors were not included. Information; consent letters and questionnaires were either hand-delivered or e-mailed; and completed forms and questionnaires were returned via these routes. Participation was voluntary. Results: Twenty nine of 43 potential participants responded; of which 79.3were male and 20.7female between the ages of 28 and 64 years (median 47 years). The year of graduation ranged from 1964 to 2000 (median 1985); and the year of leaving the country ranged from 1993 to 2005 (median 2002). The majority (72.4) were in private practice before they left; 27.5had public service appointments and 17.3were employed by private hospitals. Seventy nine percent of respondents had postgraduate qualifications. Countries to which migration occurred included New Zealand; United Arab Emirates; Bahrain; United Kingdom; Canada; Yemen; and Australia. Forty one percent of respondents indicated that they would encourage South African young people to study medicine; although 75would recommend newly graduate doctors to leave the country. Financial factors were indicated as a reason for leaving by 86.2of the respondents; better job opportunities by 79.3; and the high crime rate in South Africa by 75.9. Only 50of the respondents said that better schooling opportunities for their children played a role in their decision to leave the country. Approximately one-fifth (17.9) of the respondents indicated that they already had family abroad by the time they decided to emigrate. Conclusions: Financial reasons were the most important motivating factor in this particular group of doctors who relocated to overseas destinations; followed by working conditions and the rate of crime and violence in the country. In comparison to other investigations published previously; the results presented here clearly indicate a tendency that more doctors offer financial and crime-related reasons for migration from South Africa than before. In order to prevent the loss of medical expertise from a society already in need of quality healthcare; issues compelling doctors to look for greener pastures should be addressed urgently and aggressively by stakeholders

Knowledge of and Attitude towards Pain Relief during Labour of Women Attending

Objective: This study determined women's knowledge of and attitudes to pain relief during labour. Methods : This descriptive study included 151 women; 18 years or older; attending the antenatal clinic of Cecilia Makiwane Hospital. Women were interviewed using a questionnaire that determined their knowledge of and attitudes regarding pain relief. Results : The median age of the women was 29 years and most was pregnant for a second or third time. More than half the women (56.3) indicated that they knew about pain relief and most had received their information from a previous labour experience (56.5) or from friends and relatives (55.3). Of the women who had knowledge of pain relief (n=85); 65.9 had experienced severe pain during previous labour and 65.3 indicated injections. Half the women (51.7) believed that they should experience mild pain; however; while 55.7 of these had found the experience to be unacceptable. Most women (59.8) who had been pregnant were not told what to expect when in labour. Of those who had been told (n=41); 75.6) and good (31.2 found the information useful. The women who had previously delivered in a health facility rated the service received in relieving labour pain as fair (47.3)). Most of the women (99.3) believed that the staff had an important role to play in helping to relieve labour pain. Most of the women (78) expressed no concern about problems associated with pain relief methods; while a large number (83.4)expressed little or no confidence in labour pain relief.Conclusion : Most of the women gained knowledge regarding pain relief from past experiences or from friends and relatives. Even though the few women who received information about what to expect during labour found the information useful; most expressed little confidence in labour pain relief

Patients' satisfaction with government health care and services in the Taung district, North West Province.

This was a descriptive study that determined patients' satisfaction with health care in the Taung district state health institutions, North West Province. One hospital, three health centres and five clinics were randomly selected, and consecutive patients were recruited at outpatients during 17 May 2000 - 17 June 2000. The patients completed a questionnaire regarding the service or care provided. Five hundred and sixty seven patients participated in the study. The median age was 30 years, and most patients were female (76.7%). More than half of patients (56.8%) were not satisfied with the availability of medicines and other supplies. Approximately two thirds of patients (65.2%) did not know about the quality of telephone services rendered. There was a high level of dissatisfaction (63.1%) among patients regarding accessing doctors after hours. Most patients were satisfied with the general attitude of health workers (62.1%) but 21.2% were dissatisfied. Few (11.7%) patients felt rushed during consultation. Most patients felt they received good health education when their illness was discussed (74.6%). Words and explanations used were easy to understand (76.7%); and they were not discouraged from asking questions (69.9%, n=539). Generally the level of satisfaction among the patients was high except for difficulty in accessing doctors after hours and lack of medicines.

Scientific Letter : The Prevalence of the Diagnosis of Increased Intra-Ocular Pressure in a General Practice

Glaucoma is one of the main causes of blindness. The disease occurs in 3 to 4 of all people over the age of 70 years. As many as 50 of patients suffering from this disease are unaware of their condition until a comparatively late stage; due to the asymptomatic nature of the disease

Effect of fatigue on knee proprioception: implications for dynamic stabilization.

The high incidence of injuries that occur later during a session of sports or recreational activities suggests that fatigue may contribute to altered neuromuscular control of the lower limb and an individual's subsequent altered ability to dynamically stabilize the knee joint. One possible mechanism is a fatigue-mediated alteration in proprioception. This paper reviews experimental evidence of fatigue-induced changes in knee joint position sense and movement sense, or kinesthesia. We will discuss the possible physiological mechanisms behind these changes, including the role of joint and muscle receptors in proprioception and neuromuscular control of the knee, and the role of fatigue in changes in afferent output from muscle and joint receptors. We will then explore the implications that alteration in proprioception may have for dynamic stabilization of the knee joint.

Knee strength deficits after hamstring tendon and patellar tendon anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to examine the strength of the knee flexors and knee extensors after two surgical techniques of ACL reconstruction and compare them to an age and activity level matched control group. METHODS: Twenty-four subjects who had undergone ACL reconstruction greater than 1 yr previously were placed into one of two groups according to autograft donor site: patellar tendon (BPB; N = 8) and hamstring (H; N = 16), and compared with an active, control group (N = 30). Knee flexor and extensor strength was evaluated using isovelocity dynamometry (5 speeds, eccentric and concentric, 5-95 degrees ROM). Strength maps were used to graphically analyze strength over a broad operational domain of the neuromuscular system. Average strength maps were determined for each autograft group and compared with controls. A difference map (control minus graft group) and confidence (t-test) maps were used to quantitatively identify strength deficits. RESULTS: The combined ACL group (N = 24) revealed a global 25.5% extensor strength deficit, with eccentric regional (angle and velocity matched) deficits up to 50% of control. Strength deficits covered over 86% of the sampled strength map area (P < 0.01). These knee extensor strength deficits are greater than previously reported. In addition, the BPB group demonstrated a concentric, low velocity, knee extensor strength deficit at 60-95 degrees that was not observed in the H group. Significant graft site dependent, regional knee flexor deficits of up to 50% of control were observed for the H group. CONCLUSIONS: Strength deficits localized to specific contraction types and ranges of motion were demonstrated between the ACL and control groups that were dependent upon autograft donor site. Postoperative rehabilitation protocols specific to these deficits should be devised.