Condition critical as African doctors head overseas

Sikiniwe Khumalo tends to 40 patients during a single shift as a nurse at the Helen Joseph Hospital here. That's too many, she says, for her to offer more than basic medical care, and certainly too many to remember all their names.

Mrs. Khumalo's workload is typical of medical personnel here and around Africa, where HIV/AIDS and malnutrition have given doctors and nurses more than they can handle.

Despite this need, however, in a few months, Khumalo, a single mother of two, will pack her bags and leave the country of her birth for England, where she will have a take-home pay three times her salary in South Africa. And friends who have already left say in Britain, she will care for only six patients at a time.

"Basically, it's the money," she says. "I can't make payments here. I've been working for 15 years, but I think I'm not getting the salary I deserve."

Khumalo is not alone. South Africa is experiencing a huge drain on health professionals, many of whom, like Khumalo, are leaving the country for places such as Britain, America, and Australia where pay is higher and working conditions are better.

This comes at a time when the country's already overloaded health system struggles to deal with the increasing burden of AIDS. But overworked and underpaid doctors and nurses are looking for alternatives. They are often helped by international recruiting agencies that many African governments accuse of poaching their much-needed medical staff.

No one knows exactly how many of South Africa's medical professionals, whose training in the country's medical schools is highly respected worldwide, have left the country, since few tell the government they are leaving.

But the South African Medical Association estimates that at least 3,500 of its 26,000 practicing doctors are living abroad. The country's minister of health says that from 1995 to 1999, more than 2,500 nurses applied to have their qualifications verified, which is usually required for nurses to move abroad.

Surveys show that the outward flow is likely only to increase. Nearly 10 percent of doctors surveyed by the South African Medical Journal said they may leave within the next five years, and 1 in 3 new doctors doing their required one-year community service said they plan to emigrate.

"Students sit around and talk about where they want to go when they leave the country," says Christiaan Burger, a medical student at the University of Pretoria and spokesman for a student group protesting the planned addition of an extra year's internship. Mr. Burger and others say that this extra year of service will push more doctors to leave.

South Africa has called on wealthy governments to stop recruiting their medical professionals.

"There is a strong feeling that it is cynical on the part of countries that are better resourced to rely on a constant stream of migrants from countries that pay less," says Jo-Ann Collinge, a spokeswoman for the South Africa's Department of Health. "There should not be a systematic draining from developing countries."

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