The Migration
of South
African
Graduates
to Canada:
a Survey
of Medical
Practitioners
in Saskatchewan
Abstract
Van derVyver,JDMB, ChB, MFamMed (Stell)
DeVilliers, PIT
M B , C h B , D O M , H o n s B S c M e d S c i (Epid), MFamMed, PhD (Stell)
Correspondence to: Prof. PfT deVilliers
Department of Family Medicine and Primary Care
University of Stellenbosch P O . B o x 1 9 0 6 3
Tygerberg 7505, South Africa pltdv@gerga.su n.ac.za
Keywords: Migration, South Africa, Doctors, Canada, Survey.
Aim of study: To determine the socio-demographic profile of South African doctors who have permanently emigrated to Saskatchewan, Canada, and to find out why they left, how they h a v e a d a p t e d a n d i f t h e y i n t e n d returning to South Africa.
S t u d y d e s i g n : A c r o s s - s e c t i o n a l postal survey.
Method: All South African qualified medical practitioners in Saskatchewan with permanent registration (N=2 l8) w e r e m a i l e d a n o n y m i t y - a s s u r e d questionnaires.A second mailing was sent to non-respondents.
Results:A 59% (N= 107) response was elicited with 35 returned-to-sender. Most doctors (79%) had left South Africa after 1990. Most (58%) qualified at Afrikaans medium medical schools in South Africa. The male to female ratio was 88: | 2. Seventy-four percent Qa%) of respondents were general practitioners. Prior to emigration, 67% of respondents were employed in the
S A Fam Proa 2000;22( I): I 7-22
S o u t h A f r i c a n p u b l i c s e r v i c e . M o s t doctors (59%) earned between R525 000 and R876 000 per year in Canada. Violence was the most important r e a s o n f o r l e a v i n g S o u t h A f r i c a , f o l l o w e d b y p e r c e i v e d e c o n o m i c problems in South Africa and adverse working conditions at State health f a c i l i t i e s . A d a p t a t i o n a n d p o s i t i v e a d j u s t m e n t s i n a n e w l y a c q u i r e d country and lifestyle were evident. Returning to South Africa does not seem likely unless crime and violence diminish substantially,
Conclusion: Most emigrants were male, recently qualified from all the major medical schools in SouthAfrica, w i t h e q u a l A f r i k a a n s a n d E n g l i s h speaking proportions.They left mainly because of fear for their personal security and poor working conditions i n t h e S o u t h A f r i c a n p u b l i c h e a l t h sector.They are well settled in their new country, earn above average i n c o m e s in C a n a d a a n d a r e v e r y unlikely to return.
I n t r o d u c t i o n
The exodus of medical practitioners from SouthAfrica has been a concern for many y e a r s . T h e l a r g e - s c a l e e m i g r a t i o n o f professional people from South Africa c o u l d i m p a c t s i g n i f i c a n t l y o n t h e i n s t i t u t i o n a l , e c o n o m i c , f i n a n c i a l a n d personal levels of society.An apparently rapid increase in numbers occurred since
1990 when the in the country moved towards a democratic political system.
There is a dearth of research on the medical brain drain from SouthAfrica.rr S p e c u l a t i o n a n d v i e w p o i n t s o n t h e reasons for the medical migration from South Africa have put the emphasis on u n a c c e p t a b l e w o r k i n g c o n d i t i o n s , a i n a d e q u a t e r e m u n e r a t i o n , a ' s o o l i t i c a l problems,a'6 violence and crime.T
During the principal researcher's visit to Saskatchewan, Canada, in | 995,the extent
of the problem and the opportunities for research of this matter became evident. In July | 996 there were 2 | 8 SouthAfrican medical graduates on the register of the College of Physicians and Surgeons of Saskatchewan, the registering authority o f t h e p r o v i n c e , w h o w e r e c i t e d a s p e r m a n e n t ( n o n - l o c u m ) m e d i c a l practitioners.sThis represe nted | 4,8% of t h e t o t a l w o r k f o r c e o f 1 4 7 5 c i v i l i a n p h y s i c i a n s ( G e n e r a l P r a c t i t i o n e r s a n d S p e c i a l i s t s ) o f t h e p r o v i n c e . e A Saskatchewan Medical Association study in 199610 oroved that40% of the rural ( t o w n s < 1 0 0 0 0 p e o p l e ) d o c t o r s i n S a s k a t c h e w a n w e r e S o u t h A f r i c a n graduates. According to the Canadian
lnstitute of Health Information 2% (649 general practitioners and 480 specialists) of the 55 006 medical orofessionals in t6e whole of Canada was South African-trained at the end of 1995.
The aim of this study was to gain a better understanding about the phenomenon o f S o u t h A f r i c a n m e d i c a l g r a d u a t e s immigrating to Saskatchewan, Canada. The study objectives were:
( l ) t o d e t e r m i n e t h e i r s o c i o -demographic profile;
(2) universities of original training and sectors of work in South Africa prior to emigration;
fields of training;
why they left South Africa; patterns regarding length of stay; appointments and remuneration in Saskatchewan;
to find out whether they intended returnrnS;
(8) and to probe their adaptation to their new country.
(3)
(4)
(s)
(6)
(7)
M e t h o d s
The study design was a cross-sectional postal survey.The target population was all the South African medical graduates, permanently residing and working in the province of Saskatchewan.The register of the College of Physicians and Surgeons of Saskatchewan, dated 9th July 1996, was used as the source of the mailing list.8This register contained the names, addresses, countries of application for a work visa, university degrees and dates received and, where applicable,the fields of speciality of the registered persons.
A pilot survey was first conducted among three doctors in Saskatchewan to test the study design and questionnaire, three months prior to the undertaking of the s u r v e y . E t h i c a l a p p r o v a l o f t h e f i n a l
A custom designed database program was used for data capturing and analysis. The Epi-lnfo 6.0 1 rr statistical analysis program was used to determine the95%
protocol of the study was obtained from the College of Physicians and Surgeons of Saskatchewan and from the Research C o m m i t t e e o f t h e U n i v e r s i t y o f Stellenbosch, South Africa.
A q u e s t i o n n a i r e w a s s e n t t o a l l t h e doctors with permanent registration (N = 2 | 8 ) w h o h a d S o u t h A f r i c a n qualifi cations.A covering letter explaining the aim and purpose of the study was included.The questionnaire was divided into four sections. In the first,the reasons for leaving South Africa were explored. The second section focused on their P r e s e n t l o c a t i o n , a d a p t a t i o n a n d e x p e c t a t i o n s r e g a r d i n g t h e i r p o s s i b l e return to South Africa.The third section
Statistical
Analysis
confidence intervals for proportions by means of the Fleiss-quadratic method, r o u n d e d o f f t o t h e n e a r e s t in t e g e r . Categorical variables were compared by
covered biographic detail ofthe doctors, t h e i r s p o u s e s , c h i l d r e n , la n g u a g e preferences and current immigrant status. The fourth section covered appointments in Saskatchewan, speciality and specific professional interests. Open and close-ended ouestions were used on different scales, quantifying the responses.
T o t a l a n o n y m i t y o f r e s p o n d e n t s w a s secured by means of a double envelope system.An independent person opened t h e f i r s t e n v e l o o e . T h e f i r s t b a t c h o f q u e s t i o n n a i r e s w a s m a i l e d d u r i n g O c t o b e r 1 9 9 6 . A f t e r r e c e i v i n g 8 8 completed questionnaires by November, a s e c o n d m a i l i n g w a s s e n t t o n o n -r e s o o n d e -r s i n D e c e m b e r 1 9 9 6 .
means of the chi-square test. P-values of l e s s t h a n 0 , 0 5 w e r e r e g a r d e d a s statistical ly signifi cant.
R e s u l t s
One hundred and seven (107) completed questionnaires were received, whilst 35 questionnaires were returned-to-sender, giving a final response rate of 59% (1071
| 83). The 76 non-respondents did not d i f f e r s i g n i f i c a n t l y f r o m t h e 1 0 7 r e s p o n d e n t s in a n y o f t h e k n o w n characteristics on the register.
l. Socio-demographic profile
Eighty-six percent (921107, 95%Cl: 78-92%) of respondents were male, and Afrikaans was the home language of 5l% (55/ 107, 95%Cl:42-61%) whilst residing in South Africa,with 49% English-speaking. T h i s p r o p o r t i o n c h a n g e d s i n c e th e i r arrival in Canada to 60% favouring English a s h o m e l a n g u a g e . T h e m a l o r i t y o f respondents (86%, 921107, 95%Cl: 78-92%) were married, with an average of
1,95 children per family.
M ost respond ents (7 9%, 85 | | 07, 9 S%CI: 70-86%) left South Africa during the 5 y e a r p e r i o d p r e c e d i n g t h e s t u d y ( b e t w e e n | 9 9 | a n d I 9 9 6 ) , l 4 resoondents left between | 986 and | 990, and 8 before 1986
2. Qualifications
Fifty-six percent (60 | | 07,95%Cl: 46- 66%)
obtained their basic medical degree after | 985, and 84% (901107,95%Cl:76-90%) had qualified after l980.The majority of respondents (58%, 621107, 95%Cl 48-67%) obtained their qualification at one o f t h e f o r m e r A f r i k a a n s - m e d i u m universities (Pretoria: 36;Stellenbosch: | 9; Orange Free State:7).The rest (45/107) qualified at Witwatersrand (19), Cape T o w n (1 9 ) a n d N a t a l (7 ) .
Seventy fou r percent (80 1 1 07,9 5%Cl:65 -8 3 % ) o f r e s p o n d e n t s w e r e g e n e r a l
practitioners.The 27 specialists included psychiatrists (4), ophthalmologists (4), orthopaedic surgeons (3) and physicians ( 3 ) . F o r t y - t h r e e p e r c e n t ( 4 5 1 1 0 7 , 95%Cl:34-53%) of respondents also had a d d i t i o n a l u n i v e r s i t y o r p r o f e s s i o n a l q u a l i f i c a t i o n s , o t h e r t h a n a m e d i c a l specialist qualification.These included 20 with postgraduate medical diplomas and 6 with family physician qualifications. The spouses of 87% of respondents (80/92, 9 5 % C l : 7 8 - 9 3 % ) h a d t e r t i a r y qualifications.
Table I: Most important reoson for leaving South Africo cited by
South Africon Medicol Graduates
in Soskotchewan
(N=107)
o/ /o 95"/" Cl
1 . V i o l e n c e
/ L a c k
o f S e c u r i t y
2 . P o l i t i c a l
U n c e r t a i n t y
3 . F i n a n c i a l
O p p o r t u n i t i e s
A b r o a d
4 . l m p r o p e r
F i n a n c i a l
R e m u n e r a t i o n
5 . M e d i c a l
P o l i c y
C h a n g e s
o f t h e C o u n t r y
6. Lack
of Job Satisfaction
Total
4 3
1 9
' 1 8
I J z1 0 0
34-53
1 2 - 2 8
1 1 - 2 7
8-21
a 1 1 z - t z 1 - 73. Employment
Most of the respondents (67%,721107, 95%Cl:58-76%) had worked in the public health sector immediately prior to leaving South Africa.
Forty-six percent (49 I | 07,95%Cl:36-56%) of respondents indicated that they had entered into a contract with a Canadian health authority, which included a time commitment clause, mostly ranging from 3-5 years. Only 34.5% (37ll07,95%Cl:26-44%) of respondents indicated that they had not received any form of subsidy during or after relocation, and also did not have any definite time commitment towards a Canadian authority.
4 . l n c o m e
Fifty-nine percent of respondents (631 | 07, 95%Cl:49-68%) earned a gross income i n C a n a d a o f b e t w e e n R 5 2 5 0 0 0 a n d R876000 per year,with only 23% (241107, 95%Cl: l5-32%) who earned less than R525 000. Seven earned more than one million Rand per year.The exchange rate at the time of the study was 3.5ZAR =
l . 0 C a n $ .
5. Reasons for leaving South Africa The respondents were asked to indicate their most important reason for leaving South Africa, from a list of choices.These are tabulated inTable l.Violence and lack of security was chosen by 43% (461 107, 95%Cl:34-53%). Almost one third (3 l%, 3 3 1 1 0 7 , 9 5 % C l : 2 3 - 4 1 % ) o f t h e respondents indicated that they had been victims of violence.They had either lost f a m i l y m e m b e r s i n v i o l e n c e ( 3 / 3 3 ) , suffered physical harm to themselves or to family members ( 16i33), suffered loss of possessions (26133), received threats ( 9 / 3 3 ) , o r e x p e r i e n c e d p s y c h o l o g i c a l t r a u m a r e l a t e d to v i o l e n c e a n d c r i m e
( e / 3 3 ) .
T h e r e s p o n d e n t s w e r e a l s o a s k e d to nominate other important reasons for e m i g r a t i n g . T h e f o l l o w i n g w e r e n o m i n a t e d : A d v e n t u r e a n d t r a v e l ( 1 6 / f 07);objection to the pre-1994 political s y s t e m (5 / 1 0 7 ) ; a n d o b i e c t i o n to t h e p o s t - 1 9 9 4 p o l i t i c a l s y s t e m ( 4 1 1 0 7 ) .
A s e t o f c l o s e d q u e s t i o n s e x p l o r e d t h e i r r e a s o n s f o r e m i g r a t i o n i n m o r e d e p t h . R e s p o n d e n t s w e r e a s k e d whether they agreed or not with a list
Table fl: Reosons
for leaving South Africa as cited by
South African Medical Groduotes in Soskatchewon
o f s t a t e m e n t s l i s t e d in T a b l e ll . O n c e again the greater majority agreed with statements about the role of safety, i n s e c u r i t y , v i o l e n c e a n d p o l i t i c a l stability.
6 . A d j u s t m e n t
A d j u s t m e n t a n d a t t i t u d e s to w a r d s their new lifestyle in Canada was also e x p l o r e d . R e s p o n d e n t s w e r e a s k e d whether they agreed/ disagreed with a s e t o f s t a t e m e n t s l i s t e d i n T a b l e l l l . lt is clear that most adapted easily to t h e i r n e w p e r s o n a l a n d p r o f e s s i o n a l lives.
7. Returning to South Africa When asked about their plans regarding returning to South Africa, the 60%,(641 107,95%Cl: 50-69%) indicated that it w o u l d b e m o s t u n l i k e l y fo r t h e m t o return. Only 7% (81 | 07, 95%Cl: 4- | 5%) indicated that they were likely to return, although 33% (351 1 07, 95%Cl: 24-43%) w e r e e i t h e r u n s u r e o r d i d n o t r e p l y . Respondents were finally asked to rate certain given factors that may positively i n f l u e n c e a d e c i s i o n t o r e t u r n to S o u t h Africa (Table lV). Low crime, a stable political system and their family in South Africa ranked as the most important factors.
Agree
f/"7
N) 5 " / o L
(Y'1
1. We left South
Africa for our children's
f u t u r e
s t a b i l i t y .
B 6
68/79
7 6 - 9 3
2. The impact
or possible
effect
of violence
o n m e o r m y f a m i l y ' s
l i f e p l a y e d
a r o l e in
mv/ our deoarture.
7 9
84/107 6 9 - 8 6
3 . I n s e c u r i t y
r e g a r d i n g
t h e e c o n o m i c
future
of South
Africa played
a major
Pir!ilry mol-g,:
4 . M y w o r k i n g e n v i r o n m e n t h a d a d i r e c t b e a r i n g o n m y l e a v i n g S o u t h A f r i c a .7 B
8 3 / 1 0 76 B - 8 5
7 q ,76/107 6 1 - 7 9
5 . T h e im p a c t
o f t h e h o s p i t a l
s i t u a t i o n
(personal
safety,
poor hygenic
conditions,
obstruction
to "perform
duties")
had a direct effect
on my
d e c i s i o n
t o l e a v e
S o u t h
A f r i c a .
6 9
74/107 5 9 - 7 8
6 . T h e d e t e r i o r a t i o n i n m y f i n a n c i a l s i t u a t i o n o v e r a p e r i o d o f t i m e l e d m e t o
leave the country.
62
6 6 / 1 0 75 2 - 7 1
7 . f h e u n c e r t a i n t y
a b o u t
t h e s u c c e s s
o f a
future,
national
health
system,
was a
m a j o r
r e a s o n
f o r le a v i n g .
6 0
64/107 5 0 - 6 9
B . T h e p o s s i b i l i t y
t h a t m y c a r e e r
e x p e c t a t i o n s
w o u l d n o t b e r e a l i s e d
i n
South
Africa made me leave.
5 7
6 1 / 1 0 747 -66
9 . I e x p e c t e d
t h a t I w o u l d d e r i v e
m o r e
j o b
satisfaction
in Canada,
which is why I
c a m e
h e r e .
+ J53/107 40-59
l 0 . C h a n g e s
i n t h e S o u t h
A f r i c a n
p o l i t i c a l
I
I
r D i s c u s s i o n
-This survey was conducted only amongst S o u t h A f r i c a n e m i g r a n t s w h o h a v e D e r m a n e n t r e s i d e n t s t a t u s a n d s t i l l r e s i d e d i n S a s k a t c h e w a n . T h e 5 9 % response rate was fair,taking into account the 17% inaccuracy of the mailing list.The respondents did not differ in any of the known attributes on the register from those that did not resoond.
No accurate figures exist on the number of doctors emigrating from SouthAfrican every year.The results of this survey may seem to indicate accelerated emigration (85/ | 07) during the 5 years preceding the study ( | 99 l -1996) compared with those emigrating between 1986 and 1990 (l4l
| 07).The majority of all doctors, however, including South Africans, move out of S a s k a t c h e w a n t o w a r d s t h e d e n s e r populated areas in Canada and the United States of America, within three to five years.ro
A rather surprising finding was the fact that58% of respondents qualified at one of the formerAfrikaans-medium medical schools in SouthAfrica.ln 1997 only 46% of new doctors in South Africa graduated from one of those universities.This finding is a strong indication that emigration of d o c t o r s i s n o l o n g e r c o n f i n e d t o t h e graduates of English medium universities. This is supported by the fact that49% of respondents indicated thatAfrikaans was their home language in SouthAfrica. The 88: l2 male to female ratio of South African doctors in Saskatchewan may indicate a greater likelihood for male doctors to emigrate, since the ratio of male to female doctors in South Africa w a s 7 9 : 2 1 i n 1 9 9 7 . S o m e o f t h e r e a s o n s for this male preponderance could be the r e l a t i v e l y r e m o t e r u r a l s e t t i n g o f Saskatchewan, and the fact that husbands can often not find suitable employment and may have trouble obtaining a work permit.
Exploring the reasons for emigration was an important objective of this study.Two different sets of questions (Tables I and l l ) u n d e r l i n e t h e e f f e c t o f c r i m e a n d violence.The reason to leave SouthAfrica "for our childrent future" (Table ll) ties in with the concern regarding "violence and the importance of safety for a family".
Table lll: Adjustments
ond ottitudes towords o new tifestyle:
Past, Present and future perceptions of South African Medical
Groduotes
in Soskotchewon
A large number of the respondents (67%) indicated that they had worked in the S o u t h A f r i c a n p u b l i c h e a l t h s e c t o r immediately prior to their emigration.A large proportion also indicated that their working conditions (75%) and the hospital situation (69%) played a major part in t h e i r d e c i s i o n t o e m i g r a t e . T h e p u b l i c health sector was therefore the major loser of medical manpower, and working c o n d i t i o n s w i t h i n t h e o u b l i c s e c t o r contributed substantially to this effect. Despite adverse working conditions that were prompting emigration (Table ll), apparent job satisfaction in South Africa has made the option to emigrate an even more difficult choicer2.
Insufficient financial compensation and uncertainty regarding the South African e c o n o m y , c o u p l e d w i t h e n h a n c e d
economic prospects abroad, have played a substantial part in deciding to emigrate (Tables I and ll). Sixty-one percent of respondents agreed that financial reasons played a major role in their decision to emigrate, and it is common knowledge that medical Dractitioners in Canada earn s u b s t a n t i a l l y m o r e t h a n t h e i r S o u t h African counterparts.This is supported by the findings in this study that the majority of respondents have an above average gross income in Canada,even in Canadian monetary terms. Gross income does however not reflect overheads in a practice, nor does it reflect personal taxation, which can amount to 52% per a n n u m .
P o l i t i c a l c h a n g e a s m o t i v a t i o n f o r emigration did not seem to be a decisive factor among the respondents (Table ll).
Agree
(Y")
N95"/"Cl
e/"1
1 . A l t h o u g h
o u r c h i l d r e n
h a v e
c h a n g e d
s c h o o l s
c o m i n g
f r o m S o u t h
A f r i c a ,
t h e y
have a-dju.1ted
very well
2 . M y t r a i n i n g
a n d e x p e r i e n c e
i n S o u t h
Africa served
as an excellent
basis
for
,culrent
worr:
3 . I e n j o y
m y w o r k in m y c u r r e n t
p r a c t i c e
s i t u a t i o n .
4 . l l w e h a v e
a d j u s t e d
w e l l to t h e Canadian
l i f e s t y l e .
5 . T h e s a c r i f i c e s
I h a v e
m a d e
w e r e
w o r t h w h i l e
g i v e n
t h e g a i n s
c o m i n g .
6 . l m m i g r a t i o n
r e s t r i c t i o n s
r e g a r d i n g
m y
spouses
work made adjustments
towards
C a n a d a
m o r e
d i f f i c u l t .
7. I have
become
better
integrated
in the
c o m m u n i t y
a n d a n e w w a y o f l i f e th a n
m y s p o u s e .
B . l f m y s p o u s e
f e e l s
w e s h o u l d
r e t u r n
t o
South,Afri_car
we wou ld imedigt"ly,
9 . I s e e
m y s e l f
i n c u r r e n t
p r a c t i c e
u n t i l m y
. _ . r e ! r e . q g n t : ,
. . . ,
-1 0 . | f
I c a n b e a c c o m m o d a t e d
i n a p r i v a t e
practice
in South
Africa today,
I would
return
immediately.
9 5
o /B4
8 3
1 0 0
6 63 6
2 6
1 80 2 / 1 0 7
3 1 / 3 1
9 3 / 1 0 7
9 0 / 1 0 7
B9/107
4 1 / 6 2
30/83
2 1 / 8 2
1 9 / 1 0 7
8 6 - ' . I 0 0 B 9 - 9 879-89
7 6 - 9 0
74-89
5 3 - 7 7
2 6 - 4 8
1 7
- 3 7
1 1 - 2 7
1 0
1 1
/ 1 0 7
6-1 B
I n t e r e s t i n g l y , t h e p r e - 1 9 9 4 p o l i t i c a l d i s p e n s a t i o n t o v e r n m e n t a p p e a r s t o have had an equal influence on attitudes towards emigration,as does the current dispensation.
The respondents were mainly young and mobile, and 62% (661 107 ,95%Cl:52-7 l%) indicated that they had worked abroad prior to settling in Saskatchewan. This would have eased the adaptation process. T h e U K w a s t h e m o s t p r o m i n e n t recipient country for responde nts, 28% (30/ | 07, 95%Cl:20-38%) worked there before moving to Canada.
Emigrants are likely to have high degrees o f p e r s o n a l s k i l l s . T h i s e x p l a i n s w h y adapting to a new life style was executed s u c c e s s f u l l y b y t h e m a j o r i t y o f r e s p o n d e n t s . E i g h t y - f o u r p e r c e n t o f respondents indicated that they and their f a m i l i e s h a d a d j u s t e d w e l l t o t h e Canadian lifestyle, with children adapting apparently more easily than adults had. All resoondents with families felt that their children, having changed schools, had adapted well. In order to acquire landed immigrant status; a waiting period of two to three years is required to elapse from date of arrival in Canada.This period leaves a restriction on a spouse regarding a work visa, a factor that makes a d j u s t m e n t s i n t o t h e n e w c o u n t r y d i f f i c u l t , a c c o r d i n g to 3 8 % o f t h e respondents. Despite this, spouses still adapted well, which probably explains w h y s o f e w r e s p o n d e n t s p l a n n e d t o r e t u r n t o S o u t h A f r i c a . O n l y 3 6 % indicated that they had adapted better than their spouses to the new life. ReviewingTable lll, it seems unlikely that even a third of the respondents would r e t u r n t o S o u t h A f r i c a . A p e r t i n e n t question in our study on the possibility of returning to a private practice of their
Toble IY: Adjustments
ond ottitudes towards a new lifestyle:
Past, Present ond future percePtions
of South African Medical
C o n c l u s i o n
choice in South Africa, showed that only 77o of respondents had such intentions. F a i r l y h i g h r e m u n e r a t i o n , s u c c e s s f u l a d a p t a t i o n a b r o a d a n d w o r t h w h i l e sacrifices made in the process, imply a low percentage of returning emigrants to South Africa. Ongoing violence and little evidence that the South African economy will improve, make it even less likely that emigrants will return to this country.
SouthAfrican graduates are welcome and a c c e p t e d a b r o a d , s p e c i f i c a l l y i n Saskatchewan.This adds to the growing belief amongst the medical fraternity in South Africa that emigration is a viable option whereby one can leave serious p r o b l e m s b e h i n d a n d e n j o y a b e t t e r quality of life. Positive feedback from the emigrant contingent overseas encourages others to leave South Africa.
-
A c k n o w l e d g e m e n t s
r
I
I The authors would like to thank the following I people for their contributions:
I
I Dr Amando Gouws, Political Scientist, I Department of Political Studies, University of I Stellenbosch,provided important input in the I design of the study. Drs Deon Humon, I Glliers Morcis ond Danie Gouws assisted I in the pilot study. Ston Benjomin, Lindo I Timmerman,Hanli Grcbler ond Cynthio I du Toit rendered valued work in the I preparation of the manuscript. Dr Andr6 I Klop assisted with the final preparation I of the article.
The South African medical graduates in Saskatchewan comprise a fairly recently qualified, predominantly male group of doctors. They come from all the South African universities, and from theAfrikaans and English and language groups.They are well remunerated in Canada and have adapted well to their new country. Most have contractual agreements with a Canadian authority to serve between 3-5 years in Saskatchewan.Their return to South Africa is highly unlikely. Most cited fear for personal safety, crime, violence
and poor working conditions in the public health sector as the most important reasons for leaving South Africa.
Urgent action aimed at making South Africa a safe and prosperous country to work in would be a major step to curb the medical brain drain to Saskatchewan. The absurd situation of South African medical schools training so many doctors who leave to work in rural areas abroad while there is a pressing shortage at home in rural areas is self-evident.
Graduates in Soskotchewon
ASreef/"1
N 95"/oCl (1") 1 . L o w r a t e o f c r i m e a n d v i o l e n c e in South Africa.6 2 . 6
6 7
5 2 . 6 - 7 1 . 6
2 . A s t a b l e
p o l i t i c a l
s y s t e m
i n S o u t h
A f r i c a .
5 8 . 9
5 4 . 2
b J5 2
5 8
4 8 . 9 - 6 8 . 1
3, Family
in _S,9_y1h
Afrjca,...
4. A strong
South
African
economy.
5 . T h e c l i m a t e a n d w e a t h e r in S o u t h A f r i c a .
4 4 . 3 - 6 3 . 7
":'b.b-5e.4
48.6
4 / . 6 '
46ii./'
40.4
5 1
lo
42
4 d
s g
3 7 . 9 - 5 7 . 5
t7:i:56.b
6 . A n i m p r o v e m e n t
i n h o s p i t a l
c o n d i t i o n s .
7 . The relative
beauty
of South
Africa.
3 0 . 1 - 4 9 . 2
; ; - ; ' - l , 1 z o , J - + / . J
j'o.o-qs.+
)1.;-ig.s
1"t.e-tr.i
a'.i-r..4
B . A s o u n d
N a t i o n a l
H e a l t h
S y s t e m
i n
. the country.
9 . R e p l i c a t i n g
c u r r e n t
w o r k in S o u t h
A f r i c a .
38.4
3 6 . 5
1 0 .
T y p i c a l
s p o r t s
a n d e n t e r t a i n m e n t
i n
South
Africa.
30.4
2 i . B
14.,4
J Z2 i
15
1 1 . A relative
low tax system
in South
A f r i c a .
1 2 . S t u d y
o p p o r t u n i t i e s
i n S o u t h
Africa.
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