Silent Harvest of Death

Democratic Republic of Congo, a country the size of western Europe, there is an acute lack of medical care. Functioning public hospitals and clinics are rare - and those that do exist are in an appalling condition. Yet there are Congolese doctors who recall that in the 1960s the Kinshasa General Hospital was one of the best on the continent. Patients would be referred there from South Africa. Now , the current head of the accident and emergency department at the Kinshasa General, Dr Mbwembwe Kabamba, says he has no medical stocks at all.

"I don't have any bandages," Dr Kabamba said, "my cupboard is bare...I have all these people, poor people, and they are waiting for treatment. Some of them will die for lack of an operation. That is the reality...I am watching a lot of people dying and it hurts me. These are innocent people, and the government is there with its big villas and cars. I cannot accept that."

The International Rescue Committee which estimates that over the past decade an astonishing total of 5.4 million Congolese have died from easily preventable causes.

That is 5.4 million deaths over and above the "normal" mortality figure that would be expected in a poor African nation.

Only a tiny proportion - a fraction of 1% - died from violence. Most died for mundane reasons associated with malnutrition, simple diseases or childbirth.

Poor Health in Sierra Leone

The BBC has been carrying a series of reports from a medical clinic in Sierra Leone and it makes dire reading . Needless to say , poverty as both a cause of illness and a problem in providing health -care is highlighted but no more so than in its latest instalment .

"The biggest emergency ...has been a possible case of pre-eclampsia - a condition where the pregnant woman has high blood pressure and swells up. It may kill both the baby and the mother. We knew she might have pre-eclampsia and that she needed to go to the hospital as quickly as possible. We called her relatives and told them that they must take her to the hospital - fast. First they pleaded with us, saying, "Please let her stay. She will make it... she can deliver here." They were worried about possible medical fees at the hospital..."

Sometimes we refer people and they don't have the money - they tell us they are going to the hospital and then they go home. It is really difficult to convince people in the community here as they are poor and don't always understand how serious certain conditions are...Patients who come to our clinic pay between $1 and $2 for treatment, less than at the hospital. But we don't have the facilities, drugs or the equipment to treat serious cases, so we have to refer them.

Health Brain Drain

Many African countries now have more doctors and nurses working in richer countries abroad than they have at home . The study, carried out by the Center for Global Development in Washington, looked at census records collected between 1999 and 2001. It examined nine receiving countries: The UK, the US, France, Canada, Australia, Portugal, Spain, Belgium and South Africa.

Several countries, including Mozambique and Angola, have more doctors in one single foreign country than at home. And for every doctor in Liberia, there are two working abroad.

The loss of doctors often went hand-in-hand with civil strife, political instability and economic stagnation. Angola, Republic of Congo, Guinea-Bissau, Liberia, Mozambique, Rwanda and Sierra Leone all experienced civil war in the 1990s and all had lost 40% of their doctors by 2000.
Countries such as Kenya which experienced economic stagnation in the late 20th Century and Zimbabwe, which saw political repression as well as economic problems, saw more than half of their doctors leave.

At the same time countries with greater stability and prosperity, such as Botswana managed to keep many of their doctors .

But so did very poor countries such as Niger .The researchers speculated this could be to do with destitute countries not producing large numbers of would-be doctors with the financial capital or connections to leave.

UK Home Office figures show that 17,620 African doctors and nurses joined the NHS last year.

The charity ActionAid said the brain drain was "a huge threat" to Africa.

"One of the best way to keep healthcare professionals in the countries that need them is to pay them properly - but currently health systems in many African countries are woefully underfunded," said Nick Corby, policy officer at the charity.

NUMBER OF DOCTORS ABROAD
Mozambique - 75%
Angola - 70%
Ghana - 56%
Kenya - 51%
Rwanda - 43%
Sudan - 13%
Niger - 9%