The brain drain (9)
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Dear colleagues,
This is a very interesting discussion. Rather than join others to ad-
vance reasons for the brain drain from developing countries, I'll
like to make a contribution to what can be done in the interim.
The first thing we have to accept is that our clients/patients need
to get the best care they can from whoever is trained to provide
care. In the light of this, in some countries, physicians have ac-
cepted the intervention which allows them to delegate some responsi-
bilities to nurse/midwives (e.g. venipuncture, treatment of common
ailments, IUD insertion, providing antibiotic injections, post-
abortion care, minor suturing, draining of abscesses). In other coun-
tries, specialists/general duty physicians have opposed such delega-
tion of duties labelling it "institutionalization of quackery". Pro-
fessional organizations (medical, pharmacy, nursing/midwifery) have
joined in to "protect their turf".
Now we have entered another era, brain drain of nurses/midwives to
developed countries, notably USA and UK! Then comes the suggestion,
why not delegate some nursing/midwifery duties to nurse assistants
who are really the front line health providers in about 50% of rural
health facilities. The midwifery professionals regard this as heresy,
but remain comfortable to keep "training" traditional birth atten-
dants who are fast becoming expensive (but not necessarily efficient)
birth attendants.
With a high incidence of unemployment of our youths with secondary
education, wouldn't it make sense to recognize their potential to be
trained to provide specific tasks in the health care arena. At least
there will be a system for training and licensing unlike the TBAs and
the traditional healers who are self-licensing!! In China, we heard
of the barefoot doctors who provided care to the citizens of those
countries. The truth is that whether or not we train these nurse as-
sistanst for specific tasks, they are going to continue to provide
services.
Finally, training of the nurse assistants should be accompanied by
some recognition and salary inducement, another contentious issue
that many governments don't want to hear. This topic is a maze, but I
have chosen to talk about just one issue. Comments are welcome.
Emmanuel Otolorin
mailto:eotolorin@jhpiego.net
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