It took primitive conditions at a government hospital to end Dr. Minerva M. Rasalan's dream of helping the poor in her native Philippines and send her on a mission toward permanent residency and practice in the United States.

During her time at the underfunded hospital, she found pregnant women assigned two to a cot, patients lining the halls and gloves and needles being sterilized for reuse.

Without respirators, relatives sometimes were forced to manually bag their loved ones to keep them alive.

“It's sad, especially for the pediatric patients who we know how to treat their diseases and most of these are infectious diseases,” Rasalan told the Associated Press. “We know what antibiotics to use, but we don't have them. So, then we lose the patient.”

Rasalan is among thousands of foreign-born doctors working across the United States under special visas that allow them to practice in underserved rural and inner city areas with the promise of eventual permanent residency.

But critics argue the so-called “brain drain” of doctors leaving for work in the United States has further strained already faltering health care systems in the developing world.

Dr. Fitzhugh Mullan of George Washington University believes the United States – which is facing a shortage of doctors – must stop looking elsewhere to fix its problems.

He compares the practice to “poaching” and said it amounts to poor citizenship in the world community.

Every doctor drawn to the United States, Britain , Australia and Canada from poorer nations leaves a hole that likely will not be filled, he said.

Mullan's research shows that areas such as Sub-Saharan Africa (13.9 percent), the Indian subcontinent (10.7 percent) and the Caribbean (8.4 percent) lose large numbers of doctors to the big four nations.

But there is little reciprocation. The United States exports less than one-tenth of one percent of its doctors abroad, for example.

“That creates enormous problems for the source country and for the educational and health leaders in the country who are attempting to provide healers,” he said.

While it is unclear what effect the arrest of the foreign doctors allegedly involved in a recent attempted terrorist attack in Great Britain will have on the ongoing exodus of physicians from developing nations, there is no question why doctors in developing countries are searching for opportunity elsewhere – even in the rural United States.

While many American doctors shy away from these areas, they have a strong allure for foreign doctors seeking a better life and professional fulfillment.

India provides the largest number of foreign-born doctors to work in the four developed nations, at about 55,000, Mullan's research shows.

About 40,000 of those work in the United States. The Philippines come next with about 18,000 doctors exported, mostly to the United States.

At least 20 countries export more than 10 percent of their physician work forces to richer nations.

Sub-Saharan Africa alone has nine of the top 20 nations contributing émigrés.

Mullan said the United States has about 280 doctors per 100,000 people. India has 60. But doctor-poor Ghana has two per 100,000, while Zimbabwe, where junior doctors make about $45 a week, is down to one.

The loss of doctors in Africa, where millions have been infected with HIV and AIDS, is especially acute.

Dr. Kgosi Letlape, president of the South African Medical Association, said doctor migration creates a trickle-up effect, of sorts.

“What goes around comes around,” he said. “We are in a continuum. What South Africa loses to the developed world, to the United States say, we gain from Uganda.”

Kenneth Ronquillo, director of the Philippine Department of Health's Bureau of Human Resources, said the shortage of doctors for rural areas of his country might be as steep as 5,000, though there are no concrete numbers.

He said pay seems to be the factor most likely to chase doctors out of the country. An entry-level physician makes about $320 a month – as much as some U.S. doctors can make in an hour or two.

“When we visit hospitals, we can already see that they lack doctors,” he said. “Even in Metro Manila, there is a lack of trainees for anesthesia, and the hospitals already advertise for their needs. In the past, applicants would queue at the Philippine General Hospital.”

Rasalan has few regrets over coming to the United States. In addition to good pay and a happy situation for her family, she gets to practice a subspecialty that allows her to work with premature babies. Her life would have been very different had she stayed in the Philippines.

“Had I done my training back home, I would still be living with my mom,” she said. “She would still be supporting me. They pay nothing there as a resident. You're tired, you work like 48-hour shifts and they don't pay you much. I don't want to be a burden to my mom.”

Rasalan earned a bachelor's degree in zoology from the University of the Philippines and completed her medical training at the U.P. College of Medicine. She served a general medicine internship at Philippine General Hospital and completed her residency in pediatrics at Rush Children's Hospital in Chicago.

Rasalan completed a neonatology fellowship at Westchester Medical Center in Valhalla , New York, and is certified by the American Board of Pediatrics in the specialties of pediatrics and neonatal-perinatal medicine.