, 10 tweets, 6 min read Read on Twitter
#GlobalHealth friends: I wanted to share how some of your HIC institutions are responsible for some brain drain and poor healthcare in LMICs. This month our hospital in Kenya has been hit again, and I wanted to share what that actually means.

2/ This month we are losing another nurse to a HIC (the US). Trained in our nursing school, then the wards, then critical care, then management, this nurse has been mentored from student to leader over 10+ years - is skilled; has IQ/EQ & is a huge asset.
3/ The US has decided to sponsor a visa for him as an area of need. I guess because there is a nurse shortage. The US has 10 nurses per 1000 people. Kenya has 1.6. So by sponsoring his nurse visa, it is saying, the US need is greater than someone else’s.
4/ So if the US has such a great need, how about considering recruiting from & sponsoring visas for those from countries with similar ratios of nurse:popn? Here are some countries to choose from that could probably handle losing some skilled workers:

(source: @WorldBank)
5/ The NHS in the UK has a list of 97 countries that it theoretically won’t recruit from for precisely this reason (compliance with its own policies is another issue, but let’s give points for thinking about it).
6/ But aren’t these people looking for a better life? Isn’t this altruism on the part of the US? Well, if that is the case, how about looking at refugee policies & the border wall & saying - maybe we should open a nursing school for refugees rather than recruit settled people.
7/ By luring away staff that have taken our hospital 10yrs to train, you set us back 10yrs. How do LMICs catch up? I am all for healthy competition - if Cameroon or Nigeria want to take our skilled nurses, then the region wins. But we can’t compete with your 💰

8/ Maybe, if the US absolutely has to take people LMICs have invested years in, the INS could make as a visa condition of that the current LMIC employer of the poached healthcare worker be reimbursed $10K-$50K to train a replacement. You’ve taken our educator, but we’ll try.
9/ So, immigration & health policy makers in HICs, those who state support for #GlobalHealth. @WHO, the @UN, @theG4Alliance, @DrTedros -at the next international assembly, maybe there could be the Health Worker Retention Resolution & Declaration.
10/ All could pledge to recruit from areas from only countries above them in #HCW supply, or from no more than 1/1000 below. Or to sponsor the education of refugees into areas of need within the HIC of refuge. Because you keep sucking us dry while stating support for #UHC. /END
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