Disappearing Acts
The Big Issue Magazine South Africa | 1 february 2005

While South African hospitals are in dire straits, South African nurses are flocking to Britain, Egypt, Saudi Arabia and other countries. Not much seems to be done to keep them in South Africa, report CIORSDAN GLASS and ELLES VAN GELDER

Doctors stroll down the spotless, shining halls to visit the patients. Nurses sit in the tearoom and eat the cake they received as a token of thanks from one of their patients. Lying on fluffy pillows and bright white sheets, the patients watch their private televisions from the comfort of their beds while brand new equipment is used to nurse them back to health.

Based on this stereotype of a typical English hospital, it isn't hard to imagine why South African nurses want to work overseas - they want to escape the damp walls, obsolete equipment, heavy workload and the insecurity of government-funded hospitals.

South African nurse Dawn Ramthalile is one of many such nurses who moved to London's greener pastures five years ago. She currently works at the Accident and Emergency Department of Northwick Park Hospital. Prior to moving to London, she worked in fear, at Johannesburg's Baragwanath Hospital for 17 years.

"This was time-consuming, expensive and dangerous, mainly because I needed to wait in long queues for taxis on North Street in Johannesburg," recalls Ramthalile. Fuelled by her fear, she asked to be transferred to a clinic closer to home, but her employers rejected her request.

Angered by this, she jumped at the opportunity to work overseas. Without much hesitation, she packed her bags and relocated with her husband and youngest son in tow. Ramthalile says, "I wish I could have stayed in South Africa but I felt I had no other option other than to leave. Living and working in Britain has been good till now. I don't feel insecure anymore and my salary has increased tremendously."

No surprise

Good news for Ramthalilie, bad news for South Africa's already troubled health system. Scores of South African health care workers choose to go abroad, particularly to Britain. According to statistics, one in three public health jobs go unfulfilled in South Africa while The Health Systems Trust estimates 6% of healthcare workers in Britain are South African.

According to Mmapula Tladi-Small, head of the Association of South African Nurses in Britain, it comes as no surprise that so many nurses abandon their homeland. "While a senior nurse in Britain is able to make about R330,000 per year, their South African counterpart is likely to only make R85,000. Besides, while a nurse in Britain is likely to have around 10 to 15 patients at any given time, nurses in South Africa are likely to deal with 50 to 100 patients."

38-year-old Sokiena, who declined to reveal her surname, works at the maternity ward at Cape Town's Somerset Hospital. After deducting taxes and insurances she takes home R2,700 per month. She says that she can barely survive on that amount but cannot quit because she has three children to take care of.

"Nobody wants to work here," says Sokiena during her tea break at the hospital. "Patients are overflowing the hospital. It is often chaotic. You can't really be there for your patients. You deliver a baby and run to another woman to help with a caesarian section. In the meantime, you need to scrub and sterilise the equipment you've used because there isn't enough equipment." Because the hospital is so understaffed, Sokiena sometimes needs to work through her lunch and tea breaks.

Sokiena, and many like her, are feeling the brunt of the thousands of nurses who have left the country to work in better conditions overseas. Despite her heavy workload, she bears no ill feelings towards those nurses, saying simply that, "I can't blame them for leaving under these circumstances."

Wages

Gigi Henkeman, Sokiena's matron, says the workload enforced on her staff and their dismal payment is "disgusting." Henkeman adds that working conditions are bad in all government hospitals. "We all sing the same song. And at some places it is even worse than at my hospital. Like in Manenberg [on the Cape Flats] where the nurses need to take care of a lot of trauma patients from stabbings and shootings."

According to Henkeman, funds are needed to increase wages, buy new equipment and pay for security. "Nurses don't always feel safe in the hospital and need to take rude behaviour and abuse from patients. And if we get the victims from a gang fight, there is always the danger that they [rival gangsters] come to the hospital to finish the job."

Although the working conditions are bad, Tladi-Small says surveys show that most of the 5,000 South African nurses working in Britain hope to return home one day. One of them is Thoko Mlungwana. She worked in South Africa for 18 years before moving to London three years ago. Working at the sexual health department of Hommerton Hospital, she longs to return to mother land.

Mlungwana says: "We've been trained through South African taxpayers. People aren't benefiting from that now. It's really sad, the brain drain. Living in London has been a positive experience but I miss my family and friends."

Despite her nostalgia, she is very happy that her move allowed her to "grow professionally." "I am particularly grateful for having been given an opportunity to learn more about the treatment of HIV/Aids. I am sure I can find a job when I am back home and help the HIV/Aids patients," Mlungwana says.

With so many nurses willing to return home with their new-found skills, it should be a benefit for South Africa's healthcare system. But, on returning home, the government is "shooting itself in the foot," says Henkeman. "It almost looks like the government is punishing the nurses for going abroad instead of welcoming them. They don't allow them to enter at the level they left. They need to be satisfied with a lower position and because they aren't satisfied, they apply for jobs at the private hospitals or return overseas."

Code

While some developing countries (such as the Philipines) seem relatively content to export their healthcare workers to the British National Health Service (NHS), this drain has proved problematic for South Africa, particularly when one considers that the training of health care workers is subsidised by the South African tax payers' money. Furthermore, with the country's soaring numbers of Aids and violent crime victims, South Africa cannot afford to lose any more healthcare workers. However, actively tackling this problem has proved complicated.

Last year the British government signed the International Code of Practice on the Ethical Recruitment of Health Workers. This code was designed to restrict the recruitment of medical staff from 150 different developing countries, including South Africa, to the NHS. More than 170 agencies supplying the NHS with staff were required to adhere to the code. Theoretically, this agreement should have been a monumental breakthrough. Although the agreement restricted the British NHS, it did nothing to prevent the British private health sector or independent care homes from continuing their recruitment policies. Thus the agreement has proved ineffectual in practice, as it did nothing to stop South African health care workers from entering the NHS through the back door.

According to Henkeman, the government hasn't done much until now to motivate the nurses to stay in South Africa or return from overseas. And Tladi-Small says: "Until the government recognises the many push factors that lead to nurses leaving South Africa, the problems will continue."

After numerous attempts to obtain comment from the Department of Health, they have still not responded, leaving TBI with the unanswered question of what preventative measures government is taking.

Meanwhile, Sokiena is almost finished with her tea break. She still has eight hours to go before her 12-hour shift ends. They've received a call from a local hospital, informing them that they are going to bring their complicated cases to Somerset Hospital. This means that the beds will once again be full and the exhausted, overworked nurses will run around, right through the night, to deliver new life.









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