Africa: Taking From the Poor, Giving to the Rich

9 April 2008

Sub-Saharan Africa has 24 percent of the global disease burden but only three percent of the world's health workers, according to the World Health Organization. Dorothy Ngoma, executive director of the National Organization of Nurses and Midwives of Malawi, has 30 years of experience as a nurse and 20 as a health care teacher.

Ahead of this year's G-8 summit and the World Health Assembly, she visited the United Kingdom recently to raise awareness about the lack of adequate health care in developing countries and to call on wealthy nations to live up to their commitments to improve the situation. In an interview with AllAfrica, she started by comparing the situation in Malawi now with that in the 1970s, when she began working as a nurse:

It was not as stressful. HIV was not there. TB was there, but very small. Malaria was there, but very small. We would have 30 to 40 patients at a time and there would be four to six nurses. The population was about four million. Now we have 13 million people. The same ward that used to have 30 patients now can have as many as 100 patients. And now instead of having six nurses we have maybe two nurses per shift. On night duty it's one nurse per 100 patients. That is extremely heavy.

The disease pattern has changed. The patients are sicker. You have more bedridden patients. You have a number who are unconscious, who cannot move. In a ward of 100 you might have 10-15 who are completely bedridden, who are on IVs, who need turning, who need feeding, and maybe even you have two or three on oxygen, others who are dying.

It is that bad. That is why nurses can't cope anymore and they just prefer to go to areas that are lighter and easier and less stressful because nurses are human beings too. We have seen nurses and doctors moving from poor countries – where they are needed the most – to the richer countries because of lack of incentives and things like that. This has been more like [taking]… from the poor and adding to the richer countries, where it should actually be the other way around.

But of course it's not just the money. There are just too many patients, too few nurses, too few hands. Many patients die on you. You get frustrated, you don't have enough drugs, protective wear, even things like health insurance for the nurses and health care workers. It is all those things that are pushing the nurses out.

Nurses leave not only for other countries. They leave the practice within the country to go and do things other than nursing. In fact, the other day one of the nurses actually said, "I would earn more money going to nurse chickens than to nurse sick people, so I would rather go and start rearing chickens, nurse them, sell them and make more money for myself."

If you're going to train nurses, it takes three or four years to qualify and [if] they just go and start nursing chickens, the government will have spent a lot of money. We need to keep these nurses. Many are working with NGOs or in the private sector. They are not in the public sector where the poorest of the poor are.

When you look at the whole thing you cannot blame them, but it is draining poor countries and making the situation worse. For every nurse, doctor or health care worker we lose, it means thousands are going without care.

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