Helping Africa's Doctors

A consultant for the Centre for the Research on the Epidemiology of Disaster, a WHO Collaborating Center in Belgium, Voahangy Nombanahery Ramahatafandry, MD, MPH '97, is a native of Madagascar and has worked as medical officer for WHO, Médecins Sans Frontiéres and the European Union.

What's the most critical public health problem facing Africa right now?

The doctors there need better salaries and more training. Most doctors can hardly survive on what they make. They can't afford even a motorcycle but must walk everywhere. In Madagascar, I met one woman doctor who worked in a faraway village. If she needs to get her paycheck or see her boss, she has to take a three-hour boat ride, then [spend] three or four more hours in a bush taxi ("taxi brousse"). Many Malagasy doctors are like that, sent to villages that are so isolated that they're separated from their families. That situation does not help improve the quality of care.

How important is continuing education for African doctors?

Listen, I believe if you don't speak English and don't know computers, you are left on the side of the road, marginalized. Once you have the MD degree, that's when you have to start continuing medical education because medical science is growing so fast. For doctors to have access to the Internet, to have information and knowledge—like that offered by the Bloomberg School'sOpenCourseWare program—that is crucial.

What can the West do to help Africa to help itself?

Among other things, phase out, or at least lower, the agricultural subsidies that currently allow farmers in Western countries to dump cheap agricultural goods overseas. Take the example of cotton. Mali used to be a monoculture of cotton because the French had decided Mali should grow cotton. This was okay for a while and people had enough money to live.

But now the U.S., the E.U., China, India—they're all dumping cheap cotton in Mali and the cotton-growing peasant can no longer subsist. And that's just cotton; there are other subsidies for corn, rice, wheat, soy—the peasant farmers can't compete.