The loss of skilled medical professionals from low and middle-income countries to staff the health systems of the US, UK, Australia or Canada is a global public health problem.
For example, in Romania, the number of healthcare professionals leaving the country is not monitored, but locals report that the best and brightest medical professionals emigrate in significant numbers for well paid work abroad. In amongst the exodus of well educated, multi-lingual young professionals, stands the figure of Raed Arafat, an immigrant to Romania, and a physician. Raed has developed popular and effective emergency medical services during Romania’s transition from communist to post-communist state and is a key player in the national politics of health. When he was under secretary of state at the Romanian Ministry of Health, Raed Arafat resigned in protest over privatisation plans for healthcare services. In response, thousands of citizens took to the streets to demonstrate support for Raed Arafat’s principled stance. Arafat was quickly reinstated to his job, and subsequently promoted to minister. He remains a popular figure, who is focussed on establishing a sustainable emergency medical system, rather than making political capital from his success. Here’s Raed Arafat explaining (in Romanian) why his emergency system works so well.
Raed Arafat was born in Syria in 1964 and grew up in West Bank, Palestine, where as a teenager he volunteered with the fire service and in a local hospital’s operating theatre. By the age of 17 he had migrated to Cluj-Napoca, Romania for medical training, which led to specialist training in anaesthesia and critical care in the Transylvanian city of Târgu Mureş.
By 1989 Romania’s authoritarian government was toppled. In 1990, Raed Arafat, (by now Dr. Arafat), had bought a second-hand emergency medical vehicle equipped with a defibrillator and resuscitation kit from the German Red Cross. He used his own money and funds from his friends to establish an effective emergency-medical system, initially in Târgu Mureş, gradually expanding across Romania. The service, which now covers the whole country, is known as SMURD, and is managed by county Fire-Fighting services and integrated with county Ambulance and other emergency services. Raed Arafat became a Romanian citizen in 1998, but his status as a former immigrant and the voluntary, self-funded nature of his work throughout the 1990s, underlines a selfless dedication. That the emergency medical service he helped to establish is both needed and appreciated by the Romanian populace was a significant part of the popular protests that spread in 2012.
Consider now the minister of health in England, Jeremy Hunt, who can only dream of a show of public support. Equally, British citizens can only dream of a health minister opposing privatisation and austerity cuts, and prioritising the democratic development of a universal health service rather than his own political fortunes.
In Romania public health as a discipline and a practice is in its infancy, so perhaps a single minister of health can have a clear impact.. Arafat’s dedication to building a useful service and defending it from privatisation is nonetheless a heartening reminder of what is politically possible in Europe today.
The author spent a week in 2013 as a guest of The Cluj School of Public Health.