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West lures African nurses: trained nurses and pharmacists from Africa are in great demand in the US and Europe where they are offered better pay and prospects. But is africa the loser? Milan Vesely discusses.

Walk into any Albertson's or Walmart department store in Dallas or Fort Worth and you are sure to hear some very unlikely sounds: the lilting tones of Swahili or the clicking sounds of Xhosa. Mixed in among the Texas twangs, the sound of African dialects being spoken takes one by surprise as does the sight of colorful South African, Ugandan or Kenyan flags emblazoned on the bumpers of cars in traffic jams.



So who are these African ladies, these laughing and smiling beauties who suddenly seem to be in every department store and in every health care facility in the area?

The health care industry is now the fast track for African nurses emigrating to the US or the United Kingdom, as well as to many western European countries. Walk into any Texas hospital, and particularly any nursing home, and their smiling faces and cheerful dispositions will greet you.

In the Bishop Davies Medicare-approved facility near the Dallas/Fort Worth airport there are usually at least 20 nurses, all employed on temporary work permit basis provided by a health care employment agency.

Earning anywhere from $20,000 to $60,000 per year (depending on qualifications), these nurses are gaining the opportunity of a life time. Working in an American health care facility gives them invaluable experience with up-to-date nursing techniques and technology, while at the same time offering wages that enable them to put away a tidy financial nest egg.

At the same time they are also earning their sponsoring agencies commissions of between nine and 22%. This has proved an extremely lucrative business for employment agencies struggling to find vacancies for three million American unemployed.

"I have been here two years," Bishop Davies' Sheila Wairimu of Kiambu, Kenya said. "I miss home but am saving money and gaining experience at the same time." Pointing out that the Bishop Davies facility is an integrated rehabilitation facility for geriatric patients she asked: "Where else can I gain experience on the latest electrocardiogram machine, while at the same time being trained in the most modern physiotherapy techniques?" Nodding their heads in agreement, her partner nurses from Sierra Leone, Uganda and South Africa all echo her words.


Recent headlines in South African and English presses have decried the poaching of African nurses by overseas agencies, particularly those from the English speaking countries. Health Care Unions have also got in on the issue, pressuring their governments to ban recruitment from developing countries. Despite this, the nurse recruitment business goes on since many private agencies are exempt from their government's regulations.

"We are not in a position to direct the independent sector," Sarah Mullally, chief nursing officer in the UK said. Echoing her words Evelynn Mutio, general secretary of Kenya's National Nurses Association claimed: "The UK and US are poaching our nurses through employment agents and we can do nothing about it."

Statistics from the UK Nursing and Midwifery Council show that 13,721 nurses who trained outside the European Union were approved to work in Britain in 2001, up from 3,621 four years before.

Of those approved, 7,235 came from the Philippines, 2,114 from South Africa and 473 from Zimbabwe. While a figure of just under 14,000 nurses may not sound much considering the shortage being experienced in the NHS, the fact that 100,000 overseas nurses and midwives asked for application packs illustrates the depth of the exodus underway from many African countries already hard pressed to cope with a growing demand for health care services in their own hospitals.

Estimates for foreign nurses coming to the US are difficult to come by but many professionals believe that the figure is somewhere between 60,000 and 80,000; America often being the first choice of many from Africa.

If one considers that at least 20% of these stay on in the US after their contracts finish, then the drain on Africa's nursing pool is enormous. Furthermore, the exodus is increasing and thus is unlikely to slow down any time soon.

South African authorities began to take notice of the rising exodus of trained medical staff from their country in 2001. Eileen Brannigan, head of national nursing services for Netcare--one of the largest private hospital companies in South Africa--says that of the 90,000 registered nurses in the country, only 11,500 have specialised qualifications, and it is these that are most in demand in the West.

"More than 25% of these qualified nurses left the country last year alone," she laments, "and the South African Nursing Council gets some 300 queries a month from nurses who have registered, or who are querying about registering, with overseas authorities."


The rush of trained nursing staff applying for jobs in the United States began with American employment agencies advertising in African nursing journals. Offering good pay coupled with more acceptable working conditions, they were inundated with inquiries. In much the same way as the high technology sector has been able to recruit computer programmers from India on the basis that their skills are in short supply in the American employment pool, so these agencies were able to persuade the US Immigration and Naturalisation Service (INS) to issue short-term work permits to fill the staff shortages being experienced by many private nursing homes.

Higher pay is not the only factor being cited by the African nurses in the Bishop Davies facility as the reason for coming to the Dallas/Fort Worth area. Better working conditions, an exposure to overseas travel and mixing with cosmopolitan cultures all rank as important considerations. The fact that there is a growing Kenyan community in the nearby city of Irving also helps. "It makes finding a place to live much easier and with someone from Kenya to show me the ropes it has been a lot less stressful," Sheila Wairimu says. "It also helps with the homesickness when you can speak in Swahili or Kikuyu to a co-worker. We all car-pool to get to work, in order to save costs."

White South African Eileen Green who arrived in the US in January cited working conditions as the critical factor in making up her mind. "I never thought I would be one of the nurses leaving. I criticized many of my colleagues when they left. Then I found out that those of us who were left behind had to carry the load in my hospital," she told a South African paper. "In my hospital we had one nurse to 18 beds; there were about 500 outpatients a day and only 14 to 15 nurses allocated to this section. How can we give good nursing care in those types of conditions?"


Recent immigration legislation in the US is now making it harder for trained nurses to enter the country. The threat of terrorism has brought about a whole rash of new rules and regulations, not least a requirement for extensive background checks before a visa can be issued. This is sure to slow the pace of recruitment down. It is also preventing many of the nurses already in the US from visiting home.

"I intended to go home for one week every Christmas," one of the nurses at the Bishop Davies nursing facility said. "But now it's such a hassle with immigration and I don't want any hold up in returning with the possibility of losing my job so I won't go back until my three years are up."

The fact that many nurses from Kenya and Uganda are now bypassing the employment agencies and applying directly to the nursing homes for jobs is a welcome move. Many of the nurses already practicing in Texas are recommending their friends back home to their new employers.

In the case of the Dallas/Fort Worth area, this method of employment is now preferred by facilities such as the Bishop Davies and the nearby Woodbridge Nursing Home in Grapevine. "They do such a fine job for us that their recommendation carries great weight," night shift head nurse Yolanda said. "We find that our African nurses are very willing to work long hours and that is a great help to a busy facility such as ours."

Nursing is not the only profession now experiencing an influx of trained personnel from Africa. In the pharmacy industry there is a visible rise in staff from India, the Far East and Africa. The Eckards and Walgreens drug chains with thousands of stores nation-wide are increasingly being staffed by trained pharmacists from developing countries. Open from 10.00 am to 10.00 pm daily and some even for 24 hours, such stores require two shifts of pharmacists thereby doubling each store's staffing requirements. English speaking African pharmacists with British based qualifications are preferred for their ability to easily pass the American conversation examinations.

As African nurses and pharmacists seek greater rewards and experience in Europe and the US, they are being sorely missed back home. But there is an upside to this brain drain. Many will return at the end of their contracts with a greater understanding of their profession, and this can only be good for the health care programmes in their own countries.
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Title Annotation:Dateline USA
Author:Vesely, Milan
Publication:African Business
Geographic Code:1USA
Date:Mar 1, 2004
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