Nurse exodus leaves Kenya in crisis
Poor pay and lack of jobs are forcing workers to abandon their country's health service to seek work in the UK, reports Tracy McVeigh in Nairobi.
It takes only a few minutes of Kenyan rain to melt the baked red earth byways of the slums into pools of slippery clay that splatter high up every leg and wall and goat. The potholes brim with brown murk and the sewage runs free, carving its own streaming gutters.
In Nairobi's Zimmerman district, Jennifer Mchangi sidesteps a puddle, ducking between a corrugated-walled stall with bare shelves and a hut blasting Jamaican ska, into an alley - up a rusty metal staircase, along a creaky ledge, a key grinds in a lock and she's home: a 6ft square room, a narrow bed, a handspan-wide sink, a spotless rug and a scrap of net curtain over the little window.
It costs Mchangi 3,500 shillings a month (£25) - almost three-quarters of a nurse's salary and beyond the means of nurses with families to feed.
But her complaint is not about the rent or the rain coming through her ceiling. It is that she is one of around a quarter of qualified Kenyan nurses who has no permanent job in a country with a health system in crisis.
Her parents scrimped to send her, the brightest of their seven children, to college. She qualified in 1998 but has struggled to find work since.
Now, like thousands of others, she is saving to leave for the UK.
'It is frustrating. My parents are elderly and they expect me to help them but there is no work. The government promises us jobs will come, but they never do. I don't want to go far from my family and country but I will jump the moment I can. I wish it was today,' she said.
Kenya's health service is suffering a dire shortage of nurses - one estimate is that 10,000 are needed in the public sector alone - hospital wards are being run on ratios of one nurse to between 40 and 70 patients.
Overworked staff are leaving in droves, tempted by better conditions abroad, and they are not being replaced.
There is a large reservoir of unemployed nurses but the Kenyan government claims it is gripped by a recruitment freeze imposed by the conditions of the IMF/World Bank aid packages designed to force African countries to slim their bloated civil services.
So vital rural clinics across Kenya are being forced to close, patients are being neglected, nurses in jobs are depressingly overworked and falling prey to diseases like hepatitis and TB and Kenya's HIV/Aids drugs programme is under threat. Hundreds of agencies have sprung up offering to find nurses work in the UK - many disappear just as fast, taking the money and, more distressingly, the paperwork, of the unwary with them.
This month the government ran adverts in the main daily papers announcing it would be employing 3,800 nurses on temporary contracts funded by the Clinton Aids Foundation; within hours, thousands had turned up at the Ministry of Health compound. Looking down on them from his top floor office, Kenya's Chief Nursing Officer Chris Rakuom insisted the government could keep those jobs going after the funding runs out in two to three years.
'We recognise we have a problem. I want to make clear that Kenyan nurses love to work here. But people want progress and opportunities and if that is in the UK then people go. If the UK government can see a way to help us in return, good. But we don't want a lot of conditions that just hurt local operations, not help them. Grants, donations, but not conditions from people who do not understand Kenya.'
Perversely, the government has just opened its own profit-making agency to help Kenyans leave - about 8 per cent of national wealth comes from the diaspora sending money back home. This, plus a recent sacking of more than 1,000 nurses, means this year will see a record exodus of Kenyans to rich nations which fail to train enough medical professionals to meet their own needs and scour poorer nations for talent.
Luke Simba Kodambo, head of Kenya's National Nurses Association, said: 'We currently have a health system compromised so much that our people's health is declining. But we see that it is an opportunity for individuals and we do not want to be patronised. Kenyans have the right to move like anyone else. Let us not block the opportunity for people who wish to move but also let us encourage people to stay.'
The association's treasurer, Jeremiah Mainah, leaves for the UK later this year. 'Here I don't have the facilities to practise what I have been trained to do. I have a young family, I would like a better life. We have been patriotic for a long time. That is what has made me stay for a long time but enough is enough. I hope that perhaps in three years' time I can come back.'
It is hope shared by Dr Peter Ngatia, director of the African Medical and Research Foundation in Nairobi. 'The British government says it has a sensitive approach to the issue but what we see on the ground is active recruitment, maybe not directly by the government but by agencies. The NHS only trains 70 per cent of the doctors it needs, so where does that other 30 per cent come from? In the US they don't even train 50 per cent of the nurses they need. The health worker in this world is a precious commodity.
'So let's have a corridor of agreement: we can train more and we can share but we need remittance and we need people to come back with what they have learnt. This is the way to manage the brain drain.'
African Medical and Research Foundation: www.amref.org/uk
Read: Story by The Guardian - UK