Poor countries need their nurses more than we do

Jeremy Laurance: Poor countries need their nurses more than we do

The world's most vulnerable countries' hopes of solving their own problems are being shattered

The Independent-27 November 2002

What can be madder than this? Britain is donating 70m a year in the form of international aid to a southern African country on the verge of starvation while at the same time it is stripping it of its most precious resource skilled nurses.

Malawi turns out 235 nurses a year from its training schools, but last year the number leaving for the UK rose to 75. So almost a third of the country's output is being hoovered up by the National Health Service. That is not just mad. It is immoral.

Of course, the poor must seek their fortune where they can. There is a global shortage of nurses and the UK is not the only rich country raiding the developing world to shore up its tottering health system. But the consequence is that the world's most vulnerable countries are being cynically and deliberately hobbled, their hopes of solving their own problems shattered and their dependence on handouts from the developed world rendered inevitable for decades to come.

It was Sister Mercy Liswaniso, with her brilliant smile, who first helped me to understand the meaning of this human trade. In the intensive care unit of the Central Hospital in Windhoek, Namibia, a concrete edifice of echoing corridors and empty rooms, she scooped up a tiny infant and cradled it against her bosom as she explained why staff shortages had forced her to close one of the two postnatal wards. No new mother now remains in hospital for more than 24 hours.

Why the shortage, I asked. She chuckled and tossed her hair. "They are going to the UK," she said. In the previous month, three nurses had left for jobs in Britain and a fourth had gone for an interview in Cape Town, a 90-minute flight away.

That was in 1999. The following year I visited the public hospital in Kingston, Jamaica, surrounded by razor wire and protected by security guards, where I found one of the two sunny maternity wards on the first floor empty. In the other, 44 mothers had been admitted on the day of my visit to the 30 beds. Douglas MacDonald, the obstetrician in charge, shrugged his shoulders when asked why the ward was closed but the hospital admitted later that some departments were 60 per cent short of nurses, most gone to the US and the UK.

In Malawi, last June, I visited Bottom hospital in the capital Lilongwe, where two nurses provided all postnatal care to 50 women most of them teenagers recovering from caesareans - crammed into two wards. Every bed was occupied and relatives, who provide food and care, sat on the floor in a crowd so dense it was impossible to step between them. Bottom hospital is part of Central Hospital in Lilongwe where at the start of this year only 60 of 111 nursing posts were filled.

These three countries, of which I happen to have direct experience, are but minnows in this international trade. Yet if it is damaging them, as I discovered, what can it be doing to the bigger fish?

From South Africa we took 2,114 nurses last year, twice as many as in 2000-01 and five times as many as in 1997-98, the year after Nelson Mandela made a direct appeal to the British government to leave Africa's nurses and doctors alone. From five other countries of sub-Saharan Africa (Zimbabwe, Zambia, Kenya, Botswana and Malawi) we took 986 nurses last year, 10 times more than the 91 who came to Britain in 1997-98.

Ministers claim they have taken steps to stem the trade. In 1999 NHS trusts were banned from seeking nurses in South Africa yet the number recruited since has risen threefold. Private recruitment agencies stepped into the breach and did the NHS's dirty work for it.

Last June at Mulanje Mission Hospital in the south of Malawi, I was shown a list of recruitment agencies offering generous terms to nurses prepared to work abroad, including one based in Hatfield, Hertfordshire. The nurse who had shown me round the malnutrition clinic with its hollow-eyed children, puffy-limbed and listless from lack of food, said she was thinking of coming next year. I could not blame her an average nurse in Malawi earns about a tenth of a British nurse's salary but I do blame the agencies that touted for her business.

Last year the Government extended the ban on overseas recruitment to all developing countries (except where there is an agreement, as with India and the Philippines, to allow it) and published a code of practice which is claimed to be the first in the world. It established a register of private agencies which had signed up to the code and NHS trusts are now officially "encouraged" to deal only with them.

But the plain fact is that these measures are not working. Only one in three of the 92 private agencies has signed up to the code more than a year after it was published and Britain is continuing to suck nurses in ever increasing numbers from countries whose needs are desperate.

Only by investing in people do the countries of sub-Saharan Africa have a hope of tackling their problems. Instead of stripping them of their most vital resource, we should be directing aid to bolster the meagre salaries of those on whom their future depends. And it is time to ban NHS trusts from dealing with agencies that flout the code.