Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.

Reuters NewMedia - October 1, 2008
Kavita Chandran and Tan Ee Lyn

Eventually a doctor saved the baby's life, but many patients are not so lucky in India and in other developing countries where a scarcity of doctors and trained nurses means there is often no helping hand in times of need.

"Health systems (in developing countries) are on the brink of collapse due to the lack of skilled personnel," said Ezekiel Nukuro, an official with the World Health Organization.

"In some countries, deaths from preventable diseases are rising and life expectancy is dropping," he said.

The health crisis in developing countries is, some experts say, being exacerbated by the West as countries relax stringent immigration regulations to attract doctors and nurses from less developed countries to boost their own flagging health systems while saving money on expensive training.

The consequences of this "brain drain" are grave as it leaves gaping holes in the healthcare systems of developing countries where diseases such as AIDS, tuberculosis and malaria run rampant and children die daily from diarrhea.

Aid agencies have warned that a European Union "blue card" scheme to attract highly skilled migrants like hospital workers, which was given initial backing by ministers this month, will worsen the already debilitating brain drain.

Africa, with a quarter of the world's disease burden but only 3 percent of its health care workers, is the worst affected region. International disease experts called earlier this year for the poaching of African health workers to be viewed as an international crime.

Across the continent, AIDS patients are often left unattended for days in rudimentary clinics staffed by a single overworked nurse and a few untrained orderlies. Doctors often only visit once every few weeks.

"There is a clinic run by a nurse who is over 70 years old, and she can hardly remember what she did with a patient yesterday ... and yet she still runs the clinic because there is no one willing to work there," said Dr Pheello Lethola, an HIV and TB specialist in the southern African country of Lesotho, where almost one-quarter of the population is infected with the HIV virus.

The lack of medical workers in Africa is most pronounced in regions where AIDS is rampant as the disease has whittled away the ranks of health workers.

"A nurse taking care of 400 patients is paid $3 a day in Malawi, not enough even for a bag of maize. So healthcare workers move overseas or to private companies here," said Moses Massaquoi, a doctor with Medecins Sans Frontieres in Malawi.

WHO experts said in a report in July that international aid to Africa should be used to boost doctors' salaries and bolster recruitment and training.

The report also said efforts to connect African hospitals with laboratories and experts abroad through the Internet and phone, known as "telemedicine," might ease cost pressures in countries that lack skilled personnel.

SLEEPING OUTSIDE HOSPITALS

In India, a country with the world's third highest HIV caseload, patients may spend days queuing up for tests and drugs at New Delhi hospitals as there simply are not enough doctors and nurses to attend to them all.

"Many end up sleeping outside the clinics and we are now looking at building shelters so people can come and stay," said AIDS activist Loon Gangte, adding that some patients abandon treatment because the waiting is too grueling.

In Afghanistan, some of the best public hospitals can't afford disinfectant or rubber gloves and doctors and nurses don't earn enough to feed their families.

"I am an associate professor and I earn US$100 a month. That's not enough to buy wheat for my family," said a doctor at a public hospital in Kabul who asked not to be named.

"The chief of this ward came to me to say it was difficult to survive, he would have to go somewhere else, Pakistan or Iran," he added. "Doctors are here only for training. If there is no training, they won't even stay for one hour."

Doctors and nurses in India are being poached either by private medical centers that cater to India's expanding middle class or by hospitals abroad. Some leave medicine and opt for jobs in the burgeoning and relatively high paying IT sector.

"Demand is greater than the supply," said Dr. Sunita Maheshwari, a pediatric cardiologist at a hospital in Bangalore. Maheshwari and her husband are a rare breed as they chose to return home to practice medicine after graduating from Yale University.

"India traditionally lost all our best nurses and technicians to the West because they (the West) too don't have enough. So what do they do? They poach from here," said Maheshwari.

India suffers an acute shortage of medical care workers, including 600,000 doctors, 200,000 dental surgeons, 1 million nurses as well as x-ray technicians, dental hygienists, physiotherapists and lab technicians. There is one nurse to 1,000 patients in India, compared to about 11 nurses to 1,000 patients in Europe.

This in a country that boasts of a flourishing 'medical tourism' industry as low cost plastic surgery and other procedures attract patients from around the world. Yet India's own poor and sick often get no medical assistance at all.

NO EASY SOLUTION

Experts admit there is no easy solution as the problems of developing countries, including war, disease and malnutrition, often prompt those who are able, to leave. However, they do suggest retention strategies to reduce the problem.

"It would be impossible to solve or stop migration of health workers ... (It's an) individual's basic human right to freedom of movement," said WHO's Nukuro.

"Having said that though, I believe that strong political and international commitment, innovative strategies ... partnerships and alliances and long term investments should be among the key ingredients in tackling medical 'brain drain'," he added.

Some practical steps being taken in India include reducing the burden on health professionals by training housewives to give medical advice for conditions such as diarrhea, and to dispense fever medicine, oral rehydration tablets and rapid diagnostic kits for malaria and pregnancy.

Such community-based training projects are also underway in African countries, especially in remote rural areas.

"This is a small intervention but it will have a big impact on reducing maternal mortality rates and infant mortality rates," Naresh Dayal, India's federal Health Secretary told Reuters earlier this year.

(Editing by Megan Goldin)

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