North Hamptonshire Heartlands primary care trust
Money is not the magnet that draws African doctors to the NHS, says Dr Akeem Ali, who works in public health in Wellingborough - it's the desire to improve their skills. But he also says that African doctors are often left disillusioned by their experiences in Britain. "I have absolutely no problem with overseas doctors coming into the UK," says Ali. "I can say that with full understanding of the implications of what I'm saying. But when they come, the opportunities open to them are very limited and there is a misunderstanding between their aspirations and what they can eventually get access to."
Ali has obtained a sought-after specialist post as a registrar, which means he is on course to become a consultant if he passes the right exams, but many overseas doctors cannot get training posts and end up in what is called career grades - senior house officers or registrars that do not lead to a consultancy.
"Doctors come because they want to train. But then they get sucked into the system and non-training-grade positions don't give them the opportunity to feel accomplished. Five years on, they don't feel trained and they sit there and don't go back [to their home countries].
"There are questions to be answered," he says. "How many overseas doctors do actually get access to training positions? How many do become consultants?"
It's not just that African doctors stall professionally. Life also throws up complications. They get married or have children and want to educate them in the UK. Eventually, they find there is no easy road home.
"A lot think that they will train and be coming back home in a few years," says Ali. "They end up spending 25 years as a senior house officer."
Planning flu vaccination campaigns in Wellingborough is a long way from Ali's last job in Africa, running a rural district medical centre in Ghana from 1995 to 1998. "I had to travel 40km into the regional capital and 40km back to make a phone call. There was no water - the driver had to fetch water for me to shower or drink."
After the journey from Accra to Nadowli in the Upper West region, Ali almost wrote his resignation before he had even begun his new job. "My car broke down several times on the way because I didn't know what the road was like. I walked in and said to the regional director, 'Sir, my name is Ali and I have been posted here as a medical officer but I'm not staying. My car has lost two tyres, I have driven 14 hours and I'm not staying.' He said, 'Just stay six months.' I stayed three and a half years.
"At first I was seeing everybody who turned up. There was no electricity and I was tired and I had no food and no wife. I would get home at 8pm, I couldn't see and I had nothing to eat. I had biscuits and cereal and powdered milk, but I ran out of water. I ate dry cereal. For the first few weeks I got into the car and drove 40km to the regional capital to eat and drove back home."
But the job was engrossing. He was the only doctor in a district of 90,000 people, seeing every kind of malady. He soon realised that he could not treat everybody and on some days he prioritised immunisation. "It was the beginning of where I am today in public health," he says. "There was not much you could do for individuals, but you could do a lot in health promotion and preventive work."
It was natural to want to specialise further. Accra offered a masters degree in public health, but the competition was acute. Ali began to look abroad. Maastricht was the cheapest university he could find. He took out a loan and bade Ghana goodbye. A year later, he had his degree plus substantial debt. Returning to Ghana was not an option. He signed up with the medical relief charity Merlin for six years of humanitarian work and ended up in a senior position in London before moving into the NHS.
"Obviously, money is a driving factor for the net flow of overseas doctors into the UK," he says, "but most of us leave because we want to acquire some skills or knowledge. That is the drive for me. It is good if I earn more money, but if that had been the motive I would have left before."
He wants to settle now, too. In the past 13 years he has lived in about the same number of countries for at least six months. He has a German wife and a small daughter and the travelling has to stop. But he still wonders whether he should return to Africa.
"I have thought of going back several times. What difference would it make to me personally and what difference would it make to the population I would go and serve? I'm not sure I have a conclusion yet."
