Every month, Jenny Ranes gets a potent reminder of why she emigrated from the Philippines: her paycheck.
For the young nurse, it was a salary hike she just couldn't resist. At home, the average nurse makes less than $200 a month. In Britain it can be closer to $2,000.
"I came two years ago because of the opportunities - financially, I'm much better off," she says during a break from duty at a hospital south of London. "If you convert my salary into Philippines money, it's probably six times as much or more. The cost of living is more expensive here, but we can still send money home to our families."
A torrent of foreign nurses has arrived here in recent years, as the ailing National Health Service (NHS) aggressively recruits to plug gaping shortages left after Britain drastically cut back on training nurses in the early 1990s, principally for budgetary reasons.
In the past three years alone, more than 30,000 foreign nurses have been enticed to Britain. This means that it is now more reliant on overseas staff than any other developed country, according to a recent report issued jointly by the International Council of Nurses (ICN), the World Health Organization, and the Royal College of Nursing (RCN).
At Kingston Hospital, more than 10 percent of the 1,150 nursing staff are from overseas - a proportion mirrored in national statistics. Last year more staff was recruited from abroad than from the domestic population.
Few in Britain itself are complaining about the trend, despite increasing controversy in the country about immigration and asylum. But "donor" nations, particularly the Philippines and South Africa, are feeling the effects.
Health officials in both countries say that hospitals are being closed and operations are being canceled because of nursing shortages.
In the Philippines, the exodus has accelerated from around 4,000 nurses a year in the mid-1990s to more than 13,000 in 2001. Last year, 5,600 came to Britain alone. The year before that the figure was 7,200.
"We are already facing a crisis in a good number of hospitals," says Dr. Jaime Galvez Tan, former secretary of health and currently professor at the University of the Philippines College of Medicine in Manila.
"I see the Philippines health system collapsing in five years if there is no mitigating action coming out of countries like the UK," he adds by telephone from Manila. "Hospitals in Mindanao are closing down because the nurses have left."
In South Africa, the picture is bleaker still, with far fewer nurses trained than in the Philippines, but an emigration trend that runs into the thousands each year.
Dr. Kobie Marais, assistant director for human resources at Pretoria Academic Hospital says that a third of her nursing vacancies go unfilled. Fifty percent of nurses who resign head overseas. Last year, more than 2,000 South African nurses came to Britain.
"This is really resulting in big shortages in South Africa," Dr. Marais says. "Sometimes we have to close operating theaters for a time and have to cancel operations like open heart surgery.
"We would like Britain to train [its] own nurses."
Increasing the number of nurses is at the heart of the Labour government's program, which pledged to recruit 80,00 nurses over a 10-year period to 2006.
Labour has staked its reputation on improving public services and reversing a generation of benign neglect in the NHS which has resulted in formidable waiting lists for operations and daily scare stories of primitive treatment at public hospitals.
The problem is that training nurses domestically takes at least four years.
The Geneva-based ICN says that it is too simplistic to just lambaste developed countries for poaching - some poorer countries actually have unemployed nurses who should be allowed to find work overseas.
But in Britain there are tens of thousands of qualified nurses who choose not to practice for reasons of low pay and grueling working conditions. That should be addressed before the government seeks to replace them with cheap foreign labor, says the council.
"It is not ethical to recruit nurses into a dysfunctional system," says Mireille Kingma, a consultant in nursing and health policy for the ICN.
The British government has set ethical rules preventing staff from being poached from developing countries that cannot afford to lose their nurses. But private recruitment "sharks" often ignore these guidelines, say experts.
Marais says recruitment companies often came to her hospital to snap up staff. Ms. Ranes says the Philippines has many organizations that specialize in bringing nurses to Western countries.
And not all of these treat their recruits fairly. Britain's RCN recently claimed that exploitation in the recruitment of foreign nurses was endemic, particularly in the private sector.
The RCN's senior employment relations adviser, Howard Catton, says that some foreign nurses have complained of poor pay, excessive fees to recruitment agencies, and even "slavery" in which they are doing menial chores well below their level of expertise.
"There is more than just an odd one or two nurses that have had bad experiences," he says.
One unhappy recruit is Mi, a Korean nurse who didn't want to give her surname. "I'm very disappointed with nursing in Britain," she says. "The general standard of nursing skills is much lower than in a Korean hospital. I'm going to stay one more year and then go home."
Back outside the children's ward at Kingston Hospital, Ranes agrees that many foreign nurses will not stay in Britain for ever.
"I'll still go back to Manila one day," she says, "but most Filipino nurses here eventually want to go to America. There are even better opportunities there."