Last week a student who is one of the officers in a medical student club told me that her goal was to find a research project she could be part of so she could secure a publication on her CV to help her land a residency outside of Palestine.

Brain Drain is not a new concept in medicine, or other professions for that matter. In countries where success in an occupation is limited due to economics, dysfunctional systems, and corruption, many of the brightest and most ambitious want to leave. This is a problem, as many of you know, in developing countries. And what a loss for their country of origin.

Here, it is not unusual for physicians to put in their time at their government job, where they see 100 patients between 9 AM and 2-3 PM, then they go home and see patients in their private clinics in order to make financial ends meet. Even the family physicians who have completed their 4-year training are forced into this schedule at their government clinics because the system does not have the money to hire more physicians. If you do the math, that is three to five minutes a patient. A thorough case consultation can take more than five minutes. In the US we groan at only 15 minutes. Our residents find it difficult to use their family medicine skills, unless they are able to invite the patient to back in the afternoon, when the throng of patients slows a bit. Continuity with patients is a little better for most of them, where they see the same patients again and again.

These realities are not unusual in many developing countries where physicians are in short supply. But here I am told, there are physicians looking for jobs, as the money to pay their salaries is limited. So medical students want to leave because they want a better life as a physician--more money and a saner schedule. But leaving the West Bank is difficult due to visas which may or may not come through. And landing a residency elsewhere requires contacts and money.

Let us fast track to the USA, where the topic of concern for the last few years for many physicians has been burn out. I have blogged on this topic in the past. US physicians are troubled by the red tape of prior authorizations, the dysfunctions of the electronic medical record, patients without insurance, and full schedules. In primary care with all there is to do, 15 minutes feels like too little time. And these parameters of care seem like heaven to my colleagues here on the West Bank.

So what is the key out of this morass?

A group of psychiatrists visited from Washington DC this past week. They have a contract from MAP to develop psychiatry and mental health care in Palestine. They presented at Sunday academics for the family medicine residents and gave a pre-conference presentation at the Family Medicine Conference. Dr. James Griffith has spent some of his career defining the difference between depression and demoralization. Demoralization is the despair, helplessness, and sense of isolation that many people experience with illness and loss. Here on the West Bank, it can be the loss of a job, the inability to visit a child or parent because one cannot get a visa, and the powerlessness over your patient care schedule.

Demoralization was a new concept for me. We may treat patients for depression, but anti-depressant medications don't work. It is also what physicians experience with burn out. Whether here on the West Bank or in the US.

His suggestion for helping adult patients deal with demoralization means examining what he/she has done in the past during difficult times. What are the individuals strengths? What are the sources for those strengths? How can they build on them again in the current situation? Here is a link to a great summary.

This weekend I am preparing to return to the US. My time here has filled me with rich experiences and many lessons on how people face adversity, find joy and flourish.