Is this Modern Day Slavery?

I am torn!

A month ago a family relative who was in Antigua asked me if I could assist the Antiguan government to recruit #Ghanaian and #Nigerian #Nurses and #Doctors - I cringed and said no. My family member went on to tell me that Ghana already sends nurses to #Barbados and Antigua also wants to start. I laughed and said 'Ma friend, they should train their own people to be nurses, we need them here in Ghana'

In 2019, the Government of Ghana signed an agreement for Barbados to recruit nurses from Ghana. The first batch was 100 nurses and every quarter a number of nurses are exported to Barbados from Ghana. In September 2022, Ghana's Vice President?Dr. Mahamudu Bawumia, confirmed Ghana's committment to continually export nurses.        

Fast-forward to last week, I met a young Ghanaian man who works for the NHS who is in Ghana for a couple of weeks. When asked if he was on holiday - he said 'No, he is coming to recruit Ghanaian nurses to send to the #UK to work for the #NHS'. The horrible feeling I previously felt had reared its ugly head again, but this time it was accompanied with dread. The feeling that modern day slavery looks like our own people enslaving each other - history will tell the story that 'They conquered and divided. They had some who were for the system, fully committed and converted - they sent them out to recruit and contribute to Africa's brain drain'.

According to his findings there are presently over 30,000 doctors and nurses who are unemployed in Ghana, at home doing nothing. This is, as a result of Ghana addressing a severe shortage of nurses and midwives founded and reported by a World Health Report which classified Ghana as facing a #Health crisis for Human Resources in 2006. Ghana is cited as the leading producer of physicians, nurses and midwives in Sub-Saharan Africa. Despite this, as a nation, we have not been able to achieve Universal Health Coverage and goal 3 of the Sustainable Development Goals (#SDG's) - 'Good health and well-being'.

With the NHS experiencing the highest number of strikes and resignations, plus a dwindling number of students taking up nursing courses, they have no choice but to rely on 'cheap labour' to recruit in order to keep their system going.

On the face of it, it seems like a great idea and that it is solving unemployment problems, but if we just take a deeper look at what this 'opportunity means' for the Ghanaian doctors and nurses, one might see why I am concerned.

The idea is when you recruit a Ghanaian nurse for the UK, they will earn an annual salary of ￡30,000. After tax, their average take home salary will be ￡24,422 which translates to ￡2,035 per month.

• Their rent payment for their shared accommodation will be on average ￡800 per month
• Utilities will be on average ￡300 per month
• Food shopping ￡500 per month

Average Remainder - ￡435 per month, let's just say they want to send remittances of ￡200 per month, therefore leaving ￡235 for them to buy anything for themselves including clothes, comforts, entertainment etc.

￡235 will not and does not provide anybody with any good standard of living in the UK and neither does it provide one with any prospects of attaining the 'British Dream' (if there is such a thing). The prospect of them gaining access to the property ladder to eventually own a home is practically non-existent. To save and buy a new car in cash is unlikely, and with no credit history, they would need to wait at least 18 months to build a good credit rating before they can even consider credit purchases. Even then, when they do, their disposable income at the end of the month is already limited, which will automatically cause them to be living in debt! How long will it take each nurse to save for a ticket to fly back to Ghana to see family? and how frequently would they be able to do so?

The biggest mistake Ghanaian's can do is to compare how much they are earning and how much disposable income they have with what they will get in Ghana. The UK #economy is on average 40 times larger than the UK! If you think having ￡235 at the end of the month (GHC4,000) is alot of money - wait until you are faced with all kinds of miscellaneous payments you have to encounter, and that is not even considering when your children go to school etc. You might find yourself in a worse situation than you initially anticipated. You will enjoy the constant electricity and water, good transportation system, strong infrastructure, free healthcare - but you will pay for it and plus you will encounter real life #racism both institutional and personal for free.

What's Happening with the NHS?

The NHS is presently in a job crisis as they need to fill 65,000 jobs across the country. I want to highlight a list of cited reasons on why British nurses in the UK are leaving the NHS;

• Debt incurred after going to university to get a degree
• Overworked
• Poor pay
• Responsibility versus Pay is not worth it
• Burnout and Exhaustion

https://www.bbc.com/news/newsbeat-62290577

Another source states;

• Nearly 40%?of nurses skipped meals in 2020 to feed their families, while over six in ten worked extra time to pay their bills.
• For nurses from an ethnic minority background the situation is even bleaker, with over half (61%) admitting to missing meals owing to money worries.
• Some Nurses in the UK need to go to food banks to feed themselves.
• That?40,000 nurses have left the NHS workforce?in the year to June 2022?emerged from recent research by?Nuffield Trust?research for the?BBC. This was a record.?
• 64% of nursing staff have to work overtime to pay their bills (from 3,000 interviewed https://www.itv.com/news/2020-12-17/revealed-nurses-forced-to-use-food-banks-as-covid-and-financial-pressures-drive-many-to-brink-of-quitting)

The challenge facing the NHS is not only are younger nurses leaving but also the experienced nurses, therefore the recruitment of medical staff from Ghana is not only for the newly graduated, but for the very people who are working in our hospitals today!

In conversation, I spoke to two heads of departments who work in different hospitals in Ghana, and they expressed collectively they have lost 7 staff this week as they are leaving for the UK. Apparently our government gets paid per nurse that they export, plus there are other 'benefits' where British Universities which are in Ghana are engaged to provide additional training courses for Ghanaian nurses and are in a bid to convert the Nursing courses into a degree.

A further challenge is that Ghana is on the red list of countries in which, other countries should not, recruit nurses from (https://www.rcn.org.uk/news-and-events/Press-Releases/ten-fold-increase-in-nurse-recruitment-from-red-list-countries). The reason for countries being featured on the red list is because according to WHO each country should have a set ratio of doctors/ nurses to patients, anything less means the nation will experience a deficit in local care. From 17 countries that are on the red list, within Africa - Ghana and Nigeria are the countries with the highest recruitment over the past 3 years.

There is a loop hole which exists which people are taking advantage of;-

With the UK not being allowed to recruit directly from Ghana - the agents, recruit the nurses and doctors, pass them through Barbados, Scotland, Wales or any other country and 'technically' recruit the nurses from those countries. There are approx. 20 rogue agents that are operating in Ghana at present partaking in this 'cheap' trade labour.

Evidence for my concern

My concerns are not exaggerated or baseless - Zimbabwe (which is strangely on the Green list for export of healthcare professionals to the UK), is presently suffering from the number of Zimbabwean nurses and doctors who are leaving for the UK, Australia and Ireland.

With the World Health Organisation recommending a minimum of 23 doctors per 10,000 people, Zimbabwe has struggled with about 1.6 doctors per 10,000 patients since the last survey was done in 2015. The mass exodus is resulting in government clinics and hospitals closing down, and the ones which are still remaining are being overwhelmed by the number of patients they have to tend to. Which inevitably leads to poor healthcare services for the paying citizen, people having to travel further distances to seek medical attention and increased deaths https://www.bbc.com/news/world-africa-60524576

What would I rather?

Qualified doctors and nurses staying in Ghana and not being recruited? Family members dying in the UK as they cannot receive adequate care? These are definitely not ideal circumstances. Recently family members in the UK have used the NHS A&E and have been left waiting for up to 8 hours to be seen by a doctor. On a couple of occasions, when they were required to be admitted there were not enough beds. Visiting your GP is almost non-existent now, with surgeries being overbooked and GP's not being able to provide adequate care to their patients. There is a real problem, but the solution needs to be a 'win win' for all, including the future of Ghanaian doctors and nurses. With the UK being a 'wealthy' nation, there must be much more they offer to our nurses and doctors - when a corporate firm brings staff from a foreign country their staff receive 'expat packages' to ensure they are comfortable. In addition, there needs to be stringent measures in place which protects our current healthcare system which ensures we do not get pulled into the black hole whilst the UK climbs out of its situation.

Whilst the likes of the President of the Ghana Registered Nurses and Midwives Association incites Ghanaian nurses and doctors to leave Ghana if they get a chance (https://www.ghanaweb.com/GhanaHomePage/NewsArchive/Leave-Ghana-if-you-get-the-chance-GRNMA-to-unemployed-nurses-1672478), I think we need to look inward at solutions to build our system, and outward to see how nationals of the UK are being treated and to consider what the prospects will be like for migrant workers.

Our healthcare system in Ghana is already far stretched with a lack of hospitals, lack of beds in the hospitals we do have, low doctor to patient ratio, poor doctor care, lack of healthcare professionals across disciplines, lack of machines etc.

In Conclusion, by all means I do not want anybody to suffer, not in the UK, not in Ghana, not anywhere. It makes me uncomfortable that we are already in a deficit and we are further aiding the problem by exporting our nurses instead of building our systems and helping our own. The future looks bleak in how we can build our nation if droves of qualified nurses and doctors are leaving our system. I believe the #UK has got to do much more than pay a fee and contribute to the #infrastructure of a nursing system in #Ghana which will inevitably help them in the short, medium and long term, whilst hurting Ghana.

Is this modern day #slavery? What are your thoughts on this? I am not a health professional and therefore I am not privy to all the details of cheap labour export, but as citizen of the world, this feels wrong under the present terms of which I understand.

Nadia Takyiwaa-Mensah