23 June 2005 Edition

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New Irish Export: An endemic health crisis

If you go to an Irish hospital, and are lucky enough to be assigned a bed in a ward, and not a trolley on a corridor, very possibly you will be looked after by nurses from the Philippines, Nigeria, etc.

It is believed that up to 45% of doctors working in Irish hospitals are "non-nationals". And where are the Irish doctors? Well, they also go abroad, to countries where the system allows for good pay and not so many hours of work. So that creates a void in Ireland that is filled by foreign doctors, who leave their native countries mostly for the same reasons. And the lack of health resources and staff in those less developed countries is "solved" by aid agencies, which send specialised staff to those countries. However, the efforts of NGOs could be compared to trying to stop a haemorrhage with a plaster.

In fact, so dependent is the Irish health system on staff imports at the moment, that in 2002, the government decided that work visas for foreign doctors and other health professionals were to be fast-tracked, in an effort to combat the severe shortages of staff currently working in the Irish health service. The Work Visa scheme was introduced two years ago to facilitate the recruitment of workers from outside the EU into sectors experiencing particular skills shortages. This scheme only applied to nurses, doctors, dentists, radiographers, social workers, occupational therapists, IT and construction professionals.

The Dublin Government promised to solve the health service's problems. But waiting lists, A&E queues, and trolleys are now a feature of the Irish hospital landscape. And to the infrastructural problems, aggravated by the government strategy of centralising services (which is clearly cheaper for the government but more expensive for the health of the nation) has to be added staffing problems. Wards remain closed and operations are cancelled because of the lack of staff, and though the government promised an increase in the number of "home-groomed nurses", nothing seems to have changed.

How does that reflect on the Irish health system? The government solution to reducing waiting lists is that anyone wanting specialist attention joins a waiting list before being given a date to join the definitive waiting list. A personal example: children's ophthalmology, a waiting list of eight months, including three months waiting to join the waiting list.

So, as conditions don't improve, Irish doctors and nurses go to other countries, like Britain and the US, where their skills are well received and well paid, and Ireland continues its recruitment of developing countries health staff, without considering the consequences of its actions in countries like The Philippines.

Last month, a group of international health organisations renewed warnings about this devastating exodus of doctors and nurses from developing countries.

The British Medical Association (BMA), the Royal College of Nursing (RCN) and several international organisations say the drain of skills is putting millions of lives at risk in countries that already have severe shortages of health care workers.

The organisations warned that lives are being lost because of severe shortages of health staff in areas such as Sub-Saharan Africa.

The BMA called on governments to act on its recommendations at a conference of commonwealth health ministers in Geneva last month. James Johnson, chair of the BMA, said that the failure of countries like the US, and to a lesser extent Britain, to train enough doctors has had devastating consequences for the developing world.

For example, in Ghana, there are only 1,500 doctors for a population of 20 million people, and two-thirds of young doctors leave the country within three years of graduation. "In many parts of Africa there is simply no healthcare of any kind," Johnson added. "This cannot go on - it's time for us to act."

Dr Edwin Borman, chair of the BMA's international committee, added: "Sub-Saharan Africa needs at least another million healthcare workers, but in many countries the numbers are actually going down. At the moment, richer countries simply aren't doing enough to prevent a complete catastrophe."

Borman pointed out that Britain has taken the lead in developing an ethical recruitment policy, but said that all developed countries must follow suit if this is to be a successful initiative, with a new policy that restricts the NHS from recruiting staff in the poorest countries. However, doctors and nurses keep flying out of their countries to find jobs by themselves or come to Ireland through job agencies.

The BMA has warned that efforts to tackle global health problems like HIV and AIDS are being undermined by the migration, mostly in Africa, the epicentre of an HIV and Aids pandemic that has already killed 20 million people. That continent needs to recruit tens of thousands of health care workers if it is to meet the goal of providing anti-Aids medicines to those who need them. Yet its nurses and doctors are flocking to new jobs in developed countries, particularly Britain, where the state-run National Health Service faces chronic staff shortages.

For example, Malawi has been shown to have a more evident scale of braindrain, with only 28% of nursing posts filled in 2003, down from 47% in 1998.

South Africa, which has the world's highest number of AIDS sufferers, has vacancies for 32,000 nurses. In Zambia, only 50 of the 600 doctors who have been trained since independence in 1964 remain in the country. Many are reported to have headed for better careers and more pay in Britain, the United States, Canada, Australia and New Zealand.

Leonard Rubenstein, executive director of Physicians for Human Rights, believes that Africa needs to recruit tens of thousands of health care workers if it is to meet the goal of providing anti-Aids medicines to those who need them. "We have a terrible paradox, which is how can we possibly expect to meet the needs of people with Aids when the workforce is not only declining but the prospects for further decline are great," Rubenstein told reporters. He said the medical personnel are leaving even while a recently adopted World Health Organisation (WHO) plan calls for massive increases in the health workforce. Overall, more than three-quarters of countries in sub-Saharan Africa fall short of the WHO's minimum standard of 20 doctors per 100,000 people and 13 countries have five or fewer per 100,000.

In a report issued at the 15th International Aids Conference in Bangkok, Rubenstein called for restrictions on recruiting health care workers in sub-Saharan Africa and urged donor governments to fund improvements in local salaries. In December 2003, the World Health Organisation (WHO) set a target to get anti-retroviral drugs to three million people in developing countries by the end of 2005. Only 440,000 received them, of which a mere 150 000 were Africas.

The problem of diagnosing, treating and monitoring HIV patients in Africa has been highlighted numerous times. In a recent speech, Randall Tobias, the US Global Aids Co-ordinator said: "In places like Africa, the Caribbean and South-east Asia, there is a desperate lack of health care workers and infrastructure; all the Aids drugs in the world won't do any good if they're stuck in warehouses with no place to go."

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