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Migration and Covid deaths depriving poorest nations of health workers | Global development

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The loss of frontline health workers dying of Covid around the globe, is being compounded in the hospitals of developing nations by trained medical staff leaving to help in the pandemic effort abroad, according to experts.

With new Covid waves in Africa, and with Latin America and Asia facing unrelenting health emergencies, the number of health worker deaths from Covid-19 in May was at least 115,000, according to the World Health Organization. Its director-general, Tedros Adhanom Ghebreyesus, acknowledged data is “scant” and the true figure is likely to be far higher.

In richer countries, the share of foreign-trained or foreign-born doctors and nurses has been rising for two decades. But the pandemic’s double blows of death and migration are leaving behind knowledge gaps in already fragile health systems, where poor pay and conditions are driving staff to leave, say advocates and health workers.

Global health specialists are launching initiatives to protect medical staff, and incentivise them not to be enticed abroad.

Women in Global Health, an international network advocating for equality, has jointly launched what it calls “a new social contract for women in the health and care workforce”. The Gender Equal Health and Care Workforce Initiative, a partnership between the WHO, Women in Global Health and the French government, aims to strengthen policy investing in and protecting workers.

“Health workers are exhausted, many want to leave. We cannot afford to lose one single worker at this time,” says Dr Roopa Dhatt, executive director of Women in Global Health. “Investing in women is the best investment we can make for all our futures and the future of health security.”

Nurses in scrubs do fitness class
Nurses use a Zumba fitness class to help them cope with working situations during a coronavirus outbreak at Kenyatta National Hospital in Nairobi, Kenya, in May last year. Photograph: Njeri Mwangi/Reuters

The world is reliant on women to deliver health and care services, Ghebreyesus told the Generation Equality Forum, where the first round of commitments to the initiative was announced on 1 July.

Women account for about 90% of nurses and midwives, close to 50% of all doctors, and make up 70% of all health and care workers worldwide.

“This reliance demands that we ask ourselves tough questions on workplace conditions and equity, including how we value and reward women in the health and care workforce,” Ghebreyesus said. “And how we guarantee that workplaces are free from discrimination, violence, sexual exploitation and abuse.”

As governments – including those of Mexico, Pakistan, the Democratic Republic of Congo and Liberia – commit to the gender policy initiative, Dhatt said that millions of health and care workers were unpaid or underpaid and had no access to Covid vaccines.

“We must provide incentives for women to stay,” said Dhatt.

The global south has long supplied many of the human resources for health systems in the northern hemisphere. And as the UK, the US and Europe have struggled under the weight of their respective pandemics, demand for imported medical expertise has intensified.

Across the world’s wealthiest countries, nearly 25% of doctors and 16% of nurses were born abroad, according to a brief from the Organisation for Economic Co-operation and Development (OECD). Published in May, it examined how rich countries have sought to attract staff from developing countries in response to the pandemic.

It acknowledged that nations from where staff were being enticed “were already facing severe shortages of skilled health workers before the Covid-19 pandemic”.

The UK launched its own incentive – a fast-track Health and Care Visa in 2020 to attract more health workers from developing countries – even as the government drastically reduced its foreign aid budget from 0.7% to 0.5% of national income, against OECD advice and putting global health systems at risk, according to academics.

The Philippines is the largest contributor of nurses to wealthy countries, OECD data shows. India provides the highest number of doctors, and the second-highest number of migrant nurses.

Mitigating push factors for professionals to leave their countries requires policy to “reinforce international cooperation, notably overseas development assistance and technical assistance, to help less advanced countries build up a sufficient health workforce and to strengthen their health systems”, the OECD brief said.

The Filipino Nurses Association UK has raised concerns about the disproportionately high rate of deaths among NHS and social care staff from the Philippines, saying that the nationality had the highest mortality of all ethnicities, at about 20%. The group set up a special helpline for Filipino health workers and their families as a result. In the US, more than 30% of nurses who have died of Covid were Filipino, though they make up just 4% of the country’s registered nurses, according to the National Nurses United union.

Medical personnel in protective clothing
Medical staff treat patients in a tent at a temporary Covid isolation facility in the car park of the National Kidney and Transplant Institute Hospital in Manila, the Philippines, April 2020. Photograph: Ezra Acayan/Getty Images

In the Philippines, two prominent specialists died of Covid in March 2020: paediatric surgeon Leandro Resurreccion III and Salvacion “Sally” R Gatchalian, the president of the Philippine Paediatric Society.

Gatchalian helped create the Philippines Coalition Against Tuberculosis and led a children’s TB initiative, while Resurreccion was lauded for having returned from Australia to dedicate himself to the Philippines’ health service.

Highly skilled researchers are scarce in low- and middle-income countries, said Glenda Gray, president of the South African Medical Research Council, adding: “Any loss of scientists, either through death or migration, is a concern.”

In fragile health systems, lost knowledge when a community health worker or highly trained medical expert dies can have a long-term impact. And research suggests physician migration costs low and middle income countries $16bn (£11.5bn) annually and lost medical knowledge contributes to excess deaths.

With emigration rates of doctors and nurses as high as 50% from some African and Latin American countries, it can mean that more doctors born in these countries are working in the OECD area than in their countries of origin.

Africa’s research community lost renowned HIV scientist Gita Ramjee to Covid in March 2020.

“Gita was fundamental and inextricably linked to the endeavours to find solutions to prevent HIV in women. She was tireless in this pursuit, her tenacity will never be forgotten,” Gray said. Winnie Byanyima, executive director of UNAIDS, said Ramjee’s loss was “when the world needs her most”.

“The psychological impact of deaths, infections and [increased workloads] prompted many doctors to request leave and, in the event of management refusal, some resorted to resigning from governmental hospitals,” Egyptian physician Abdel Hamid Mahmoud said.

Johan Fagan, an ear, nose and throat disease specialist at the University of Cape Town in South Africa, said policies such as the UK’s fast-track visa would spur further migration.

“These countries aren’t training enough of their own healthcare professionals and are exploiting the workforce in developing countries,” Fagan said. “In a pandemic, this has a significant impact on our health systems and how we’re able to deliver care.”

Algerian Dr Al Arabi Bin Hara predicted a new exodus of skilled workers from his country, saying: “Last year and at the beginning of this year, there was the smallest number recorded in doctors’ immigration because of the closed borders as [a result] of the measures imposed by the pandemic.

“The post-Covid phase will witness a mass flight of doctors, as long as the situation remains as it is and the suffering continues.”

What hurts, said Bin Hara, is that hospitals and clinics in Europe – particularly in France – were attracting Algerian doctors with critical specialisations.

Older people queue while nurses conduct their duties
Older people queue for a Sinopharm vaccination behind nurses at a hospital in Harare, Zimbabwe, in March this year. Photograph: Tafadzwa Ufumeli/Getty Images

In Zimbabwe, a country with one of the highest doctor emigration rates, Dr Charles Moyo said Africa would face a healthcare crisis if the tide of health worker losses was not stemmed.

“The healthcare system is already strained by limited resources and by Covid. If more manpower is lost, the entire healthcare system could collapse,” he said.

The International Council of Nurses (ICN), which has backed the Gender Equal Health and Care Workforce Initiative, celebrated the World Health Assembly’s adoption of the WHO’s updated global nursing and midwifery strategy, which presents policy priorities to support midwives and nurses.

ICN chief Howard Catton said the message was clear, adding: “We must invest now in nursing education, leadership, jobs and practice, and we need member states to own their new strategy and implement it now.

“Of course, the tragic irony is that if we had done this before, we would have had a better protected healthcare workforce, and fewer of our colleagues would have died.”

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‘She asked me, will they kill you if they discover you?’: Afghan girls defy education ban at secret schools | Afghanistan

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When inspectors arrive at the school gate, which is most weeks now, the older girls know the drill. They slip away from their classes, race to a musty room and huddle together for long minutes that sometimes stretch into hours, hoping they won’t be discovered by the men who want them shut up at home.

The Taliban have banned secondary education for girls, the only gender-based bar on studying in the world.

One year on from the withdrawal of US troops and the militant group’s takeover of the country, learning algebra is now an illegal act of resistance. Teenagers who should be worrying about complex equations, English grammar or Persian poetry, also have to weigh up what happens if they are found in a classroom.

Students leave a secret girls’ school in Afghanistan in July
Students leave a secret girls’ school in Afghanistan in July. Photograph: Nanna Muus Steffensen/The Guardian

“I have noticed plenty of changes in our students,” said Arezoo* headteacher of one Kabul school that decided to keep its doors open to high school girls in defiance of the ban.

“Psychologically they are under stress all the time, I can see in their eyes and behaviour. They used to come with lots of energy and excitement. Now they are never sure if this will be their last day in class. You can see how they are broken.”

Some inspections last hours and the fear spills over. “Even the younger girls (who are allowed in school) are affected. When we say the Taliban are coming and the older girls have to hide, the girls in 3rd and 4th grade start crying.”

Taliban officials claim the ban is temporary, variously citing the need to change security, uniforms, teachers, buildings or the curriculum. But many Afghans remember last time the group controlled Afghanistan, when a “temporary” closure of girls’ schools endured for their entire six-year rule.

So as girls slid into depression, robbed of their dreams of becoming doctors, pilots, engineers, teachers orartists, women and men around Afghanistan began fighting back.

A student holds a sign she has prepared for the Guardian’s visit to a secret girls’ school
A student holds a sign she has prepared for the Guardian’s visit to a secret girls’ school. Photograph: Nanna Muus Steffensen/The Guardian

“I told my mother I had this idea, to reopen classes for high school girls, and asked her what she thought,” said Jawad*, who manages one private school that decided to reopen secondary classes.

“She asked me, ‘will they kill you if they discover you?’ I told her no, they will probably just hit me. So she said ‘Do it, you’ll forget a slap in an hour or two.’”

“Secret schools” have sprung up all over the country, as varied as the educators running them. Some are online classes, though they can only reach the minority of Afghans with smartphones and data access.

Some are private schools, operating much as they did before, apart from the long shadow of fear. Others are much more improvised efforts, designed as much to keep up morale and girls studying something in the hopes schools will reopen, than as a substitute for formal education.

Two girls take refreshment after class
Two girls take refreshment after class. Photograph: Nanna Muus Steffensen/The Guardian

Improvised efforts

“In the beginning everyone was crushed and disappointed, and they would even question what is the point of studying,” said Mahdia*, who set up a school teaching 7th grade classes in a mosque close to her semi-rural home near a provincial capital.

An engineer who recently graduated near the top of her class at one of Afghanistan’s best universities, the 23-year-old worked on infrastructure projects until last summer, and misses her job terribly. But she sees little chance of being allowed back.

“Some positions in some ministries are still open to women, but for engineering a lot of our work is in the field and the Taliban are strongly against it for women. All my [female] classmates are unemployed, there is nothing for them to do.”

A girl participates in a math class
A girl participates in a maths class. Photograph: Nanna Muus Steffensen/The Guardian

So while she studies English and looks for scholarships to do a further engineering degree in another country, she decided to teach local girls.

She negotiated with a mosque to hold the classes there – she comes from a Shia community that has avidly supported girls’ education over the past two decades – and got practical support from an NGO, Shahmama, which provides text books and stationery, and is raising funds to pay the teachers a small stipend.

“I do this as a volunteer, to support the girls and create hope in their future, and the girls also give me hope,” Mahdia said.

On a recent afternoon, her students slipped across the fields in pairs in the afternoon heat, books in hand like girls going to school in any other country. When they noticed a stranger watching though, they gathered speed and ducked inside the mosque.

The group includes one girl who was within weeks of finishing 11th grade when the previous government collapsed, three who were in 9th grade, 11 who were in 8th grade and six who were in 7th grade.

“Of course, sometimes we feel bad to be back in 7th grade, but it’s better than sitting at home doing nothing,” said Zarifa*, who has gone back two years. “We get to meet classmates and revise our lessons.”

Mahdia teaches one subject, for an hour a day, but assigns homework to keep the girls busy in the long hours at home when it is easy to start thinking about everything that has been lost. She starts and ends each session with a motivational talk.

“Every day when we start and finish I talk to them a bit, and try to motivate them, with messages like ‘no knowledge is wasted’. I tell them I am here to teach and support you, you have to stay hopeful, take your opportunities.”

A class gets underway
A class gets under way. Photograph: Nanna Muus Steffensen/The Guardian

Defiance and compromise

Schools such as Mahdia’s are beacons of hope in a bleak time, and many of their students are filled with extraordinary defiance of the armed men who cut short their studies.

“I have my argument ready if a Taliban stops me. I will say ‘you didn’t study so you are like this, I have to study so I won’t be the same,’” said Hasinat*, a 7th grade student.

But the compromises so many girls and teachers have made to be there – repeating grades, hiding from inspectors, swallowing the loss of their own careers – underline how much has been stolen from the women of Afghanistan by its new rulers.

And many of the adults running these schools fear their work will not be able to continue indefinitely, because of financial and official pressure.

Illegal classes kept girls’ dreams alive last time the Taliban were in power. Those who defied the Taliban to study include the journalist Zahra Joya, named as one of Time magazine’s women of the year for 2022, and the educator and Washington Post columnist Shabana Basij-Rasikh.

They mostly went to primary school during Taliban rule, dressed as boys. Older female students are much harder to conceal, and Jawad is bracing for the day when the girls are discovered in class or their hiding place uncovered.

“Perhaps I can continue this risky job for a year or two but then I may get arrested, and when I do, what will happen to them?” he said. “The day they force me to really ban the girls, I will shut the school and leave the country.”

Even if authorities decide to turn a blind eye to some schools – and they have given at least one prestigious private chain tacit permission to keep some of its branches open outside the capital – a financial crunch looms.

Secret schools all need private funding, and while some comes from NGOs, most rely on fees. Afghanistan’s economy is collapsing, expected to shrink by about a third, and many families are struggling to find money for school even when it is a priority.

“The financial situation of the school is very bad since the Taliban. Students were paying 1,500 to 4,000 afghanis a month (£14 to £36), but most of those families left. We have new students now but they can’t afford more than 500 to 2,000 a month mostly,” said Gulbano*, s the financial manager of one Kabul school.

“We had to offer very low fees as no one has much money at home, and we are educating some orphans for free,” she added. The director of another school still offering girls’ high school classes said he was besieged by requests for cheaper fees, but was already operating at a loss.

One of the students leaves a secret girls’ school
A student leaves a secret girls’ school. Photograph: Nanna Muus Steffensen/The Guardian

Parental pressure

Jawad decided to restart classes after mothers and fathers begged him to help. “All the families were coming to ask about their girls. They said, ‘our boys are coming but what about our girls?’”

“Education is everything,” said one father, whose 10-year-old daughter, something of a prodigy, is newly enrolled in 7th grade there. He found the school by doggedly asking about classes every time he saw girls coming out of a building carrying books.

“Of course I have concerns for her and me, but I want my daughters to achieve their dreams, I don’t want them to just become ‘aunties’, sitting at home all day just asking their husbands for money.

At Mahdia’s semi-rural school, less than a quarter of the girls have mothers who were able to go to school, and under half have fathers who are literate.

“They have a lot of difficulties in life, so they always motivate us, saying ‘don’t be like us,’” said Mursal*, who is married and supported by her husband. “Before they give any medicine to my younger siblings, I have to read the label and the dose for them.”

The Taliban have tacitly acknowledged parental pressure for education, allowing schools to stay open in a handful of provinces, including northern Balkh, and southern Zabul.

Hopes that the government might reverse course nationally have been repeatedly crushed, first in March when girls were called back to school then ordered home again as soon as they reached their classrooms.

More recently, a national gathering of clerics was expected to endorse girls’ education, but ended with only a vague nod to women’s rights. Sources with links to the Taliban leadership say hardliners who oppose girls’ education have the upper hand for now, so Afghan girls have to keep studying in secret, and Afghan men and women have to keep breaking the law to help them do it.

“I’m not old, but I’ve got lines on my forehead. The way the girls look makes me very sad sometimes, like I want to cry.” said Jawad, who is fundraising for a therapist for the students. “I think to myself ‘why do I have to hide you from our government.’”

* All names and some identifying details have been changed to protect the girls and their schools.

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Ukraine’s Finance Minister Reports Problems Finding Cash to Pay Troops Despite West’s Aid Bonanza

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The US and its allies have approved over $76 billion in military and fiscal aid to Kiev, equivalent to 40% of Ukraine’s GDP in 2021. However, much of this assistance doesn’t seem to be reaching its intended destinations, with CBS issuing (and then deleting) a story last week showing that as little as 30% of the military aid was reaching the front.

Ukraine is having trouble scrapping together the money required to pay soldiers’ salaries and has resorted to money printing thanks to a growing gap between military spending and declining tax revenues, combined with a slowing flow of Western aid, Finance Minister Sergii Marchenko has indicated.

“Every day and night it’s a constant headache,” Marchenko told the Wall Street Journal in an interview.

The minister explained that the government is now spending more than 60 percent of the budget on military-related expenditure, and has received assurances from Western countries of new loans and grants to cover non-military spending.

“The support we get now gives us the opportunity to win this war and to do it sooner rather than later. Without this money, the war will last longer and it will damage economies more,” Marchenko said.

The minister indicated that the government is disregarding concerns from the National Bank about skyrocketing inflation, saying “it is better to risk high inflation than not to pay soldiers’ salaries.” He added that he expects the conflict to turn into a “marathon” lasting for the remaining of 2022 and 2023. “This is a war of attrition. You have to think in these terms,” Marchenko said.

Ukraine has received a total of more than $50 billion in military and non-military aid authorizations from the US alone, including everything from weapons and new defense contracts for the military-industrial complex to replenish old inventories, to fiscal support and loans to help the Ukrainian state stay afloat, pay its creditors on time and avoid paralysis, to humanitarian assistance.
A worker paints a Saint Javelin, a Virgin Mary holding an American-made anti-tank missile, in Kyiv, Ukraine, Tuesday, May 24, 2022 - Sputnik International, 1920, 08.08.2022

CBS Deletes Documentary Revealing That Just ‘30%’ of West’s ‘Aid’ to Ukraine Reached Frontlines
US assistance has been matched by nearly $16 billion in aid from the European Union, plus $6.22 billion, $3.34 billion, $2.85 billion, $2.61 billion and $2.11 billion from Britain, Germany, Poland, Canada and France, respectively, for a grand total of over $76 billion.
On Friday, Ukrainian presidential chief economic advisor Oleg Ustenko urged the International Monetary Fund to shell out $5 billion as part of a larger $15-20 billion aid package over the eighteen months to two years to encourage others, including the US, the EU and other countries to go ahead with additional support. Last month, Prime Minister Denys Shmygal told attendees of a Switzerland-based conference dedicated to Ukraine’s economic recovery that the country would need some $750 billion in assistance.
Corruption concerns and questions about the final destination of the tens of billions of dollars doled out to Ukraine aid periodically emerge in mainstream media reporting on the conflict. Last month, Ukrainian-born Republican Congresswoman Victoria Spartz accused Ukrainian presidential chief of staff Andriy Yermak of sabotaging the country’s defenses, and of appointing officials engaged in corruption to fight graft. Ukrainian officials dismissed her concerns as “Russian propaganda.”
Fitch Ratings - Sputnik International, 1920, 13.08.2022

Fitch Ratings, S&P Global Ratings Consider Ukraine’s Debt Restructuring as Default
Last week, CBS News posted and then deleted a bombshell documentary which uncovered that as little as 30 percent of the military assistance Western countries had sent to Kiev in the first months of the conflict had actually reached the frontlines. The documentary was quickly taken down to be “updated” to account for new information from the Pentagon and other sources.
Ukrainian Foreign Minister Dmytro Kuleba tweeted that the retraction was not enough and called for an “internal investigation” at CBS to determine “who enabled” the documentary’s release and why.



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Brazilian woman and fake seer con elderly mother out of $142 million | International

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A woman was arrested on August 10 by Rio de Janeiro police who charged her with conning her mother out of millions. In a strange story of greed abetted by fake psychics, Sabine Boghici and her accomplices stole more than $142 million in money, jewelry and artwork from Boghici’s mother over a two-year period.

Geneviève Boghici, the widow of a major art collector and dealer named Jean Boghici, was walking out of a bank in January 2020 near the famous Copacabana Beach in Rio de Janeiro (Brazil) when she was approached by a supposed psychic prophesying her daughter’s imminent death unless she underwent “spiritual therapy.” They walked together to Boghici’s apartment, where the psychic threw some shells in a mystical ritual that confirmed the tragic prophesy. The 82-year-old victim knew that her daughter suffered from psychological problems, and her affinity for the supernatural swayed her to transfer $980,000 to the swindlers.

Soon after the two-year con began, the elderly woman became suspicious and halted the money transfers when her daughter started to isolate her from friends. Sabine would not allow her mother to use the phone and dismissed all the domestic workers, justifying them as Covid-19 precautions. Yet Sabine and her cronies entered freely to loot her mother’s home of its valuables. Several psychics took items from the home, saying they were “cursed” and needed to be “prayed over.” The increasingly suspicious Geneviève tried to resist, but Sabine began threatening her life. According to the police, she wouldn’t allow her mother to eat and put a knife to her throat.

Police recover 'Sol Poente' by Brazilian painter, Tarsila do Amaral.
Police recover ‘Sol Poente’ by Brazilian painter, Tarsila do Amaral.Policia Civil de Rio de Janeiro (EFE)

The victim told the police that her daughter had some sort of relationship with one of the supposed psychics, Rosa Stanesco Nicolau, who practiced her trade in Rio de Janeiro as “Mãe Valéria de Oxossi” (Mother Valeria), and was a known con artist. Starting in September 2020, under constant threat from her daughter and accomplices, the elderly woman made another 38 bank transfers to the thieves.

Sabine and her cohorts stole 16 paintings and sculptures, and sold them all to art galleries or private buyers. Two of these works – Elevador Social (Social Elevator) by Rubens Gerchman, and Maquete para o menú espelho (A model for my mirror) by Antonio Dias – were bought by Eduardo Costantini, owner of the Museum of Latin American Art of Buenos Aires (Argentina), for his private collection. The São Paulo (Brazil) gallery owner who brokered the deal said he was not suspicious because he had known the family for a long time and the seller was the daughter of the deceased art collector. Constantini released a statement saying that he bought the paintings in good faith and was in direct contact with Genevieve Boghici.

In 2012, a fire in the Boghici’s Copacabana apartment destroyed part of their valuable collection, including Di Cavalcanti’s Samba and Alberto Guignard’s A Floresta (The Forest). Sol Poniente (Setting Sun), painted by Tarsila do Amaral in 1929, is one of the most valuable works in the Boghici collection ($49 million). It survived the 2012 fire but not the rampant greed of their daughter. The stolen painting was found under a bed by police, who arrested Sabine and three other people, including the fake seer. In a final twist to the whole bizarre story, the scamming psychic was apprehended trying to escape through a window.

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