Healthcare system in Morocco

Author:Karim Moutchou Medical Student, Fez Faculty of Medicine and Pharmacy

Morocco, the birth place of millions immigrants living around the world, is seeing a new rise in the figures of “VIP immigration” as an important part of its most needed population is deciding to leave the country for a better social and more importantly professional life. Moroccan doctors and medical students are interested more and more in Germany as a primary destination. The German nation seems to have opened its arms for foreign doctors more than any other country in the last decades. This situation has raised at the same time hope and concerns among everyone involved on both sides of the Mediterranean and it presents both new opportunities and challenges to the receiving and sending countries.

In 2010, The Organization for Economic Co-operation and Development, OECD said that at least 2.6 millions of people born in Morocco are living outside of it, a percentage close to 10% of the number of Moroccan citizenship holders, making it thusly the 10thlargest population of immigrants around the world, a very advanced position because morocco is only in the 40thplace when it comes to the total number of citizens. The same report pointed out that 7000 of those immigrants are doctors. But it seems there will soon be more thousands of physicians crossing the Mediterranean or the Atlantic sea to first world countries.

The number of practicing physicians in Germany rose from 237.000 to 385.000 between 1990 and 2017 with low modifications in the general population numbers. Without neglecting the clear fact that German doctors are also immigrating to other countries, mainly European Union members as a medical degree from any EU member allows its holder to practice in all the others. The search for better opportunities around the continent and in places like the United States and Canada made the immigration to Germany necessary to balance the one out of it.

In 2013 German Medical Association published a report detailing the number of doctors of different nationalities practicing in Germany, there were for example 580 Egyptian doctors and 533 from Jordan, but the number of Moroccan doctors wasn’t even mentioned in the report, which most probably means that it was low enough to be neglected . The wave of immigration from Morocco to practice in Germany is still fresh, and official numbers will take some time to change after an important sum of physicians finishes the long procedure.

The language barrier doesn’t seem to stop Moroccan doctors from desiring the country, very few high schools around the country offer German courses, and it’s almost certain that anyone wanting to reach the B2 level required to be accepted in Germany needs to invest an important amount of energy and endear a lot of expenses that surpasses 10.000 of USD.

A 2ndyear resident in a small town in Germany, who finished medical school in Morocco before investing two years and more than 12.000USD dollars to move there, has been telling his friends and colleagues in Morocco that they should follow his path: ‘it wasn’t easy, I was depressed and disappeared during the process more often than not, going through thousands of documents and spending hundreds of hours was not easy and it for sure wasn’t clear, but as soon as I was accepted and started my journey as resident here, I realized that it was all worth it, I feel a new energy similar to the one I had when I joined medicine school for the first time”.

Specific reasons behind this immigration wave vary vastly from one person, from professional to personal ones, but they all share one goal “better future”.

Omaima, a recently graduated doctor who has been studying the language and planning to move to Germany as soon as she gets accepted, expressed a more personal reason for that, related to her own health issues and distrust in the medical system in Morocco not just for her patients but for herself too, saying: since I was diagnosed with Multiple Sclerosis, I felt more motivated to move to a developed country, realistically I know that my situation can get worse at any moment, and I would like to be in a place with a better system, that I can trust with my own life and health, I have seen the treatment that patients with the same condition as mine get in hospitals in Morocco, even the most privileged ones don't get the chance to have a good medical care that I want for myself, bottom line, I don't trust the healthcare system here to take care of my future patients, and my future self.

Many experts assume that for Germany this immigration phenomenon constitutes an opportunity to benefit from the best and the brightest coming from developing countries, the vast majority arrives to Europe after finishing medical schools in their birthplaces, sparing Germany from studies expenses and offering new medical vision and experiences.

On a more epidemiological level, the new wave of immigration from 3rdworld countries caused by economical, political, environmental problems and refugees fleeing war zones put new challenges to a European medicine that had to deal for the last decades with a group of diseases focused mainly around cardiovascular risk factors and cancers, especially with an aging population and low fertility.

Immigrants come from countries where infectious diseases are still dominant and bring an important number of children and young adults with a presumed higher fertility rate than the average European family. The presence of doctors well aware of the epidemiological situations and cultural differences will be very helpful - if not necessary - to develop medicine on a larger scale in the European Union.

But as everyone can imagine, immigration is still a very sensitive subject in all destination countries, and like all other types of immigrants, Doctors from morocco and other developing nations are facing discriminative actions and resistance from the nationalists movements.

Omar, a young doctor who considers Germany as his first choice for residency after graduation in the near future, started to feel differently about the country of his dreams after he spent one month as an exchange student in Heidelberg's hospital, one of the oldest and best medical centers in the country. The experience made him realize that there is a non-neglected portion of the population and even professors, especially the old generation and especially in the small cities, which is still not welcoming of young doctors from third world countries. He says that he felt a real discrimination in the eyes and actions of a lot of people inside and outside of the hospital, and that he was often considered, even with his medical career and ambitions, in the same basket with illegal immigrants or refugees coming from the other side of the Mediterranean Sea and the Middle East.

Omar believes that there is a clear preference for german students and that he might not be welcome in some departments and hospitals, except if he proves his excellent skills just to be treated fairly. He didn’t miss the chance to point out the younger generation of medical students and doctors seem much more welcoming than the old ones. He still thinks that one experience is not enough to have a real idea on the situation, but it is important for students and doctors to try similar short term internships to have an idea about the social and medical situation of the country before taking a final decision to move there.

On the Moroccan side, it is still not clear if the majority of the doctors and medical students who move Germany will eventually decide to practice there for a long time, switch to another EU country or go back to practice in the private sector in Morocco and bring what they learned back to their country.

Two doctors named Khalid and Mohammed, who studied medicine in Germany and finished their residency trainings before going back to Morocco to practice said that even though Germany offered them medical knowledge and a decent social life, they preferred going back to Morocco to be closer to family and have an more stable financial situation as most Moroccans citizens in other fields work for low wages averaged at around 350-450USD, which is just a small fraction of what a doctor with a good experience can earn in the private sector “better to be very rich in a poor country than just above the average in a rich country”.

Practicing in Morocco after a whole medical career or even just a residency program in Germany would demand brining back a lot of knowledge and experience to the country, and students or doctors who would like to go there believe that they will for sure get that. a resident in Germany gets on average a lot more experience than his peer in Morocco.

Angiography for example is still exclusive to professors in university hospitals around the kingdom, the vast majority of Moroccan residents never get to learn it, but in first world countries, Germany included, it’s an obligation for residents to perform it and master it before graduation. Same goes for many other medical procedures.

As for the patients, who are obviously the most important parameter in the healthcare equation, the quick switch in the demography of doctors in hospitals from the typical German Caucasians to much diverse groups from different countries, mainly third world but also from some European union and other first world countries from which students who couldn’t find a spot in the medical school or residency programs in their countries or simply preferred Germany, this switch will for sure means unprecedented situations of cultural and social differences. Moroccan doctors, coming from a developing Islamic Arabic African country, will have to adapt to an aging population with different moral and religious values

These cultural interactions can be confusing or even hard in the beginning for both patients and doctors but medicine has proven over its history that it develops better when cultures clash, the international world where we live now demands that doctors like all other professionals work in different parts of the world and with different cultural and scientific backgrounds to advance for a better and healthier world.