Tribune (Malawi) article re: med staff drain

[patricks]

I found this especially to the point-- (it's written by Malawi's Minister of Health.) SDNers thinking about full-time overseas practice may be interested...
Reflections/thoughts?
_____________________________________________________
International Herald Tribune

AIDS: Africa's doctors

by Hetherwick Ntaba

FRIDAY, JULY 8, 2005
LILONGWE, Malawi

Here in my country, ten people die of AIDS every hour. About
one million people are infected with HIV out of a population of some 12
million. Our government is working hard to try to slow down this
epidemic: We have an extensive voluntary counseling and testing program
and hope to treat as many as 80,000 people with antiretroviral drugs by
the end of the year.

Unfortunately, there is only so much we can do. One of our biggest
obstacles, which many nations on our continent share, is a shortage of
health care workers. Simply put, Africa cannot fight poverty and disease
without more doctors and nurses.

AIDS has killed many of Malawi's health care workers, along with
teachers, attorneys and other educated people. The life expectancy in
Malawi is now only 36 years. Our health system can only afford to pay
public sector doctors $400 per month, which means in the midst of this
pandemic we are losing hundreds of health care professionals every year
to higher paying jobs in Britain, the United States and other Western
countries. In one year, we lost our entire annual output of nurses to
Britain. The result is that we have only about 10 percent of the
physicians we need and only about a third of the nurses.

We are not alone. Across Africa, a slender 1.3 percent of the world's
health care workers struggle to care for people suffering 25 percent of
the world's disease. Meanwhile, Western countries recruit them every
year by the thousands. In one year alone, Britain recruited 3,000 nurses
from African countries. Indeed, some African countries' health delivery
systems are in danger of collapsing because of this human resource
crisis. It is like the biblical saying, "To those that have more, more
is being given. For those with less, even that is being taken away."

While Malawi may never pay as much as Britain, many of our doctors and
nurses would like to stay at home and join the fight against AIDS and
other diseases if only they could earn a living wage. But this would
take money - funds that are not available.

Last week, the U.S.-based group Physicians for Human Rights released an
estimate, the first of its kind, revealing how much it would cost to
ease Africa's health care worker shortage. Money is needed to increase
salaries, improve training for workers and to help build health systems
that are crumbling.

The costs are not small, but neither is the problem: Physicians for
Human Rights estimates some $2 billion in 2006, rising to $7.7 billion
per year, would be needed to double the number of health workers in
Africa by 2010. Prime Minister Tony Blair's Commission for Africa
report, released in March, calls for triple the current number of health
care workers.

Aside from the health care worker crisis, reaching our target for
administering antiretroviral drugs faces another challenge: Money that's
been provided by donors for drug treatment is not easily accessible.
When the funds have been available, it's not easy to procure the drugs
from the generic manufacturers in India. There is a line to obtain the
World Health Organization prequalified medications; after we place an
order we must wait for as long as four months. The number of people
coming forth for antiretroviral drug treatment has been overwhelming but
because of the bottleneck in our access we have had to ask patients to
return home.

Some have doubts about whether we can reach our goals. But Stephen
Lewis, UN special envoy to Africa for AIDS, calls us "a nation
obsessed."

It's true, we won't give up: The very future of Malawi depends on
whether we win this fight. We believe that if we had the resources, we
would already have surpassed our goal.

This week, the Group of Eight industrialized nations is meeting in
Scotland to consider measures to alleviate poverty in Africa. In
response, more than 600 African doctors, nurses, development groups and
associations of people living with AIDS, along with groups from G-8
countries, such as the British Medical Association, have signed a
statement calling on the G-8 to commit money to help improve the health
worker crisis in Africa. The G-8 meeting is an unprecedented opportunity
to make a change in what some call the Rosetta Stone of the AIDS
epidemic: to enable thousands and thousands of health workers stay in
Africa, where they are desperately needed. Let's hope that the G-8 hears
Africa.

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[CoffeeCat]

It's a difficult problem without easy solutions, as with most countries in Africa. I'd say that developed countries shouldn't recruit nurses from developing countries but the conditions under which the nurses and doctors work under and their level of pay is outrageous, of course they'd want to leave, and shouldn't they have that option? Many countries have programs where students from developing countries train outside of their home country and then return for a specified number of years, but many of them leave after they're released from their contract.

 

[Learfan]

This is very sad to say but much of Africa is beyond any form of help that will materially impact the quality of life of the majority of the residents. There is a reason why Western Europe, the United States and Japan are prosperous and free while much of Africa is neither. There exist preconditions for prosperity without which capital does not accumulate and people remain mired in poverty. With poverty comes powerlessness against disease. Have you taken notice that a tremendous quantity of aid in the form of loans and grants from the World Bank, IMF and other international aid organizations as well as business investment has been poured into a variety of African nations for decades with little to show for it? There is a reason why aid is ineffective. For prosperity to develop, the following conditions are required. This list is not all inclusive.

1. Rights to private property must exist, be provable via documentation accepted throughout the nation and be defensible.
2. A working court system must exist to enforce contracts and defend property rights.
3. Government corruption must be held in check. It will always exist but it must be kept to a relatively low level.
4. There must be a organized and relatively unregulated market for capital.
5. There must be a published set of laws that will be applied to all in a relatively even handed manner. The system cannot be made to function perfectly but without the rule of law, prosperity cannot exist.
6. Warfare within the nation must not be a frequent event.

Most African nations offer none of these advantages to their citizens. As an example, note that a family of farmers in most African nations may work the same plot of land for generations but their ownership of the land is not acknowledged by any deed or court. The family cannot sell the land, pledge it for a loan or use it as collateral to buy equipment to improve the productivity of farming operations. They are effectively serfs, tied to the land as farmers without options. To bring prosperity to Africa will require massive reform of government, development of a workable legal system and the development of an organized system of recognized property rights. Until these changes are made, poverty will continue to reign and people will continue to be powerless against disease.

 

[doublepeak]

This is very sad to say but much of Africa is beyond any form of help that will materially impact the quality of life of the majority of the residents. There is a reason why Western Europe, the United States and Japan are prosperous and free while much of Africa is neither. There exist preconditions for prosperity without which capital does not accumulate and people remain mired in poverty. With poverty comes powerlessness against disease. Have you taken notice that a tremendous quantity of aid in the form of loans and grants from the World Bank, IMF and other international aid organizations as well as business investment has been poured into a variety of African nations for decades with little to show for it? There is a reason why aid is ineffective. For prosperity to develop, the following conditions are required. This list is not all inclusive.

1. Rights to private property must exist, be provable via documentation accepted throughout the nation and be defensible.
2. A working court system must exist to enforce contracts and defend property rights.
3. Government corruption must be held in check. It will always exist but it must be kept to a relatively low level.
4. There must be a organized and relatively unregulated market for capital.
5. There must be a published set of laws that will be applied to all in a relatively even handed manner. The system cannot be made to function perfectly but without the rule of law, prosperity cannot exist.
6. Warfare within the nation must not be a frequent event.

Most African nations offer none of these advantages to their citizens. As an example, note that a family of farmers in most African nations may work the same plot of land for generations but their ownership of the land is not acknowledged by any deed or court. The family cannot sell the land, pledge it for a loan or use it as collateral to buy equipment to improve the productivity of farming operations. They are effectively serfs, tied to the land as farmers without options. To bring prosperity to Africa will require massive reform of government, development of a workable legal system and the development of an organized system of recognized property rights. Until these changes are made, poverty will continue to reign and people will continue to be powerless against disease.

Although some of your points do need to be addressed in some nations, you should not generalize the whole continent of Africa. I just hate it when people have this view that everywhere in Africa is like the deepest poor places like they show on the saving the children type of commercials. Don't get me wrong, there are major problems. My fiance is from Zimbabwe, where Mugabe, their "President", is currently instructing urban settlements to be bulldozed.

South Africa, for example, satisfies ALL the criteria you specified yet it has the highest incidence of HIV in the world (in considering percent of population infected). This is the wealthiest nation in Africa, yet its government cannot afford to pay their health care workers good wages, so there is a brain drain when they go to the UK and the US. Worse than that, nurses are unemployed. The state doesn't have enough money to pay all the nurses that graduate. But what can they do? They cannot simply put all their money into health care because they need to solidify infastructure around the country. They need to be able to build low cost houses to eliminate squattercamps, they need to provide schooling, and the list can go on forever. Foreign capital is not coming quick enough into the country that has opened its industries up to globalization (since the ANC has been in power and apartheid abolished). Its not like poof...you are doing the right things and your country will flourish.

Poverty does cause the people to be powerless to disease. You can not just give monetary hand outs where the effect miniscule and not change the situation and simply have the citizens survive fine for another month before being stuck in the same predicament they were in before. You need to create infastructure to be able to help the masses. Much of the aid is directly for this....spreading electricity, educational programs, water sanitation....little things that over time will allow a larger workforce to develop and then progress can start to begin and they can start to sustain themselves.

The aid that the countries of Africa has recieved is no where near what is needed to allow the countries to begin to sustain themselves on their own.