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In Reply: Dr Pust asks how clinicians in high-income countries can contribute to the attainment of the United Nations Millennium Development Goals and the improvement of health more broadly in low-income countries.

He is correct to draw attention to the dramatic contrast between the physician-citizen ratio in a country like the United States and in sub-Saharan Africa. However, it is important to acknowledge that the United States and other high-income countries contribute to the problem by employing and depending on medical and nursing graduates from many low-income countries.¹ For example, between a third and a half of South African medical graduates emigrate.² The situation may be even worse in poorer countries such as Zambia where, some years ago, it was found that only 50 of the 600 physicians trained by the medical school in Lusaka worked in the public sector health service.³ The situation is similar for nurses. In Malawi, . . . [Full Text of this Article]

Andy Haines, MBBS, MD
andy.haines@lshtm.ac.uk

Gill Walt, PhD; Kelley Lee, MPA, MA, DPhil
London School of Hygiene and Tropical Medicine
London, England

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