Table 3 Examples of empowerment dynamics emerging from coding
EPV matrix cell number | Number of comments | Illustrative codes (description) | Illustrative quotes |
|---|---|---|---|
13 | 33 | Private health sector investments (Expanding private health sector; private health insurance scheme, etc.) | “Another area which is also gradually expanding when it comes to medicine, there are lot of private universities now setting up medical schools. And there are lots of private hospitals also coming up. And you may have a lot of doctors now weighing options as whether to work in the government sector or to go purely private. And we have a lot of those who are in private sector and they are happy.” (Ghanaian-trained, male, 48, internal medicine, Accra, Ghana) |
15 | 84 | Remittances (financial support of family and significant others in home country, etc.) | “When I was in Ethiopia, I don't think I have given any substantial amount of money to my family, even occasionally. I don't remember giving them any helpful amount of money. But, since I came to the United States, I have sent I think a good amount of money to my family, at least to make them have no problem with their day-to-day basic lives.” (Ethiopian-born and trained, male, 38, internal medicine, Washington, DC, USA) |
17 | 31 | Physical assets of private health settings (Optimization of facilities, equipment, and human resources in private health settings, etc.) | “I think in the private health sector, things are better because they are there purely to make profit, so they take better care of their equipment. They are charging patients. So, they are able to maintain things. And also, people's expectations of the private hospitals are higher, so they need to live up to expectations. Because if you own a private hospital and people are not satisfied with your service, then they can go to another hospital. So I think competition and all that has helped make them better. … But, I always say that private hospitals are usually run by the same doctors who work in the public hospitals. They're the same people, but in a different setting. And their performance varies. Because, when they need stuff at the private hospital, they get it. They need it in a public hospital, it will take, what, two, three, four months?” (Ghanaian-trained, female, 33, public health, Accra, Ghana) “The beneficiaries of public institutions and government policy seem to have deliberately killed public institutions to allow the private ones to flourish. …It is like robbing Peter to pay Paul.” (Nigerian-trained, male, 45, community health, Abuja, Nigeria) |
19 | 17 | National labor unions (Establishing health unions; mobilizing health workers nationally; organizing strikes; collective bargaining, etc.) | “Prior to our action, what the doctors were receiving in terms of total emolument was really, really, miserable; especially those doctors who were working exclusively in the academic setting as lecturers. … One of the good things that we succeeded in achieving from the strike was to make locum tenens legal, once the doctors finish their regular clinical work. Prior to that, locum tenens was illegal.” (Nigerian-trained, male, 45, community health, Abuja, Nigeria) |
20 | 25 | Visa network and channels (Network of actors and organizations in the visa-granting process; manner of entry in the US) | “It was my penultimate year. I was one of the recipients of the Green Card Lottery. So, I think that played a huge role in the certainty for me to immigrate to the United States.” (Nigerian-trained, male, 41, psychiatry, Tennessee, USA) “I was admitted to the University of Boston in 2007 for the MPH but could not afford it. I was again admitted to University of Arizona in 2008 for the MPH but could not afford it. I wanted to use all these as spring boards for my emigration plans.” (Nigerian-trained, male, 45, community health, Abuja, Nigeria) |
21 | 30 | Defining own identity (Resisting complete assimilation in host country; accepting or declining host country citizenship; asserting one’s national origin, etc.) | “When I meet colleagues, friends, or just strangers, and we talk; they ask me: ‘Where are you from?’ What they mean is: ‘You have an accent’ or ‘I could detect, I could feel out that you weren’t born and raised in the U.S. You are from somewhere else.’ So, as long as people here are asking me where I am from, and are expecting that I answer, ‘I am from this country, or that country,’ then, I will never be able to claim complete identity here [in the US].” (Nigerian-trained, male, 44, pathology, Tennessee, USA) “I am Ghanaian. The passport you hold doesn’t say where you come from. Where you come from is where you feel you come from in your heart. And, I am Ghanaian. So, when we come to the point where you can hold a Ghanaian passport and go anywhere without the limitations for visas and stereotyping and all that then probably one would be comfortable holding a Ghanaian passport.” (Ghanaian-trained, female, 35, critical care, Washington, DC, USA) |
22 | 39 | Regional and national residency training institutions (West African College of Physicians; West African College of Surgeons; Ghana College of Physicians, etc.) | “Apart from the West African College of Surgeons, there was a new Ghana College of Physicians and Surgeons that started training surgeons in the country at that time. So, I decided to join.” (Ghanaian-trained, male, 38, obstetrics and gynecology, Accra, Ghana) |
23 | 21 | Diaspora-driven support of home-based health organizations (Medical trips to the home country; donation of medical supplies to health organizations in origin country, etc.) | “At the individual level, we all do what we can, but we need a collective decision, a collective effort to make a significant change. Some of us, including myself, gather resources at our own expenses and take them home. The local village where I came from, I spent at least $5000 in the last three/four years, helping them. I gather the medications and I appeal to other people, and I take various medications there. But the question is: Do they end up in taking care of the people? The staff will take the medications. For all I know they might sell it or do something else with that. That is not the appropriate way of helping the people. There is no comprehensive way to do that. So, at the individual level you help various people. But, at the collective level, that is a different area altogether. Some individuals within the Ghana College of Physicians and Surgeons, the means by which you got me, wanted to establish a parallel organization, meaning building a hospital in Ghana that, we had hoped would practice in the same way we do in the US and hopefully become a focus to bring some change. And, that didn’t work out so well after various people invested various amount of money. The guy who forwarded your email to me was one of the people. He spent about $35,000. I only put in $10,000. It is now zero. So, you know, we have hopes, and then we have realities that occur along the way.” (Ghanaian-trained, male, 52, emergency medicine, Maryland, USA) |
24 | 172 | Personal and professional development (Advanced training and specialization; peer-reviewed publications; international exposure and recognition; achievement drive, etc.) | “At the onset when I left, I had believed that when I am done with all these specializations I want to go back to Cameroon. I want to be able to set up practices and implement things which are actually not there, or may not be readily available, especially in the fields I chose. So, I came to the U.S., after been to England and other places; I came to the U.S. and did a residency at Henry Ford Hospital in pediatrics and adolescent medicine. And after residency I worked for Wayne State University Hospital, the Detroit Medical Center, as a physician. But then again, I felt like I needed to be a fellow. And I needed to have more studies. So, at the end of a three-year period, I took up a fellowship in adult and pediatric allergy and immune system disorders at the Louisiana State University Health Science Centers, where I finished and currently is board certified in the fields of pediatrics, in the fields of adult and pediatric allergy and immune system disorders.” (Cameroon-born, Nigerian-trained, female, 44, pediatrics, Michigan, USA) “I was in the U.S. for three months as a clinical observer. I've gone to different countries attending seminars, workshops and conferences. And I’ve published in the international journals. When I was in the U.S. actually, I stayed in Baltimore in the St. Agnes Hospital. And, I remember the program director of the residency training at that time asked me if I was interested to come back to the U.S. He asked me to go and do the USMLE exams and he offered, if he is still the director, to give me a place. But, I actually was not interested. I really wanted to go to the U.S. to get exposed to training, and not because of lack of opportunity.” (Nigerian-trained, male, 41, cardiology, Kano, Nigeria) |