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STEVE INSKEEP, host:

This is MORNING EDITION from NPR News. I'm Steve Inskeep.

RENEE MONTAGNE, host:

And I'm Renee Montagne.

There's a brain drain in health care, as doctors and nurses from the developing world are recruited by Western countries. It was documented in a study published last week in The New England Journal of Medicine. The study found that immigrants from India, the Philippines and Nigeria account for the largest number of foreign doctors working in Britain, the United States and Canada. As part of a series on global health, NPR's Brenda Wilson reports that the shortage is complicating the fight against AIDS and other diseases.

BRENDA WILSON reporting:

There is only one doctor for every 10,000 people in Kenya. In many African countries, the scarcity is even greater. Dr. Peter Ngatia, the director of curriculum development and training for the African Medical Research Foundation in Nairobi, says that part of the explanation is that in the competition for skilled health professionals, Africa is losing.

Dr. PETER NGATIA (Director, African Medical Research Foundation): It takes a hundred and fifty thousand US dollars to train a doctor here in Africa. That doctor leaves after internship. Africa has lost not just a hundred and fifty thousand dollars, but everything that goes with it. A person should be able to do their studies here and go and work anywhere in the world. That is what globalization probably is all about, but by so doing, the weaker get weaker, and the stronger get stronger.

WILSON: There are only 5,000 doctors from sub-Saharan Africa practicing in the US, a small number for the US, but it represents a huge sacrifice in the developing world. Ngatia says the allure is not just the money and living conditions. He says they've been led to expect something else from the practice of medicine, because African medical schools use the curriculum of the developed world. For example...

Dr. NGATIA: You turn the heart inside out to know the little, little things about it, to know everything that you could about the ...(unintelligible) and things like that. Whereas here, it is the other way around. Most of the conditions that you saw are malaria, malaria, malaria, TB, diarrhea, common things.

WILSON: Common things that kill millions of children in Africa and the developing world each year. Physicians in Africa cycle out in what has been called a medical carousel that never turns full circle. They may start in South Africa, then move to the United Kingdom and on to Canada with their sights set on the US. The last place on earth hardly any doctor wants to be is a small out-of-the-way place in Africa.

(Soundbite of groaning)

Unidentified Man #1: (Foreign language spoken)

(Soundbite of groaning)

WILSON: About 10 minutes north of Kenya's border with Tanzania, in a Masai village on the edge of a forest of tangled green, a 30-year-old woman is lying on a cushion on the floor of an ambulance.

Mr. CHARLES SHULAY(ph) (Nurse): We have an emergency...

Unidentified Man #2: What's the matter?

Mr. SHULAY: ...an obstetric emergency. Her mother was--has been in labor since 7 yesterday, and she was brought this morning to a health facility. It's prolonged labor and unable to deliver.

WILSON: Charles Shulay, a nurse at the Intersopia Community Health Center(ph), says she was brought there by relatives but will have to be taken to a hospital 40 kilometers away. It happens in Africa every day: A woman in labor unable to walk and unattended by anyone who is trained to assist when complications develop. It's not unusual in such situations for a woman to be in labor for days. And what you have is one of the highest rates of maternal mortality in the world. Kenya ranks 154, near the bottom.

Because there are not enough doctors, the center's run by a clinical officer, not quite a doctor but more than a nurse. And he isn't trained to perform a Caesarean.

(Soundbite of groaning)

Mr. SHULAY: Sometimes you don't reach the health facility. You can assist on the road.

(Soundbite of groaning)

Mr. SHULAY: We need to be asking the ...(unintelligible) to give us two or three people, so in case they have to add blood.

(Soundbite of door closing; vehicle running)

WILSON: This woman is in luck. Even though she will have to ride over stretches of boulder-strewn roads and several streams, through the dusty unpaved desert of the Rift Valley to Mugati Hospital(ph), an hour-and-a-half drive. In all of this district there are about four doctors for half a million people. Such conditions, Dr. Ngatia says, led AMRF to push to revise the curriculum in Kenya's medical schools.

Dr. NGATIA: Yes, we'll need doctors, but we'll not get one doctor for 10,000 people. But we can get another person. Let's call him a medical assistant, somebody who the Western people have called a pseudo-doctor or half-doctor. They aren't going to be certified by the Medical Council of the UK or US, but they're for Africa.

WILSON: Clinical officers are the backbone of Kenya's health system. They run most of the health centers, they have some medical training, they know anatomy and can perform minor surgery. But they are not allowed to perform Caesareans as clinical officers do in Mozambique, where studies show they are just as proficient as doctors.

Dr. NGATIA: Because even doctors themselves make mistakes. If the clinical officer has got the right anatomy, has got the right surgical skills, and right attitude towards it all, then they are as good as any. They're basically saying, `You East Africans can do with less quality of health care or less expensive.'

WILSON: Dr. Festus Ilaco(ph) is the director of programs at AMRF, a colleague of Ngatia who personally finds these developments disturbing.

Dr. FESTUS ILACO (Director of Programs, African Medical Research Foundation): Me, I know if I was ill and I have a chest pain, I would see a chest physician or a cardiologist if I have to, and that's what everybody else would like, too. Let's not assume that the less educated people also want mediocre care.

WILSON: But Ilaco also acknowledges that in the interim, Kenya's poor and rural people will probably have to depend on clinical officers and comprehensive health nurses, because they have broader skills.

Dr. ILACO: We know nurses can deal with 80 percent of the problems, but at least 20 percent, it kills people.

WILSON: At Intersopia Health Center, things return to normal after the truck carrying the woman in labor pulled out. And normally here, four nurses and a nurse midwife are preoccupied with 80 percent of the illnesses--diarrhea, tuberculosis and malaria--that are debilitating even when they don't kill.

Ms. CHARITI SECOY(ph) (Nurse): (Foreign language spoken)

Unidentified Woman: (Foreign language spoken)

Ms. SECOY: (Foreign language spoken)

WILSON: One feverish child after another is examined by Chariti Secoy, including this 11-year-old schoolboy who was sent to the center by his teacher, who noticed him sitting with his head on the desk.

Ms. SECOY: The boy's coughing and with runny nose and was complaining of severe headache. So probably it can be malaria with pneumonia.

WILSON: Twenty-eight-year-old Secoy is a mother herself of a two-year-old, and though she says she is committed to her work, she also speaks with longing of advancing her career in medicine.

Ms. SECOY: Yeah, this is my home, but for me, I would like to go for further study, if only I get that chance. It's only financial problems that is keeping us here.

WILSON: But there's always the chance that she, like the young physician in a rural outpost in Africa, could be drawn somewhere else. Brenda Wilson, NPR News.

MONTAGNE: Tonight, global health coverage continues at 9 PM with "Rx for Survival," a television special on PBS, and you can check your local listings.

You're listening to MORNING EDITION from NPR News.

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