Suggestion for the EU

Bottom continues much as it has the whole time I have been here. Two weeks ago I had one day during which I attended 9 deliveries. That day we were particularly short-staffed - just two nurses - and there were a few hours during which I was alone with four students and 14 laboring women. In general, most development organizations are focused on capacity building and training; less on salaries/staffing/recruiting/retention of staff. With money spent in this way the few nurses and clinicians assigned to maternity (of course it is the same in all medical wards) rotate through one training program after another to improve their individual skill sets. There is a great deal of repetition among the topics but each organization teaches a slightly different protocol. As a result, I notice that people often revert to their own “non-standardized” techniques as soon as the trainings are completed. I do not believe training and capacity building are unnecessary, but with this as the primary approach the situation becomes almost comic. We can talk about monitoring labor and managing emergencies but when you walk into a labor ward and see two nurses with 14 patients, there is no feasible way all 14 women will receive good care, even if the nurses run frantically between the beds all day.

Last week while driving I heard a story on BBC Africa about the EU’s creation of Blue Cards. Apparently, with the aging of the European work force and the declining birth rates in many European countries it has been determined that Europe will need to attract skilled workers in order to support and build its economy. The Blue Card scheme (modeled after the US’s Green Card) will facilitate the entrance of skilled workers from Africa and Asia. While listening I was grateful that the interviewer shared my sentiment – WHAT ABOUT AFRICA AND ASIA?!!!!! - but despite his repeated attempts to engage the interviewee, that question passed unanswered.

How can we – the global community, especially the western world – consider ourselves proponents of human rights on one hand while with the other we skillfully divert the few resources (human in this case) away from the poorest of the world? How can we talk about improving access to health care and education via our development institutions and hope to be believed? In truth, what we are saying with these policies is that we will consider caring as long as it is not an inconvenience to us. Lucky for the wealthy, the poor are in general a silent group; unless you stand by their bedside you won’t hear their cries. Right now, in Malawi, we have a physician to population ratio of 1:6,500. Even with rocket boosters on their heels, the impact of training and capacity building will be limited.

I have another thought – perhaps a brilliant solution. I am just remembering another BBC story about training individuals with lower levels of education, skills that are normally provided by highly educated individuals. There are many examples of this in the health care sector in Africa, for example small shop owners in rural areas are taught how to diagnose common illnesses and to prescribe the correct medications. Ok, here’s the idea . . . why don’t we allow the unemployed unskilled people who are literally dying to get into Europe in, with these Blue Cards and train them to do these skilled jobs there. This way we are providing training, capacity building, and employment opportunities for many would remain unemployed in Africa and Asia, we are adding to the European work force, and we are not stealing doctors, nurses, or other “best and brightest” individuals away from their home countries where they are most needed.