Alex Mulumba, who works in the operating room at a critical care hospital, is one of the few nurses in the Zambian capital with the skills and experience. He has recently learned that many places are looking for his expertise, too, and will pay him far more than the $415 per month he earns now.
Mr. Mulumba is considering Canada, where his friends have found work quickly. He said you have to build something with your life.
Canada is one of many wealthy nations that are aggressively recruiting medical workers from the developing world to replenish a health care work force that was decimated by the Covid-19 pandemic. The recruitment of health workers from countries with weak health systems during a Pandemic has upended migration patterns and raised new questions about ethics.
Howard Catton is the chief executive of the International Council of Nurses. He said that the high risk was that you were recruiting nurses from countries that couldn't afford to lose their nurses.
According to the president of O'Grady Peyton International, there are about 1,000 nurses arriving in the United States each month from African nations, the Philippines and the Caribbean. She said demand for American health care facilities is the highest she has seen in three decades. There are thousands of foreign nurses waiting on waiting lists for interviews at American embassies around the world to get visas to work in the U.S.
The number of international nurses who register to practice in the United Kingdom has increased since the middle of 2020, according to a senior fellow with the Health Foundation.
Mike Noveda, a senior nurse in the Philippines who has been temporarily assigned to run Covid wards in a major hospital in Manila, said that there are 15 nurses in his unit and half have an application in process to work abroad. They will leave in six months.
The shortage of health workers is a growing concern as the Omicron variant surge and the Pandemic enter their third year. According to the W.H.O., as many as 180,000 people have died of Covid. In the United States, about 20 percent of workers have left their jobs. In the past year, the W.H.O. has recorded strikes and other labor action by health workers in more than 80 countries. In both rich and poor countries, the loss of the health work force has had a negative effect on patient care.
Dedicated immigration fast-tracks for health care workers have been created by European and North American countries.
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A room filled with wheelchairs and hospital beds is in a clinic outside of Lusaka.
The British government introduced a health and care visa program in 2020 that targets and fasttracks foreign health care workers to fill vacancies. Reduced visa costs and quicker processing are some of the benefits of the program.
Canada has made it easier for foreign-trained nurses to be recognized for their qualifications. A pathway to residency is being offered by Japan. Germany is allowing foreign-trained doctors to work in assistant physician positions.
In 2010 the member states of the W.H.O. adopted a Global Code of Practice on the International Recruitment of Health Personnel, driven in part by an exodus of nurses and doctors from nations ravaged by AIDS. African governments were frustrated that their universities were producing doctors and nurses who were being lured away to the United States and Britain as soon as they were fully trained, for salaries their home countries could never hope to match.
The right of individuals to migrate is recognized in the code, but it calls for wealthy nations to recruit through bilateral agreements with the health ministry in the country of origin.
In exchange for an organized recruitment of health workers, the destination country should supply support for health care initiatives designated by the source country. In order for health workers with new skills to return to their home countries, destination countries are supposed to offer "learn and return".
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The chief nursing officer for the National Heart Hospital said that they are always overstretched for critical care. You can't just put a nurse in the operating theatre.
Mr. Catton said that was not the current pattern. He said that nurses who are recruited want to establish themselves in another country and bring their families with them.
A new government has pledged to hire 11,200 health workers this year, despite the fact that thousands of graduates of nursing schools are unemployed. Veteran nurses such as the director of nursing at the hospital that Mr. Mulumba works at, are the most sought after by recruiters.
Ms. Mwape said that people are leaving constantly and that she was flooded with emails from recruiters telling her how quickly she could get a visa.
She said that the net effect is that we are handicapped.
The most skilled nurses are the ones that we lose. We should have 20 trained critical-care nurses in the I.C.U. General nurses can't handle the burden of Covid.
The first step to emigrate to the United Kingdom is language testing, which was started by Dr. Brian Sampa. The head of the doctor's union is aware of how valuable physicians are in the country. He said there are less than 2,000 doctors working in the public sector and 5,000 in the entire country. The W.H.O. recommends at least one doctor per 1,000.
The doctors died in Covid. In his last job, he was the only doctor in a district with 80,000 people and he spent a lot of time in the operating theater doing emergency surgeries.
He is not happy about the health system. When he was treating critically ill Covid patients, he searched the entire hospital for a single C-clamp that could run oxygenation equipment. He makes less than a thousand dollars a month.
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A father and his daughter are outside of his home. In his last job, he was the only doctor in the district and spent nearly 24 hours at a time in the operating room doing emergency surgeries.
There are more pros to leaving than staying. For those of us who are staying, there are things holding us, but not because we are comfortable.
The migration of health care workers from low-income nations to high-income ones increased by 60 percent in the decade to 2016 according to Dr. Giorgio Cometto, an expert on health work force issues who works with the W.H.O.
The Philippines and India have overproduced nurses for years with the intention of sending them abroad to earn and send money back to their home countries. The Philippines is reporting shortages. The nurse in Manila said that his colleagues were applying to leave in record numbers because of the demands of the Pandemic.
Many workers and prospective employers are in limbo because immigration processes have slowed down during the Pandemic.
Some countries are sincere about bilateral agreements, but that isn't the only level at which recruitment happens. Mr. Catton said that recruitment agencies pitch up in-country and talk directly to the nurses offering very attractive packages.
The United Kingdom doesn't recruit for its National Health Service in countries with fragile health systems. Some health workers get around that by entering Britain first with a placement through an agency that works in private nursing homes. They move to the N.H.S. once they are established in Britain.
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A technician used her cellphone to illuminate a broken machine in a clinic.
The Center for Global Development in Washington has an expert on international migration from developing countries.
He said that offering someone a life-changing career opportunity for themselves, something that can make a huge difference to their kids, is not an ethical crime. It is an action with consequences.
One in 10 nurse jobs in the United Kingdom were vacant. Mr. Catton said that some countries are making overseas recruitment a core part of their staffing strategies. If that is the plan, he said, then recruiting countries should be more careful about how they monitor the impact on the source country and calculate the cost of training nurses in that country.
Alex Mulumba, the operating room nurse from Zambia, says that if he goes to Canada, he won't stay permanently, just five or six years to save up some money. He won't bring his family with him because he wants to stay in his hometown.
He said that he had to try to do something about it.
In Los Angeles and London, there were two people who contributed reporting.
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