Brain gain

Pinoy Kasi : Brain gain

First posted 01:23am (Mla time) June 02, 2006
By Michael L. Tan
Inquirer

Editor's Note: Published on Page A15 of the June 2, 2006 issue of the Philippine Daily Inquirer

THE United States’ new immigration law has been in the headlines lately, with even stricter conditions now for people wanting to work there -- unless you’re a nurse. The new law actually lifts current quotas on the number of foreign nurses that can enter the United States.

The nursing export industry is elated, but there’s also alarm and apprehension coming from the Department of Health, the hospitals and many others who see a greater health crisis ahead as we lose more nurses and doctors-turned-nurses.

As we desperately look for ways to stem this brain drain, we might be forgetting to address a more basic question that has plagued us since we first began exporting nurses, back in the 1950s: Just how do we look at our human resources for health?

Frontline workers

Through all these years, we’ve invested so much for the development of doctors and nurses, with the assumption that they would be the ones to move the health care system forward. For the most part, we’ve done quite well with this aspect of health resource development in the sense that we train them so well that they’re exportable to the most developed countries of the world.

They’re exportable because we train them mainly to work in the West. These doctors and nurses will have no problems handling the most complicated surgical procedures, and describing the various health problems of affluent countries, but would be at loss convincing an elderly Filipino patient she has a cataract, rather than “pasma sa mata,” or convincing a parent to use life-saving oral rehydration solution for diarrhea.

As we fret now about the impact of the exodus of doctors and nurses, we’re forgetting that the health care system can still move forward, maybe even improve, if we would just give more attention to our midwives and community health workers. They are the ones who man (or rather, woman) the front lines in our battle against our many health problems. Even more importantly, many have no intentions of migrating.

Many of the achievements of our health system in the last few decades would not have been possible without these frontline workers. To give just one important example, infant and child death rates have dropped dramatically in the past 50 years or so, plummeting from something like 15 percent of all births to about 5 percent now. This was achieved mainly through a package of interventions that Unicef called GOBI-FF: growth charts to detect malnutrition among children, oral rehydration drinks for diarrhea, breastfeeding, immunization, food programs and family planning.

It was the midwives and village health workers who delivered the GOBI-FF packages throughout the country, to the most remote villages. They still do that today, while handling many other responsibilities, including delivering babies, conducting health education, checking households for every kind of problem imaginable, from the lack of toilets to domestic violence.

While doctors and nurses complain about night shifts, the midwives and village health workers are on call 24 hours a day, seven days a week. Doctors and nurses grumble about heavy patient loads in hospitals. Our midwives and community health workers are responsible for literally hundreds and thousands of people, sometimes as a one-woman team.

Doctors and nurses whine about working conditions in hospitals and lack of equipment. Midwives and community health workers often have no equipment at all, no transport except their feet, and they work under the most difficult of conditions. A few months back, I featured in this column a story told by former secretary of health Dr. Alfredo Bengzon about how he had met a midwife who was working even as she was recovering from bullet wounds sustained during an encounter between government troops and rebels. A few months later, he learned that same midwife had drowned while trying to deliver vaccines during a storm.

How do we compensate our midwives and community health workers? Government midwives barely get the minimum wage, if they get anything at all (there are municipalities that can’t even afford to pay them). And the community health workers? Some get a token stipend; others work voluntarily.

Upgrading

I’ve always had a special affection for midwives and village health workers because I worked with them in community-based health programs for many years. Besides their commitment, what’s been so impressive has been their eagerness to learn and the speed with which they do pick up. I’ve had community health workers who had barely finished grade school and would sit through training sessions without taking notes and yet excelled at their work.

There’s so much they can learn to do, yet our laws still forbid them from handling many important procedures. For example, community health workers are, technically, still not allowed to give injections or to stitch a wound.

Amid the brain drain, we forget the potentials of “brain gain” in terms of the health personnel who have stayed. Don’t think that they do this because they have no choice; there is a growing overseas demand for midwives. In fact, with their two-year training, the midwives have an edge over those who have taken only a six-month caregiver course.

Solving the nursing brain drain requires a look at the big picture, trying to work out a better fit between our needs and the development of human resources. I’ve wondered, for example, if those short caregiver courses are deemed adequate for a Filipino to go off and care for other nations’ children and elderly, then an upgraded two-year midwifery course would work wonders. With a little more focused training, midwives should be certified as paramedics or practical nurses.

Our village health workers at present go through quick training, sometimes as short as a week of lectures, and yet they become quite effective. Why then can’t we develop a longer course that will upgrade their skills so that they can become health aides? Maybe the best village health workers can be given scholarships for a six-month course appropriate to the Philippines. Some of the six-month caregiver courses include such lifesaving skills as basic French, choosing a good wine and, lately, eating without a spoon. We could replace them with training for communications and health education. So many of our problems are rooted in low health literacy so good health communicators will work wonders.

I am not saying we should just let our doctors and nurses leave. We need to rethink our curriculum and training in medical and nursing schools. But even as we do that, we should be looking for ways to maximize the contributions of our front-line workers, the ones who intend to stay.

Think about it: Upgraded village health workers and midwives would mean more health problems handled at the household and community levels. We save more lives, and relieve pressures on the hospitals, so doctors and nurses can do what they’re best trained for -- right here in the Philippines.