This Week's News 5 August 2011

6

City college to train, supply paramedics to hospitals
Hindustan Times

31/07/2011

Divya Sethi
Following shortage of paramedics in hospitals, the Haryana IGNOU Community College in Manesar has decided to start nursing courses. Support staff in hospitals comes from across India, mostly Kerala, and there are few colleges providing nursing training in north India. The courses will be run jointly with IGNOU at the Manesar campus.
Hospitals have welcomed the move as it will help fill the gap in shortage of nurses.
“The project is in its initial stages. We have to chalk out a strategy before introducing the courses. We also have to collaborate with city-based hospitals for placements,” said Ravin Ahuja, deputy registrar, Haryana IGNOU Community College. “Also, we can’t install all the equipment here, so we need hospitals’ help for practical training,” he added.
The course will be for lab technicians in intensive care units, ultrasound department and pathology labs. There will be 20 seats in each course.
Haryana’s first plastic surgery surgeon, Dr SK Soni, said a hospital cannot be run only by doctors. “A hospital can’t survive if the support staff is not good. We need trained and skilled staff. It will be a boon for doctors as well as patients,” added Dr Soni.
Director of Pushpanjali Hospital in Civil Lines, Dr SP Yadav, said these courses will help hospitals a lot. “Sometimes, we are compelled to train support staff on our own, which takes time and energy. But our job will get easier if we get trained staff,” said Yadav.

10

Shortage of doctors in some parts of Australia reaching ‘critical’
Australiaforum, AU

01/08/2011

Ray Clancy

Demand for overseas doctors is high in Australia with the state of South Australia in particular needing more doctors as a quarter are due to retire in the next five years.
Over a third of doctors working in Australia are overseas trained. According to the Rural Doctors Association of South Australia the state is facing a looming doctor shortage.
Peter Sharley, the President of the Australian Medical Association in the state is calling on the South Australia government to fund new internship and training places and it is likely that any skilled medical professionals immigrating to Australia could be in high demand.
‘We have been falling behind for a very long time. The State Government here has guaranteed intern positions for the next couple of years, but after that students graduating don’t have that assurance,’ he explained.
Current figures show that approximately 245 medical students are expected to graduate in 2011. Of those, 207 are permanent residents while 38 are international students.
Many medical professionals look to migrate to Australia due to the opportunities available, as well as the cost of living being much lower than other countries.
However, there has been a backlash against the number of foreign graduate doctors with reports recently over allegations relating to their lack of care.
The AMA nation vice president, Professor Geoffrey Dobb, said that there has been ‘an unfair and unwarranted attack on the thousands of highly skilled International Medical Graduates currently working in our health system’.
‘There are systems in place to ensure that bad medical practice and poor medical outcomes involving all doctors are thoroughly investigated and followed up. It is wrong to demonize all IMGs because of the alleged indiscretions of a small number,’ he explained.
He pointed out that Australia needs foreign doctors. ‘Without the contribution of IMGs to our health system, especially in public hospitals and in country areas, many Australians would find it a lot more difficult to access medical care. Over a third of doctors working in Australia are overseas trained,’ he added.
The RDA survey found that 77% of patients were waiting longer than three days to see their family doctor, while 6% were waiting five weeks. RDA SA president Tim Wood said many GPs would see emergency patients, but some patients were forced to see other doctors.
The situation is expected to get worse as 23% of SA’s rural doctors expect to leave general practice within five years. Wood said the average age of country GPs in SA was 51, making action ‘critical’.
The survey also found that 80% of rural doctors say they need more GPs in their towns, while half are seeking more GPs in their practice. Wood added that people in rural areas would endure longer waiting times, while many were already transferred to metropolitan centers for simple surgical procedures.
‘There is currently a shortage of doctors and nurses in Australia, particularly in regional areas. General practitioners or specialists can apply for a visa to work in Australia if they have obtained their primary medical qualification in a country other than Australia or gained their medical qualifications in Australia and are not an Australian permanent resident,’ says the Department of Immigration and Citizenship.
Doctors who wish to practice in Australia must first be registered with the Medical Board in the State or Territory where they intend to practice. After the visa is granted, doctors must apply to Medicare Australia for a Medicare Provider Number if they will be working in general practice or will be prescribing drugs.
The Australian government has a special website for overseas doctors – www.doctorconnect.gov.au/

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North America

1

Maternal Deaths Focus Harsh Light on Uganda

The New York Times

29/07/2011
By CELIA W. DUGGER

ARUA, Uganda — Jennifer Anguko was slowly bleeding to death right in the maternity ward of a major public hospital. Only a lone midwife was on duty, the hospital later admitted, and no doctor examined her for 12 hours. An obstetrician who investigated the case said Ms. Anguko, the mother of three young children, had arrived in time to be saved.

Her husband, Valente Inziku, a teacher, frantically changed her blood-soaked bedclothes as her life seeped away. “I’m going to leave you,” she told him as he cradled her. He said she pleaded, “Look after our children.”
Half of the 340,000 deaths of women from pregnancy-related causes each year occur in Africa, almost all in anonymity. But Ms. Anguko was a popular elected official seeking treatment in a 400-bed hospital, and a lawsuit over her death may be the first legal test of an African government’s obligation to provide basic maternal care.
It also raises broader questions about the unintended impact of foreign aid on Africa’s struggling public health systems. As the United States and other donors have given African nations billions of dollars to fight AIDS and other infectious diseases, helping millions of people survive, most of the African governments have reduced their own share of domestic spending devoted to health, shifting to other priorities.
For every dollar of foreign aid given to the governments of developing nations for health, the governments decreased their own health spending by 43 cents to $1.14, the University of Washington’s Institute for Health Metrics and Evaluation found in a 2010 study. According to the institute’s updated estimates, Uganda put 57 cents less of its own money toward health for each foreign aid dollar it collected.
Rogers Enyaku, a finance expert in Uganda’s Health Ministry, disputed the assertion, saying the country’s own health spending had increased, “but not that substantially.” Still, the government set off a bitter domestic debate this spring when it confirmed that it had paid more than half a billion dollars for fighter jets and other military hardware — almost triple the amount of its own money dedicated to the entire public health system in the last fiscal year.
Poor people surged into Uganda’s public health system when the government abolished patient fees a decade ago. Increasingly, African countries are adopting similar policies, and experts say that many more people are getting care as a result. But Uganda’s experience illustrates the limits of that care when a system is poorly managed and lacks the resources to deliver decent services, experts say.
At regional hospitals like the one here in Arua, more than half the positions for doctors are vacant, part of a broader shortage that includes midwives and other health workers. A majority of clinics and hospitals reported regularly running out of essential medicines, while only a third of facilities delivering babies are equipped with basics like scissors, cord clamps and disinfectant, according to a 2010 Health Ministry report.
The hospital where Ms. Anguko died handles obstetric emergencies for a region of almost three million people, but it recently had no sutures in stock to sew up women after Caesarean sections. Dr. Emmanuel Odar, the hospital’s sole obstetrician, said that even in childbirth emergencies, families must buy missing supplies themselves, typically at nearby pharmacies. Patients without money must beg or borrow it, Dr. Odar said.
“We are overwhelmed with cases of people looking for free services, and they expect a lot despite supplies not there, human resources lacking and the beds not enough,” he said.
Dr. Olive Sentumbwe-Mugisa, a Ugandan obstetrician and adviser with the World Health Organization, participated in the Health Ministry’s investigations of the deaths of both Ms. Anguko and Sylvia Nalubowa, a second woman named in the lawsuit against the government, and concluded that both women arrived in time to be saved.
“We are in a state of emergency as far as maternal services are concerned,” Dr. Sentumbwe-Mugisa said. “We need to focus on the quality of care in our hospitals and address it in the shortest period of time. That will mean more resources. We cannot run away from that.”
In its lawsuit filed in March, the Center for Health, Human Rights and Development, a Ugandan nonprofit group, contended that the government violated the two women’s right to life by failing to provide them with basic maternal care. ..continued

Full text: http://www.nytimes.com/2011/07/30/world/africa/30uganda.html?pagewanted=1&_r=1

2

Reversing the Brain Drain: Expanding Medical Opportunities in Rwanda

The New York Times

27/07/2011
By JOSH RUXIN
For decades, young doctors and nurses have been fleeing poor countries for the bright lights and fat paychecks of wealthier nations, abandoning the parts of the world with the highest burden of disease and most desperate need for medical help. Sixty percent of medical doctors who trained in Ghana in the 1980s have since left the country, and there are more Ethiopian doctors in Washington DC than in all of Ethiopia. Sub-Saharan Africa today houses more than a tenth of the world’s population, and shoulders a quarter of the global burden of disease, but it has just three percent of the world’s health care workers.
That said, some young Africans have broken the mold.
Cousins Gerard Urayeneza and Vianney Ruhumuliza were born and raised in a small, isolated town in Southern Rwanda. Both grew up with lofty dreams of practicing medicine. With a little luck and a lot of opportunity, they were able to access medical training in Rwanda. Vianney even finished his schooling abroad in Michigan. Gerard and Vianney did something even more unusual, though: they bucked the international brain-drain trend that is dangerously affecting medicine in the developing world, and committed themselves to building local medical capacity in their native country.
Rwanda, where I live, has just one medical school for a growing population of nearly 11 million. Aspiring students face stiff competition for the limited number of spots available in the school –just 42 students will graduate this year – so many have no choice but to desert the dream of becoming a doctor or nurse altogether. The result is that medical capacity in Rwanda is severely limited, and many rural districts (with about 300,000 people per district) have fewer than a dozen full time medical doctors. Without a robust medical educational system that promises high pay for public health doctors, it’s hard to imagine how Rwanda will overcome its current situation.
Well aware of how grave the challenges are, my ears perked up a few years ago when Dr. John Streit, a retired obstetrician-gynecologist from Saratoga Springs, New York, told me that he was working with Gerard and Vianney to start a new Rwandan medical school. John met Gerard at a conference in Rwanda and was compelled by his story: After Gerard received his medical training, he worked as a skilled nurse practitioner and ultimately transformed a rural, two-room clinic near his hometown into a fully functioning health center – no small feat with his limited resources. Today, it is a three-story regional facility called Gitwe Hospital. It serves 285,000 Rwandans, has 200 beds, and employs nine doctors and 50 nurses.
Next, Gerard started Rwanda’s first private college, which has four majors (including pre-medicine) and a widely respected reputation; another impressive accomplishment for anyone, especially a man from a rural village in Rwanda. There is still one huge problem, though: when students graduate from this college, they face extraordinary challenges if they want to become doctors. The one medical school in the country housed at the National University of Rwanda simply does not have enough capacity to train them all.
Recognizing this challenge, Gerard connected with his cousin Vianney to lay the groundwork for building and staffing a second medical school. A partnership with the Rwandan Government and the NGO Medical Missions for Children (www.mmfc.org) jumpstarted plans to make Kigali Medical University (KMU) a reality. Gerard and Vianney designed an English curriculum and invited John Streit to serve as President.
What’s more, recognizing the promise of the initiative, The Rwandan Development Bank added funds to the KMU Foundation (www.kmuf.org) by granting a one million dollar loan to help construct the complex and provide more space for hospital-teaching purposes. Construction on the first of three academic buildings is nearing completion.
Not all the graduates from KMU will choose to stay in Rwanda, though with guidance from Gerard, Vianney, and John, most probably will. But building educational institutions in this developing country has more benefits than meets the eye. Rwanda doesn’t have much in natural resources. But it does have a great reserve of human capital: Citizens ready, willing and able to serve their country. Rwanda must develop that resource, and there is perhaps no better way to start than through education.
KMU will accept its first class of medical students this year and the school will continue to expand. Though perfect targets for the brain-drain phenomenon, talented Rwandans now have the chance to train, practice and serve at home, healing Rwanda in more ways than one.
Josh Ruxin is the founder and director of Rwanda Works and a Columbia University expert on public health. He is also the director of the Access Project and Access’s Neglected Tropical Disease Control Program. Dr. Ruxin has extensive experience operating at the intersection of public health, business and international development. He lives in Kigali, Rwanda, with his wife and two daughters.
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3

Colleges and Universities Respond to Healthcare Shortage
US News and World Report

29/07/2011

By Catherine Groux
Due to advancing medical technology and a growing elderly population, the healthcare industry is expected to create about 3.2 million new positions in the next seven years, the U.S. Bureau of Labor Statistics (BLS) reports. Additionally, as this field continues to grow, certain jobs within the sector will expand rapidly; half of the fastest-growing occupations are healthcare-related.
For example, positions for registered nurses (RNs) are expected to increase by about 22% through 2018, according to the BLS. While this might give individuals who have a degree in this field more job opportunities after graduation, the growth of the nursing field has been so drastic that it is creating a shortage of professionals. In a 2009 issue of Health Affairs, Dr. Peter Buerhaus estimated that by 2025, the country will need an additional 260,000 registered nurses.
Similarly, the BLS reports that jobs for physicians will see significant growth. In the next seven years, the number of positions for these professionals is predicted to increase by approximately 22%. According to the U.S. Department of Health and Human Services, by 2020 the nation will lack a necessary 100,000 physicians.
In response to the shortage of healthcare professionals, many colleges and universities have stated they feel it is their responsibility to prepare students to hold these roles in the future. As a result, many institutions are increasing their efforts when it comes to their healthcare programs.
Three community colleges in Maryland, partially thanks to government support, recently collected the $4 million they needed to create the Mount Airy College Center for Healthcare Education, the Baltimore Sun reports. This new facility, which is scheduled to open in the fall of 2012, will give students additional access to workforce education programs in the healthcare industry.
Similarly, many institutions are giving their students access to new program offerings in order to bolster the number of healthcare professionals in the future. Officials from New Hampshire's Plymouth State University recently announced that it will launch a bachelor's degree program in nursing beginning this fall, according to the institution's website. The school will also add completion programs for current registered nurses who have an associate's degree, but wish to further their education.

4

Health care industry outlook could avert talent shortages

Michigan Live

04/08/2011

By Mark Sanchez

Educators needed help offering students real-life lessons in a clinical setting.
Care providers were willing to help out and provide the staff and space.
But neither side was quite aware of what the other needed until they got together in a 2008 pilot initiative in Ottawa County that brought health care employers and educators together to identify future work force needs.
“They were seeing things from different perspectives,” said Craig Nobbelin, coordinator of the Regional Skills Alliance at the Alliance for Health. “It was a matter of communication.”
The issue was just one identified via the pilot effort in Ottawa County that has led to a broader initiative to give care providers and educators a model to better anticipate the future.
Following the simple notion that the better data you have, the better decisions you make, the Alliance for Health’s Health Care Employers Council is in the early stages of an effort to craft an annual health care employment outlook for West Michigan.
The outlook would give colleges in the region a better idea of the academic programming required to educate tomorrow’s health care work force, both in terms of which medical professions are growing and the number of workers needed to fill those jobs — and when.
“We want to be able to better determine what the needs are for the health care occupations in the region so educators can better adjust the class schedules and curriculum to meet the needs of the employers,” Nobbelin said.
The Alliance for Health is presently seeking to secure commitments from care providers across West Michigan to regularly provide data and their own internal employment projections to produce an annual regional employment outlook for health care, Nobbelin said.
While colleges already gather data on their own from individual care providers to plan their academic programs, a cooperative approach orchestrated by the Health Care Employers Council could be invaluable, said Julie Parks of Grand Rapids Community College.
“They’re actually gathering data for us in a much more efficient way so we can use it,” said Parks, GRCC’s director of workforce training, who oversees certification programs.
Right now the best gauge for future work force needs comes from federal and state outlooks that offer broad glimpses of what’s ahead.
Having a local outlook, rather than relying on federal or state data, can even lead to educators collaborating more among themselves, Park said.
“It’s going to help us better plan who is going to do what and to really have some hard discussions,” she said. “It really should pull the whole thing together.”
The 2008 pilot conducted in Ottawa County showed a need for multi-skilled students and to increase the math incorporated into GRCC’s pharmacy tech program, Parks said.
The Health Care Employers Council recently put out a preliminary outlook that shows hiring expectations in 11 professions through 2014. The preliminary outlook projects registered nurses and personal and home health aides as the occupations with the highest demand.
The goal now is to build on the preliminary effort and issue a forecast on staffing needs for 21 medical occupations, said consultant Eric Heller of Metrics Reporting in Grand Rapids.
If care providers can collaborate to provide data needed to craft a regional outlook, and educators respond accordingly, they can assure an adequate talent pool in the market, avoid a talent glut for individual professions and avert staffing shortages that can lead to employers competing too aggressively for talent, Heller said.
Preventing a talent shortage is key, Heller said. If not, “there’ll be bidding wars between the hospitals for people, and they’ll be stealing people from each other,” he said.
“We’ll see a rise in health care costs” as a result, Heller said.
Heller, though, insists the goal is not to suppress wages.
“We just don’t want wages to get out of control,” he said.
Hospitals, behavioral health care providers and other facilities in Kent and Ottawa counties have committed to providing data to the project, Heller said.
The Health Care Employers Council decided to develop a market-specific outlook for the seven-county area around Grand Rapids because the region may not always follow state or national trends.
Even within the region, as the Ottawa County pilot found out, future work force needs vary, Nobbelin said.
“Even within organizations that are miles from each other, needs were vastly different,” he said.
The Alliance for Health initiative will seek to standardize data and how it is collected and reported, Nobbelin said. He notes, for instance, that some care providers in the Ottawa County pilot differed in job descriptions for similar occupations.
The Ottawa County pilot stated that health care is the fastest-growing profession in West Michigan, and it projected employment to grow 15 percent to 20 percent through 2016.
As of 2009, health care directly employed 41,954 people in Kent County, generating wages of $2.45 billion, according to the Partnership for Michigan’s Health.
Neighboring Ottawa County had 9,568 people employed in health in 2009 earning a combined $420 million.

5

The Ailing Health of a Growing Nation .

The Wall Street Journal

30/07/2011
By AMOL SHARMA, GEETA ANAND and MEGHA BAHREE
JODHPUR, India—Mohammad Arif visited his wife, Ruksana, in the labor ward of Umaid Hospital here on Feb. 13. She was to have a cesarean-section the next day. It would be her first child.
"You're going to deliver on Valentine's Day," Mr. Arif told his wife.
"Everything will be fine, with God's will," she said.
Instead, the young family fell victim to the dysfunction plaguing India's public-health system, an overstretched and underfunded patchwork on which the vast majority of India's 1.2 billion people rely.
On Valentine's Day, 20-year-old Ms. Ruksana gave birth to a baby girl. But the young mother's bleeding couldn't be stopped. Umaid Hospital was about to descend into crisis: Up and down the maternity ward, new mothers were mysteriously starting to die.
A few days later, Ms. Ruksana's doctor, Ranjana Desai, pulled Mr. Arif aside and told him, "Along with medicines, she also needs your prayers."
India supplies doctors to hospitals the world over. Within India itself, a thriving private health-care industry—serving a growing middle class and the wealthy—is a byproduct of the nation's economic ascendancy. By some important measures, India's health is improving: Over two decades, life expectancy has risen to 64 years in 2008 from 58 in 1991. Infant mortality has declined as well.
Yet maternal and infant health remains an area where India particularly lags behind. Last month in the state of Bihar, 49 children died from an unidentified viral infection over a few weeks in three districts. A month ago at a hospital in the city of Kolkata, 22 babies died in four days.
India's infant-mortality rate—50 deaths per 1,000 births—is worse than Brazil's and China's. India's poorer neighbor, Bangladesh, also does better.
Overall, the nation's vast, government-run health system can be a dangerous place. Hospitals are decades out of date, short-staffed and filthy. Patients frequently sleep two to a bed. The Indian government invests only 1% of gross domestic product in health care, according to the Organization for Economic Cooperation and Development. Only seven countries spend less.
The nation faces a health crisis on two fronts, experts say. Not only has it failed to solve developing-world health problems such as high infant mortality and malaria, but now it also faces a sharp rise in rich-country health problems, such as diabetes. India has 50 million diabetics, the most of any country, as diets and lifestyles have changed amid rising prosperity.
Efforts to improve maternal health are having unintended consequences. In 2005 India started paying women $30 to have their babies in hospitals instead of at home. Partly as a result, last year hospitals performed 17 million deliveries, up from just 750,000 in 2006. Many hospitals simply can't handle the traffic, government and hospital officials say.
Overall, India's central government set a goal in 2005 of doubling national health-care expenditures to 2% of GDP. It has fallen far short of that, officials say, partly because of the need to improve other social programs, such as education.
"We have so many competing social priorities," says Anuradha Gupta, a senior official at the health ministry who works on maternal and child issues.
Umaid Hospital, constructed in 1937 in an Art Deco style, stands in the heart of Jodhpur, a historic fortress-city of 1.4 million in the western state of Rajasthan, one of India's poorest. Funded by the government, Umaid provides care to the poor and specializes in women and children.
The hospital performs 20,000 deliveries a year—about one every 30 minutes—a more-than-tripling since 2003, says Superintendent Narendra Chhangani. Most births occur in a labor room barely changed in some three-quarters of a century. The hospital's 400 obstetrics beds are served by 15 gynecologists, Dr. Chhangani says, half the number needed.
Recruiting new doctors is tough, Dr. Chhangani says, because the pay is low and conditions are poor. Patients' families sleep on floors and in a courtyard next to the labor wards. The smell of urine hangs in the corridors. Wobbly ceiling fans stir the air.
In February, a government survey of the hospital found that needles weren't always disinfected and noted an incident of a rat bite in the nursery. Dr. Chhangani says the report exaggerated the hospital's hygiene problems and didn't reflect the practical realities of an urban Indian hospital.
Those realities can create an environment ripe for the kind of disaster that struck in February, just as Mr. Arif arrived with his pregnant wife, Ms. Ruksana. She checked in to Umaid on Feb. 4.
Ms. Ruksana, 5-foot-2-inches, was herself born in the countryside outside Jodhpur. She completed the fifth grade before her father pulled her out of school to help with chores.
When she was 15, she had an arranged marriage with Mr. Arif but didn't move in with him for another two years because she was so young. The day Ms. Ruksana found out she was pregnant last year, she and Mr. Arif went to celebrate at a fair with folk singers and food stalls, enjoying a fast-food dish of buttered bread and thick vegetable curry.
It was probably a bit of a splurge. Their household of seven, including an extended family of relatives, earns a total of less than $100 a month dyeing and ironing scarves and bedsheets from a nearby factory.
At Umaid Hospital, doctors decided Ms. Ruksana, partly because of her size, should have a C-section. She delivered her baby girl on the afternoon of Feb. 14. Her name: Mehek, which means "fragrance."…Continued Full Text: http://online.wsj.com/article/SB10001424053111903591104576466251010968520.html?mod=djemHL_t