August 14, 2006

Sarah Adams, MCC AIDS Coordinator

What a day! So much to do! The program of activities is 487 pages long. And then of course there are two supplemental program guides. At any given time, there are 25 different sessions to choose from, not to mention marches, exhibitions, and video showings.

In the midst of all the formal activities, I thought I’d say a word about an informal one. As with all conferences, this one isn’t without its protests. There is one particularly persistent group of protestors. Their cause is the need for doctors, nurses, and other medical personnel in the developing world. Their voice is an important one. In every major event so far, they have been seen. Their banner? White lab coats with the message “Fight AIDS: Fund Health Workers Now” written in black ink – hoisted up on sticks high above the crowds. Headless, empty shells symbolizing the lack of medical personnel available in so many parts of the world.

Each year, thousands of doctors and nurses leave their country of origin in order to find work in Western nations. The UK, Canada, and others have gotten a reputation for ‘poaching’ well-qualified medical professionals from the developing world, luring them to the West with generous benefit packages.

This is a hard issue. We live in an open society, and certainly everyone deserves the right to live and work where they choose. And of course everyone deserves the right to earn a decent wage and provide for their family.

The problem is that Africa needs nurses. It’s not as if these nurses are leaving because there are too many in Africa. Most of them are leaving because they can’t find decent jobs. Because their governments can only afford to hire a limited number of nurses. Because salaries can be as low as $25-30 per month for a qualified nurse – not because governments think this is a fair wage, but because they do not have the money to pay fair wages.

The saddest part of the equation is that Western governments don’t seem to realize how much they are taking away from African countries. Many African governments have education systems that pay for the full training of nurses and doctors. Imagine the cost of an RN or MD degree in the West. And yet Western governments are recruiting these professionals, taking them away from the resource-poor countries that have put a lot of money into training them, and not paying any compensation at all to the African government systems that have provided their training. What incentive do African nations have to provide quality higher education to their people, when these skilled people are forced to leave the country and offer their services in the West?

The issue of the lack of health workers is especially important as we talk about the need to increase medical treatment for people living with HIV. If we want to increase HIV testing availability, we need trained lab technicians. If we want to increase programs for the prevention of mother to child transmission, we need trained doctors. If we want to ensure hundreds of thousands of new people take their medications properly, we need trained nurses and adherence counselors. Without qualified personnel in Africa to undertake these initiatives, they simply cannot be scaled up. Even if the will is there, it is simply impossible without the necessary medical infrastructure in place.

So what can we do? Some, like those here, choose to protest. You have the power to advocate. Here are just a few examples of things you can do:

• Write your political leaders and demand debt relief for countries that suffer from high HIV infection rates. It has been proven that when African governments do not have to put their money into the repayment of debts (and moreover the interest accrued on those debts), they are able to put much-needed resources into health care systems. On a visit to Tanzania about two years ago, workers at a hospital in rural Mugumu told me that, following a round of debt relief that Tanzania had received, they were being paid monthly salaries for the first time in years.
• Follow the news and see where money is being spent. When the U.S. government spends money on AIDS relief, where is it going? When the World Bank offers grants for AIDS work, how is it spent? Follow these initiatives. See if enough money is being designated for the salaries of health care workers.
• Urge your government to compensate African governments for the health professionals it takes. If the UK knows it’s taking 50 nurses a year from Botswana, and the cost for training each nurse is $5,000, why shouldn’t the UK agree to provide $250,000 annually to the government-sponsored nurse training institutions. African governments are using their limited resources to train these nurses, because they need them. Wealthy health systems in the West should not benefit freely from the investment of these African governments.

Again, it’s a complicated issue. No one wants to deny any medical worker the right to practice in a place where they will earn a good wage, where they can work in well-stocked clinics, where they have access to medications and can provide quality care to their patients. But many, many of these workers would prefer to be in their home countries, serving their own communities. They’d like to know they will have bandages when they need them. They’d like to know they won’t run out of drugs half-way into the month. They’d like to know they will get a fair wage, on a consistent basis. Until we can assure these basic principles, we will all continue to suffer.