Swine Flu Fallout
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 United States, 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 2,000 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 United States 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 United States.
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 United States 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.”
Change of Heart?
During the fall campaign, then-candidate Barack Obama opposed a free trade agreement with Colombia, because “labor leaders have been targeted for assassination on a fairly consistent basis, and there have not been prosecutions.”
But according to Teo Balive of Upside Down World, after Obama and right-wing Colombian President Alvaro Uribe had a sit-down at the Summit of the Americas, Washington is suddenly talking about reviving the agreement. Afterwards, White House spokesman Robert Gibbs told the press, “The president has asked our trade representative, Ambassador [Ron] Kirk, to work with the Colombians to work through our remaining concerns about violence against labor leaders in Colombia.”
Balive says Uribe “showed Obama statistics that claim a drop in the murder of unions and an increase in the arrests of the perpetrators.” Only 3 percent of the cases have been solved.
Colombia is the single most dangerous place in the world to be a trade unionist. Jose Luciano Sanin of the National Labor School told a recent U.S. Congressional hearing, “More than 60 percent of all the murdered unionists in the world are Colombians. The murder rate of unionists in Colombia is five times that of the rest of the world, including those countries with dictatorships that have banned union activity,”
Since 1986, 2,711 unionists have been murdered, mostly by right-wing paramilitaries that worked closely with the military and had ties to the Uribe government, according to recent testimony in a U.S. court.
Paramilitary leader and drug lord, Diego Murillo, who was sentenced to 31 years in prison on April 22, told a New York courtroom that he had contributed “large sums of money” to Uribe’s 2002 campaign for president.
The Uribe campaign denied the charge, but it has stirred up a storm in Colombia. The charge “in a U.S. court is extremely serious, and cannot be ignored,” Gloria Florez, head of the indigenous organization, the Minga Association, told the Inter Press Service. “The Colombian state has the obligation to open an investigation into the declaration,” she said, “The justice system has to move on this issue.”
While the number of murdered trade unionists dropped shortly after the paramilitaries were disbanded, those numbers are once again on the rise, jumping from 39 in 2007 to 49 last year. In April and May, five trade unionists were assassinated, bringing the total for 2009 to 17.
It also appears that the Uribe administration is silencing some of the key perpetuators by extraditing them to the United States.
Jose Ever Veloza Garcia, who went by the name “H.H.,” confessed to some 1,200 murders, “including the brutal murder of workers belonging to the region’s banana unions,” according to Balive. “During the time the unions were really strong and there were a lot of strikes,” Veloza admitted, “what we did, and it was our duty, was to force the workers to go back to work at the plantations…those who disobeyed and didn’t go to work, knew what they had coming.”
Just as Veloza was starting to sing about his ties to the Uribe administration, including his links to the Colombian ambassador to the Dominican Republic, Uribe extradited him to the United States to face drug charges.
The Colombian Supreme Court just ordered the arrest of Uribe supporter Senator Zulema Jattin for ties to militia leader Rodrigo Tovar. Tovar, along with 13 other death squad leaders, was extradited to the United States last year on drug charges.
One hopes that the Obama administration’s “remaining concerns” are that Colombia is still a lethal place for trade unionists and that the Uribe government is up to its elbows in the blood of those 2,711 murdered activists.