Super Mum: The London Years

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Read on for more on the ‘brain drain’ and the peerless mama mbugua…and then go to this link for another story on her.

Nursing a problem

Salil Tripathi

Tuesday August 9, 2005

Guardian Unlimited

Charity Kirigo worked long hours as a nurse at the national hospital in Kenya, finding it extremely difficult to make ends meet.
A mother of three, she did not see a bright future for her children if she stayed in Kenya – so she applied to the NHS, which was looking for nurses.

“Salaries in Kenya were very little,” she said. “Everyone had to have some side business – selling cotton wool, cooking, doing some other work at home – and it was very difficult to make a living. I had to take action.”

Ms Kirigo came to England in 1995, just as staff shortages were beginning to hit the NHS. Between 1990 and 1997, the number of people coming into the nursing profession in Britain fell from 18,980 to just over 12,000.

Nurses recruited from abroad accounted for 26% of the 16,000 nurses registered in 1997, and five years later that figure had grown to 43% of the registered total of 37,000.

Many came from the Philippines, South Africa and India. Even though the number of African nurses was relatively small, it nevertheless represented a large proportion of the health workers in their countries.

Life wasn’t easy for Ms Kirigo when she came to Britain, but she had access to a superior infrastructure and modern techniques.

She had to endure some humiliation from patients, who questioned her competence because she had come from Africa, but she saved enough money to send her children to university and to buy property in both the UK and Kenya.

Last year, Ms Kirigo moved back to Kenya. “I had a target to help my children get a good education,” she said. “Once I knew they could stand on their own, I decided to go back.”

Now in Nairobi, she is working to raise £437,000 to set up a telephone-based counselling service, HIV Helpline, to offer advice to families living with HIV, and plans to recruit 20 workers.

Her story humanises the debate about healthcare professionals in Britain. It shows what is happening at the micro level at a time when the macro outlook appears so dismal.

Nevertheless, organisations such as Save the Children are critical of the influx of nurses from developing countries.

“Many African countries have limited funds available for health,” Mike Aaronson, the charity’s director general, said. “Vulnerable children suffer disproportionately when these services are failing. It is shameful that many poor countries are spending millions of pounds training nurses and doctors to prop up the NHS.”

The crisis is acute – around 36 African countries do not meet targets of one doctor per 5,000 people, according to the World Health Organisation.

Even in non-conflict affected countries such as Zambia and Ghana, there is only one doctor per more than 10,000 people, while disparities are evident within a country such as Kenya. In Nairobi, there is one doctor for 500 people, but in Turkana district the ratio is 1:160,000.

Aware of the criticism, the NHS has adapted a code of practice that bans it from actively recruiting staff from developing countries. But it needs workers – and thousands of people living in poor countries want to work in a better environment.

It is true that Africa’s health sector needs more resources, but those resources will not become available by preventing skilled workers such as Ms Kirigo from coming to Britain.

What’s often left unsaid in this debate is the role of emigrating British nurses. That poses the moral dilemma that if a UK-trained nurse is free to leave for the US, Canada, or Ireland (the three most desired destinations) – and even beyond, to the Middle East, Australia and New Zealand – why shouldn’t Ms Kirigo and her compatriots come to Britain?

There has been a remarkable increase in the number of British nurses moving overseas. More than 2,000 left for the US last year, a quarter of the 8,000 who left the country overall. In 1997, the number of nurses who went overseas was half that.

Overseas recruitment is not the only reason African health workers leave their home countries. For many, there are simply no available jobs.

“When I was studying in Kenya, we were absorbed automatically,” Ms Kirigo said. “Now there are more nurses than the country needs or can pay for. If all the Kenyan nurses who work in the UK were to return to Kenya, there won’t be enough jobs for them … I am not betraying my country.”

Forcing people to stay at home will not work. As Kwadwo Mensah, Maureen Mackintosh and Leroi Henry write in The Skills Drain of Health Professionals from the Developing World, a paper published by the UK charity Med-Act: “Coercive measures to prevent departure work poorly; worse, they can intensify pressures to leave.”

There are inequities in this dilemma, but remittances partly mitigate the situation. According to the World Bank, migrant workers send more than $90bn (£44.7bn) to their home countries, the second-largest source of funds for poor countries after foreign direct investment. It is a significantly higher amount of money than that provided by development aid.

Health charities acknowledge the power of remittances, but remain critical because such flows go direct to families and do not replenish the loss suffered by the state in providing the subsidy in the first place.

With that in mind, the economist Jagdish Bhagwati, of Columbia University in the US, says states should tax their citizens who work and live abroad – something the US already does.

Several charities have argued that the UK should provide financial restitution and fresh development aid to Africa so that it can bolster its health sector. However, developing a grand plan would take time.

That is why individuals such as Ms Kirigo are so important. Granted, all emigrant health workers may not return home, but their remittances lift their families out of poverty.

What can be done about the skills gap? “Skilled Africans are going to emigrate. I would propose a Grey Peace Corps, where our ageing and early-retired skilled professionals can be tapped for two and three-year stints to work in Africa,” Dr Bhagwati said.

“While Africans, whom we must train in vastly increased numbers at our universities, will work here, our people must work in Africa until the need for skills can be met meaningfully.”

• Salil Tripathi is a London-based writer who specialises in Asian and international economic affairs. The article can be found here.

SocietyGuardian.co.uk © Guardian Newspapers Limited 2005

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About bulletsandhoney
I read my first book when I was three, then my second one a few weeks later. It has carried on this way for decades with only temporary distractions of eating, fighting, loving, heartbreak and other such irrelevant biographical details.

11 Responses to Super Mum: The London Years

  1. This post, says it all about the brain drain – that there are real people and it’s not some abstract concept.
    Your mum personifies the reality of women’s three roles – reproductive, productive and community nurturing (setting up of the helpline.).
    V. inspiring!

  2. MMK says:

    afrofeminista – Thanks for commenting. She does personify those roles as so many do while unsung and yet oh so critical to all of us.

  3. wanduma says:

    Thanks for sharing this. She is for real and an inspiration to all of us!

  4. MMK says:

    wanduma- you are welcome to come to the digs for some chapatis after such a nice comment. And of course afrofeminista the same goes for you. Mum has refused to believe me when I try and tell her how important it is for her to share her story because there is so much there for many people to learn from. But I am working on her and before long anticipate that she shall be penning her memoirs!

  5. Anonymous says:

    I believe that story-telling is a historical imperative. We cannot successfully navigate unchartered waters without some script to guide us. This is particularly so for African women. Story-telling is also part of the struggle to transcend the challenges that life throws in our path.

    I would look forward to your mother’s memoirs, albeit for a slightly different reason than you might think. For me it would be a narrative of an “alternative” path. My own mother took a path of tolerance and acquiescence for the social, cultural and economic inequities that came her way. I have always wondered what may have happened if she took a different path. To me, your mother’s story speaks of such an alternative destiny. Please pass a message to her…We want more!

    I do apologize for the lengthy comment and for being a rude guest. I’ve been visiting often and thoroughly enjoy your blog. Also, after looking at some of your links, I realized that I met you briefly a few years ago. I always wondered about the guy who went to study war.

  6. MMK says:

    anonymous – Thanks for your kind comments. But pray tell, who are you and when did we meet? Please feel free to send me an email.

    I appreciate and cannot agree more with your urgent sense of the importance of stories, of speaking out and leaving a trail of words for others to follow, or avoid for that matter.

    Texts are the stuff on which so much of our lives are built. Those who do not generate stories are condemned to having theirs written for them by those who might not necessarily be doing so in their interest.

  7. I so totally agree with telling stories of Kenyan and other African women from our own perspective.

    It’s not done enough. Our modesty as women and especially Africans is legendary, but I think it can also work against us. I hope your mum joins a growing number of women telling their own stories.

    As for the Chapati – wouldn’t mind;)

  8. Kajamaa says:

    One thing that I admire greatly and appreciate is the fact that she came and did what she had to do to take care of her family and has now gone home. Many of us myself included for some reason or another are waiting to become millionaires before we go back to Kenya. Kenya is our home inspite of it’s flaws and we need to be part of the struggle of building a new Kenya instead of waiting until others have done it for us.

  9. MMK says:

    kajamaa – Thanks for visiting. I think that you should go right ahead and become a millionaire. Kenyans do not all have to be in Kenya to build that country and I think that your personal success will inevitably be to the benefit of Kenya. There is a kind of masochistic self-flagellation that folks outside the country sometimes get into where they are guilty about not being in the ‘fight’ when in fact they have Kenya with them wherever they are. I say, become a millionaire and then hook me up with that cash if you feel any guilt whatsoever about earning it abroad 🙂

  10. Bathus says:

    Your mom’s story reminds of my own mom’s life.

    My mom was a nurse, too. Orphaned during the Great Depression, she had to leave school after the 8th grade and was living on her own in Chicago at the age of 13.

    Needless to say, she was tough as nails. To make a long story short, she worked hard every day of her life, went back to school to get a high school diploma at the age of 35, and then went on to college to get her nursing degree at the age of 42. Along the way she married my dad, worked to help put him through college, and raised and educated four kids, (three of whom turned out to be lawyers, but that’s not her fault).

    For my mom, family came first. But that didn’t stop her from helping others. One time she brought a patient–a perfect stranger–home to live with her for three months because the old woman had no family nearby to look after her while she recuperated from hip surgery. At my mom’s memorial service, there were many other people I had never met before who came up to me and said, “Your mom gave me a hand when I needed it most.” Still she wouldn’t tolerate laziness or self-pity. If you tried to BS her or take advantage of her, you were going to be in for a rough time.

    Okay, I admit that I love to brag about my mom. The truth is your mom and my mom are not really all that exceptional, or at least they didn’t used to be that exceptional. It’s the moms and dads who work to give their children a chance at a better life, and who stop to give a neighbor a helping hand, not the self-important bureaucrats with their bloated “programs” and “initiatives,” who do the most to solve the big problems of poverty, hunger, and illiteracy.

  11. MMK says:

    Thanks for sharing Bathus. Your mum was quite an exceptional person: to be so determined and compassionate.

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