Milkweed

Stephanie Flores Per 2 Milkweed Book Report The book my class was told to do our book reports was on Milkweed. This book is written by the famous author Jerri Spinelli. In this novel, there are three main characters which are Misha Pilsudski, Janina Milgrom, and Uri. Misha is a young boy in the beginning of the story that has no family, lives on streets, and steals food from people to stay alive. He later joins a big group of kids who also steal food, and they live together in places that are abandoned. The leader of this group in called Uri. Uri is a very intelligent, young man who has red haired. Since he doesn’t look like a Jew, he ends up becoming a Jackboot at the end of the story. Janina Milgrom is a Jewish little girl who meets Misha when he steals food from her garden. This book is set in the year 1939 when World War 2 is barley starting out in Warsaw, Poland. It’s happens during the Holocaust. Another possible theme for this book is that your identity means everything. Before Uri named Misha, Misha was a nobody. He had no friends, and he just kept on running for forever. His identity was born when Uri gave him his name and his fake life story under the barbershop. Misha was very proud of his identity, and when somebody asked him who he was, he said his story it like it was the greatest thing in the world to him. One event in the story that contradicts this is when Uncle Shepsel tries to give up his identity as a Jew. His efforts were pretty good, but they still weren’t successful in the end. The last possible theme that I think is good for this book is to never have fear and if you do have fear, you won’t survive. One event that supports this theme is when Uri tells the other orphan boys that if you have fear you won’t survive on the streets. This is true because if the boys had fear to steal the food from stores and people they would mess-up a lot or not even do it. If that happened, they would either get caught and killed, or just end up starving cause of hunger. They key point of stealing the food was to be invisible and if you had fear, you wouldn’t be invisible. I learned many things about the historical events that occurred in this story. I learned that all the Jews had to move to a place called â€Å"the Ghetto†. It seems weird that people can be so mean to others just because they’re a different religion but they’re still good people on the inside. Another thing I learned was what the Holocaust was. I never really understood what it was, and surprisingly it’s very interesting to learn about once you get deeper into it. I’m actually very shocked in learning how the way people used to live during those times. It’s crazy to think that little kids my age and even younger would be living in the streets stealing food for a way to survive. Also it’s unbelievable, how it says that a lot of different families can would be sharing space in a tiny room. I was very surprised while reading this book because I didn’t think I would end up liking it. It was actually very good, and it taught me many things I didn’t know about how times were in other places back then. I liked how the author described everything very detailed, and while I was reading the book I could picture some events in my time. It got me thinking of how fortunate I am right now, in having all the things I have. One thing I didn’t like was that the chapters were very short and it would make it harder for me to stop reading it. I would recommend this book to my friends. Milkweed by Jerry Spinelli was an overall good book.

Jane Eyre by Charlotte Bronte

Jane Eyre, by Charlotte Bronte is a gothic, Romantic novel that was seen by critics at the time as a controversial text. All though not revolutionary it did contain elements of social rebellion. Elizabeth Rigby from the Quarterly Review labelled ‘Jane Eyre’ an â€Å"anti-Christian† novel and an â€Å"attack on the English class system†. When read from a 21st century context, the novel shows, through the use of various motifs and imagery, the development of one central character. You can read also Analysis of Literary Devices of Jane Eyre Bronte shows Jane’s development, while highlighting aspects of her own social and personal context through the characterisation of Jane’s friends, family and acquaintances. A contemporary contextual reading allows the audience to view Jane Eyre as a character based novel. One critical paper known as the â€Å"Tablet† described Jane Eyre as being â€Å"simply the development of the human mind†. This bildungsroman genre underpins this reading of Jane Eyre. Similar to other Victorian authors of the time, like Charles Dickens, Bronte uses Jane to represent an individual’s search for identity and their adjustment to society. Q. D Leavis wrote that â€Å"the novel is not†¦but a moral psychological investigation†. As such the novel becomes laden with varying themes and ideal and is neither restricted by genre or by political view (much like the human mind) Characterisation is used consciously from the beginning of the novel to show the development of Jane’s individual nature and strength. One of the motifs used to represent Jane’s character is the colour red. A fine example of how the colour gains various meaning as the Jane develops is in the first 3 chapters. While in the first Chapter she is enshrouded by the curtains, which provide here with haven from The Reeds the colour soon becomes one symbolic of anxiousness, fear and anger as she is locked up in the red room. â€Å"A bed supported by massive pillars of mahogany , hung with curtains of deep red damask. † The description of the magnificent bed reflects Jane’s feeling of inferiority and belittlement. However in chapter 3 she awakes to the soft red glow of the fire which provides here with warmth and comfort. Bronte continues to use this theme later on to represent Jane’s passions for Mr Rochester and the wild nature of Bertha. Jane is represented as a strong-willed character with her own opinions, morals and mindset. While she is somewhat repressed by the society and context she lives in, she does not let this limit her entirely. Jane is not afraid to speak her mind even from a young age, nor is she afraid to think outside the conventional framework of society. â€Å"Women feel just as men feel†¦they suffer too rigid a constraint†. All other characters are seen through Jane’s eyes, and it is their impact on her development that is important, rather than their individual personalities. In the early stages of the novel, Jane is seen to be in conflict with Mrs Reed but later in the novel, the maturity that Jane has developed is seen, when Jane overlooks Mrs Reed’s cruelty, and treats her with kindness. â€Å"A strong yearning to forget and forgive all injuries†. Bronte’s use of setting provides a backdrop against which Jane develops from a young girl to an adult. The Five main settings symbolise the stages in Jane’s quest to find herself. The setting traces Jane’s childhood development at Gateshead Hall, followed by her schooling and work at Lowood institution and the development of Jane’s passionate nature at Thornfield. Moor House is then characterised by a moral and religious development of Jane. â€Å"God directed me to a right choice†. This counteracts the critic E. Rigby’s anti-religious reading of Jane Eyre, discussed later. Jane’s development concludes with her reunion with Rochester at Ferndean. Jane’s words â€Å"Reader, I married him†; show her internal fulfilment as she has found a balance between passion and reason and found her place as an individual in society. The gradual development of character highlights the textual integrity of â€Å"Jane Eyre† and enables readers in all contexts to trace the development of a central character. The narrative technique used by Bronte shows the gradual development of Jane as the central character. The first person narrative voice given to Jane enables a closer connection between Jane and her readers, allowing expression of feelings and emotions as her character develops. â€Å"Reader, though I may look comfortably accommodated, I am not very tranquil in my mind†. A duality present in Jane’s narration presents a child’s voice, echoed by a mature and intelligent adult voice of reasoning and reflection. â€Å"I should, if I had deliberated, have replied to that question†. This self-reflexivity is important in showing Jane’s character development. Consistency of Romantic imagery, linking nature and weather to characters, also adds to character development and sustains textual integrity. â€Å"The sun was just entering the dappled east and his light illuminated the wreathed and dewy orchard trees†. The imagery reflects the implications of characters choices and its impact on future character development. In the garden, after Jane agrees to marry Rochester, a storm breaks out and the great chestnut tree is damaged. This imagery symbolises the forbidden relationship that Jane agreed to. Throughout Bronte’s novel, elements of her personal and social context are highlighted, adding depth to her characters and her novel. Religion was significant in Bronte’s personal context, and in the Victorian context. Changing religious ideas, religious doubt, and an increase in non-conformists had emerged due to science and history. While the critic E. Rigby labels Jane Eyre an â€Å"anti-Christian† novel, I believe Bronte is representing religion without taking a clear stance on the issue. Bronte conveys no specific religious message but instead shows more of a general concern for religion, reinforced with religious language. â€Å"No nook in the grounds more sheltered and Eden-Like†. The text does not ignore religion or openly oppose Christianity; rather it represents the contextual importance of religion, while adding depth to Jane’s character development. Feminism is another contextual influence in Jane Eyre. The critic S. Gilbert suggests that Jane Eyre is â€Å"a traditional feminist reading of the Bronte’s†¦Ã¢â‚¬ . This critic has drawn parallels between Bronte’s life and Jane’s life, inferring that Bronte was exploring her contextual feminist struggle through the character of Jane. While there are some elements of feminism in the novel (mostly due to the independent ubringing of Charlotte Bronte) it is not the central theme. As seen from the above discussion, Jane Eyre is about the development of a human mind, with feminist themes simply an influence on Jane. Jane’s feminist comments show her character exploring the social context. â€Å"Women are supposed to feel very calm generally, but women feel just as men feel†. These elements link back to a â€Å"moral psychological investigation† rather than an exploration of feminism. ‘Jane Eyre’ is primarily focused on the development of an individual. The text shows Jane’s development from a child to an adult using characterisation, setting, narrative voice and romantic imagery. Bronte adds depth to characters by introducing aspects of her social and personal context. While critics in the Victorian context label Jane Eyre as a â€Å"feminist novel† or an â€Å"anti-Christian book†, in my contemporary reading it is neither of these things. Its merely the exploration of an individuals development.

Lord Byron

In `Excerpt from Don Juan`, answer the following: Select 3 stanzas from Canto I that you can explain. Do not give plot summary, so carefully choose a stanza that lends itself to analysis or some research. Write about three to four sentences. In Subject Line, identify your stanza, e.g., 44 (Canto I, Stanza 44). Stanza 5 Brave men were living before Agamemnon And since, exceeding various and Sage, A good deal like him too, though quite the same none;  Ã‚   35 But then they shone not on the Poet’s page, And so have been forgotten: – I condemn none, But can’t find any in present age Fit for my poem (that is, for my New One) So, as I said, I’ll take my friend Don Juan. –  Ã‚  Ã‚   40 In analyzing Stanza 5, it’s interesting to read as we wonder who else Byron may have considered in this poem he sat down to write. Was he considering other brave men, poets, heroes before finalizing it with Don Juan? Who were the others â€Å"a great deal like him† (Canto 1, Stanza 5, Line 35). This stanza can be more interesting to readers who examine the history of what was viewed as the scandalous controversial nature of his writing of â€Å"Don Juan† and what concessions did Byron have to end up making before it was published. Stanza 5 sums up what he was saying about heroes in the previous stanzas. Stanza 6 Most epic poets plunge â€Å"in medias res† (Horace makes this the heroic turnpike road), And then your hero tells, whene’er you please, What went before—by the way of episode, While seated after dinner at his ease,  Ã‚   45 Beside his mistress in some soft abode, Palace, or garden, paradise, or cavern, Which serves the happy couple for a tavern. The analysis of Stanza 6 lets the reader in that Byron is intentionally not following Horace’s recommendation of when to start an epic. Byron is (intentionally?) not following the rules of what at the time was being seen by other writers as the better way of starting an epic, which was in the middle. This stanza proves to us the writer is choosing not to write using the examples of Homer or Virgil but writing this epic his own way (Canto 1, Stanza 6, Lines 41-44). Stanza 7 That is the usual method, but not mine— My way is to begin with the beginning;  Ã‚   50 The regularity of my design Forbids all wandering as the worst of sinning, And therefore I shall open with a line (Although it cost me half an hour in spinning) Narrating somewhat of Don Juan’s father,  Ã‚   55 And also of his mother, if you’d rather. Although the reader isn’t aware of it until later, Byron reveals to us that he knew in advance he would digress in the poem (Canto 1, Stanza 7, Line 54). The reader now learns that was the writer Byron’s intention from the start. The reader can wonder if Byron is even conscious of how he changes some of the â€Å"traditional† epic writing in writing this work. In `Excerpt from Childe Harold`s Pilgrimage`, answer the following: 1. Does the Byronic hero know any form of Keatsian love? Yes, in that Keatsian love is often associated with â€Å"beauty-as-truth.† In Canto 2, Stanza 9 we read as Byron writes of having loved and it was still in his thoughts although he is now alone with those thoughts. We also read of this â€Å"beauty-as-truth† love in Canto III Stanza I when he relates of the love for his daughter. 2. Beginning with stanza 17, the narrator talks about Waterloo. Why? Waterloo is current to at this time to Byron. Just a few months before this, the fate of Europe had been decided because of that Battle. So it is important that the reader is aware that it is sacred ground to him. The battle was fought on June 18th, 1815 which makes this a very relevant event during his lifetime of 1788-1824. 3. In what ways is this poem about mid-life crises? Childe in this epic refers to a â€Å"knight† and we read as this knight is gloomily wandering as a vicious world-worn man. In his thoughts throughout the â€Å"pilgramage† it relates closely to a man who is going through similar thoughts a man in mid-life crises might go through as though he has already fully lived. 4. How does the Byronic hero relate to nature? Byron relates better to nature than he does to humans. In Canto 4, Stanza 178, Byron states this: There is a pleasure in the pathless woods, There is a rapture on the lonely shore. There is society where none intrudes, By the deep Sea, and music in its roar: I love not Man the less, but Nature more, From these our interviews, in which I steal From all I may be, or have been before, To mingle with the Universe, and feel What I can ne'er express, yet cannot all conceal However, in reading this piece, I feel its obvious throughout to the reader that the writer can connect more easily with nature than humans. Because most of Byron’s work is autographical in nature, this is easy to understand if the reader about Byron’personal life. References â€Å"Characteristics of the Byronic Hero.† University of Michigan. Online. Internet. 17 May 2003. (2002, February 11). Childe Harold's Pilgrimage. Retrieved May 17, 2007, from The Project Gutenberg Web site: http://www.gutenberg.org/dirs/etext04/chp110h.htm (2007). George Gordon, Lord Byron. Retrieved May 17, 2007, from Bob's Byway Web site: http://www.poeticbyway.com/xbyron.html ; ;

The importance of exchange rate regimes Essay Example | Topics and Well Written Essays - 2500 words

The importance of exchange rate regimes - Essay Example In terms of monetary policy (management of money and interest rates), the exchange rate is managed by a country through its exchange rate regime, an organized set of rules through which a nation’s exchange rate is established, especially the way the monetary or other government authorities are or are not involved in the foreign exchange market. These regimes include floating exchange rates, pegged exchange rates, managed float, crawling peg, currency board and exchange controls. It is the manner in which a country manages its currency in vis-à  -vis foreign countries and the foreign exchange market.  Dornbusch et al. (1999) differentiates the fixed and floating exchange rate regimes through the following: in a fixed exchange rate system, foreign central banks stand ready to buy and sell their currencies at a fixed price in terms of another currency, for example, dollars. From the end of the second world war up to 1973, major countries had fixed exchange rates against one an other. Presently, there are still those that use the system while others prefer to use the floating exchange rate. Recent developments include the revaluation of the Chinese yuan in July 2005 in which Chinese monetary authorities decided to allow the currency to gradually â€Å"float† against the dollar. By contrast, the central banks allow the exchange rate to adjust to equate the supply and demand for foreign currency in a floating exchange rate system.   Dornbusch et al. (2003) divides such exchange rate regime into three more subsystems.... Mishkin (2003) defines the exchange rate as the price of one currency in terms of another (say euros per dollar) and it is in the foreign exchange market that they are determined. In terms of monetary policy (management of money and interest rates), the exchange rate is managed by a country through its exchange rate regime, an organized set of rules through which a nation's exchange rate is established, especially the way the monetary or other government authorities are or are not involved in the foreign exchange market. These regimes include floating exchange rates, pegged exchange rates, managed float, crawling peg, currency board and exchange controls. It is the manner in which a country manages its currency in vis--vis foreign countries and the foreign exchange market. Dornbusch et al. (1999) differentiates the fixed and floating exchange rate regimes through the following: in a fixed exchange rate system, foreign central banks stand ready to buy and sell their currencies at a fixed price in terms of another currency, for example, dollars. From the end of the second world war up to 1973, major countries had fixed exchange rates against one another. Presently, there are still those that use the system while others prefer to use the floating exchange rate. Recent developments include the revaluation of the Chinese yuan in July 2005 in which Chinese monetary authorities decided to allow the currency to gradually "float" against the dollar. By contrast, the central banks allow the exchange rate to adjust to equate the supply and demand for foreign currency in a floating exchange rate system.1 Dornbusch et al. (2003) divides such exchange rate regime into

Research methods (inferential methods) Essay Example | Topics and Well Written Essays - 1250 words

Research methods (inferential methods) - Essay Example It is possibly influenced by the intervening variable as well. Unit of Analysis: Whereas the independent variable is nominal and can only take the value of either Science or otherwise, the dependent variable is ordinal. This can be divided into a five point scale from strongly agree to strongly disagree. Since the response to this study and the assessment of the study is on individuals, this has to be looked at as individual cases. The dependent variable can become continuous while interpreting. Sampling: The sampling size can be a larger fraction of the population because the target population is smaller. Of the science graduates nearly 20% of them can be taken up as samples. Only then the results will also be dependable. The sampling has to be random within a stratification formed ideally of genders. Validity: The survey will be valid if the assumption is right. That is, to say, if the people are not travelling in public transport or do not walk down to the university, then they are lazy is right. Under this condition, the survey will hold good. However, this could be questioned by the intervening variable that has already been set. The above graph indicates the age distribution in the Bradford 041A area. The above graph indicates that the demographic shift is moving towards more of middle aged and older people in the Bradford 041A region. ... This shows that the terraced bungalows are the most common ones in the region. The above graph indicates the economic activity of the Bradford 041A region. This indicates there are a larger number of economically active people who are working full time and the self employed or enterpreneural spirit is in a few people comparitively which is even less than the unemployed. 3. Survey questions Survey 1: Sampling mobile opinion - postcard questionnaire survey The topic chosen for the survey is very interesting. The methodology has been designed very well. Generally post card surveys may not give the adequate response for a number of reasons that are beyond the control of the researcher. For instance, there could be a set of postcards that might have been responded well but may not have reached the researcher due to the vagaries of the postal system or might not been dropped in the post box due to negligence or forgetfulness. When we employ the FARCE system, F, A & R might be correct and well designed but the aspects of engaging and connecting (C & E) with the respondent is not there. Hence the level of accuracy is certainly less. The advantage with this system is that not much of time and energy is expended by the researcher. Survey 2: Conference survey of professionals - online survey With the advent of internet, this is one of the most popular surveys undertaken by researchers. The advantages are many: Firstly, the reach is far and wide and the survey can be completed in a few days time. Secondly the analytical part of the survey is also done immediately. This sort of a survey is a sophisticated form of the postcard survey. The only difference is that, in the 'FARCE' context, F, A, R & C is taken in to account and E may or may not be left out. E can

REDUCING HIV RISK AMONG YOUNG MINORITY WOMEN & A HEALTH CARE TEAM Research Paper

REDUCING HIV RISK AMONG YOUNG MINORITY WOMEN & A HEALTH CARE TEAM HELPS REDUCE HIGH BLOOD PRESSURE AMONG INNER-CITY BLACK MEN - Research Paper Example Dr. Martha developed a program that provided free health facilities to black men diagnosed with High Blood Pressure in the inner-city. In his analysis, a group of 300 black men recruited for the experiment indicated that one out of five had accomplished adequate blood pressure control. Human immune deficiency virus is another deadly disease that can be controlled through a change in attitude. The virus is spread through heterosexual activity. The theory to the control of a spread in the virus is, ‘The key to defeating HIV lies with protection’ (Jemmott 1998). The black youth women are the most targeted group as they are prone to the contraction of HIV activities due to their activities and interaction among each other. Education has been identified as a method to prove this theory. This is because it fosters awareness by implicating the dangers of negligence towards the use of protection as the key to defeating HIV spread and its resultant effects (Kendall 2012). Dr. Loretta Sweet Jemmott has carried out an experiment on the theory by developing an educational intervention that delivers eight modules on safe sex practices and abstinence to inner-city black middle school student (Jemmott 1998). The program was successful as it helped in the reduction o f risky sexual behaviour. As a result sexual education was introduced in the education curriculum of the United States of America as well as internationally. The conceptual basis of the two cases of study is to present the logical argument that prevention is better than cure thus there is need to control the spread and effect of various dangerous diseases in order to enhance health practices and population growth of Africa Americans in the United States. Jemmott L, S. (1998). Journal of the American Media Association: Abstinence and safe sex HIV risk-reduction intervention for African American Adolescents: A random controlled trial. New York. National Institution of Public

Economic history Essay Example | Topics and Well Written Essays - 500 words - 1

Economic history - Essay Example setting up policies like maximizing the use of domestic resources, limiting wages, export subsidies, all aimed at accumulating monetary reserves (Brue & Randy 42). David Hume disagreed with mercantilism on their trade restrictions by stressing that trade restrictions are restriction of innovation, and so these opened avenues for uniform market competition. Physiocrats stressed the importance of agriculture in the economy; he proposed that agriculture is a vital organ in the development of any economy. He suggested an economic environment free of government restrictions when it comes to transactions between two private parties; the only regulations he proposed are those that protects property rights. Since individuals have a natural right to freedom, it should be understood that nature is a self-regulating system and harmonious so human control should never be factored in. Adam smith proposed the idea of artificial stimulation of manufacturing and trade; he made it clear that real wealth of a country not only consist of gold and silver, but also in its houses, lands and consumable goods of all different kinds (Brue & Randy 45). He fueled foreign trade by recognizing that it could explore the overseas markets and largely promote development of production capabilities of the nation and consequently lead to a rise in real wealth owned by a country. He also contributed to the idea of a free market by proposing to the government to reduce and abandon control over foreign trade, and he suggested for the implementation of free trade policies. David Ricardo shed light on the importance of agriculture, by analyzing the importance of diminishing returns. He postulated that a utility is mandatory for exchange values, but does not determine it. He promoted extreme industrial specialization by proposing that a nation should put more efforts on industries in which it is more internationally competitive. Ricardo suggested trade with other countries to obtain goods not produced

Management Research Project Assignment Example | Topics and Well Written Essays - 1000 words

Management Research Project - Assignment Example Garman (2010). In their research, they elaborate resistance to organisational change and its impact. Similarly, Lloyd C. Harris, Andrew Crand (2002), Sjoerd Beugelsdijk, Arjen, Slangen, Marco van Herpen (2002), and Bernard Burnes (1996) have all conducted research on organisational change, motivation, and information communication technology. (b) Change and its impact on employees’ motivation are unavoidable. Recently, many factors have influenced the organisational environment and culture. Consequently, this impact has positively and negatively affected the employees’ motivation. However, for organisations, it is highly essential to provide congenial environment to employees as this will enable them to retain their level of motivation which will convince and direct them to achieve their job related goals and objectives. However, motivation is defined as a force enabling someone to work in a specified direction for obtaining a certain organisational objectives (Mills et al., 2007). In the same context, both intrinsic and extrinsic motivation has been separated as both have different types of impacts and benefits offered by organisations. For example, intrinsic motivation is doing something for one’s own sake (Jacobs, 1993). On the other hand, extrinsic motivation is externally provided incentive in w hich an employee is offered an incentive or reward for completing certain targets. The field of information communication technology (ICT) experiences more effects of changes than any other fields and it faces both positive and negative impacts of change for a number of reasons. For example, every day new advancements, softwares, methods, and techniques are being invented and the frequency of these changes is so fast that new version is hardly implemented and the latest version is developed. In this regard, Iyanda and Ojo (2008) carried out study over the impact of adopting new ICT on the motivation of employees in the Botswana organisations;

Information about the wine region of bordeaux Essay

Information about the wine region of bordeaux - Essay Example This made Aquitaine property of England and gave rise to export of the wine to England for the pleasure of King Henry. This brought about the discovery of Bordeaux in Britain making the marriage a significant event to the history of the region as trade increased (â€Å"Bordeaux Wine History†¦Ã¢â‚¬ ). Generally, Bordeaux refers to three things a French city where its name loosely translates to ‘edge of water’ and had a population of about 250,000 in 2008, a region estimated to be 1075 square kilometers and a class of wines. The vineyards within the area extend over 113,000 hectares of land. Wine production in the area was begun for consumption by the Roman soldiers that were posted at the banks of the Garonne River. There are two major group varieties of Bordeaux red and white where the red wine group includes Cabernet Sauvignon, Merlot, and Malbec. The white wine group comprises Muscadelle, Sauvignon Blanc, and Semillon, where the first two are produced from the white Graves’ grapes. For the red category, Sauvignon Cabernet produced using the grapes of the Medoc or Graves and Merlot from the St Emilion. Whilst living in France between 1784 and 1789, Thomas Jefferson then Minister to France, went around Bordeaux collecting wines that included Medoc, Graves and Sauternes (Swaney and Limburg). The Bordeaux wines came into existence at a period when there were more well-known wines from Gaillac and Bergerac, eastern of Bordeaux. The local winemakers and merchants of the Bordeaux wine region made sure their wines on board of the ships headed to England before allowing those from the South West region that is Bergerac and Gaillac through. Another significant attribute of wine production in Bordeaux is that it was brought about by merchants, contrary to other regions in France where it was under the control of monks. Wines from areas such as Medoc were produced from the 17th century, as before that such

Describe the three major causes of soil erosion Essay

Describe the three major causes of soil erosion - Essay Example The formation of a 1 centimeter soil can take up to 400 years and the production of a sufficient depth of farming might take 3,000-12,000 years (Edwards, 2005, p. 36). Soils are easily and increasingly eroded but may take years to form, leading to ruining of land resources. Soil erosion rapidly occurs in mismanaged lands, lands where protective vegetation is removed, places with rapid population growth, steep lands, and places with extreme climatic conditions or rainfall is seasonal, downpour, and unreliable (Edwards, 2005, p. 36). In line with the rapid occurrence of soil erosion are major causes of soil erosion which the essay will discuss in detail. This includes overcultivation, overgrazing, and deforestation. Soil erosion is a natural process but most of the human interventions contribute to the increased incidences of soil erosion. The potential harm to the ecological balance, biological species, and human harm is insurmountable; thus, this paper will discuss in addition the ca use, promoting factors, effect, and examples of overcultivation, overgrazing, and deforestation observed within the society. ... In addition, overcultivation partly occurs due to introduction and use of mechanized machinery such as tractors and discs ploughs and the introduction of irrigation schemes (Park, 2001, p. 438). Overcultivation is one of the major causes of soil erosion. The constant use of land for crop production removes the protective soil covering and crops do not have the capacity to strongly hold the soil, which increase the risks of soil erosion. Likewise, the use of tractors and disc ploughs destroy native perennial vegetation, encourage soil degradation, and remove protective soil cover (Park, 2001, p. 438). Due to the removal of soil covering, topsoil is exposed to wind erosion and blown away, making the soil dry and infertile. Water irrigation is the proposed solution for dry lands but often increases soil salinity and water logging which may also increase the likelihood of erosion if left abandoned (Park, 2001, p. 438). Thus, it can be inferred that when there is overcultivation, the poss ibility of soil erosion is likewise to occur. Overgrazing Overgrazing is the most widespread cause of soil erosion and occurs when there are too many animals for the amount of grass available (Edwards, 2005, p. 36; Waugh, 2003, p. 254). Overgrazing is common among traditional farmers who rely heavily on grazing animals. Overgrazing can be attributed to a variety of factors such as status symbol, food security, food supply, rise of export agriculture, and veterinary care (Park, 2001, p. 438). Overgrazing makes the soil condition worse. Palatable plants are replaced by unpalatable plants, pressure increases on the less-grazed pasture, bare ground, sand sheets and dunes increases which

Art Essay Example | Topics and Well Written Essays - 250 words - 24

Art - Essay Example Mary Lin emerged as the winner and her victory surprises everyone including herself. Maya Lin’s design was V-shaped, having a sunken wall of black stone, with the names of all those killed in the war engraved in a chronological or sequential order, (Binyon L., 2010). â€Å"She designed the memorial in a manner to enhance easy searching of the loved one,† explained Binyon. Lin stated, â€Å"Searching out a loved one, a mourner will walk along the monument and find the name among the 57661 listed.† Her explanation for its fulfilling of the contest is that she wanted to illustrate a journey. A journey that would enable the mourner experience death and he or she could never fully be with the dead. â€Å"Lin’s statement and design is an affront,† a small group protested (Binyon L., 2010). They want to change the color of the wall to white and to include an eight-foot-high sculpture of wounded soldiers and a flag at the Centre of the wall. However, Lin refutes the changes as they have ill motives. Therefore, the Commission of Fine Arts p rovides a remedy by stating that the wall will remain black, but it will have the statue and the flag at the side. Hagopian stated, â€Å"Memorial would be completed despite the strong conservative resistance to Lin’s design.† (Hagopian P., 2009). The Vietnam’s Memorial was dedicated on Veterans’ Day and Maya Lin with Lyn being the winner of the design. Hagopian P. (2009). The Vietnam War in American Memory: Veterans, Memorials, and the politics of healing.

Illusion of free will Essay Example for Free

Illusion of free will Essay In our society, free will is something that is ingrained in our set of beliefs that every citizen of the world should possess. We generally believe that we possess free will because of the choices we make on a day-to-day basis that is generally not forced upon by any direct outside force like in a totalitarian society out of a science-fiction story: the decision of whether or not to go to school in the morning, or finishing an essay at the last minute or allowing the grade to drop for an extra day are excellent examples of my view of free will. In Paul Halbach’s â€Å"The Illusion of Free Will†, he systematically attempts to debunk the debate between the combating theories of free will and hard determinism. He conveys his argument by stating that determinism and free will are incompatible with one another: one cannot exist if the other is true. If he can thoroughly prove that determinism is true, then free will would be deemed incapable with the human condition which we must accept. Holbach breaks down his strategy into two parts, the first of which he explains how the thought process and decision making of human beings are complex, yet mechanical, which boils down to the fight of competing desires. Lastly, he attacks different views on actions people would normally view as explanations of free will. Holbach believes that the human mind makes decisions based on the laws of nature governing the person’s environment; the upbringing, culture, surroundings and countless situations a person has experienced are what determines his or her way of thinking. The causal effects of everything around a man is always what governs every decision he makes, as Holbach states that â€Å"he always acts according to necessary laws from which he has no means of emancipating himself† (Holback 439). He uses the example of presenting a parched man being presented with a fountain and wants to drink from it. Upon realizing that the water in it has been poisoned, the man can still choose whether or not to drink from it. Not drinking the water upon realization of its impurity is a voluntary choice to resist the urge to quench his thirst, although it still stems from the same desire of self-preservation. Regardless of if he does or does not is not of importance because of the prevailing motive behind making either decision, proving that every action one takes is predetermined by an impulse involuntarily generated based on the man’s upbringing and experiences which creates his sense of morals, beliefs, and self-worth, none of which he has any power of influencing. If this is the case, then determinism is true, and free will is only an illusion.

King Lear Character Analysis Essay English Literature Essay

King Lear Character Analysis Essay English Literature Essay Edgar is arguably one of the plays most pitiful characters, by the end of the play he is probably the character who ends up with the most wits. Edgar proves he is adaptable to the changing situations around him by making four different persona changes throughout King Lear. He started as a simpleminded victim of Edmund, but then he changed to a poverty stricken beggar, then an ordinary peasant, then a chivalrous champion challenging Edmund, and lastly the wiser, peaceful version of Edgar. Edgar is also the religious voice in the play. In the beginning of King Lear, Edgar would be clothed in some of the nicest garments because he`s the son of the Earl of Gloucester. Edgar was oblivious to the fact that his illegitimate brother had a plan ruing to oust their father from power. When Edmund told him to run away for a short period of time because Gloucester was mad at him, the simpleminded Edgar did not think twice and listened to his brother. After learning of his death warrant issued by his father Gloucester, Edgar realizes that the only way to stay alive is to take on his first of four persona transformations. When he makes his decision to become a Bedlam Beggar, he says Poor Turlygod! Poor Tom! Thats something yet! Edgar I nothing am (2.3.20-1). Edgar realizes that if he does not change himself to Poor Tom he will not survive. Edgar is wise for doing so because Gloucester has all the guards in the country looking for him (2.3.4). As he becomes a beggar, he is stripping himself of everything, his title, his clothes, and his personality. This goes along with one of the main themes of nothing in King Lear. Edgar starts conversing with Lear, his Fool, and Kent, whom are about to enter the hovel. Lear has already stated that he thinks that Edgar is a philosopher. While Gloucester is trying to bring Lear out of the storm, But Lear tells him Ill talk a word with this same learned Theban (3.4.150). Edgar is being spoken highly of by Lear, a Learned Theban is a learned Greek or scholar. In Shakespeares days, Greeks were associated with wisdom and education, especially in Philosophy. Edgar is the religious voice and can be seen as an optimistic voice throughout King Lear. Several times, Edgar spoke of the relationship between man and god. He believes in good will triumph evil; he is also able to see above luck, and believe in a higher plan. Edgar is Gloucesters saviour in the play. Without Edgar, Gloucester would have died sooner than he did with Edgar. As a result of everything that has happened to Edgar, he becomes much wiser and is able to show his compassion. Edgar has been hopelessly optimistic throughout King Lear. Even after seeing his father blinded, Edgar is being hopeful in thinking that it is only the worst if we believe it is, and nothing gets better if it is no believe to be the worst (4.1.26-7). He has some reason, else he could not beg. I th last nights storm I such a fellow saw, Which made me think a man a worm. My son Came then into my mind, and yet my mind Was then scarce friends with him. I have heard more since (4.1.31-7). After Gloucester is physically blinded, he was finally able to comprehend that Edmund, not Edgar was the one who had betrayed him. Even though, Edgar could hear Gloucester yearning for him, Edgar did not reveal himself to Gloucester. This is possibly one of the biggest mysteries in King Lear. Edgar may not have revealed himself to Gloucester as a form of torture because he was the one that issued the death warrant. It can also be looked at in the form of Edgar blinding Gloucester However, the reason may be that it was too overwhelming for Edgar to see Gloucester (his father who has always been strong) so broken and helpless. Any Father could not possibly ask his son to lead him to a cliff so he can jump to his death, but Gloucester who is depressed and blind, asks Edgar who he thinks is just a beggar to do the task. Edgar does not refuse the task of leading his father to jump to his death; instead, he carries out a clever plan to fool his father into thinking that he survived the jump. Edgar describes to his father that they are at the top of the cliff with the waves hitting the bottom of the cliff, but they cannot be heard because Gloucesters other senses are dulling from the pain of having his eyes gouged out. Gloucester believes his son and when he goes to jump, he faints. When Gloucester comes back to his senses, Edgar has transformed himself again to a peasant to make his plan work. The Peasant Version of Edgar convinces Gloucester that some fiend convinced him to jump, not Poor Tom, so the gods pitied him and saved him (4.6.69-72). The Gloucester suicide scene as a whole showed that Edgar still cares about his Father even though he issued the death warrant. He realized if he had let Gloucester die then he would have no one left that cared about him. At the beginning of the final act, Edmund takes on yet another persona. Hes disguised in the uniform of a knight when he draws Albany aside and give him the letter that Oswald was carrying. Edgar states that he wants to challenge Edmund in a duel to the death (5.1.44). He then becomes a chivalrous champion after he wins the duel against his brother Edmund. Edgar has endured so much throughout King Lear; becoming nothing, and having to see his father die from two extremes of grief and joy. But once Edgar takes his knight helmet off, he changes for the last time. He goes back to being Edgar, but there is little to no similarities between his first and current persona. First of all, he is no longer simpleminded, the things that he has seen have made him wise. The weight of this sad time we must obey, speak what we feel, not what we ought to say. The oldest hath borne the most; we that are young shall never see so much nor live so long. (5.3.323-26). In that quote he was saying that nobody will ever go through as much as Lear did or live so long, so we have to learn from this experience (5.3.323-26). Edgar is arguably one of the play`s most wise and caring characters. Edgar is the religious voice in King Lear. He has proven that he is adaptable to the changing situations around him by taking on five different personas throughout King Lear.

Medical Brain Drain in Developing Countries

Medical Brain Drain in Developing Countries CHAPTER ONE BACKGROUND The loss of human capital from developing countries to developed countries is not a new phenomenon. It is commonly refer to as brain drain which broadly represents the migration of highly skilled professionals from one country or part of a country to another in search of a better prospect (Sako, 2002). The loss of highly skilled professional attributed to brain drain has been of interest internationally for over four decades (Giannoccolo, 2004). Concern over the international migration of health workers first came to limelight at the Edinburgh Commonwealth Medical Conference in 1965. This situation prompted the World Health Organisation (WHO) in 1970 to examine the global process and flows of doctors and nurses (Mejia, 1978). The report however made little impacts on migration of health workers which has continually been on the increase over the years (Levy, 2003, Pang et al. 2002) The concept of the medical brain drain, that is the migration of doctors and other health professionals from developing economies to developed countries has been the subject of interest and research across a variety of fields including labour economics, human resource studies and human geography (Diallo, 2004, Buchan, 2004 and Stilwell et al., 2004) The migration of medical personnel has been identified by WHO as the most critical problem facing the delivery of health service in developing countries (WHO, 2007), besides the emigration of doctors in particular to other countries have received a more considerable attention (Beecham, 2002) The extent to which health professionals migrate to developed countries has continue to be on the increase in recent years and this has been attributed to an apparent response to demand from the developed countries where medical professional are in short supply to cater for demands due to demographic changes, aging population, growing income, feminisation of workforce amongst others (Pond and McPake, 2006). Foreign-trained medical and nursing workforces are estimated to account for more than a quarter of health professionals of the Australia, Canada, the US, and the UK (OECD, 2002).The quest for highly skilled professionals has been on the increase in many developed countries. According to statistic report from the Global Atlas of Workforce cited in Pond and McPake, (2006), the United Kingdom (UK) was ranked among the least staffed of high income countries with 166 doctors and 497 nurses per 100,000 populations the second lowest doctors density and the fourth nurses lowest density among the Organisation for Economic Cooperation and Development (OECD) countries. Moreover, as at the year 2000, the UK health system currently require about 10,000 physicians and 20,000 more nurses to meet the demand of the NHS plan (Department of Health, 2000). Between the year 1999 and 2004 when the targets was achieved earlier than expected, a new target was set to increase the number of nurses by 35000 ( 10%) and physicians by 15000 (25%) between 2001 and 2008. In order to achieve the new target, several methods were adopted to recruit doctors and nurses from other country to fill the shortage within the NHS. However, the approach created a surge in the international recruitment of health worker (Department of Health, 2004). Conversely, the poor economy condition in the developing countries coupled with poor remunerations, lack of infrastructural facilities, and low morale, emigrating to developed countries by doctors is seen as an opportunity for a better prospect. Furthermore, the continuous rise in disease prevalence, emigration, productivity losses, and shortage of doctors in Sub-Saharan Africa, has resulted in health resource crisis (Aluwihare, 2005). Insufficiency in human capacity for health care delivery in developing countries have been identified as a significant factor that is responsible for the inability to achieve the target set by WHO for the treatment of 3 million HIV infected people by year 2005. (This initiative was tagged 3by5) (WHO, 2005). This has also been identified as a major constraint limiting the progress of Millennium Development Goals (MDGs) Initiatives (IOM, 2005). In response to the migration of health professionals to developed countries and the undermine effect to the economy, social and health status of exporting countries, the Commonwealth Ministers of Health agreed to uphold and keep the Commonwealth values of cooperation, sharing and supporting one another, thus a consensus approach to deal with the problem of international recruitment of health workers was adopted. The Code of Practice for the International Recruitment of Health Workers is intended to provide a framework to governments within which international recruitment should be carried out (Commonwealth Code of Practise, 2003). Similarly, Department of Health (2004), presented a revised policy on code of practise for international recruitment of health care professionals this demonstrated the concerned of the UK government in protecting the health care system of developing countries. The revised code of practise for recruitment addresses role of private employer and agencies in the international recruitment of health professionals from developing countries (Eastwood et al., 2005). Nevertheless, developing countries have made some effort in preventing the emigration of physician to developed countries. In spite of this, addressing factors that encourage emigration, such as large disparity in remunerations, standards of living, opportunities for career development amongst host other benefits are usually difficult to come by. At the 1998 UN Conference on Trade and Development, WHO study indicated that 56% of doctors from developing countries migrate to developed nations, while only 11% migrate in the opposite direction; the imbalance is even greater for nurses. (Chanda, 2002). As a result, further effort is being deployed by developing countries to search for means to manage the migration of the health workforce to developed countries (Hussey, 2007). Despite measures, it may be difficult to totally prevent health professionals from migrating. As the large scale of medical brain drain from developing countries is now having a negative impact on the development process of the health system of those countries, it is however imperative for stakeholders to develop a consequential means to curtail the continual movements of health professionals. Nigeria Health Services Historical Background Nigeria, the most populous black nation in the world with a total population of 140 million people (2006 census). As a country with mono-cultural economy, the major source of foreign earnings is from crude oil. The poor level of resources allocated to the health care sector is one of the main factors responsible for the deplorable health condition in the country (Campbell, 2007). The public health service in Nigeria started in 1946 with a 10-year colonial administration plan; the development came about when treatment was required for soldiers of the West African Frontier Force and the colonial administration staff. In 1975 attempt was made to adopt primary health care under the Basic Health Service Scheme (BHSS). The BHSS aimed to improve the accessibility to heath care in terms location, affordability, increase access to disease prevention and distribution of services, and provision of adaptable health services based on local need and socially acceptable method of technology (Hodges 2001). The Current Health Care System in Nigeria Over the last two decades, the health care system in Nigerias has deteriorated a fact ascribed to the countrys poor governance and leadership which was more pronounced during the military era. This was reflected in budget allocations and the fiscal requirements of the Structural Adjustment Programmes. The deficient of reliable data makes it difficult to provide a detailed assessment of the degree of financial commitment to the health sector (Ali-Akpjiak and Pyke, 2003). According to World Bank source, Nigeria public spending per capita for the health sector is less than $5 USD and is as low as $2 USD in some parts of the country. This is far below the $34 USD recommended by WHO for developing countries within the Macroeconomics Commission Report. Nevertheless the Federal Government recurrent budget on health showed an increasing trend from 1996 to 1998, a decline in 1999 and started to rise again in 2000, available evidence shows that most of the recurrent expenditure is spent on personnel. The Federal Government recurrent expenditure on health as a share of the total Federal Government recurrent expenditure which stood at 2.55% in 1996, 2.96% in 1997, and 2.99% in 1998, declined to 1.95% in 1999 and 2.5% rose in 2000. Beyond budgetary allocations, there is a wide gap in the available between the budgetary figures and the actual amount of funds released from the treasury for health activities (WHO 2009a). The decline in the Nigeria health sector was accompanied by collapse of institutional capacities, poor remuneration and lack of conducive environment, dilapidated equipment and infrastructure have over the years, job dissatisfaction and low motivation, have led to increase migration of health professionals to seek employment in overseas countries. In a bid to curtail the impasse, Nigeria has subscribed to the Commonwealth Code of Practice for the International Recruitment of Health Workers for which a framework of responsibilities is presently being developed (WHO 2009b). Demographic and Health Indicators The demographic data in Nigeria are not very reliable. Data gathered from various exercises such as census, vital registrations and surveys are often inconsistence and sometimes contradictory. Nonetheless, there is evidence that the key indicators have either remained constant or worsened (WHO 2005). Life expectancy declined from 52.6 years for male and 58.8 years for female in 1991 to 45 years and 46 years for both Male and Female respectively in 2004. The infant mortality rate (IMR) in 2004 is 103 per 1000 live births when compared to 87.2 per 1000 live births in 1999. Fifty percent of deaths under 5 years of age have been attributed to malnutrition. The maternal mortality rate (MMR) of 800 per 100,000 births is the second highest in the world after India. This has been attributed partly to shortage of skilled medical personnel. For instance only 41.9 % of primary health facilities is provides antenatal and delivery services. Moreover 57.3% of such health facilities operate without a doctor, midwives or senior community extension worker. The Nigeria health system is one of the worst in sub-Saharan African with a disability life adjusted expectancy of 38.3 years and ranked 187 in the world (WHO 2005) Health Workforce in Nigeria Among the several challenges facing the health system in Nigeria is the lack of competent health care professionals. This has been attributed to inadequate infrastructures and poor remunerations packages, making a sizeable numbers of doctors, nurses and other medical professionals vulnerable to be lured away to developed countries in search of a fulfilling and lucrative employments (Stilwell and Awofeso, 2004, Raufu, A., 2002) There are 52, 408 Nigerian Doctors registered with the Nigeria Medical Council as at December 2007, There are 128,918 nurses and 90,489 midwives on the register, although only a fraction of these pay the required practicing licensing fee. There are 13,199 pharmacists, 840 radiographers, 1,473 physiotherapists, 12,703 medical laboratory scientists, and 19,268 Community Health Officers. All these health workers are required to pay annual practicing licensing fees; however the lists have not been pruned for those have migrated out to foreign countries, deaths, retirements or those that have left the profession for another career entirely. Health workers are poorly distributed and most are in favour of urban areas, southern, tertiary health care services delivery, and curative care. For some cadres of health workers such as doctors and nurses, more than 50% have their place of work in the South Western part of the country with vast majority residing in the commercial city of Lagos (Labiran et. al, 2008). Medical Brain Drain in Nigeria Among the countries in sub-Saharan African, Nigeria is a major export of health professionals. An estimated number of 20, 000 health professionals emigrate from Africa annually. A trend that poses threat to sustainable health care delivery in Nigeria. Statistical data on Nigerian doctors who are legally migrating overseas are scarce and unreliable, this is largely due to the fact that most wealthy nations like Australia currently makes it very difficult for overseas trained doctors to practise in their country primarily on the basis of medical skills. However, hundreds of doctors trained in Nigeria continue to emigrate to developed countries annually (Stilwell and Awofeso, 2004). Better remunerations and medical facilities among other factors are cited as one of the major reason for flight of Nigerian doctors (Raufu, 2002) and also there are limited incentives and encouragement for overseas based Nigerian doctors that is willing to relocate back to the country (Stilwell et al., 2004) . Purpose of the study In sub-Saharan African, there is has been a significant rise in disease burden, loss of productivity and the emigration of medical doctors to developed counties have resulted in the in dearth of the most required health resource (Aluwihare, 2005). Most studies on medical brain drain have examined the subject from the perspective of recipient developed countries and little attention has been paid to the donor developing countries. Thus, scarcity of data from developing country makes it difficult to fully describe the impact of migration on countries of origin (Hagopian et al., 2004). Most studies on doctors migration from Sub-Saharan African have tended to focus on numbers, without exploring the underlying reason for migration, assessing the potential negative impact of migration on the health care systems, or considering means to alleviate the problem. In actual fact, information regarding the extent of migration is usually obtained through data from countries of destination (Stilwel l et al 2003). The migration of medical doctors from Nigeria and other countries in sub-Saharan African generates three areas of major concern. The first is a loss of the basic health services available to the citizen. for instance, Ghana, faced with a ratio of nine doctors to every 100 000 patients and no more than 22 paediatrician are licensed to practise in country and no more than 10 specialists of any kind practising in the remote area. Similarly, Nigeria lack adequate doctors to care for the sick especially patients residing in the rural communities The second effect doctor migration from Nigeria is that it prevent the health sectors the ability to organize and expand. Public health institutions heavily depend on doctors to lead, develop and promote them as they work to advance health care delivery. As obtained in US, doctors are well positioned to serve their organisation by actively involved in managing resources and articulating priorities. It is therefore speculated that as the numbers of available medical doctors in developing countries reduces. The third challenges are that doctors migration depletes a significant element of the middle class in developing countries. As in the developed countries, medical doctors in African comprise of an important segment of the social and economic make up of the middle class. They are generally accorded a lot of respect in the society, as being above corruption, they advocate for improvement in quality of education of public schools and they play a vital role in political (Hagopian et al., 2005). In Nigeria, over 70.2% of the population lives on $1 per day (WHO, 2006) Research aim and objectives The aim of this study is to analyse the causes of medical brain drain from developing countries, benefits and burdens associated with brain drain based largely on the views of Nigerian doctors practising in UK. The objectives are: To identify the factors that influence the decision of medical doctors to migrate to developed countries migration To identify the impacts of migration on healthcare in developing countries CHAPTER TWO LITERATURE REVIEW Concept of Brian Drain Brain drain has been defined by many analysts in different ways. It is not surprising the social phenomenon has been examined and analysed from different perspective, based on their general orientation and or awareness of the subject. Brain drain will be conceived in this study as the loss of medical professionals or significant number of human capital within the health care system to other sector of the economy or country. Migration of skilled professionals differs from one country to another and from time to time it is however misleading to generalise the possible impacts of migration in developing countries. Moreover, it can be argued that various studies have attempted to measure the phenomenon from different perspective. Single analytic measurement cannot be used to justify all migration although migration of highly skilled professionals from developing countries has been attributed to various factors which political, social and economical factors account for a significant reasons behind the phenomenon (AUN report, 2002). The migration of highly skilled workers can justify the use of the term brain drain however the expression should be used cautiously. Replacing drain by a more common and value expression such as migration may generate alternate meaning. The difference in the word may be heightened by saying while all brain drains constitute brain migration notwithstanding, brain migration may not necessarily refer to brain drain. Brain drain denote the de-facto transfer of resources spent on impacting education and developing both technical and professional skills of the drained brain in question by the parent (donor) country to the (recipient) country of transfer. The developed countries thus save financial resources on education and professional training and invariably obtain the service of professionals such as doctors, nurses, engineers, scientists who earn more than their colleague in developing countries with a better comfortable living environment (Glaser and Habers, 1978). Several efforts have been made to define the concept of brain drain, most especially by international organisation. According to United Nations Educational, Scientific and Cultural Organisation (UNESCO report, 1969), the brain drain could be defined as an abnormal form of scientific exchange between countries, characterized by a one- way flow in favour of the most highly developed countries. Approximately four decades later, the definition of brain drain has undergone no significant change with a lot of highly skilled workers still leaving the shores of developing countries in pursuit of greener pastures in the developed nations. Medical doctors, engineers and scientists usually tend to predominate or account for a larger proportion among the migrants. Their higher the level of skills or professional qualification, make them more susceptible to migration. Gillis, et al. (1987) suggested two main reasons why brain drain is detestable to most developing countries. The first is that the calibres of people that migrate represent one of the scarce human resources in these developing countries and secondly the amount of resources, financial cost and time involve in educating these group of people is expensive and heavily subsidise by the government. Such migration to foreign country therefore becomes expensive and costly to the donor countries. In most cases the developing countries completely loose these highly skill professionals to the developed countries (Edokat, 2000). This phenomenon has generated a lot of arguments that have been advanced for or against brain drain; however this is not a concern for this study. All that can be concluded is that migration of highly skilled workers from developing countries to develop countries creates a vacuum in the former countries (Edokat, 2000). Types of brain drain Primary external brain drain occurs when trained professional or skilled human resources emigrate from their country of origin to work in developed countries such as America, Europe and Australia. Secondary external brain drain occurs when a trained professional or skilled human resources leave their country or any other less developed country to work in a another developing country such as Botswana, South Africa, Zimbabwe and Namibia. Internal brain drain occurs when a trained professional or skilled or skilled human resources seek for employment in a field not related to his to his/her expertise or when such individual migrate from the public sector to private sector or to another sector within a particular country. While this may pose a problem for a country, it is however not a loss of human resource to the country or the continent. Brain Drain Theories These theories are based on general migration approaches. In brain drain discussion, these approaches have been referred to briefly or summarized. Occasionally specific remarks will be made to provide more clarity regarding the theories. It is however important to state that nearly the theoretical outlook consists of specific mix of different theories or based on the nature of the dominating factors. On the other hand, the scientific approach in which the theories were founded. Another approach in the use of division based on the level Micro, Meso or Macro. These groups cover greater number of theoretical approaches (Oderth, 2002). This level has been defined as: Micro level the decision making of individual is affected by his or her motives, circumstances and access to information. Meso level an aspect of social ties that affects migration such as the effect of network of friends and relatives on migration Macro level opportunities and constraints available at societal level which include political, socio-cultural and economical factors There is no Grand theory linked with research on brain drain although attempts have been made to integrate the subject with economic and social theory, spatial analysis and social science (Kangasniemi et. al., 2004). The study of brain drain and other behaviour by demographers was able to draw insights from other disciplines such as statistics, history, economy, medicine and anthropology (Oderth 2001). A common example is the push and pull model of labour mobility. The model states that individual migration decision is a combination of family, economic, social and political factors. Categories of factors identified to be affecting migration include: 1) Factors at the point of origin, 2) Factors at point of destination, 3) Intervening obstacles and 4) personal circumstances. The push and pull model has been widely used by scholars in studies. Economic factors of employment and material benefits are regarded to have the strongest influence on migration decision (Oderth 2002) Despite the frequent use of the push and pull model approach in migration literature, the approach has been seen as too mechanical and rational choice based and with less consideration for intervening obstacles or institutional and structural constraints (Massey et al, 1993). Most migration tends to be unidirectional from poor to rich nations. The rate of emigration also differs vary considerately between countries and regions on similar economic level and the poorest or the less educated people hardly ever move. A major challenge for the migration is lack of insights in the interconnectedness of all the processes (Kangasniemi et. al., 2004) Another model is the migration system approach it involves formation of a link that encourages migration between a sender and receivers which are strengthened over a period of time. Such links include economic, political and cultural interaction often based on historical activities. Once a link has been created between the migrant places subsequent migration is facilitated through the links. The migration system approach emphasis that social network of the migration provides the intending migrants with information and assistance to ease migration. An important feature of such system is that immigration to a country is directed to specific regions. Such migration is partly dependent on specific areas (Gillis, et al. (1987)). The scope of medical brain drain The World Health Report (2006) estimated that an approximately 817,992 (138%) health workers would be required In Africa to achieve the coverage of basic health interventions. The rate at which doctors and other health professional migrate differs from country to country. Nevertheless, the pattern of migration shares certain similarities. The severe shortage of doctors particularly in rural health facilities has critical negative effects on accessibility and equitable distribution of health care in sub-Saharan African (Ovberedjo, 2007). Studying a specific group of employments from a pool of migration statistics revealed a substantial net loss of human capital among certain key profession in sub-Saharan African. An obvious and highly skilled professional to emerge from such analysis are medical doctors (SOPEMI, 2008). This particular phenomenon can be described as Medical Brain Drain. However, to what extent doctors migrated from sub Saharan African to developed countries? This section will review the scope of migration among doctors in sub Saharan African. Medical brain drain is important and deserves consideration because it is obvious that any decrease in the labour supply among doctors in any country is bound to generate a significant negative impact on the health system of that particular country. In year 2000, statistical data revealed an average of 18.2% of employed doctors working in OECD countries were foreigners. The United States has the largest number of doctors (about 200,000) born and trained in foreign countries followed by the United Kingdom which account for almost 50,000 and France about 34,000. Health worker in India and Philippine formed a greater percentage of the immigrant health workforce OECD countries. In addition, doctors from India account for 56,000 of foreign born doctors practising in OECD countries while nurses of Philippine origin account for about 110, 000. These represent about 15% each of the total (SOPEMI, 2008). The French and the Portuguese African speaking countries contribute some of the highest emigration rate to OECD countries for medical doctors some of other African countries such as Guinea Bissau, Sao Tome and Principe, Senegal, Carpe Verde, Congo, Benin and Togo rank between 17th and 23rd places with emigration rate of 40%, while the English speaking countries in African such as Malawi, Kenya and Ghana have lower emigration rate ranked 25th, 28th and 38th respectively. South African and Nigeria were the only two countries in sub-Saharan African among the top 25 countries with foreign doctors and nurses practising in the OECD countries. This was due to the fact that most African countries have smaller population of workforce (SOPEMI, 2007). Statistical data from the American Medical Association (AMA) Physician Master file shows that 5, 334 non-federal trained doctors trained in Africa medical schools were licensed to practise medicine in the United States in 2002. Nigeria account for 2,158, while South Africa 1,943 doctors. Another 478 doctors are from Ghana medical schools. Other countries contributing to the list in sub-Saharan African include Ethiopia 257 physician, Uganda 153 doctors, and Kenya 93 doctors. The total number of 5,334 represents 6% of the total number African doctors (Hagopian et al. 2004). After United States, the United Kingdom and Canada are the most common destinations in developed countries for African Physicians, with a total of 3,451 and 2, 151 African trained doctors are recorded to be practising in United Kingdom and Canada respectively. Moreover figures in the UK include only doctors who arrived after 1992 thus the number may probably be higher, other destinations for African-trained doctors include Australia, New Zealand and the Gulf States (Hagopian et al. 2003) Migration of doctors also occurs between countries within African continent. For instance, countries such as South Africa, Senegal and Botswana export doctors to developed countries and likewise import doctors from other African countries to cater for shortfall in medical personnel (EQUINET, 2003). Causes of Brain Drain The factors guiding individual choice of migration is in essence personal and thus susceptible to the prevailing personal circumstances. Nonetheless, the economic and social context of such decision deserves an important consideration. Moreover, the disparity between the economic and social development status of different sectors within a particular country and of different countries within African has countries has broaden over the year (Stilwell, 2004). Brain drain of doctors and other highly skilled professional from Africa has been blame on unfulfilled dream at country of origin caused by strife, corruption and misuse that mark Africas post-colonial history (Bridgewater, 2003 cited in Mbanefoh, 2007). Also according to Dovlo (2003), causes can be linked using six gradients which include job satisfaction, salary, career opportunity, governance, social security and benefit, protection and risk. Furthermore the dualistic nature of the world economy has been found to be a major contributing factor to brain drain, as highly skilled medical professionals particularly doctors try to escape the endemic poverty by migrating to wealthy, developed and technologically advanced countries of the world (Mbanefoh, 2007). Factors guiding individual decision to emigrate are a result of the interplay of economic, cultural, social, political and legal forces. Others factors encouraging cross-border migration are usually considered under two main categories: Push factors (Supply) and Pull factors (Demand) (Kline, 2003). Over time the pattern of migration is facilitated through networks that provide prospective migrants with information about job opportunities in countries of destination as well as offer various support to help adjustment after migration (Matin, 2003). Push factors (Supply) these are conditions that make a doctor to be dissatisfied with work and professional careers in their country of origin. The factors may be evident both in the developed and developing countries facilitating the migration of health care professionals from one country to another which is perceive to offer better opportunities in some way. However, these factors are more prominent in developing countries, and they greatly influence the decision of doctors to emigrate in these countries. Pull factors (Demand) these are conditions in countries of destination that motivate workers to migrate. In the same manner as push factors, pull factors can also influence the migration of doctors from one developed country to another developed country. However, the pull factors has a more pronounced influence on individuals in developing countries for instance, there is surge in migration of nurses to Canada after the review of cost of Medical Brain Drain in Developing Countries Medical Brain Drain in Developing Countries CHAPTER ONE BACKGROUND The loss of human capital from developing countries to developed countries is not a new phenomenon. It is commonly refer to as brain drain which broadly represents the migration of highly skilled professionals from one country or part of a country to another in search of a better prospect (Sako, 2002). The loss of highly skilled professional attributed to brain drain has been of interest internationally for over four decades (Giannoccolo, 2004). Concern over the international migration of health workers first came to limelight at the Edinburgh Commonwealth Medical Conference in 1965. This situation prompted the World Health Organisation (WHO) in 1970 to examine the global process and flows of doctors and nurses (Mejia, 1978). The report however made little impacts on migration of health workers which has continually been on the increase over the years (Levy, 2003, Pang et al. 2002) The concept of the medical brain drain, that is the migration of doctors and other health professionals from developing economies to developed countries has been the subject of interest and research across a variety of fields including labour economics, human resource studies and human geography (Diallo, 2004, Buchan, 2004 and Stilwell et al., 2004) The migration of medical personnel has been identified by WHO as the most critical problem facing the delivery of health service in developing countries (WHO, 2007), besides the emigration of doctors in particular to other countries have received a more considerable attention (Beecham, 2002) The extent to which health professionals migrate to developed countries has continue to be on the increase in recent years and this has been attributed to an apparent response to demand from the developed countries where medical professional are in short supply to cater for demands due to demographic changes, aging population, growing income, feminisation of workforce amongst others (Pond and McPake, 2006). Foreign-trained medical and nursing workforces are estimated to account for more than a quarter of health professionals of the Australia, Canada, the US, and the UK (OECD, 2002).The quest for highly skilled professionals has been on the increase in many developed countries. According to statistic report from the Global Atlas of Workforce cited in Pond and McPake, (2006), the United Kingdom (UK) was ranked among the least staffed of high income countries with 166 doctors and 497 nurses per 100,000 populations the second lowest doctors density and the fourth nurses lowest density among the Organisation for Economic Cooperation and Development (OECD) countries. Moreover, as at the year 2000, the UK health system currently require about 10,000 physicians and 20,000 more nurses to meet the demand of the NHS plan (Department of Health, 2000). Between the year 1999 and 2004 when the targets was achieved earlier than expected, a new target was set to increase the number of nurses by 35000 ( 10%) and physicians by 15000 (25%) between 2001 and 2008. In order to achieve the new target, several methods were adopted to recruit doctors and nurses from other country to fill the shortage within the NHS. However, the approach created a surge in the international recruitment of health worker (Department of Health, 2004). Conversely, the poor economy condition in the developing countries coupled with poor remunerations, lack of infrastructural facilities, and low morale, emigrating to developed countries by doctors is seen as an opportunity for a better prospect. Furthermore, the continuous rise in disease prevalence, emigration, productivity losses, and shortage of doctors in Sub-Saharan Africa, has resulted in health resource crisis (Aluwihare, 2005). Insufficiency in human capacity for health care delivery in developing countries have been identified as a significant factor that is responsible for the inability to achieve the target set by WHO for the treatment of 3 million HIV infected people by year 2005. (This initiative was tagged 3by5) (WHO, 2005). This has also been identified as a major constraint limiting the progress of Millennium Development Goals (MDGs) Initiatives (IOM, 2005). In response to the migration of health professionals to developed countries and the undermine effect to the economy, social and health status of exporting countries, the Commonwealth Ministers of Health agreed to uphold and keep the Commonwealth values of cooperation, sharing and supporting one another, thus a consensus approach to deal with the problem of international recruitment of health workers was adopted. The Code of Practice for the International Recruitment of Health Workers is intended to provide a framework to governments within which international recruitment should be carried out (Commonwealth Code of Practise, 2003). Similarly, Department of Health (2004), presented a revised policy on code of practise for international recruitment of health care professionals this demonstrated the concerned of the UK government in protecting the health care system of developing countries. The revised code of practise for recruitment addresses role of private employer and agencies in the international recruitment of health professionals from developing countries (Eastwood et al., 2005). Nevertheless, developing countries have made some effort in preventing the emigration of physician to developed countries. In spite of this, addressing factors that encourage emigration, such as large disparity in remunerations, standards of living, opportunities for career development amongst host other benefits are usually difficult to come by. At the 1998 UN Conference on Trade and Development, WHO study indicated that 56% of doctors from developing countries migrate to developed nations, while only 11% migrate in the opposite direction; the imbalance is even greater for nurses. (Chanda, 2002). As a result, further effort is being deployed by developing countries to search for means to manage the migration of the health workforce to developed countries (Hussey, 2007). Despite measures, it may be difficult to totally prevent health professionals from migrating. As the large scale of medical brain drain from developing countries is now having a negative impact on the development process of the health system of those countries, it is however imperative for stakeholders to develop a consequential means to curtail the continual movements of health professionals. Nigeria Health Services Historical Background Nigeria, the most populous black nation in the world with a total population of 140 million people (2006 census). As a country with mono-cultural economy, the major source of foreign earnings is from crude oil. The poor level of resources allocated to the health care sector is one of the main factors responsible for the deplorable health condition in the country (Campbell, 2007). The public health service in Nigeria started in 1946 with a 10-year colonial administration plan; the development came about when treatment was required for soldiers of the West African Frontier Force and the colonial administration staff. In 1975 attempt was made to adopt primary health care under the Basic Health Service Scheme (BHSS). The BHSS aimed to improve the accessibility to heath care in terms location, affordability, increase access to disease prevention and distribution of services, and provision of adaptable health services based on local need and socially acceptable method of technology (Hodges 2001). The Current Health Care System in Nigeria Over the last two decades, the health care system in Nigerias has deteriorated a fact ascribed to the countrys poor governance and leadership which was more pronounced during the military era. This was reflected in budget allocations and the fiscal requirements of the Structural Adjustment Programmes. The deficient of reliable data makes it difficult to provide a detailed assessment of the degree of financial commitment to the health sector (Ali-Akpjiak and Pyke, 2003). According to World Bank source, Nigeria public spending per capita for the health sector is less than $5 USD and is as low as $2 USD in some parts of the country. This is far below the $34 USD recommended by WHO for developing countries within the Macroeconomics Commission Report. Nevertheless the Federal Government recurrent budget on health showed an increasing trend from 1996 to 1998, a decline in 1999 and started to rise again in 2000, available evidence shows that most of the recurrent expenditure is spent on personnel. The Federal Government recurrent expenditure on health as a share of the total Federal Government recurrent expenditure which stood at 2.55% in 1996, 2.96% in 1997, and 2.99% in 1998, declined to 1.95% in 1999 and 2.5% rose in 2000. Beyond budgetary allocations, there is a wide gap in the available between the budgetary figures and the actual amount of funds released from the treasury for health activities (WHO 2009a). The decline in the Nigeria health sector was accompanied by collapse of institutional capacities, poor remuneration and lack of conducive environment, dilapidated equipment and infrastructure have over the years, job dissatisfaction and low motivation, have led to increase migration of health professionals to seek employment in overseas countries. In a bid to curtail the impasse, Nigeria has subscribed to the Commonwealth Code of Practice for the International Recruitment of Health Workers for which a framework of responsibilities is presently being developed (WHO 2009b). Demographic and Health Indicators The demographic data in Nigeria are not very reliable. Data gathered from various exercises such as census, vital registrations and surveys are often inconsistence and sometimes contradictory. Nonetheless, there is evidence that the key indicators have either remained constant or worsened (WHO 2005). Life expectancy declined from 52.6 years for male and 58.8 years for female in 1991 to 45 years and 46 years for both Male and Female respectively in 2004. The infant mortality rate (IMR) in 2004 is 103 per 1000 live births when compared to 87.2 per 1000 live births in 1999. Fifty percent of deaths under 5 years of age have been attributed to malnutrition. The maternal mortality rate (MMR) of 800 per 100,000 births is the second highest in the world after India. This has been attributed partly to shortage of skilled medical personnel. For instance only 41.9 % of primary health facilities is provides antenatal and delivery services. Moreover 57.3% of such health facilities operate without a doctor, midwives or senior community extension worker. The Nigeria health system is one of the worst in sub-Saharan African with a disability life adjusted expectancy of 38.3 years and ranked 187 in the world (WHO 2005) Health Workforce in Nigeria Among the several challenges facing the health system in Nigeria is the lack of competent health care professionals. This has been attributed to inadequate infrastructures and poor remunerations packages, making a sizeable numbers of doctors, nurses and other medical professionals vulnerable to be lured away to developed countries in search of a fulfilling and lucrative employments (Stilwell and Awofeso, 2004, Raufu, A., 2002) There are 52, 408 Nigerian Doctors registered with the Nigeria Medical Council as at December 2007, There are 128,918 nurses and 90,489 midwives on the register, although only a fraction of these pay the required practicing licensing fee. There are 13,199 pharmacists, 840 radiographers, 1,473 physiotherapists, 12,703 medical laboratory scientists, and 19,268 Community Health Officers. All these health workers are required to pay annual practicing licensing fees; however the lists have not been pruned for those have migrated out to foreign countries, deaths, retirements or those that have left the profession for another career entirely. Health workers are poorly distributed and most are in favour of urban areas, southern, tertiary health care services delivery, and curative care. For some cadres of health workers such as doctors and nurses, more than 50% have their place of work in the South Western part of the country with vast majority residing in the commercial city of Lagos (Labiran et. al, 2008). Medical Brain Drain in Nigeria Among the countries in sub-Saharan African, Nigeria is a major export of health professionals. An estimated number of 20, 000 health professionals emigrate from Africa annually. A trend that poses threat to sustainable health care delivery in Nigeria. Statistical data on Nigerian doctors who are legally migrating overseas are scarce and unreliable, this is largely due to the fact that most wealthy nations like Australia currently makes it very difficult for overseas trained doctors to practise in their country primarily on the basis of medical skills. However, hundreds of doctors trained in Nigeria continue to emigrate to developed countries annually (Stilwell and Awofeso, 2004). Better remunerations and medical facilities among other factors are cited as one of the major reason for flight of Nigerian doctors (Raufu, 2002) and also there are limited incentives and encouragement for overseas based Nigerian doctors that is willing to relocate back to the country (Stilwell et al., 2004) . Purpose of the study In sub-Saharan African, there is has been a significant rise in disease burden, loss of productivity and the emigration of medical doctors to developed counties have resulted in the in dearth of the most required health resource (Aluwihare, 2005). Most studies on medical brain drain have examined the subject from the perspective of recipient developed countries and little attention has been paid to the donor developing countries. Thus, scarcity of data from developing country makes it difficult to fully describe the impact of migration on countries of origin (Hagopian et al., 2004). Most studies on doctors migration from Sub-Saharan African have tended to focus on numbers, without exploring the underlying reason for migration, assessing the potential negative impact of migration on the health care systems, or considering means to alleviate the problem. In actual fact, information regarding the extent of migration is usually obtained through data from countries of destination (Stilwel l et al 2003). The migration of medical doctors from Nigeria and other countries in sub-Saharan African generates three areas of major concern. The first is a loss of the basic health services available to the citizen. for instance, Ghana, faced with a ratio of nine doctors to every 100 000 patients and no more than 22 paediatrician are licensed to practise in country and no more than 10 specialists of any kind practising in the remote area. Similarly, Nigeria lack adequate doctors to care for the sick especially patients residing in the rural communities The second effect doctor migration from Nigeria is that it prevent the health sectors the ability to organize and expand. Public health institutions heavily depend on doctors to lead, develop and promote them as they work to advance health care delivery. As obtained in US, doctors are well positioned to serve their organisation by actively involved in managing resources and articulating priorities. It is therefore speculated that as the numbers of available medical doctors in developing countries reduces. The third challenges are that doctors migration depletes a significant element of the middle class in developing countries. As in the developed countries, medical doctors in African comprise of an important segment of the social and economic make up of the middle class. They are generally accorded a lot of respect in the society, as being above corruption, they advocate for improvement in quality of education of public schools and they play a vital role in political (Hagopian et al., 2005). In Nigeria, over 70.2% of the population lives on $1 per day (WHO, 2006) Research aim and objectives The aim of this study is to analyse the causes of medical brain drain from developing countries, benefits and burdens associated with brain drain based largely on the views of Nigerian doctors practising in UK. The objectives are: To identify the factors that influence the decision of medical doctors to migrate to developed countries migration To identify the impacts of migration on healthcare in developing countries CHAPTER TWO LITERATURE REVIEW Concept of Brian Drain Brain drain has been defined by many analysts in different ways. It is not surprising the social phenomenon has been examined and analysed from different perspective, based on their general orientation and or awareness of the subject. Brain drain will be conceived in this study as the loss of medical professionals or significant number of human capital within the health care system to other sector of the economy or country. Migration of skilled professionals differs from one country to another and from time to time it is however misleading to generalise the possible impacts of migration in developing countries. Moreover, it can be argued that various studies have attempted to measure the phenomenon from different perspective. Single analytic measurement cannot be used to justify all migration although migration of highly skilled professionals from developing countries has been attributed to various factors which political, social and economical factors account for a significant reasons behind the phenomenon (AUN report, 2002). The migration of highly skilled workers can justify the use of the term brain drain however the expression should be used cautiously. Replacing drain by a more common and value expression such as migration may generate alternate meaning. The difference in the word may be heightened by saying while all brain drains constitute brain migration notwithstanding, brain migration may not necessarily refer to brain drain. Brain drain denote the de-facto transfer of resources spent on impacting education and developing both technical and professional skills of the drained brain in question by the parent (donor) country to the (recipient) country of transfer. The developed countries thus save financial resources on education and professional training and invariably obtain the service of professionals such as doctors, nurses, engineers, scientists who earn more than their colleague in developing countries with a better comfortable living environment (Glaser and Habers, 1978). Several efforts have been made to define the concept of brain drain, most especially by international organisation. According to United Nations Educational, Scientific and Cultural Organisation (UNESCO report, 1969), the brain drain could be defined as an abnormal form of scientific exchange between countries, characterized by a one- way flow in favour of the most highly developed countries. Approximately four decades later, the definition of brain drain has undergone no significant change with a lot of highly skilled workers still leaving the shores of developing countries in pursuit of greener pastures in the developed nations. Medical doctors, engineers and scientists usually tend to predominate or account for a larger proportion among the migrants. Their higher the level of skills or professional qualification, make them more susceptible to migration. Gillis, et al. (1987) suggested two main reasons why brain drain is detestable to most developing countries. The first is that the calibres of people that migrate represent one of the scarce human resources in these developing countries and secondly the amount of resources, financial cost and time involve in educating these group of people is expensive and heavily subsidise by the government. Such migration to foreign country therefore becomes expensive and costly to the donor countries. In most cases the developing countries completely loose these highly skill professionals to the developed countries (Edokat, 2000). This phenomenon has generated a lot of arguments that have been advanced for or against brain drain; however this is not a concern for this study. All that can be concluded is that migration of highly skilled workers from developing countries to develop countries creates a vacuum in the former countries (Edokat, 2000). Types of brain drain Primary external brain drain occurs when trained professional or skilled human resources emigrate from their country of origin to work in developed countries such as America, Europe and Australia. Secondary external brain drain occurs when a trained professional or skilled human resources leave their country or any other less developed country to work in a another developing country such as Botswana, South Africa, Zimbabwe and Namibia. Internal brain drain occurs when a trained professional or skilled or skilled human resources seek for employment in a field not related to his to his/her expertise or when such individual migrate from the public sector to private sector or to another sector within a particular country. While this may pose a problem for a country, it is however not a loss of human resource to the country or the continent. Brain Drain Theories These theories are based on general migration approaches. In brain drain discussion, these approaches have been referred to briefly or summarized. Occasionally specific remarks will be made to provide more clarity regarding the theories. It is however important to state that nearly the theoretical outlook consists of specific mix of different theories or based on the nature of the dominating factors. On the other hand, the scientific approach in which the theories were founded. Another approach in the use of division based on the level Micro, Meso or Macro. These groups cover greater number of theoretical approaches (Oderth, 2002). This level has been defined as: Micro level the decision making of individual is affected by his or her motives, circumstances and access to information. Meso level an aspect of social ties that affects migration such as the effect of network of friends and relatives on migration Macro level opportunities and constraints available at societal level which include political, socio-cultural and economical factors There is no Grand theory linked with research on brain drain although attempts have been made to integrate the subject with economic and social theory, spatial analysis and social science (Kangasniemi et. al., 2004). The study of brain drain and other behaviour by demographers was able to draw insights from other disciplines such as statistics, history, economy, medicine and anthropology (Oderth 2001). A common example is the push and pull model of labour mobility. The model states that individual migration decision is a combination of family, economic, social and political factors. Categories of factors identified to be affecting migration include: 1) Factors at the point of origin, 2) Factors at point of destination, 3) Intervening obstacles and 4) personal circumstances. The push and pull model has been widely used by scholars in studies. Economic factors of employment and material benefits are regarded to have the strongest influence on migration decision (Oderth 2002) Despite the frequent use of the push and pull model approach in migration literature, the approach has been seen as too mechanical and rational choice based and with less consideration for intervening obstacles or institutional and structural constraints (Massey et al, 1993). Most migration tends to be unidirectional from poor to rich nations. The rate of emigration also differs vary considerately between countries and regions on similar economic level and the poorest or the less educated people hardly ever move. A major challenge for the migration is lack of insights in the interconnectedness of all the processes (Kangasniemi et. al., 2004) Another model is the migration system approach it involves formation of a link that encourages migration between a sender and receivers which are strengthened over a period of time. Such links include economic, political and cultural interaction often based on historical activities. Once a link has been created between the migrant places subsequent migration is facilitated through the links. The migration system approach emphasis that social network of the migration provides the intending migrants with information and assistance to ease migration. An important feature of such system is that immigration to a country is directed to specific regions. Such migration is partly dependent on specific areas (Gillis, et al. (1987)). The scope of medical brain drain The World Health Report (2006) estimated that an approximately 817,992 (138%) health workers would be required In Africa to achieve the coverage of basic health interventions. The rate at which doctors and other health professional migrate differs from country to country. Nevertheless, the pattern of migration shares certain similarities. The severe shortage of doctors particularly in rural health facilities has critical negative effects on accessibility and equitable distribution of health care in sub-Saharan African (Ovberedjo, 2007). Studying a specific group of employments from a pool of migration statistics revealed a substantial net loss of human capital among certain key profession in sub-Saharan African. An obvious and highly skilled professional to emerge from such analysis are medical doctors (SOPEMI, 2008). This particular phenomenon can be described as Medical Brain Drain. However, to what extent doctors migrated from sub Saharan African to developed countries? This section will review the scope of migration among doctors in sub Saharan African. Medical brain drain is important and deserves consideration because it is obvious that any decrease in the labour supply among doctors in any country is bound to generate a significant negative impact on the health system of that particular country. In year 2000, statistical data revealed an average of 18.2% of employed doctors working in OECD countries were foreigners. The United States has the largest number of doctors (about 200,000) born and trained in foreign countries followed by the United Kingdom which account for almost 50,000 and France about 34,000. Health worker in India and Philippine formed a greater percentage of the immigrant health workforce OECD countries. In addition, doctors from India account for 56,000 of foreign born doctors practising in OECD countries while nurses of Philippine origin account for about 110, 000. These represent about 15% each of the total (SOPEMI, 2008). The French and the Portuguese African speaking countries contribute some of the highest emigration rate to OECD countries for medical doctors some of other African countries such as Guinea Bissau, Sao Tome and Principe, Senegal, Carpe Verde, Congo, Benin and Togo rank between 17th and 23rd places with emigration rate of 40%, while the English speaking countries in African such as Malawi, Kenya and Ghana have lower emigration rate ranked 25th, 28th and 38th respectively. South African and Nigeria were the only two countries in sub-Saharan African among the top 25 countries with foreign doctors and nurses practising in the OECD countries. This was due to the fact that most African countries have smaller population of workforce (SOPEMI, 2007). Statistical data from the American Medical Association (AMA) Physician Master file shows that 5, 334 non-federal trained doctors trained in Africa medical schools were licensed to practise medicine in the United States in 2002. Nigeria account for 2,158, while South Africa 1,943 doctors. Another 478 doctors are from Ghana medical schools. Other countries contributing to the list in sub-Saharan African include Ethiopia 257 physician, Uganda 153 doctors, and Kenya 93 doctors. The total number of 5,334 represents 6% of the total number African doctors (Hagopian et al. 2004). After United States, the United Kingdom and Canada are the most common destinations in developed countries for African Physicians, with a total of 3,451 and 2, 151 African trained doctors are recorded to be practising in United Kingdom and Canada respectively. Moreover figures in the UK include only doctors who arrived after 1992 thus the number may probably be higher, other destinations for African-trained doctors include Australia, New Zealand and the Gulf States (Hagopian et al. 2003) Migration of doctors also occurs between countries within African continent. For instance, countries such as South Africa, Senegal and Botswana export doctors to developed countries and likewise import doctors from other African countries to cater for shortfall in medical personnel (EQUINET, 2003). Causes of Brain Drain The factors guiding individual choice of migration is in essence personal and thus susceptible to the prevailing personal circumstances. Nonetheless, the economic and social context of such decision deserves an important consideration. Moreover, the disparity between the economic and social development status of different sectors within a particular country and of different countries within African has countries has broaden over the year (Stilwell, 2004). Brain drain of doctors and other highly skilled professional from Africa has been blame on unfulfilled dream at country of origin caused by strife, corruption and misuse that mark Africas post-colonial history (Bridgewater, 2003 cited in Mbanefoh, 2007). Also according to Dovlo (2003), causes can be linked using six gradients which include job satisfaction, salary, career opportunity, governance, social security and benefit, protection and risk. Furthermore the dualistic nature of the world economy has been found to be a major contributing factor to brain drain, as highly skilled medical professionals particularly doctors try to escape the endemic poverty by migrating to wealthy, developed and technologically advanced countries of the world (Mbanefoh, 2007). Factors guiding individual decision to emigrate are a result of the interplay of economic, cultural, social, political and legal forces. Others factors encouraging cross-border migration are usually considered under two main categories: Push factors (Supply) and Pull factors (Demand) (Kline, 2003). Over time the pattern of migration is facilitated through networks that provide prospective migrants with information about job opportunities in countries of destination as well as offer various support to help adjustment after migration (Matin, 2003). Push factors (Supply) these are conditions that make a doctor to be dissatisfied with work and professional careers in their country of origin. The factors may be evident both in the developed and developing countries facilitating the migration of health care professionals from one country to another which is perceive to offer better opportunities in some way. However, these factors are more prominent in developing countries, and they greatly influence the decision of doctors to emigrate in these countries. Pull factors (Demand) these are conditions in countries of destination that motivate workers to migrate. In the same manner as push factors, pull factors can also influence the migration of doctors from one developed country to another developed country. However, the pull factors has a more pronounced influence on individuals in developing countries for instance, there is surge in migration of nurses to Canada after the review of cost of