Guyana provides majority of nurses for Caribbean -PAHO adviser
By Miranda La Rose
Stabroek News
July 18, 2004
Guyana is a major provider of medical services in the Caribbean, with the St Lucia health service run almost entirely by Guyanese, PAHO Human Resource Development Adviser, Dr Jean Yan said.
Outlining a managed migration programme at a seminar organised by the Institute of Development Studies (IDS) of the University of Guyana (UG) at Le Meridien Pegasus last week, Dr Yan said "Guyana... helps basically everybody in the Caribbean. Could you imagine what the Caribbean would be without Guyana?"
UG Deputy Vice-Chancellor, Al Creighton noted that a high proportion of doctors and nurses in St Lucia are from Guyana with 40% of the doctors at the St Jude's Hospital in Vieux Forte being graduates of the UG Medical School.
Noting the emphasis on training to meet the national skills needs in various areas, Creighton noted that Guyana was one of the Caribbean's greater exporters of intelligentsia and trade in skills such as teachers, nurses, doctors, intellectuals, hence the move by UG, Guyana and the Caribbean as a whole towards a managed migration programme.
The Regional Nursing Body (RNB), the Caribbean Nurses Organisation (CNO) in collaboration with Pan American Health Organisation (PAHO) and the Office of the Caribbean Programme Coordination conducted research on nursing in the region and formulated the nurses' managed migration programme. The programme was presented to the Council for Human and Social Development (COHSOD) at its meeting held in Trinidad and Tobago in April.
It divides the Caribbean countries into three groups: the beneficiaries, providers and beneficiaries/providers. Beneficiary countries are that group of smaller countries like the British Virgin Islands, the Turks and Caicos, and the Abacos Islands, which do not have the capacity to train and so depend on the other countries of the Caribbean to help them, especially Guyana. Provider countries include Guyana - the largest provider in the Caribbean - Dominica and St Vincent and the Grenadines which are experiencing acute shortages at present. Provider/beneficiary countries are those such as Jamaica, which receives nurses from the Caribbean countries and sends Jamaican nurses all over the Caribbean.
To the RNB and the CNO the problem is not so much internal migration and meeting the region's needs. Dr Yan said it included the migration of nurses to the developed countries, mainly the United Kingdom, the USA and Canada.
Noting the need for a partnership with developing countries recruiting in the region as recommended by the programme, Dr Yan said one recruiter was hired by a US corporation to recruit nurses for a fee of US$1 million. Neither the recruited nurses nor the region earned anything from that US$1 million, she said when a part of it could have been used to update and "enhance what we have so that when they come back they would have more."
She said a partnership with recruiting countries was necessary because of the region's limited resources. Such a relationship would see the developed countries and the Caribbean become partners in training, which would allow the region to upgrade standards and recoup some of the investments it made in training. It would also allow for workable solutions to be arrived at which do not marginalise the Caribbean or leave it in a situation that is worse every year.
Among those involved in the managed migration programme at the national level are ministries of health, chief nursing officers, national nurses associations, training colleges and national nursing councils. At the regional level there are the RNB, CNO, Caricom, the Regional Negotiating Machinery and the University of the West Indies, while at the global level the agencies include the Lillian Carter Center for Nursing, PAHO/WHO, Johnson and Johnson, Health Canada and the UK Department of Health.
From the nursing fraternity perspective, Dr Yan said managed migration is a balance between the rights of individuals to work and live where they want, while achieving a balance in their responsibility to the Caribbean to provide quality health care service.
The study which resulted in the nurses managed migration programme examined six protocol areas: recruitment balanced with retention; education and training; and utilisation and employment. Dr Yan said the programme came about because of serious nursing shortages in the region's hospitals where the vacancy rates were as much as 90% in recent years.
Currently, she said, countries in the region still train nurses based on vacancies not considering the number retiring that year, those who will continue in nursing and those who will migrate. The programme recommends training in excess of the number required for retention within the system.
The current entry requirement for nursing programmes limit training to young people. The programme suggests lifting the age required for training to admit individuals who have established themselves, whose children are at school and who want to do some things for themselves. Lobbying for the suggestion Dr Yan said: "They are the serious ones. They want to stay in the Caribbean. They want a stable work environment."
Since training in the Caribbean is provided by governments and bonding is often a problem for most governments, the programme suggests policy reviews "to hold on to our valuable resources for some time."
It also recommends improved terms and conditions of work, including shared governance and participation in decision-making. Professional education is also another sore point for nurses who after obtaining their basic training must wait lengthy periods for continuing and further training.
The nursing bodies are now looking at migration as a global issue, but the nurses are not experts in trade "as yet", Dr Yan said, adding that they hope to learn from the experts in trade to be able to articulate their needs and positions. The region has been losing some US$60 million in investment in training over the past four years with 300-odd nurses migrating annually to the developed countries.
Because of this, she said the nursing bodies would like to make this movement more organised and systematic. She said when some of the region's nurses go to work in the developed countries they are demoted to nurse aides. She said that was a problem that the managed migration programme has to address.
She noted that for more than a decade nurses wrote a common regional examination so that a graduate of any country can work in another Caribbean country. "So when it comes to training, health and services, health education and standards we have already demonstrated that the countries in the region can work together and come up with a common examination that is tested through a regional mechanism."