The recent scare has served to reveal one of medicine’s great scandals: the systematic plunder of nurses and doctors from the developing world by the U.S. Europe, Canada and Australia. A study by the George Washington University School of Public Health found that 30 percent of the medical workers in Ghana, 41.4 percent in Haiti, and 27.5 percent in Sri Lanka leave their countries to practice in the First World.
There are, for instance, more Malawi doctors practicing in England than there are in their native country. Some 13,000 doctors trained in sub-Saharan Africa are now practicing in the West. The result is that while Africa has 25 percent of the world’s disease burden, it has only 1.3 percent of its health workers.
According the United Nations Migration and Millennium Development Goal, “Poor countries, many of them with the fewest healthcare workers, but the highest infectious disease burdens, are ‘subsidizing’ the healthcare systems of wealthier countries.”
Ghana, for instance, spent $70 million training health workers who then moved to Britain. “In comparison, by recruiting Ghanaian doctors,” Dr. Edward Mills of the British Columbian Centre for Excellence in HIV/AIDS in Vancouver told Reuters, “The UK saved about 65 million pounds ($130 million) in training costs between 1998 and 2002.”
A 2006 study by the Centre for Global Development found that 17,000 South African medical workers were employed abroad. Yet to deal with spread of AIDS, malaria and tuberculosis, South Africa should add at least 620,000 nurses.
More than 20 million Africans are infected with HIV, and projections are that from 2006 to 2012 the number of patients per doctor will nearly triple, from 9,000 to 26,000. At the same time, recruitment will reduce the number of doctors from 21,000 to 10,000.
The average U.S. doctor sees about 2000 patients a year.
“The massive outflow of nurses, midwives and doctors from poorer countries to wealthier countries is one of the most difficult challenges posed by international migration,” and the loss of these workers is producing a medical crisis “unprecedented in the modern world,” concludes the UN Population Fund Annual Report.
For decades, Europe and the U.S. have used “fast track” immigration to recruit medical workers, luring them away with vastly better wages and working conditions. A surgical nurse in South Africa makes $13,000 a year. In Britain, the same nurse will earn $66,000 a year.
While the drain on Africa, the Indian sub-continent, and the Caribbean is the greatest, New Zealand also loses 22.6 percent of their medical workers to emigration, and the Philippines 16.7 percent.
“A lot of young Filipinos are going into nursing as preparation for leaving the country to search for a better life,” says Zenei Triunfo-Cortez, a Registered Nurse and member of the California Nurses Association. “As a result of the emigration, lots of [Philippine] hospitals—especially in rural areas—have been forced to close because of a shortage of both doctors and nurses.”
Entry-level nurses in the Philippines earn $2000 a year, compared with $36,000 in the U.S.
In some areas, the critical shortage of nurses may mean there are medical clinics but no medical workers, which means there is no one to administer drugs.
“It is immoral of the United States to ignore the impact of it [immigration of health care workers] on the countries which these nurses come from,” says Vicky Lovell of the Institute of Women’s Policy Research.
Nursing has a direct impact on medical outcomes. The death rate among the general population during the 1918-19 pandemic was about 2.7 percent—quite high for flu—but far higher among those who received no nursing.
In his book “The Great Influenza,” author John Barry notes that in 1918-19 public health officials discovered that nurses were even more important than doctors. “Nursing could ease the strain on a patient, keep a patient hydrated, calm, provide the best nutrition, cool the intense fevers. Nursing could give the victim of the disease the best chance to survive.”
But powerful forces are at work encouraging medical workers to immigrate. Health Maintenance Organizations find it is cheaper to recruit nurses from abroad than to improve working conditions and wages for their homegrown workforce. Government agencies—as the study of Ghana demonstrated—save tens of millions of dollars by poaching other country’s medial workers.
Because of the immigration safety valve, medical authorities in the developed world don’t bother to train enough health workers. Britain trains only 70 percent of the doctors it needs, and the U.S. trains only 50 percent of the nurses it needs.
“Immigration is not the only way we can get nurses,” argues Lovell. “Raising wages is easier and more effective.”
A team of international disease experts, which included HIV/AIDS expert Mills, has demanded an end to the practice, going so far as to call it a “crime.” Writing in the British medical magazine The Lancet, the team is calling on developed countries to stop recruiting health workers, and compensate the countries they have plundered by offering training programs, health facilities, and medical schools.
Britain’s National Health Service has agreed to stop recruiting South African doctors and nurses, although it will continue to lure away specialists like neurologists, audiologists and pathologists. However, private medical providers have not joined the Health Services self-imposed recruitment moratorium.
“What we are saying,” Mills told Reuters, “is that if one of these countries that is being systematically poached were to pursue it as a crime, contributing to unrest…then they would have some leg to stand on.”
CONN HALLINAN can be reached at: firstname.lastname@example.org