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AIDS: Africa's doctors

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Here in my country, ten people die of AIDS every hour. About one million people are infected with HIV out of a population of some 12 million. Our government is working hard to try to slow down this epidemic: We have an extensive voluntary counseling and testing program and hope to treat as many as 80,000 people with antiretroviral drugs by the end of the year.

Unfortunately, there is only so much we can do. One of our biggest obstacles, which many nations on our continent share, is a shortage of health care workers. Simply put, Africa cannot fight poverty and disease without more doctors and nurses.

AIDS has killed many of Malawi''s health care workers, along with teachers, attorneys and other educated people. The life expectancy in Malawi is now only 36 years. Our health system can only afford to pay public sector doctors $400 per month, which means in the midst of this pandemic we are losing hundreds of health care professionals every year to higher paying jobs in Britain, the United States and other Western countries. In one year, we lost our entire annual output of nurses to Britain. The result is that we have only about 10 percent of the physicians we need and only about a third of the nurses.

We are not alone. Across Africa, a slender 1.3 percent of the world''s health care workers struggle to care for people suffering 25 percent of the world''s disease. Meanwhile, Western countries recruit them every year by the thousands. In one year alone, Britain recruited 3,000 nurses from African countries. Indeed, some African countries'' health delivery systems are in danger of collapsing because of this human resource crisis. It is like the biblical saying, "To those that have more, more is being given. For those with less, even that is being taken away."

While Malawi may never pay as much as Britain, many of our doctors and nurses would like to stay at home and join the fight against AIDS and other diseases if only they could earn a living wage. But this would take money - funds that are not available.

Last week, the U.S.-based group Physicians for Human Rights released an estimate, the first of its kind, revealing how much it would cost to ease Africa''s health care worker shortage. Money is needed to increase salaries, improve training for workers and to help build health systems that are crumbling.

The costs are not small, but neither is the problem: Physicians for Human Rights estimates some $2 billion in 2006, rising to $7.7 billion per year, would be needed to double the number of health workers in Africa by 2010. Prime Minister Tony Blair''s Commission for Africa report, released in March, calls for triple the current number of health care workers.

Aside from the health care worker crisis, reaching our target for administering antiretroviral drugs faces another challenge: Money that''s been provided by donors for drug treatment is not easily accessible. When the funds have been available, it''s not easy to procure the drugs from the generic manufacturers in India. There is a line to obtain the World Health Organization prequalified medications; after we place an order we must wait for as long as four months. The number of people coming forth for antiretroviral drug treatment has been overwhelming but because of the bottleneck in our access we have had to ask patients to return home.

Some have doubts about whether we can reach our goals. But Stephen Lewis, UN special envoy to Africa for AIDS, calls us "a nation obsessed."

It''s true, we won''t give up: The very future of Malawi depends on whether we win this fight. We believe that if we had the resources, we would already have surpassed our goal.

This week, the Group of Eight industrialized nations is meeting in Scotland to consider measures to alleviate poverty in Africa. In response, more than 600 African doctors, nurses, development groups and associations of people living with AIDS, along with groups from G-8 countries, such as the British Medical Association, have signed a statement calling on the G-8 to commit money to help improve the health worker crisis in Africa. The G-8 meeting is an unprecedented opportunity to make a change in what some call the Rosetta Stone of the AIDS epidemic: to enable thousands and thousands of health workers stay in Africa, where they are desperately needed. Let''s hope that the G-8 hears Africa.

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