NAIROBI, Kenya—Ricarda Wahome moves expertly among the narrow, rusted metal beds of the central Nairobi hospital, her spotless white uniform and firm but tender manner the picture of professionalism.
A chief nurse at the hospital with 27 years of experience in Kenya, Wahome says her pay is so meager and her hospital so poor that she's thinking of looking for a job in the United States or the United Kingdom.
The promise of higher salaries and better working conditions lures some 20,000 African nurses and health-care workers annually to richer countries. The brain drain makes it even harder for African countries to treat diseases such as AIDS, tuberculosis and malaria, which kill millions each year, experts say.
But with the United States facing its own nursing shortage, some on Capitol Hill want to make it easier for foreign nurses to immigrate to America. A provision in the Senate immigration bill would lift a cap on special visas for nurses, which is now 500 each year.
The idea has drawn criticism from U.S. and African health experts, who say it would accelerate the loss of health-care workers where they're desperately needed.
The United States needs "to resolve our (nursing) shortage by increasing U.S. production, retention and efficient deployment of nurses, and not by increased recruitment from countries that can ill afford to lose them," said Eric Friedman, a researcher with Physicians for Human Rights in Washington.
With the baby-boomer generation aging, America's demand for nurses is far outpacing the supply. In 2000, the Department of Health and Human Services projected a shortfall of 800,000 nurses by 2020.
That gap has lessened in recent years as U.S. schools train more nurses, Friedman said, but the demand for foreign nurses remains. Besides the nursing-visa program, hundreds of nurses immigrate to the United States each year through other channels, such as moving to be with family members.
The 16,500 African-trained nurses working in the United States are a fraction of the 2 million nurses total, but they represent a major loss to their home countries. Cash-strapped African governments spend little on public health, resulting in a massive shortage of health facilities and equipment and relatively few doctors and nurses.
In its annual report on global health, released this month, the World Health Organization said that Africa, which bears one-quarter of the world's burden of diseases, has just 3 percent of the world's health workers.
For every 100,000 Americans there are 937 nurses, the report said. In Kenya it's 114. In Ethiopia, one of Africa's fastest growing countries, it's a mere 21.
At Wahome's Nairobi hospital, linens sometimes go unwashed and vital drugs are in short supply. Wahome earns less than $200 a month. Since her husband passed away three years ago, she's relied on her two adult children to support her.
"Because my children are grown now, maybe it's time that I can move on," said Wahome, a matronly figure in a long dress and braided hair clasped tightly in a bun.
Britain is the primary destination for African nurses, registering more than 2,600 over 12 months in 2004 and 2005.
The United States is a less popular destination due to stiffer registration requirements and higher travel costs. Still, 692 Africans applied for U.S. nursing licenses in 2003, nearly half of them from Nigeria.
Most of the migrants are among their countries' most experienced nurses.
"Wages are obviously part of it, but it's also working conditions, their own safety, their ability to have the drugs, supplies and equipment they need," Friedman said. "And part of it is management: Do they feel like they have career-advancement opportunities? Do they feel they are being respected and treated fairly?"
On the front lines of Africa's various health crises, nurses toil in difficult conditions, risking their own health because of inadequate sanitation and, in some places, a shortage of basic supplies such as clean gloves and syringes. The problems are most acute in rural areas.
Even at Nairobi's Mbagathi District Hospital, the relatively well-funded public facility where Wahome works, there aren't enough blood-pressure devices or oxygen machines. Nurses complain about the skimpy paychecks, which often arrive late.
"They are owed money. They are not paid for working holidays," Wahome said.
Last year, 5,000 employees at Kenya's largest hospital, Nairobi's Kenyatta Hospital, went on strike demanding a sixfold pay increase. The strike lasted two chaotic days—during which hundreds of patients went without food and medication, trash lay uncollected and soiled bed sheets were placed in windows—until the government ordered the employees back to work.
Ironically, Kenya has more nurses than it can afford to employ. The government, which provides the bulk of the country's health care, spends only $8 per person per year on public health, according to the WHO report. Without enough jobs to go around, some 7,000 nurses are unemployed.
Isabella Mbai, the head of the nursing department at Moi University, said this was a bigger health-care problem for Kenya than losing nurses to Western countries.
(c) 2006, Knight Ridder/Tribune Information Services.
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