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Background: The migration of health professionals in Africa, medical brain drain, deserves critical attention due to its adverse effects on the healthcare system (HCS) for developing nations, which indirectly impacts population health outcomes and creates greater inequity among vulnerable populations. In the case of Nigeria, the international and internal migration of medical doctors (MDs) has created a great challenge for public health systems; it worsens already weak healthcare systems, which widens the health inequalities gap worldwide. Globally Nigeria ranks among the worst countries in regards to maternal health outcomes. Although it represents 2% of the global population, it disproportionately contributes to nearly 10% of global maternal deaths.Aims and Objective: The aim of this study is to examine the impact of the brain drain on Nigeria’s HCS from the perspective of Nigerian MDs in the United States (US) versus Nigerian MDs who remained in Nigeria. The social ecologic model was used as a framework to examine push factors out of Nigeria and pull factors into host countries such as the US.Methods: A thematic analysis of qualitative data (key-informant interviews) obtained from a convenience and snowball sample of 17 MDs residing in Nigeria and the US.Results: Nearly all participants, 94% (17 out of 18), confirmed that a shortage of Nigerian medical doctors living and working throughout Nigeria exists acknowledging a medical brain drain impacting Nigeria’s HCS. The medical brain drain, which exacerbates the shortage of MDs, indirectly causes adverse effects on all health outcomes especially maternal and child health in rural/low-resource communities.Conclusion: There are many effects of the health care systems that are both directly and indirectly influenced by the shortage of available MDs such as doctor burnout, work related stress and medical negligence; all negatively impact patient experience, patient health outcomes and job satisfaction of MDs. Despite challenges associated with the shortage of available MDs, the Nigerian government in collaboration with health care administrators and MDs both abroad and at the home front can work towards strengthening Nigeria’s health sector through various development initiatives to regulate, support and sustain the health care system.

1 Abstract This study explores the lived experiences of Foreign-Trained Black Immigrant Medical Doctors (FTBIMDs) who are International Medical Graduates (IMGs), finding work and working in the United States of America. Their identity construction as Blacks in America renders them racialized and undervalued. In bringing to the forefront the problem of “doctors becoming doctors,” this dissertation uncovers the difficulties and challenges for FTBIMDs who go through the long and winding process of finding work and working in the USA. This research is informed by Racial Formation Theory (Omi & Winant, 2015), Post-Colonial Theory (Fanon, 1967), Borderlands Theory (Anzaldua, 1987) and Forms of Capital Theory (Bourdieu, 1986). As a pioneering study, post-intentional phenomenology (Vagle, 2014) is utilized as a methodology for data analysis. Data sources included in-depth interviews and participant observations with13 Foreign-Trained Black Immigrant Medical Doctors. Six major findings or “tentative manifestations” (Vagle, 2014) emerged from the study. These include: 1) finding work is a challenging endeavor; 2) medical residency and licensing is complex; 3) there is the occurrence of brain waste; 4) difference is a hindrance; 5) the immediate and extended family well-being is affected by the process of FTBIMD finding work and working in the U.S.A. and 6) the FTBIMDs utilize coping mechanisms. These tentative manifestations have important implications for the theory, practice, and policy. There is a need for policies geared at removing obstacles to the medical residency and licensing system without lowering standards. Given the health care needs of the diverse population utilizing FTBIMDs and IMGs would be a way of attempting to provide health security as well as attending to the Doctor Shortage in the U.S.A. Licensing FTBIMDs/IMGs would also foster family literacy including, parental involvement in 2 the successful education of children in school and bridge the intergenerational gap for the future workforce. Keywords: Medical Doctors; immigrant employment; brain waste; intellectual Borderland; Black and race. Cette étude explore les expériences vécues par les Médecins Noirs Immigrés Formés à l'Etranger (MNIFE) / Diplômés Internationaux en Médecine (DIM), dans la recherche de l’emploie et en travaillant aux États-Unis d'Amérique. La construction de leur identité en tant que Noirs en Amérique les rend racialisés et sous-évalués. En soulignant de manière pointue le problème des « médecins devenant médecins », cette thèse révèle les difficultés et les défis des (MNIFE) qui traversent le long et sinueux processus de la recherche d’un emploi et dans leur emploie aux États-Unis. Cette recherche est éclairée par la Théorie de la Formation Raciale (Omi & Winant, 2015), la Théorie Postcoloniale (Fanon, 1967), la Théorie Borderlands (Anzaldua, 1987) et la theorie des Formes du Capital (Bourdieu, 1986). Du fait que cette étude est pionnière, la phénoménologie post-intentionnelle (Vagle, 2014) a été utilisée comme méthodologie pour l'analyse des données. La source des données incluait des entrevues approfondies et des observations des participants auprès de 13 médecins formés à l'étranger. Six conclusions majeures ou "manifestations provisoires" (Vagle, 2014) ont émergé de l'étude. Il s'agit notamment des suivantes : 1) Trouver du travail est une entreprise difficile ; 2) la résidence médicale et la délivrance du permis sont complexes ; 3) le phénomène de gaspillage des cerveaux est observé ; 4) la différence est un obstacle ; 5) le bien-être familial immédiat et élargi est affecté par le processus de recherche et 3 de travail des MNIFE / DIM aux États-Unis et 6) Les MNIFE utilisent des mécanismes d'adaptation. Ces manifestations provisoires pourraient avoir des implications importantes sur la théorie, la pratique et les politiques. Il est nécessaire de mettre en place des politiques visant à éliminer les obstacles au système de résidence médicale et de délivrance du permis sans baisser les standards. Compte tenu de la diversité de la population et leur besoin de santé, accroitre des opportunités pour les MNIFE (DIM) de devenir médecins autorisés aux États-Unis, serait une façon de faire face aux disparités de santé. Tout comme L'utilisation des MNIFE et des DIM serait un moyen de tenter de combler le besoin de la sécurité sanitaire, ainsi que de répondre au problème de la pénurie des Médecins aux Etats-Unis. Donner aux MNIFE / IMGs la possibilité d’exercer favoriserait l'alphabétisation familiale, y compris, la participation des parents dans la réussite de l'éducation des enfants et briserait l'écart intergénérationnel pour la main-d'oeuvre future. Mots clés : Médecins, emploi des immigrants, gaspillage des cerveaux, frontière intellectuelle, noir et race.

This dissertation examines the history of the creation of a deeply divided and unequal medical educational and health care system in South Africa. During the 20th century the training of medical practitioners and the type of health care services that they were to provide was directly influenced by racial segregation ideology and discriminatory policies. During World War II, it came to be realized that the training of non-European students had to be of the highest western biomedical standards; however, this training was to be provided in racially segregated institutions to produce black doctors to practice amongst their own communities in a racially divided health care service. This thesis focuses on the racially segregated training provided by the University of Natal's non-European medical school in Durban. Due to apartheid restrictions on the provision of black medical training elsewhere in the country, this school was for many years the main institution dedicated to providing medical education for black students. Segregated medical education in apartheid South Africa unfolded as a site of struggle and as a setting of contradiction. While the school played a pivotal role in providing training on a segregated basis that separated blacks from whites and produced non-white doctors to work in a racially segregated profession in line with apartheid educational and health care policies, the school also became a contested educational and political space where some students challenged the apartheid state and its policies. The medical school's anomalous establishment set up as a black school under the control of the more liberal white University of Natal, and its training of a multi-racial student body, who were allowed to live and study together, provided a unique opportunity for students to intermingle across state-designated racial categorizations and provided space for political discussions and activities to take place among them around shared grievances. The emergence of a powerful Black Consciousness student politics during the 1970s was one key consequence. The formation and operation of the Durban medical school was thus critical to both the struggle against apartheid, but also the construction of a racially segmented medical profession in the country whose effects are still present in post-apartheid South Africa.