For Malawian nurse Hilda Maganga, the financial pull of a spell in a ward in Britain is close to overwhelming her desire to tend to patients in her Aids-stricken and impoverished homeland.
"I would like to do a two-year stint in the United Kingdom, make my money and come back to retire for good," says the 54-year-old as she contemplates joining the brain drain of Malawian health professionals.
Official figures show about 120 registered nurses have migrated to Britain and the United States alone every year in the last decade, with the Health Ministry unable to even begin to match the wages on offer abroad.
With 14% of the country's 12-million population infected with HIV, the demands on the health service are as great as at any stage in the former British colony's history since independence in 1964.
While the World Health Organisation recommends health services should employ a minimum of 100 nurses and 20 doctors per 100 000 people, Malawi currently has only 56,4 nurses and two doctors for every 100 000 potential patients.
The figure is in sharp contrast, not just to the West, but to other countries in the region as well. Wealthier South Africa, for example, has 393 nurses and 74,3 doctors for every 100 000 people.
Dorothy Ng'oma, executive director of National Organisation of Nurses and Midwives of Malawi, said there was no hiding from the impact of the shortages.
"The situation is very bad, it's a crisis," she said. "The shortage of nurses in particular is very acute, with one nurse handling over 100 very sick patients in most hospital wards."
"We have only 3 000 nurses on register for a population of 12-million ... It's a heavy burden on them when they have to deal with various infectious diseases like HIV and Aids, tuberculosis and malaria."
Officials say half of 70 doctors sent abroad for specialist training have not returned home after completing their studies in the last five years, often lured by better salaries.
The vacancy rate for nurses in rural areas -- where the majority of people live -- is 60%, according to a 2006 survey by the Ministry of Health.
According to the volunteer group Médécins Sans Frontières (MSF), staff shortages are most severe in the southern districts of Thyolo and Chiradzulu, where the number of nurses working at the main hospital has fallen from 50 to 28 in the last year alone.
"The situation is dramatic and constitutes in our eyes an acute emergency that is still widely underestimated," Ulrike von Pilar, MSF's head of mission in Malawi, wrote in a recent activity report.
Health workers are "overwhelmed, overworked and exhausted", the report added, citing a single medical assistant in Thyolo who sees 200 patients a day.
In a bid to counter the shortages, Malawi launched an emergency plan three years ago, which saw health workers receive an average 52% pay rise thanks to a $236-million fund bankrolled by donors such as Britain.
A junior doctor now earns $450, while a senior nurse goes home with $300.
The plan also aims to strengthen training capacity, repatriate professionals that left the country and fund recruitment of foreigners.
However, the sums on offer are still a fraction of the cash available in places such as Britain and also fail to address complaints about pensions.
Maganga, who works at the children's wing of Queen Elizabeth Central Hospital in Blantyre, was recently lured back into nursing as a result of the increased salary but she still feels "short-changed" after pocketing a one-off payment of $1 000 as her pension three years ago.
"It was peanuts when you consider 25 years of service. This is one of the reasons why Malawian nurses have abandoned their posts and flocked to Britain."
She said the impact of the brain drain could be clearly felt during her shifts at Queen Elizabeth, where she attends to 75 children in one ward.
"We are only two nurses in the ward at a time. Sometimes you are all alone when in the past there could be six of you," she said.
Health Minister Marjorie Ngaunje acknowledged the health service was struggling at a time when the population was rapidly growing.
"Yes, there are serious problems, but Malawi needs to train 1 000 nurses annually if we want to arrest the situation," she said.
"The number of nurses we train every year is small. We need to increase intake at our colleges."
MSF warned that failure to address the situation rapidly could undermine Malawi's ambitions plans to provide free anti-Aids drugs to 150 000 HIV sufferers by the end of 2008.
"It is evident that the rapid scaling-up of antiretroviral therapy aimed at urgently serving 180 000 Malawians will be limited by non-availability of adequately trained nurses, clinical officers and doctors," it said.
Sunday, 7 October 2007
YOU'LL NEVER TAKE MY GIRL, MADONNA
EXCLUSIVE HUGE BLOW TO MADGE'S NEW AFRICAN BABY DREAM Mercy's uncle insists she's staying Tot 'does not belong with a star' Wrangle on David is more agony
Pop queen Madonna is devastated after the uncle of the second baby she is desperate to adopt vowed not to let the tot go.
The superstar longs to make little Mercy James a sister to David Banda, the boy she and hubby Guy Ritchie plucked from poverty-stricken Malawi last year.
But in a devastating blow to Madonna's dream, Mercy's defiant uncle John Ngalande insisted that the 20-month-old girl will live with him.
Speaking from Malawi, John told The People: "I would rather we be poor and struggling with Mercy, than for her to go and live with a big white star far away."
Mercy was put in an orphanage when her 18-year-old mother Mwandida Maunde died. Her father was a schoolboy and has played little part in her life.
John, 36, revealed that he always expected the tot would eventually live with him and is outraged at the thought of her being taken away by 49-year-old Madonna.
John said: "We were told when Mercy went into the orphanage that we would be in constant contact with her and that she would come back to us after six years. I would like to stick to that.
"Whether it be Madonna or any other white person, I'm against our child being taken away."
It is another serious setback for the American singer, who has lawyers working for her in Malawi. She hoped to collect Mercy - who she dubbed her "smiling angel" - from her orphanage next April.
But Madonna still faces problems over her adoption of David, two.
Her London home was inspected by Malawi's chief social welfare officer Simon Chisale last month but The People has learned that the process is far from complete.
Madonna and Brit film maker Guy, 39, face two further inspections from Malawi officials, who will come to Britain in November and December.
The case will go before a Malawi court next April before the adoption can be finalised.
A friend of the star revealed: "It is a very stressful time for Madonna and Guy. "They really wanted to adopt Mercy as they fell in love with her on first meeting. They thought she would be a great sister for David.
"The couple had hoped that by now everything about David would have been finalised.
"As far as they are concerned they are offering two parent-less children the chance of a happy, loving home and a better future.
Yet they are facing problems at every turn."
A Malawi source said: "There is a sense of resentment in this country over rich western couples coming over and whisking away children.
"While it is clear that the children are being offered better opportunities, there is a still unrest among the locals. There is a general movement against it."
Madonna already has a 10-year-old daughter Lourdes from a previous relationship, and son Rocco, seven, by Guy.
Pop queen Madonna is devastated after the uncle of the second baby she is desperate to adopt vowed not to let the tot go.
The superstar longs to make little Mercy James a sister to David Banda, the boy she and hubby Guy Ritchie plucked from poverty-stricken Malawi last year.
But in a devastating blow to Madonna's dream, Mercy's defiant uncle John Ngalande insisted that the 20-month-old girl will live with him.
Speaking from Malawi, John told The People: "I would rather we be poor and struggling with Mercy, than for her to go and live with a big white star far away."
Mercy was put in an orphanage when her 18-year-old mother Mwandida Maunde died. Her father was a schoolboy and has played little part in her life.
John, 36, revealed that he always expected the tot would eventually live with him and is outraged at the thought of her being taken away by 49-year-old Madonna.
John said: "We were told when Mercy went into the orphanage that we would be in constant contact with her and that she would come back to us after six years. I would like to stick to that.
"Whether it be Madonna or any other white person, I'm against our child being taken away."
It is another serious setback for the American singer, who has lawyers working for her in Malawi. She hoped to collect Mercy - who she dubbed her "smiling angel" - from her orphanage next April.
But Madonna still faces problems over her adoption of David, two.
Her London home was inspected by Malawi's chief social welfare officer Simon Chisale last month but The People has learned that the process is far from complete.
Madonna and Brit film maker Guy, 39, face two further inspections from Malawi officials, who will come to Britain in November and December.
The case will go before a Malawi court next April before the adoption can be finalised.
A friend of the star revealed: "It is a very stressful time for Madonna and Guy. "They really wanted to adopt Mercy as they fell in love with her on first meeting. They thought she would be a great sister for David.
"The couple had hoped that by now everything about David would have been finalised.
"As far as they are concerned they are offering two parent-less children the chance of a happy, loving home and a better future.
Yet they are facing problems at every turn."
A Malawi source said: "There is a sense of resentment in this country over rich western couples coming over and whisking away children.
"While it is clear that the children are being offered better opportunities, there is a still unrest among the locals. There is a general movement against it."
Madonna already has a 10-year-old daughter Lourdes from a previous relationship, and son Rocco, seven, by Guy.
Identical twins from Lorain serve in Africa
LORAIN -- When Lorain natives Rebecca and Allison Goldberg went to Africa this summer to help others live a better life, they were following a public-spirited family tradition.
Rebecca spent five weeks in Uganda offering free dental services and doing research after her first year at The Ohio State University College of Dentistry. Allison spent three weeks in Malawi studying the success of that country's HIV/AIDS testing program.
The sisters, 24-year-old identical twins who graduated from Lorain Admiral King High School in 2001, said they learned about social responsibility from their older brother Jeremy, their parents, Sherwin and Sandy Goldberg, and grandparents, Hyman and Frances Goldberg.
The life lesson is rooted in the ancient Jewish concept of Tzedakah, which roughly translates in English to charity, Rebecca said. The training started young, she said, at the Agudath B'Nai Israel synagogue on Meister Road. When the twins were grade-school age, the synagogue took them on visits to nursing homes. The pair and their brother also belonged to Young Judea, a youth group that emphasizes Jewish traditions and developing leadership.
''Money comes and goes,'' Rebecca said. ''But helping people will last longer than making money.''
Rebecca took that attitude to Kampala, Uganda, from June 11 to July 20. She worked at two dental clinics, the Makerere University Hospital Clinic and the Mulago Clinic, which is a public hospital, she said. With her friend and fellow dental student Charu Gupta, Rebecca planned the trip, made contacts in Uganda, got approvals from ethics boards in Uganda and Ohio and had to earn approval from OSU, since they went abroad without faculty members.
The two saw hundreds of patients at the two clinics, Rebecca said.
''We did oral exams, noting how many cavities were present, how many teeth had been extracted, and so forth,'' she said. ''We also provided 200 fluoride varnish treatments to children. It's a syringe application to reinforce the enamel of their teeth, to help them grow.'' In addition, hundreds of toothbrush and floss kits were given away, with instructions on its use.
She and her friend surveyed their patients to learn about their educational and economic backgrounds, how often they brushed, their general health knowledge and the difference between their concept of good oral health and the reality of good oral health.
''We learned that money is a huge issue,'' Rebecca said. ''A lot of people weren't even aware of floss, what it was or how to get it. We found that even when they knew about toothbrushes, they needed urgent dental care. They thought they knew what they were doing, but we found a big discrepancy.''
In addition to treating and surveying patients, Rebecca said she hoped to foster a relationship between the Ugandan clinics and the OSU dental school.
''It made sense to develop a dental outreach and research effort that could be long-term,'' she said. ''It's important to continue showing up in the community and teaching to improve oral health. Now, when other dental students go there, they can give the people what they really need.''
Allison also hopes her work in Africa this year is the beginning of a long learning process. She went to Malawi from July 10 to July 27 for her employer, Abt Associates, to observe and document an HIV-AIDS counseling and testing event. For the second year, the Malawian government promoted a one-week drive to test as many citizens as possible across the country, she said.
As an associate analyst for Abt Associates, Allison does research, develops surveys and writes case studies.
''This is my first job out of college,'' she said. ''It gives me a broad perspective on health issues, both domestic and international. It's a very enriching experience.''
Abt Associates was contracted for the project by the United States government through the President's Emergency Plan for HIV/AIDS Relief, or PEPFAR, she said. The results of the Malawi study will be co-published with United States Agency for International Development and the World Health Organization in November, she said.
''The Malawi government was hoping to test 130,000 people in one week, but they actually tested almost 190,000,'' she said. Allison traveled across the country to interview those who provided testing and patients who were getting tested.
''I learned that the country is incredibly mobilized,'' she said. ''There's a strong sense of leadership from local levels to the national level.'' Allison traveled from cities to rural areas, sometimes crossing deserts in four-wheel-drive vehicles to observe the testing and conduct surveys.
About 8.4 percent of the tests came back positive for HIV/AIDS, many times the infection rate in the United States.
''When you go to a country like this, with a public health crisis, you can't ignore it,'' Allison said. ''You see the poverty and you feel the need to make a difference.'' But the people of Malawi were an inspiration for her, she said.
''Malawi is called the warm heart of Africa,'' she said. ''The people are incredibly friendly and open. When you met people they wanted to hug you. And when I returned to communities, they gave me gifts. They're incredibly poor, but they were giving gifts to me.''
Allison credits her brother Jeremy, who founded the Global Youth Partnership for Africa to encourage understanding and promote cultural exchanges and development projects between Americans and Africans, as a big influence on her life.
Like Allison and Rebecca, Jeremy, 27, said he follows the teachings he absorbed from his Jewish faith and his family. In addition to Tzedakah, he cited Tikkun olam as an important concept.
''Tikkun olam is defined as mending the world or repairing the broken world,'' he said. His father, Sherwin Goldberg, displayed the concept while coaching Jeremy's sports teams in junior high school.
''Some of the other kids' parents never showed up to support them,'' he said. ''Many times the kids didn't have rides to practice or games. My dad offered to be their biggest fan, to give them support and be a mentor and friend. You always had the sense that he wanted to give back.''
Sherwin Goldberg, 53, is a case manager and job developer for Goodwill Industries of Lorain County.
''Tzedakah is a fundamental part of the Jewish way of life,'' he said. ''It's the important obligation to give what you can. When children see parents do something, it is maintained through the generations.''
Sherwin's father, Hyman Goldberg, agreed. At age 86, he still practices law part time, offering free services to clients who are having trouble making ends meet. He said he learned about working to help others from his own parents.
''My parents were always interested in helping those in need, regardless of race or color,'' he said.
Hyman Goldberg's parents came from Lithuania with five young children in 1921, he said.
''They didn't know English and had to start from scratch,'' he said. ''In the Depression, my mother worked for Jewish Emergency Relief. When people were on the road, looking for work, she arranged for them to get a meal and a roof over their head.''
Sandy Goldberg, the mother of Allison, Rebecca and Jeremy, said she and her husband encouraged their children to give back to their community, but also to be extraordinary.
''We always told them to reach for their hopes and their dreams,'' she said. ''They all have passion for what they do. And all three of them have great things coming in their future.''
Rebecca spent five weeks in Uganda offering free dental services and doing research after her first year at The Ohio State University College of Dentistry. Allison spent three weeks in Malawi studying the success of that country's HIV/AIDS testing program.
The sisters, 24-year-old identical twins who graduated from Lorain Admiral King High School in 2001, said they learned about social responsibility from their older brother Jeremy, their parents, Sherwin and Sandy Goldberg, and grandparents, Hyman and Frances Goldberg.
The life lesson is rooted in the ancient Jewish concept of Tzedakah, which roughly translates in English to charity, Rebecca said. The training started young, she said, at the Agudath B'Nai Israel synagogue on Meister Road. When the twins were grade-school age, the synagogue took them on visits to nursing homes. The pair and their brother also belonged to Young Judea, a youth group that emphasizes Jewish traditions and developing leadership.
''Money comes and goes,'' Rebecca said. ''But helping people will last longer than making money.''
Rebecca took that attitude to Kampala, Uganda, from June 11 to July 20. She worked at two dental clinics, the Makerere University Hospital Clinic and the Mulago Clinic, which is a public hospital, she said. With her friend and fellow dental student Charu Gupta, Rebecca planned the trip, made contacts in Uganda, got approvals from ethics boards in Uganda and Ohio and had to earn approval from OSU, since they went abroad without faculty members.
The two saw hundreds of patients at the two clinics, Rebecca said.
''We did oral exams, noting how many cavities were present, how many teeth had been extracted, and so forth,'' she said. ''We also provided 200 fluoride varnish treatments to children. It's a syringe application to reinforce the enamel of their teeth, to help them grow.'' In addition, hundreds of toothbrush and floss kits were given away, with instructions on its use.
She and her friend surveyed their patients to learn about their educational and economic backgrounds, how often they brushed, their general health knowledge and the difference between their concept of good oral health and the reality of good oral health.
''We learned that money is a huge issue,'' Rebecca said. ''A lot of people weren't even aware of floss, what it was or how to get it. We found that even when they knew about toothbrushes, they needed urgent dental care. They thought they knew what they were doing, but we found a big discrepancy.''
In addition to treating and surveying patients, Rebecca said she hoped to foster a relationship between the Ugandan clinics and the OSU dental school.
''It made sense to develop a dental outreach and research effort that could be long-term,'' she said. ''It's important to continue showing up in the community and teaching to improve oral health. Now, when other dental students go there, they can give the people what they really need.''
Allison also hopes her work in Africa this year is the beginning of a long learning process. She went to Malawi from July 10 to July 27 for her employer, Abt Associates, to observe and document an HIV-AIDS counseling and testing event. For the second year, the Malawian government promoted a one-week drive to test as many citizens as possible across the country, she said.
As an associate analyst for Abt Associates, Allison does research, develops surveys and writes case studies.
''This is my first job out of college,'' she said. ''It gives me a broad perspective on health issues, both domestic and international. It's a very enriching experience.''
Abt Associates was contracted for the project by the United States government through the President's Emergency Plan for HIV/AIDS Relief, or PEPFAR, she said. The results of the Malawi study will be co-published with United States Agency for International Development and the World Health Organization in November, she said.
''The Malawi government was hoping to test 130,000 people in one week, but they actually tested almost 190,000,'' she said. Allison traveled across the country to interview those who provided testing and patients who were getting tested.
''I learned that the country is incredibly mobilized,'' she said. ''There's a strong sense of leadership from local levels to the national level.'' Allison traveled from cities to rural areas, sometimes crossing deserts in four-wheel-drive vehicles to observe the testing and conduct surveys.
About 8.4 percent of the tests came back positive for HIV/AIDS, many times the infection rate in the United States.
''When you go to a country like this, with a public health crisis, you can't ignore it,'' Allison said. ''You see the poverty and you feel the need to make a difference.'' But the people of Malawi were an inspiration for her, she said.
''Malawi is called the warm heart of Africa,'' she said. ''The people are incredibly friendly and open. When you met people they wanted to hug you. And when I returned to communities, they gave me gifts. They're incredibly poor, but they were giving gifts to me.''
Allison credits her brother Jeremy, who founded the Global Youth Partnership for Africa to encourage understanding and promote cultural exchanges and development projects between Americans and Africans, as a big influence on her life.
Like Allison and Rebecca, Jeremy, 27, said he follows the teachings he absorbed from his Jewish faith and his family. In addition to Tzedakah, he cited Tikkun olam as an important concept.
''Tikkun olam is defined as mending the world or repairing the broken world,'' he said. His father, Sherwin Goldberg, displayed the concept while coaching Jeremy's sports teams in junior high school.
''Some of the other kids' parents never showed up to support them,'' he said. ''Many times the kids didn't have rides to practice or games. My dad offered to be their biggest fan, to give them support and be a mentor and friend. You always had the sense that he wanted to give back.''
Sherwin Goldberg, 53, is a case manager and job developer for Goodwill Industries of Lorain County.
''Tzedakah is a fundamental part of the Jewish way of life,'' he said. ''It's the important obligation to give what you can. When children see parents do something, it is maintained through the generations.''
Sherwin's father, Hyman Goldberg, agreed. At age 86, he still practices law part time, offering free services to clients who are having trouble making ends meet. He said he learned about working to help others from his own parents.
''My parents were always interested in helping those in need, regardless of race or color,'' he said.
Hyman Goldberg's parents came from Lithuania with five young children in 1921, he said.
''They didn't know English and had to start from scratch,'' he said. ''In the Depression, my mother worked for Jewish Emergency Relief. When people were on the road, looking for work, she arranged for them to get a meal and a roof over their head.''
Sandy Goldberg, the mother of Allison, Rebecca and Jeremy, said she and her husband encouraged their children to give back to their community, but also to be extraordinary.
''We always told them to reach for their hopes and their dreams,'' she said. ''They all have passion for what they do. And all three of them have great things coming in their future.''
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