NHS: Global Health

Baroness Tonge Excerpts

Monday 20th December 2010 Lords Chamber

[Baroness Tonge]

My Lords, I join in congratulating the noble Lord, Lord Crisp, on securing this debate and also on his work in this field.

Eight years ago I was in Malawi as a member of the All-Party Parliamentary Group on Population, Development and Reproductive Health. We were looking at health provision in that country generally as well as focusing on maternal health. It was of course at the height of the AIDS epidemic in Malawi. I have never forgotten the visit we had to one of the hospitals there. From the distance we saw a pleasant enough building but as we entered the gates we saw people lying on rough, old blankets on the grass outside, brought in by relatives who needed to get back to their own work as quickly as possible, there being no help at all out in the villages outside the hospital. Inside the hospital itself, every ward was packed with dying AIDS patients; on bedsteads, on mattresses under the bedsteads and packed in between the beds. We saw ward after ward of human misery in a hospital totally unable to cope. Those patients received no treatment except some rehydration if they were lucky. It was a scene from hell.

At that time, for a population of around 10 million, there were 43 doctors in Malawi and so few nurses in that hospital that it was coping with well over 100 patients to each nurse. Even with that scant provision there was a 40 per cent vacancy rate. The staff were exhausted and demoralised and many had left after their training to work in South Africa or Europe where they could be guaranteed decent work experience and in-service training. It was not just the poor salaries that drove them away; and who could blame them?

The Malawi Government soon resolved to take action and with overseas aid, including, I am glad to say, a good deal from our own Department for International Development, more staff were trained. Salaries were increased combined with contracts to stay in Malawi. Students’ fees were paid if they contracted to work for at least three years after qualification and volunteer doctors were brought in from abroad—yes, also from this country—to provide in-service training to staff and better care to patients. Of course the advent of anti-retroviral drugs for AIDS stemmed the tide of that scourge. Healthcare is now slowly improving in Malawi, but very slowly.

What can we learn from this? First, we must make our doctors and nurses aware of these problems. We can do this by better education at undergraduate and postgraduate level—deans, please note. We must make it easier for young doctors to take a year out in the developing world. The current pressure on them in their postgraduate training prevents this, because it does not count towards their certificate of complete training and the year abroad will not be recognised by the NHS. Sabbaticals are difficult to obtain. I have discovered that they need something called an “out of programme experience”, and the bureaucracy involved makes it more like an out of body experience. It is a huge deterrent to young people wanting to go abroad. Hospital trusts will not want to employ locums and there is no national directive to encourage them to release doctors.

The national conscience should dictate that we help developing countries to upgrade their health systems. Their staff have helped our National Health Service for decades at the expense of their own people in their own countries. It is payback time and I hope the Minister can reassure us that action will be taken.