May 7, 2007

'Brain Drain' in health system continues unabated

Most nurses who have left Malawi have immigrated to the United Kingdom (UK), offering that country their services in the past. But now the United States of America (US) is fast becoming another attractive destination after many nurses are having an extension to their working visa being rejected in the UK, even after having worked there for nearly five years.
The American Hospital Association has reported that the US last year needed an extra of 118.000 nurses, a demand that will rise to 800.000 by 2020. In order to cater for this shortage a little un-noticed provision in the Immigration Bill is expected to be used. This could intensify the drain of nurses from the developing world. Reaction has been swift and filled with outrage with Physicians for Human Rights (PHR), a US advocacy group saying that this provision could undermine the multi-billion dollar effort by the US to combat AIDS and Malaria by potentially worsening the already existing shortage of health workers in poor countries like Malawi. "We're pouring water in a bucket with a hole in it, and we (US) drilled the hole," declared Holly Burkhalter from PHR when the proposals were first made.
There is no doubt, the public health sector in Malawi is already badly hit by the "Brain Drain" in the large exodus of medical professional personnel leaving the country for greener pastures in the developed world. It has been reported that over the past five years 52% of health administrators, 64% nurses and 85% physicians have left the government health system either to join private medical providers, join other NGOs or have left the country to join overseas health systems.
Recent media reports on the US Senate Immigration Bill with a small but significant provision that will make it possible for an unlimited number of health care workers and their immediate family to live and work in America makes the US another possible destination for nurses from Malawi. The Senate Bill 2611 already passed by the Senate Judiciary Committee will make it possible for more foreign nurses to live and work in the US. The provision is intended to assist the US government fill the gap of a shortage of nursing staff needed for their health system. At present the US has 500 special visas for nurses each year that makes it possible for nurses and their immediate family members to get a green card and live in the US. The possibility of recruiting foreign nurses to cater for the needs of the US has drawn some negative responses from experts from within the US and Africa who have been following the situation of the "Brain Drain" from the African continent.
Experts believe that the lifting of the immigration cap on nurses will have a serious affect on the African continent's health system where HIV/AIDS, Malaria and Tuberculosis (TB) are at epidemic levels and hospitals are inundated with patients who need nursing care. Already, some African countries are demanding that the developed countries tapping into their health system for personnel should pay some sort of compensation towards the loss of medical care workers.
The United Kingdom has in the past been a popular working destination for nurses and other medical staff from Malawi. In an effort to ease the strain experienced by the health system in the country because of the drain, pledges and funds of large amounts of money have been made and already been given to the Ministry of Health for the increase of salaries and to better working conditions in order to retain the nurses and other medical staff working in the system.
Mitchell Moss, Public Affairs Officer at the US Embassy in Malawi said according to material and information collected by the department and talks with colleagues from the Centre for Desease Control (CDC), the lifting of the 500 cap would not have a significant effect on Malawi. "Nurses' qualifications here are based on the UK educational system, and they are not immediately qualified to work as nurses in the US, where they must sit for qualification exams in order to be able to be licensed to work as nurses," he confirmed. He indicated that for the year 2004 -2005 over 26,000 African nurses registered to work in the UK, adding: "In 2003, only 692 African nurses applied to work in the US, over half of those from Nigeria."
Talking to nurses at several clinics within Lilongwe, the capital reveals that the US might now be an attractive option. A nurse who opted for animosity said: "Although it is more expensive to travel and it is very far from home, the chances of getting a permit to work are better because of the big shortage the U.S. is experiencing at present," she said. Asked why she did not want her name to be given, she said, "I am already making plans and I don't want people to spoil them for me. I want to take my chances." Another nurse said things were more difficult in the UK now with extensions to permits being denied. "I know that there are some of my friends who have been working in the National Health Services (NHS) and one or two in the private sector that have had their visas rejected after the five years they were given. So the US is now a better choice because the law is different there than in the UK" she said.
With developed countries needing nurses for the own medical system, already trained nurses are good option to fill the gap. What is concerning most is the gap that is being created by the departure of such important professionals. More trained medical care workers leaving for greener pastures in developed countries will put an even greater strain on the health system that is already short-stuffed and reeling from drug shortages. Ironically, most people from villages have to walk many miles to the nearest referral hospital only to be told to wait for long periods of time, even days to be attended to because there are just not enough members of staff to deal with the number of patients. The eventual possibility is that even after waiting so long, there will be no medication since there is such a shortage of even essential drugs at most of the government hospitals. The result of lack of medical care workers and the lack of medication in the public hospitals is that an illness like malaria that should be easily cured can become fatal in Malawi. (The Chronicle Newspaper, Lilongwe)

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