By the mid-1960s a steady drain of Caribbean doctors to Canada, USA and the UK, was subsidising these already well-endowed health systems, and depriving the struggling Caribbean economies of millions of rare dollars annually. This uncompensated loss denied the region of half or more of the annual output of doctors from the University of the West Indies (UWI). This book, "PGME at the UWI, Stemming the Brain Drain from the Caribbean", deals with the challenges poor nations face when they seek to develop educational programs of high standard, free of external vested interests and control. It describes the actions taken at that crucial time in UWI history, soon after its independence from London University, when it was expanding, facing financial and social difficulties, with internal want and unrest, and external pressures threatening its integrity. This was a time of global conflict, the Cold War and student protests, spreading in and from the USA. The author, immersed in this problem from the mid-sixties, and the need for other reforms, became the first full-time Dean of the Medical Faculty in 1971, and worked with medical colleagues, and a few from other faculties, and with external agencies, whose names are given, to combat the forces threatening the UWI's existence as a regional body, and destroy its potential to unite the 14 units of the Commonwealth Caribbean that funded it, and gave its scholars a place and a voice. Given the bare minimum in resources, he and others-many named in the book-initiated a series of reforms and innovations in medical education, programs and policies to produce a range of specialists, family doctors and other manpower, and start a novel division of Community Medicine, of which details are provided, tailored to Caribbean needs. By these incentives to graduates, they hoped to stem the "brain drain." Jamaica's PM Manley urged him to turn "fantasy to reality", and other Caribbean leaders agreed. The plan was bold and costly, but they persisted, over the skepticism, gratuitous criticisms and ridicule of some influential foreign observers, and later "threats" by US entrepreneurs, who were luring each island for use as bases for US medical education for profit. Ten years later, one skeptical journalist who had labelled him a dreamer, summarised his work as "high quality on a low budget." Today, the UWI Health Sciences Faculty thrives on three campuses, produces enough doctors, generalists and specialists, for Caribbean needs and some for export even! The output continues: from aides and assistants to nurse practitioners, administrators and educators, family and specialist doctors, dentists, veterinarians, and a range of technicians and basic scientists, through Masters and Doctorate programs, who now provide medical services for the Commonwealth Caribbean. Community Medicine was not pursued, but the concept, described in the text, remains valid and survives as a document that had received preliminary approval by the Ontario Ministry of Health, but shelved. The book includes tables of data, photographs, and an Appendix with copies of original documents and published papers.
About the Author: Dr Mohan Ragbeer is a polymath, who recently retired from the practice of geriatrics, health promotion and disease prevention, following a career as a Professor of Pathology and medical educator at McMaster University, Hamilton, Ontario. He graduated in 1957, MB, BS (Lond.) from UCWI, Jamaica, a London University College, and after three and a half years in Guiana and Britain, returned to Jamaica to join the newly independent UWI. He became immersed in educational issues: student evaluations and examinations, which he revised, and adapted the curriculum to the needs of Caribbean Health Ministries. In January 1969, he was appointed Associate Dean for Education and Student Affairs, and composed regulations for specialty training. In 1971, he became the first full-time Dean of the Faculty, reformed its structure and administration, started residency training (PGME), and Community Medicine (CM), supported by the Jamaica Government, Caribbean Health Ministers (now CARICOM Ministers of Health), HOPE Foundation, and PAHO. Kellogg Foundation and Pan-American Federation of Associations of Medical Schools (PAFAMS) supported CM. Despite scarce resources, he succeeded in launching specialty training and laying the basis for Faculty expansion to Trinidad, Barbados and the Antilles. The book relates the problems he and colleagues faced of newly self-governing, economically deprived islands caught up in the hangover from colonialism, as the Cold War raged worldwide, and inevitably involved them. The UWI was unique: a single university serving fourteen states-raised by the British as competing colonies-left to struggle, cooperate and relate with their University, individually and collectively. Schisms among the major partners, and ideological conflicts, threatened university programs in the seventies, but he and colleagues persisted, despite political turmoil, and established sound bases for reforms and innovation in medical education; the book describes the issues, events and personalities. In 1977, he joined McMaster University, retiring in 1996 to pursue a career in geriatrics, holistic primary care, and other interests: writing, photography, and history, publishing two books, "The Indelible Red Stain", on Guyana, (Amazon, 2011 & 2016, in 2 volumes, each 700 pages; and "India, under siege," the enemy within.(Amazon, 2015, 515pp.) He writes a current affairs column for Toronto's Indo-Caribbean World newspaper, and is working on an autobiography.