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.