By Conn Hallinan – June 21, 2009
Swine Flu Fallout. The recent designation of H1N1 as a “global pandemic” underlines one of medicine’s great scandals: the
systematic plunder of nurses and doctors from the developing world by the U.S.
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 2000 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 U.S. 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 U.S.
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.
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 U.S. 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.
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 U.S.
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 U.S. 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 U.S. 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. 