Malawi’s Internal Brain Drain

20 June 2008

Note to self: I have got to talk to the folks at the University of North Carolina about their hiring practices in Malawi. The issue of an internal brain drain in general and UNC in particular keeps coming up again and again in my interviews.

Am told 200 registered nurses work for the UNC research program in Malawi—as opposed to 86 RNs for all of Kamuzu Central Hospital. Just to put that in perspective, until recently, Malawi graduated about 60 registered nurses each year—at government expense. With the new emergency response program, which provides extra money for salary top-ups and training, the new target is 100 new RNs per year.

But what good is having an emergency program to provide nurses the incentives they need to stay in Malawi if they end up leaving the public sector anyway for higher salaries and better hours working for a university or NGO?

There are several different levels of nurses in Malawi. At the top are bachelor-degreed registered nurses, graduates of the University of Malawi in Lilongwe. They’ve spent four years at university after graduating from high school and sitting entrance exams. These are the ones who are most sought after by other countries as well as the NGOs.

Next come the diploma RNs, also called enrolled nurses or nurse-midwife technicians (the newer term). They get about three years training post-high school in nursing and midwifery. They are the backbone of health care in Malawi, providing perhaps 80% of care in the country. Their training does not give them skills that are internationally portable.

After that, it seems there’s a category called auxiliary nurses, sort of like patient aides in the U.S. But this is a bit unclear to me and I need to learn more about what they do exactly and how and where they fit in.

19 June 2008
Daily Routine

Must be getting over jet lag. Awakened at 5 AM by the call to prayer. Dozed a bit. Heard shuffling of feet and a door closing somewhere. By 6 AM hotel staff were mopping the floor of the hallway. Breakfast at 7 AM on the patio. Cool enough you would like something over your shoulders but don’t absolutely need it. And so the day begins.

Have established a different routine in the afternoon, after I’ve completed my interviews.
By 4 PM I close the windows against whatever mosquitoes or other insects might be flying around at dusk (have yet to see a simple window screen anywhere in Lilongwe). Work on notes or read or head to the nearby Internet cafe. Make sure I’m back at the hotel by 5 PM, in other words well before sunset, which is about 5:45 PM. Still a surprise how fast night falls. It’s dark by 6 PM.

Fish out my malaria pills, bottle of Purelle and flashlight. Drop the mosquito netting over the bed, close the curtains and spray the room with DOOM insecticide spray while holding my breath (the can distinctly warns you not to be in the room for at least 30 minutes after spraying), close the door and head to dinner. (Yes, there are still mosquitoes--and the little buggers are very stealthy. They don't whine the way mosquitoes do in the US.) The rest of the evening depends a little on whether there is a power cut or not. A little television, a little reading and then to bed.