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HEALTH-PARAGUAY: Hello Rome, Goodbye Dengue!

David Vargas

ASUNCIÓN, Apr 20 2007 (IPS) - The corridors in Paraguay’s Hospital de Clínicas are crammed with dozens of patients with symptoms of dengue waiting for treatment, but in the nurses’ station they are having a party. Mirian López, a registered nurse with several years’ experience in intensive care, has just found out that she has a job waiting for her in Italy.

López will soon join the ranks of the nearly 400 Paraguayan nurses who have emigrated to Italy since 2000 to work in public and private hospitals.

They represent over 10 percent of the nursing work force in this South American country of six million, where the Public Health Ministry budget covers a total of only 3,500 posts for nurses, auxiliary nurses and technicians.

Of these, only 1,567 posts are for registered nurses. And according to law, health personnel may work in up to two posts in different services, so the actual number of professional nurses is even lower, ministry sources said.

What for López is wonderful news is a source of increasing concern for health authorities, especially since the country is experiencing a fresh outbreak of dengue fever.

Emigration of trained healthcare personnel to Europe and the United States has exacerbated the already serious shortage of qualified staff in public hospitals.

According to official statistics, there are 1.2 nurses per 10,000 people in Paraguay, a much lower proportion than in other countries in the region, such as Argentina and Uruguay, which have 12 nurses per 10,000, slightly above the minimum ratio of 10 per 10,000 people recommended by the World Health Organisation (WHO).

The brain drain is affecting clinical medicine and intensive care services most of all, the president of the Paraguayan Nurses Association (APE), María Concepción Chávez, told IPS.

Nursing vacancies are filled at best by inexperienced auxiliary nurses or technicians with insufficient training. “The proper functioning of many services is under serious threat. Several of our intensive care units are closed because of staff shortages, and specialisation takes two to three years,” she said.

Since the dengue epidemic was declared early this year, the Health Ministry has registered 25,856 cases of the classic form of the disease, and 52 of the much more deadly haemorrhagic dengue fever. Fourteen people have died, and more than 3,535 patients have had to be hospitalised. Although the authorities insist that the situation is under control, there are 200 new cases a day.

Pan American Health Organisation (PAHO) Representative Carmen Serrano was one of the first to sound the alarm. She said the phenomenon of nurses’ emigration was serious, though it was not unique to Paraguay. “There is a worldwide crisis, because nurses’ value as human resources in healthcare isn’t properly recognised in developing countries. In some countries, like Bolivia, the situation is much worse,” she told IPS.

The WHO Assembly addressed the issue in 2006, and debated the need to make reparations to the poorest countries for the loss of their trained health staff to rich nations. Serrano said the ideal solution would be to restore “other service components and medical supplies to the countries that are losing health personnel.”

According to the APE, a nurse’s salary in Paraguay averages 300 dollars a month. Seventy percent of nurses in the public health service are contract workers, which means they have no medical insurance, pension contributions or job security, and their contracts have to be renewed every six months or every year.

In Italy López has an initial contract for one year, which is renewable. Her salary will be 1,500 euros (2,000 dollars) a month and she will have medical insurance, 30 days paid vacation, and an end-of-year bonus.

“It’s a unique opportunity,” López told IPS. As a requirement for the job, she took intensive Italian classes for a year. Applicants must also have their professional qualifications validated, and pass a stiff entrance examination set by the Italian nursing association.

Contacts with the Italian employers are provided by recruiting firms like Obiettivo Lavoro, an Italian consultancy which came to Paraguay two years ago and also has branches in Bolivia, Peru and Brazil.

The company researches employment opportunities in Italian hospitals, recruits and trains staff in Paraguay, and applies for the necessary visas and work permits.

“Paraguayan nurses have an excellent bedside manner and are popular with patients. Paraguayans are preferred among the South American nurses, and are highly sought after in hospitals and clinics for their professional skills,” the company’s representative in this country, Jorge Romero, told IPS.

The WHO reported that unfilled global demand for health workers amounted to more than four million. Industrialised countries have a greater shortage of nurses, mainly due to the ageing of their population, it said. Italy, for example, has an estimated shortfall of 50,000 nurses, Canada needs 60,000, and the United States 168,000.

This gap will grow as average life expectancy increases, the WHO warned.

The APE in Paraguay emphasises training as the solution. “We need more and better nursing staff, so that the profession as a whole does not become out of date,” said Chávez. But it is a complex problem, especially in a country like this one, where the average number of professional nurses entering the labour market every year is under 200, according to official figures.

The four-year degree course in nursing at the National University of Asunción – where education is free of cost – costs the state approximately 14,000 dollars. Most of the nurses recruited to work abroad are graduates of this university, which in spite of its budgetary and infrastructure problems is the main professional training institution in this field.

Chávez said APE’s main concern was that most of the nurses who emigrated were aged between 30 and 35. “In 10 to 15 years’ time, these nurses will return to Paraguay, without job prospects, pensions, or social security, and this will create social instability,” she said.

But such concerns are secondary for López and 21 other aspirants who are on the Obiettivo Lavoro agency’s waiting list to travel to a new life in Italy. “The salary I earn here isn’t getting me anywhere, and although it’s hard to leave my family and friends, the sacrifice is worth it,” López said.

The farewell party is soon over. The flood of dengue fever patients is not letting up, and the line grows as the morning goes on. On leaving, López could not conceal her exhilaration: “Ciao Roma, arrivederci dengue!”