Jeremy Laurance: A cynical trade measured in suffering

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The Independent Online

Two centuries ago Britain plundered Africa for its slaves. Now it is stripping the continent of another kind of human cargo - its medical workforce.

Two centuries ago Britain plundered Africa for its slaves. Now it is stripping the continent of another kind of human cargo - its medical workforce.

It was Sister Mercy Liswinaso, with her brilliant smile, who first helped me understand the meaning of this human trade. In the intensive care unit of the Central Hospital in Windhoek, Namibia, 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 post-natal wards. ''The nurses are going to the UK,'' she said.

That was in 1999. In subsequent years I visited hospitals in Malawi, Zambia, South Africa and Jamaica and the story was the same. At the public hospital in Kingston, Jamaica, 44 mothers had been admitted on the day of my visit in 2001 to the 30-bed maternity ward, while a neighbouring ward was closed. The hospital was 60 per cent short of nurses - most gone to the US and UK.

At Bottom Hospital in Lilongwe, Malawi, in 2002 the maternity ward I visited was crammed with women barely out of girlhood aged 15, 16 and 17 who were recovering from Caesareans with only a couple of nurses to care for them. Between 2002 and 2004, 139 nurses left Malawi for the UK.

It is a brutal, cynical trade whose cost is measured in untreated disease, avoidable suffering and shattered lives. Ghana is 50 times poorer than the United Kingdom yet we take their expensively trained doctors and nurses without paying a penny in return. A report by Save the Children and the charity Medact, published in February, estimated that Britain had saved £65m in training costs for the doctors it had taken from Ghana since 1999 and £38m for the nurses.

Tony Blair and Gordon Brown have committed themselves to tackling poverty in Africa. Yet, as the World Bank has recognised, an effective health system is a fundamental pre-requisite of economic progress. While we give hundreds of millions in aid with one hand, we are systematically stripping their skilled health workers - the vital resource of impoverished nations - with the other.

The trade is cynical because we could train enough doctors and nurses for our needs if we chose to. But it is cheaper to import them. Over 40 per cent of nurses joining the UK register in 2003-4 were from overseas, including 354 from Ghana. Over one- third of doctors in the UK were trained overseas, including 9,152 from sub-Saharan Africa, a region ravaged by Aids, malaria and tuberculosis which can least afford to lose them.

The UK is not the only country raiding the developing world to shore up its tottering health system. America turned away 150,000 well-qualified applicants for nursing schools last year yet the US Bureau of Labour Statistics estimated in February that the country would need one million extra nurses by 2012. America already has more than half of the world's nurses but instead of training those it needs, it plans to use its economic might to suck in thousands more.

There is a worldwide shortage of skilled health workers and a global market that governments, commercial agencies and individuals have learnt to exploit. The market is getting tougher as countries compete for extra skilled hands.

International concern about this human trade is growing. The World Medical Association presented a call for action to the ministerial assembly of the World Health Organisation last week, describing it as ''one of the most serious global problems today''. The British Medical Association and its counterparts in the US, Canada and South Africa, described it in a statement this month as a ''medical emergency''.

Africa's future depends on its ability to tackle the burden of disease that threatens the continent's development. Only by investing in people do its poverty-stricken countries have a hope of tackling the problems they face.

Instead of stripping them of their most vital resource, we should be directing aid to bolster the health services which we have plundered to shore up our own. Millions of lives hang on the outcome.

How NHS beats ban

The NHS was banned from poaching doctors and nurses from developing nations, including Ghana, in 1999. The ban was extended to include private agencies hiring on behalf of the NHS, who had stepped in to fill the gap, in 2001.

Despite the ban, the number of doctors from Ghana in Britain has more than doubled in six years from 143 to 293. Ghana has 2,000 doctors for 20 million people and around 80 per cent leave within five years of qualifying. The UK has 60 times more doctors than Ghana for a population just three times larger.

The exodus of nurses has soared with a 10-fold increase in those coming to Britain since 1999. There were 1,021 registered in the UK in 2004, of whom 800 have arrived in the past three years. The number of nurses in Ghana has fallen in the past decade from 15,000 to 11,800.

"We have a crisis," said Dr Ken Sagoe, director of human resources at the Ministry of Health. "We are training 600-800 nurses a year but we have not seen any major increase in numbers. We are losing as many as we train."

Professor Kwabena Frimpong-Boateng, director of Korle Bu hospital, said: "It's devastating. We cannot compete with the UK and the US on salaries. We should not continue to subsidise the training of doctors and nurses for the UK."

The problem is no longer solely one of poaching. Most of those arriving come of their own volition. The NHS is banned from active recruiting in the developing world - but not from hiring those who turn up on its doorstep. The numbers already in the UK and US are now so large that they lure their friends back home, bypassing the agencies. A nurse in Accra can obtain a copy of Nursing Times and apply for jobs directly.