Brain Circulation

• What drives “brain drain”? Why do bright young surgeons and researchers move from their home country to another? 
• However, the brain drain phenomenon is changing to one of “brain circulation”
• Spending a period abroad is opening up new horizons for today’s generation of rising stars – and many are returning to improve things back home
• Everyone can learn something from the experience, and the traffic can go in both directions!

The great climate, the cultural diversity, the overwhelmingly beautiful landscapes, and an endless list of other wonderful attributes makes me feel immense pride about where I come from – Latin America – but it has, for many years, suffered from “brain drain.” Why? The magic of Latin America has coexisted with inequality and unstable economies that has had an undeniable effect on our societies – and a direct impact on our professional and scientific communities. And ophthalmology has not been exempt from this phenomenon. Andrés Oppenheimer is a brilliant Argentine journalist and lawyer who lives in Miami, who described a new concept: ‘brain circulation.’ It refers to how (mainly Asian) countries want to give their young professionals the chance to study and work abroad, predominantly in the US and Europe, to attain the highest quality standards. It means that their knowledge and training can be potentiated and exploited later on when they return to their countries of origin. For Oppenheimer, ‘brain drain’ is a dated concept, and needs to make way for the term ‘brain circulation,’ which has been spurred by both globalization and a greater access to knowledge.

Ophthalmology and Latin America

If you’ve ever attended an ophthalmology congress or course in a Latin American country, you’ll encounter a unique collaborative spirit and truly high levels of professionalism. Argentina, Brazil, and Colombia, to name but a few, have offered the world outstanding ophthalmologists who changed the course of specializations, and their legacy is continued by new generations of Latin American ophthalmologists. Few would deny that Latin America is a great source of ‘raw material’; we produce bright brains that produce ideas of a highly innovative character. And we understand the need to have our professionals working at the highest standards in world ophthalmology and want to inspire in them a permanent thirst for innovation, and a commitment to do things in the best way possible. Achieving that comes down to education and knowledge sharing – and being aware of the opportunities that exist to facilitate the process. In the modern world, knowledge belongs to us all – and therefore it must be available to those who search for it, and those who are willing to enhance it and continue transmitting it.

The new era: sharing knowledge

Thankfully, the time when knowledge was guarded by the few from the many is over. We live in an era that sees a constant flow of information, skills and tools, which are (and should continue to be) available to everyone. Knowledge is the common currency in the 21st century. And in the field of ophthalmology, we must understand how crucial it is to equip our ophthalmologists with more clinical as well as surgical experience. Noelia Kunzevitzky at Stanford University has vast experience in the subject. She was raised and educated in Argentina but emigrated to the US to perform ophthalmic research. Noelia had the chance to work with and train dozens of researchers and prospective ophthalmologists from all over the world. Today, many of them have returned to their own countries, and are developing brilliant professional careers as well as international collaborative projects. What does Noelia have to say? “Science does not need to be limited by geography. When I left Argentina 13 years ago to pursue a doctorate in Cell Biology at Bascom Palmer Eye Institute at the University of Miami, there were only a few research groups in Argentina asking questions in Ophthalmology. Studying abroad increased my professional network significantly and allowed me to promote several international collaborations, many of which have lasted over a decade. I am proud to be part of a now larger community closing the gap between researchers and clinicians, and ultimately improving the quality of care for patients anywhere in the world.”

Brain circulation in reverse

A question worth considering is whether ‘brain circulation’ may work favorably for many when you look at it from the right perspective. There is an increasing number of ophthalmologists, mainly European, who choose to travel to Latin America to attain post-graduate qualifications. Access to a combination of the latest technology and a large number of cases at regional ophthalmology hospitals makes this a tempting option. Karim Tourkmani, a Spanish ophthalmologist, didn’t hesitate when taking the opportunity to spend a year working for the Asociación Para Evitar la Ceguera (APEC) – the most important Ophthalmological Hospital in Mexico City – for his Fellowship training in Cornea and Refractive Surgery. He now resides in England and shares his feelings about his experience with us: “It was a fantastic year, where I set up a strong base for my career as a corneal and anterior segment surgeon. Also, I learned many other things about Mexican lifestyle and culture, as well as other Latin American countries, as I made very good friendships with many Mexicans, Argentinians, Peruvians and Colombians. From a purely ophthalmological point of view, I gained vast knowledge about pathologies commonly found in tropical countries, but very rare in Europe, where I come from. Besides, I learned to perform penetrating keratoplasty and LASIK, among other techniques.” Landon Grage, a resident at UCSD Shiley Eye Institute, is another good example of how barriers are being broken. He speaks Spanish, and dreams of pursuing fellowship training at APEC, having learned about the main features of the hospital. “I will finish my residency program in San Diego, then I would like to complete my Fellowship in Mexico, then I will return to my home state in the USA,” he says, also proving that brain circulation can flow both ways.

My viewpoint 

I strongly believe that the brain circulation approach will pay off because these professionals will be able to offer up-to-date, responsible and highly advanced ophthalmological care – and also help advance it. For us in Latin America, it means that we can count on a whole generation of excellent specialists who will return to our countries, paving the way for the development of ophthalmology in our region over the coming decades, and continuing the legacy of knowledge exchange. I am convinced that there will be a powerful chain effect and, in a relatively short time, we will not be talking about brain drain anymore, but instead talking about the far more beneficial effect of brain circulation! C. Andrés Benatti is a Cornea and Refractive Surgeon and Associate Professor at Clinica de Ojos Córdoba, Córdoba, Argentina, International Professor at APEC, Mexico City, Mexico and a former International Fellow at UC San Diego Shiley Eye Institute. Benatti is also co-founder OftalmoUniversity.com.

About the Author(s)

C. Andrés Benatti

C. Andrés Benatti is a Cornea and Refractive Surgeon and Associate Professor at Clinica de Ojos Córdoba, Córdoba, Argentina; International Professor at APEC, Mexico City, Mexico; and a former International Fellow at UC San Diego Shiley Eye Institute. Benatti is also cofounder OftalmoUniversity.com.

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