Wanted in AIDS fight: 4 million more workers
By, Stephen Smith, The Boston Globe, August 21, 2006
This is what it's like in the children's wing of the big Kenyan hospital where Ruth Nduati is a pediatrician: Most days there are more than 100 gravely ill patients cramming a ward intended for 35. And most shifts there are only three or four nurses to tend to all of the feverish children.
``It's a challenge to make sure the medications are given on time, it's a challenge to make sure the procedures are carried out," said Nduati, her bearing both grandmotherly and disarmingly direct. ``Too often, it's the mothers who have to carry out the procedures for their own children. It should not be this way."
In hospitals and clinics across Africa, the story is the same: too many patients and too few healthcare workers to treat them. While more than 60 percent of the world's AIDS patients live in sub-Saharan Africa, the region has only 3 percent of the world's health workers, according to the World Health Organization, which estimates that developing nations need an additional 4 million health workers.
At the 16th International AIDS Conference, the shortage of healthcare workers was recognized as a dire threat to the global campaign against the disease. The massive effort to deliver AIDS medications could be squandered without enough doctors and nurses to dispense the drugs appropriately.
Former President Bill Clinton and Microsoft founder Bill Gates, both of whom addressed the conference, said that something must be done. So did bellowing protesters wearing white lab coats, who interrupted speeches.
And the World Health Organization weighed in, too, issuing an elaborate blueprint that calls for spending as much as $14 billion over the next five years to fix the problem.
In part, the shortage stems from too many healthcare workers moving from the countryside to the city, and from too many medical professionals in the city dying of AIDS. In Botswana, for example, 17 percent of medical personnel were killed by AIDS between 1999 and 2005.
In Kenya, despite the incredible shortages Nduati faces, the nation is known to have thousands of unemployed nurses. But the government, like others in Africa, is subject to caps on public-sector spending -- a result of efforts by the International Monetary Fund and World Bank to enforce fiscal discipline -- so it can't afford to pay them to staff crowded clinics.
That's one reason so many doctors, nurses, and other professionals have left their homelands, tempted by the salaries of wealthier nations.
``We can't really blame people for wanting to have a better life," said Dr. Jim Kim, a Harvard professor who just spent three years as director of the WHO's AIDS division. ``So we will have to establish the conditions that will make them want to come back."
That doesn't only mean raising their pay. ``The medical institutions are often bankrupt and devoid of intellectual stimulation," Kim said, ``and young physicians will say, `I trained to be a doctor, not a mortuary attendant.' "
Kim, along with a Harvard colleague, Dr. Paul Farmer, established Partners in Health, a model that aims to bring high-quality healthcare to the poorest parts of the world, using the people who live there to deliver the treatment. It has also become a beacon for young doctors who otherwise would have left their homeland.
Dr. Cruff Renard was a star in his medical school class, and when he graduated from medical school in Haiti a few years ago, he knew exactly where he wanted to practice: with Partners in Health, treating the subsistence farmers of his homeland's Central Plateau region.
``Now," said Renard, an infectious disease specialist, ``we receive a lot of demand from young physicians. They don't learn about HIV or TB in school. They know they will learn about that with us."
The Harvard Medical School doctors who founded Partners in Health also recruited, trained, and employed villagers as community health workers. Often, Kim recalled, the villagers were illiterate and learned by looking at pictures. Now, hundreds of community health workers fan out across central Haiti, making sure neighbors take their drugs for tuberculosis and AIDS.
But it isn't only the patients who benefit. So do the health workers themselves, moving from lives as peasants to lives as paid medical workers, respected in their villages.
The same thing must happen in Africa, said Northeastern University law professor Brook K. Baker, who this fall will teach a global AIDS policy class.
In South Africa's Limpopo Province, for example, an AIDS service agency called Center for Positive Care has 1,000 volunteers, said Baker, who has visited Africa annually for a decade. All but 54 of them are women. Those volunteers, Baker said, should become paid staff members, which will empower them and, by extension, do something to curb HIV infections.
``We know there are women who are volunteers at health programs during the day and engaging in transactional sex at night simply to put food on the table," said Baker, who joined other protesters at the AIDS Conference in urging for increased spending on healthcare workers.
The protesters demanded that the United States invest $650 million next year toward easing the medical worker shortage in Africa.
``Think of how much we're spending every day on wars in Iraq and Afghanistan," Kim said. ``Why don't we take a war holiday for just one day to pay for healthcare workers?"
Source: Stephen Smith can be reached at stsmith@globe.com.
This is what it's like in the children's wing of the big Kenyan hospital where Ruth Nduati is a pediatrician: Most days there are more than 100 gravely ill patients cramming a ward intended for 35. And most shifts there are only three or four nurses to tend to all of the feverish children.
``It's a challenge to make sure the medications are given on time, it's a challenge to make sure the procedures are carried out," said Nduati, her bearing both grandmotherly and disarmingly direct. ``Too often, it's the mothers who have to carry out the procedures for their own children. It should not be this way."
In hospitals and clinics across Africa, the story is the same: too many patients and too few healthcare workers to treat them. While more than 60 percent of the world's AIDS patients live in sub-Saharan Africa, the region has only 3 percent of the world's health workers, according to the World Health Organization, which estimates that developing nations need an additional 4 million health workers.
At the 16th International AIDS Conference, the shortage of healthcare workers was recognized as a dire threat to the global campaign against the disease. The massive effort to deliver AIDS medications could be squandered without enough doctors and nurses to dispense the drugs appropriately.
Former President Bill Clinton and Microsoft founder Bill Gates, both of whom addressed the conference, said that something must be done. So did bellowing protesters wearing white lab coats, who interrupted speeches.
And the World Health Organization weighed in, too, issuing an elaborate blueprint that calls for spending as much as $14 billion over the next five years to fix the problem.
In part, the shortage stems from too many healthcare workers moving from the countryside to the city, and from too many medical professionals in the city dying of AIDS. In Botswana, for example, 17 percent of medical personnel were killed by AIDS between 1999 and 2005.
In Kenya, despite the incredible shortages Nduati faces, the nation is known to have thousands of unemployed nurses. But the government, like others in Africa, is subject to caps on public-sector spending -- a result of efforts by the International Monetary Fund and World Bank to enforce fiscal discipline -- so it can't afford to pay them to staff crowded clinics.
That's one reason so many doctors, nurses, and other professionals have left their homelands, tempted by the salaries of wealthier nations.
``We can't really blame people for wanting to have a better life," said Dr. Jim Kim, a Harvard professor who just spent three years as director of the WHO's AIDS division. ``So we will have to establish the conditions that will make them want to come back."
That doesn't only mean raising their pay. ``The medical institutions are often bankrupt and devoid of intellectual stimulation," Kim said, ``and young physicians will say, `I trained to be a doctor, not a mortuary attendant.' "
Kim, along with a Harvard colleague, Dr. Paul Farmer, established Partners in Health, a model that aims to bring high-quality healthcare to the poorest parts of the world, using the people who live there to deliver the treatment. It has also become a beacon for young doctors who otherwise would have left their homeland.
Dr. Cruff Renard was a star in his medical school class, and when he graduated from medical school in Haiti a few years ago, he knew exactly where he wanted to practice: with Partners in Health, treating the subsistence farmers of his homeland's Central Plateau region.
``Now," said Renard, an infectious disease specialist, ``we receive a lot of demand from young physicians. They don't learn about HIV or TB in school. They know they will learn about that with us."
The Harvard Medical School doctors who founded Partners in Health also recruited, trained, and employed villagers as community health workers. Often, Kim recalled, the villagers were illiterate and learned by looking at pictures. Now, hundreds of community health workers fan out across central Haiti, making sure neighbors take their drugs for tuberculosis and AIDS.
But it isn't only the patients who benefit. So do the health workers themselves, moving from lives as peasants to lives as paid medical workers, respected in their villages.
The same thing must happen in Africa, said Northeastern University law professor Brook K. Baker, who this fall will teach a global AIDS policy class.
In South Africa's Limpopo Province, for example, an AIDS service agency called Center for Positive Care has 1,000 volunteers, said Baker, who has visited Africa annually for a decade. All but 54 of them are women. Those volunteers, Baker said, should become paid staff members, which will empower them and, by extension, do something to curb HIV infections.
``We know there are women who are volunteers at health programs during the day and engaging in transactional sex at night simply to put food on the table," said Baker, who joined other protesters at the AIDS Conference in urging for increased spending on healthcare workers.
The protesters demanded that the United States invest $650 million next year toward easing the medical worker shortage in Africa.
``Think of how much we're spending every day on wars in Iraq and Afghanistan," Kim said. ``Why don't we take a war holiday for just one day to pay for healthcare workers?"
Source: Stephen Smith can be reached at stsmith@globe.com.
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