Wednesday, June 7, 2023

A First World problem causes a Third World problem, and vice versa


This report from the BBC caught my eye.

The recruitment of nurses by high-income countries from poorer nations is "out of control", according to the head of one of the world's biggest nursing groups.

The comments come as the BBC finds evidence of how Ghana's health system is struggling due to the "brain-drain".

Many specialist nurses have left the West African country for better paid jobs overseas.

In 2022 more than 1,200 Ghanaian nurses joined the UK's nursing register.

This comes as the National Health Service (NHS) increasingly relies on staff from non-EU countries to fill vacancies.

Although the UK says active recruitment in Ghana is not allowed, social media means nurses can easily see the vacancies available in NHS trusts. They can then apply for those jobs directly. Ghana's dire economic situation acts as a big push factor.

Howard Catton from the International Council of Nurses (ICN) is concerned about the scale of the numbers leaving countries like Ghana.

"My sense is that the situation currently is out of control," he told the BBC.

"We have intense recruitment taking place mainly driven by six or seven high-income countries but with recruitment from countries which are some of the weakest and most vulnerable which can ill-afford to lose their nurses."

The head of nursing at Greater Accra Regional Hospital, Gifty Aryee, told the BBC her Intensive Care Unit alone had lost 20 nurses to the UK and US in the last six months - with grave implications.

"Care is affected as we are not able to take any more patients. There are delays and it costs more in mortality - patients die," she said.

She added that seriously ill patients often had to be held for longer in the emergency department due to the nursing shortages.

One nurse in the hospital estimated that half of those she had graduated with had left the country - and she wanted to join them.

There's more at the link.

That report was about nurses;  but one could find similar reports about almost every skilled profession in Third World countries.  To many students there, a professional qualification is a ticket to a better life in a First World nation, and they pursue it avidly.  Across the Third World as a whole, I doubt whether even one in three professionals - medical personnel, engineers, architects, computer specialists, whatever - stay there more than a few years after they qualify.  Their skills are in high demand in other countries that offer a better life, and they'll willingly accept lower wages than local personnel in exchange for an immigration visa and the vastly improved living conditions that go with it.

One can't blame them, of course;  but it's devastating many poorer countries, who simply can't afford to educate their brightest and best students, only to lose them to richer nations who can offer them more.  I know that several countries in Africa now make medical students sign agreements that they'll work for at least a certain number of years in their countries of origin after graduation, or lose their student subsidies and be forced to repay them.  This hasn't stopped the problem:  many of those students simply abscond without bothering to go through emigration formalities, then refuse to pay.  Attempts to coerce them by making their parents co-responsible for repaying study subsidies haven't worked, either, because many of their parents are so poor they can't do so, no matter how much pressure is applied.  (Besides, once established overseas, many professionals bring their family over to join them, nullifying such pressures.)

Even churches face such pressures.  The Catholic Church in the USA can't find enough candidates for the priesthood to meet local demand, so it "imports" priests from India and elsewhere to fill the gaps.  I'd estimate that there are currently at least several hundred of them, if not into four figures worth.

On the receiving end of such emigration, there are problems too.  Cultural differences, work ethos, etc. are very different, making it awkward for new arrivals to fully integrate into their professions here.  There's also the problem that professional standards are often not the same.  What might be acceptable treatment, or management practices, or whatever, in the Third World may not be at all appropriate in the First.  I've heard several complaints about foreign doctors from Americans that I'm pretty sure amounted to not much more than cultural differences.  Being an immigrant myself, I could perhaps weigh up the nuances better than those born and raised here.

There's no real answer to the problem.  It's been in progress for a long time, and as long as the First World is richer and more comfortable than the Third, it'll continue.  Sadly, that means a lot of Third World nations will continue to lose their brightest and best citizens to countries that can offer them more, leaving the rest of their citizens to cope with shortages and an infrastructure that's breaking down under the "brain drain".



Anonymous said...

I can attest to this here in Tallahassee. I was in the hospital earlier this year and all the nurses in my wing were Indonesia, only the head nurses were American. I had a good repore with the natives and asked what was going on. They brought them in during covid and priced the natives out by slashing their hours. They had to keep the head nurses to oversee and correct all the mistakes the Indo's made.

John Prigent said...

It works the other way around, too. I used to have to go to East Africa on business for a total of about 1/4 of each year. I used to be amazed at the number of long-term expats who never bothered to learn the local language, Swahili. A common cry was 'why should I bother, my staff understand intructions in English and tell the others what to do'. I still remember sitting in an office while its very senior expat inhabitant called for one of the locals to tell a driver where to take me next. I could have done that myself, I'd already learnt enough Swahili to hold conversations after a couple of trips there. Needless to say, I got far better welcomes from the locals when they realised that I spoke their language and was always trying to learn more words of it.

bultaco1495 said...

There is another related issue with respect to this problem. This may not be the time to bring it up, but it should be talked about sometime. It is the issue of corporations constantly telling us (and Congress, BTW) that they desperately need qualified candidates for various positions at their corporations, but are having a very hard time finding them. So the only way they say to help their corporations is to increase the amount, and also making it easier (two separate concepts) to attract and employ new employees from other countries. I believe that colleges and universities graduate students every year that are perfectly qualified to fulfill these positions. I believe that many of them received great grades and would do well. But they rightfully expect to get paid a good wage or salary for such positions (yes, not a lot to start, of course, . . . we understand that). But I believe that corporations know that they can obtain a person who can do the job for a lot less salary. And yet we constantly hear and read that corporations cannot find qualified candidates for the jobs that they are offering.
[I hope what is written above does not devolve into a "those darn Democrats" and a "those darn Republicans" discussion in the comments field . . . . ]

Anonymous said...

Worked at one large IT shop in the Midwest. They were busy laying off US IT staff, while at the same time lobbying the government for more H-1Bs because they get couldn't enough US citizens for their jobs - or so they claimed. Later on, I did contract work at a large North Carolina shop. They tried outsourcing a project to India and when the code came back the NC staff had to fix a number of bugs before it would work. They did it again, with the same result. They then announced that the offshore experiment was so successful that they were going to offshore all contract work. As my contract was about to expire I told them I was not renewing and ended up getting a job elsewhere.

Landroll said...

At three to five million new border crossers a year, soon those coming will soon realize they didn't need to leave home. Bultaco has hit the worker hire problem in the 'nads though.

James said...

bultaco1495, it is the Uniparty after all that has sold out the people to the corporations, they are all in it together. I worked in dialysis for over 26 years and we had a large percentage of Filipinos, In their country they had nursing schools that trained for the US market and when the US cut back on bringing them in a number of those schools just shut down.
Of course the question must be asked why not hire from the citizenry rather than new immigrants. Due to relaxed educational standards for certain minorities, Native candidates were often not competent. I have stories from over 26 years in the business that are too weird to be fiction. I'll tell just one, when a nurse in one of our facilities couldn't find injectable Tylenol, she crushed up a tablet in tap water and injected that. When the other horrified staff reported this to the manager, who shared a background with said nurse, the manager said well everybody makes mistakes and she needs her job.
I would have to be truly desperate to put myself in the hands of the medical system today.

LL said...

The law of fungibility.

I do a lot of business in Asia where I'm paid by "whales". An Asian person could likely do the job as well as I do, but they have more confidence in a white guy/company of white people doing the work and charging 3X what the locals might charge.

It's not the medical field, but the point is the same. I work outside of the US (while living in the US) almost exclusively because I can charge much more, I'm usually treated better by clients, etc.

Javahead said...

Sometimes, even non-professional jobs in first-world economies pays better than professional work at home.

My wife is from Hong Kong, and most of her family still lives there. One of the things I noted is that even middle class families in HK often have live-in maids, usually from the Philippines. Pay is low by our standards; though the government mandates minimum pay and benefits (food, lodging, ~4500 HKD per month, basic medical, 1 day off a week, 1 trip home a year if I recall correctly) most don't make more.

And it STILL attracted educated women who were teachers or nurses back home. I was told that when living expenses were taken into account, they could earn more money working as a maid in HK. On Sundays, their usual day off, some of the urban parks would be packed as they socialized with their friends.

BTW - 4500 KHD/month is ~500 USD per month. And many - most? - were sending money home to their families.

Anonymous said...

Lot's of foreign engineers and tech people in my neck of the woods who come here for a better life. The irony is that after a few years they realize how underpaid they are. I point out why that is and that they are lucky to be paid to work in their field since a lot of native tech people have been forced out of the field entirely. Goes right over their heads.

Aesop said...

You wanted free trade, not fair trade, and that includes human movement, so that's what you got.

The only reason every nurse in this country isn't foreign-born now is because nurses were being replaced by semi-competent Turd World nurses by several planeloads a day, and the nurses here who couldn't find work, and watched salaries drop below entry-level service workers, finally wielded a modicum of political might, and arm-twisted the FedGov into stopping the healthcare worker visa (AKA "Registered Nurses for $5/hr") program.

(IT professionals, stop me if you've heard this one.)

The master plan is to use people like toothpaste, squeezing out every dollar of profit, and aggregating it at the top.

And eventually, everybody but your oligarch would-be overlords loses, and everywhere is Bangladesh.

Using capitalism as cover to re-implement medieval serfdom and peasantry on a worldwide scale is brilliant, except for the morally execrable part, right?!?

This never stops until you start hanging the that implement and facilitate this at street corner lamp posts, stuffing their severed genitals in their mouths, sending their burned and quartered carcasses on display tours to the ends of the republic, and putting their severed heads on fenceposts and overpass railings afterwards, pour encourager les autres.

Or, you can ignore that behavior, roll over, and keep getting more of it, good and hard.

CGR710 said...

Folks, there's a bunch of different factors influencing this whole problem, so let's try listing some of the most influential:
1) the demographic collapse: the baby boomers got the whole pill advantages for their free love lifestyle, but it drastically affected the demographic so that the next generations GenX, Millenials, GenZ, and so forth are marked by a distinctive descending path, which means less children->less people->less qualified workforce->less candidates for open positions->need for external qualified workforce->positive immigration. Unfortunately, the political class choose "simple solutions" like un-managed immigration as "solutions" for complex problems like negative demographic balance.
2) misusing the educational budget for god knows which of their pet, vote-gaining projects. The result is less and worse qualified personnel required for caring for our senior generation. I remember an somehow obscure east-European poet stating that "those who have parents aren't lost yet, those who have parents still do have a past" (sorry for the lousy translation), but it depicts the huge social problem our society is currently confronted with: disposing of our elder to ease the financial burden, but loosing our cultural and moral anchor...
3) switching focus to instant gratification as the single focus of our society, while conveniently forgetting that the future must be built and not bought...
We live in the times of the social decline, equally comparable to Nitezsche's Götterdämmerung (or was it Götzerdämmerung?), where the system of values is being questioned and experiences a continuous descending path...

Douglas2 said...

In the UK, it is the same government doing both:
• deciding how many places there are for new student intake in the UK medical and nursing schools
• Funding the NHS-Trusts to hire the doctors and nurses.

Canada is the same, but on a provincial level for both degree-program places and job-places.

There is absolutely no excuse, given that medicine is such a competitive degree-course to gain entry to, to not have a supply of newly-qualified doctors and nurses within the UK that matches the need for new hires. They are turning away highly qualified applicants to medical and nursing programs every year, thus ensuring that they need to poach a substantial proportion of their hires from less-developed countries.

RSR said...

Not to mention the relative avoidance of Ebola, etc. in the 3rd world.

Don Curton said...

Not to get all racial, but I read an interesting take on the decline of the black community in the US. Back when segregation was mostly enforced, the so-call "talented tenth", or the smartest and brightest of the black community stayed in that community, contributing to its success (by whatever measure you call success).

Once segregation effectively ended, that talented tenth got sucked into the white community, benefiting the white businesses and such. However, this caused the black communities to suffer since there was nothing to replace their best and brightest once the smart ones left. Oops.

When this effect is confined to some foreign country as outline in your post, it's easy to ignore, but when it happens to our own inner cities the decline is much more obvious and direct. I'm not saying that we should go back to segregation, but I don't necessarily disagree with Scott Adams of Dilbert fame either.

Paul, Dammit! said...

My current pastor is an Indian gentleman, and I have little to say on the man, good or bad. He does the job, has the credentials and a pulse, cranks out a valid mass on Sundays.

My last pastor, OTOH, who absolutely doted on my mom in her last years, was a little bitty Vietnamese guy, 5 foot nothing, fresh out of the seminary with a strong accent. He had been one of the Boat People, who came to the US when he was a kid. He had also been a shrimp fisherman down in the bayou, and found his calling later in life. Since I had been a commercial fisherman, my mom got talking to him. He was so happy to be a priest and so grateful to the US for taking him in as a kid, he immediately got permission to join the Navy as a chaplain once he took the Holy Orders. Guy gave a hell of a sermon at my mom's funeral that didn't leave a dry eye in the pews but did leave us feeling better.

Tom Bridgeland said...

I'm an RN. I work with a lot of foreign-born doctors and nurses. Mostly not worse than the native-born, some are really wonderful people. But no doubt that the lack of inflation-matching pay increases has a lot to do with how easy it is to hire them.

Anonymous said...

The Catholic Church in the USA would have no shortage of priests if it wanted true Catholic men.

But true Catholic men are weeded out in seminary.

Only modernists, heretics, and fags are advanced.

Ask me how I know....