Correspondence
European Centre for Disease Prevention and Control. Expert consultation on scientific evidence linked to polio virus in Israel and Syria. http://ecdc.europa.eu/en/publications/ Publications/Expert%20consultation%20 mtg%20report%20-%20polio%20Israel%20 Syria%20-%20final.pdf (accessed Feb 12, 2014).
Immigration for health care in Iran: burden or blessing? With increased violence in neighbouring countries, immigration to Iran for health care has amplified in recent years. Patients presenting with traumatic injuries (from roadside bombs, mines, bullets, etc) have increased. These injuries are often large and involve multiple organs.1 Victims, especially civilians who have no protective gear, require extensive medical interventions and lengthy rehabilitation, specific medical knowledge, expertise, and equipment. Clinicians in Iran are well acquainted with these types of injuries because of their experience in treating warfare injuries during the Iraq–Iran war. Iran’s neighbouring countries like Afghanistan, Iraq, and Pakistan have been the scene of civilian attacks during the past decade. Violence and conflicts have also risen in other Middle-East countries such as Lebanon, Egypt, and Syria in the past months. Because of the geographic proximity and low-cost and relatively high quality of health care in Iran, referral of patients from neighbouring countries has been high. However, migration of these victims to Iran has posed an additional burden on the health-care system. During the past 3 years, we treated 214 victims transferred from Iraq at our three trauma centres in Tehran. Many victims had received emergency treatment before being transferred to Iran. But no data were available regarding the primary diagnostic or therapeutic interventions received abroad before transfer. None of the patients’ records specified how they were transferred from the site of the www.thelancet.com Vol 383 March 22, 2014
incident to the first hospital or from the first hospital to the border. As a result, our medical centres had to do a complete diagnostic work-up to evaluate patients’ conditions on admission—imposing an extra financial load on the Iranian health system. For these victims, the average hospital stay was 13·43 days, which is longer than the 5–8 days trauma patients usually stay, 2 placing an additional financial burden on the health system. Iran’s health policy is to help war victims, and these financial burdens, covered by the government, seem unavoidable. We declare that we have no competing interests.
Hadi Khoshmohabat, *Mohammad Hosein Kalantar Motamedi, Masoud Saghafinia, Amin Shams [email protected] Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran 1
2
Saghafinia M, Nafissi N, Motamedi MR, et al. Assessment and outcome of 496 penetrating gastrointestinal warfare injuries. J R Army Med Corps 2010; 156: 25–27. Motamedi MH, Khatami SM, Tarighi P. Assessment of severity, causes, and outcomes of hospitalized trauma patients at a major trauma center. J Trauma 2009; 66: 516–18.
Emigration: an opportunity for Iranian physicians, a challenge for the government In recent years, many Iranian medical graduates emigrated to other countries for work or postgraduate education. 1,2 There are different reasons for this phenomenon and most of them are missed or ignored by the Iranian Government. Iranian medical students have to go through a difficult and highly competitive entrance exam, followed by a tough process to access better professors, and spend their internship in poorly equipped hospitals. Interns face long working hours and lack adequate support, accommodation, internet
access, and regulations. And above all, they do not have many hopes for their postgraduate education. The residency entrance exam is much harder than the medical school entrance exam. Every year, many attend this exam but with very limited capacity in universities only a few can continue. For those who want to work as a general practitioner, the work is in difficult conditions in deprived areas and it can be very diffcult to get permission to establish a practice in a big city. The lack of a proper referral system is also an important flaw of the Iranian health-care system, and it generates uneven distribution of income, with some specialists earning a lot of money, while many general practitioners do not have a decent income.3 Because of this unpleasant prospect, many Iranian physicians prefer to emigrate to other countries for a brighter future. And successful Iranian scientists and physicians abroad encourage their fellows to continue their education outside Iran. This brain drain weakens the healthcare system and is harmful for the country. With the recent failure of policies such as the family physicians project, 4 many physicians choose emigration and the challenging process of adaption to new culture and language. To address Iranians’ pressing health issues, such as HIV, public awareness and trained medical staff are required, but the pace of physician emigration could damage any effort to improve the health of the Iranians.
Hasan Sarbakhshian/Associated Press
5
We declare that we have no competing interests.
Faezeh Shams, *Amin Shams [email protected] Private Practice, Tehran 14689 93113, Iran 1 2 3 4
Mullan F. The metrics of the physician brain drain. N Engl J Med 2005; 353: 1810–18. Panahi R. Factors affecting the brain drain from Iran. J Basic Appl Sci Res 2012; 2: 3003–15. Iravani MR. Brain drain problem: a review. Int J Bus Soc Sci 2011; 2: 284–89. Shalileh K, Mahdanian A. Family physicians’ satisfaction in Iran: a long path ahead. Lancet 2010; 376: 515.
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European Centre for Disease Prevention and Control. Expert consultation on scientific evidence linked to polio virus in Israel and Syria. http://ecdc.europa.eu/en/publications/ Publications/Expert%20consultation%20 mtg%20report%20-%20polio%20Israel%20 Syria%20-%20final.pdf (accessed Feb 12, 2014).
Immigration for health care in Iran: burden or blessing? With increased violence in neighbouring countries, immigration to Iran for health care has amplified in recent years. Patients presenting with traumatic injuries (from roadside bombs, mines, bullets, etc) have increased. These injuries are often large and involve multiple organs.1 Victims, especially civilians who have no protective gear, require extensive medical interventions and lengthy rehabilitation, specific medical knowledge, expertise, and equipment. Clinicians in Iran are well acquainted with these types of injuries because of their experience in treating warfare injuries during the Iraq–Iran war. Iran’s neighbouring countries like Afghanistan, Iraq, and Pakistan have been the scene of civilian attacks during the past decade. Violence and conflicts have also risen in other Middle-East countries such as Lebanon, Egypt, and Syria in the past months. Because of the geographic proximity and low-cost and relatively high quality of health care in Iran, referral of patients from neighbouring countries has been high. However, migration of these victims to Iran has posed an additional burden on the health-care system. During the past 3 years, we treated 214 victims transferred from Iraq at our three trauma centres in Tehran. Many victims had received emergency treatment before being transferred to Iran. But no data were available regarding the primary diagnostic or therapeutic interventions received abroad before transfer. None of the patients’ records specified how they were transferred from the site of the www.thelancet.com Vol 383 March 22, 2014
incident to the first hospital or from the first hospital to the border. As a result, our medical centres had to do a complete diagnostic work-up to evaluate patients’ conditions on admission—imposing an extra financial load on the Iranian health system. For these victims, the average hospital stay was 13·43 days, which is longer than the 5–8 days trauma patients usually stay, 2 placing an additional financial burden on the health system. Iran’s health policy is to help war victims, and these financial burdens, covered by the government, seem unavoidable. We declare that we have no competing interests.
Hadi Khoshmohabat, *Mohammad Hosein Kalantar Motamedi, Masoud Saghafinia, Amin Shams [email protected] Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran 1
2
Saghafinia M, Nafissi N, Motamedi MR, et al. Assessment and outcome of 496 penetrating gastrointestinal warfare injuries. J R Army Med Corps 2010; 156: 25–27. Motamedi MH, Khatami SM, Tarighi P. Assessment of severity, causes, and outcomes of hospitalized trauma patients at a major trauma center. J Trauma 2009; 66: 516–18.
Emigration: an opportunity for Iranian physicians, a challenge for the government In recent years, many Iranian medical graduates emigrated to other countries for work or postgraduate education. 1,2 There are different reasons for this phenomenon and most of them are missed or ignored by the Iranian Government. Iranian medical students have to go through a difficult and highly competitive entrance exam, followed by a tough process to access better professors, and spend their internship in poorly equipped hospitals. Interns face long working hours and lack adequate support, accommodation, internet
access, and regulations. And above all, they do not have many hopes for their postgraduate education. The residency entrance exam is much harder than the medical school entrance exam. Every year, many attend this exam but with very limited capacity in universities only a few can continue. For those who want to work as a general practitioner, the work is in difficult conditions in deprived areas and it can be very diffcult to get permission to establish a practice in a big city. The lack of a proper referral system is also an important flaw of the Iranian health-care system, and it generates uneven distribution of income, with some specialists earning a lot of money, while many general practitioners do not have a decent income.3 Because of this unpleasant prospect, many Iranian physicians prefer to emigrate to other countries for a brighter future. And successful Iranian scientists and physicians abroad encourage their fellows to continue their education outside Iran. This brain drain weakens the healthcare system and is harmful for the country. With the recent failure of policies such as the family physicians project, 4 many physicians choose emigration and the challenging process of adaption to new culture and language. To address Iranians’ pressing health issues, such as HIV, public awareness and trained medical staff are required, but the pace of physician emigration could damage any effort to improve the health of the Iranians.
Hasan Sarbakhshian/Associated Press
5
We declare that we have no competing interests.
Faezeh Shams, *Amin Shams [email protected] Private Practice, Tehran 14689 93113, Iran 1 2 3 4
Mullan F. The metrics of the physician brain drain. N Engl J Med 2005; 353: 1810–18. Panahi R. Factors affecting the brain drain from Iran. J Basic Appl Sci Res 2012; 2: 3003–15. Iravani MR. Brain drain problem: a review. Int J Bus Soc Sci 2011; 2: 284–89. Shalileh K, Mahdanian A. Family physicians’ satisfaction in Iran: a long path ahead. Lancet 2010; 376: 515.
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