Nurse Carolyne Mujibi went to work in Kenya's largest hospital after her father died there — from nursing neglect, she believes. Too much work, too little pay and an assault by a frustrated patient chipped away at her desire to try to make a difference in Kenya.
She is preparing to leave to go work in the United States, hoping for greater job satisfaction and more material rewards, and joining a brain drain from the developing world to the West that experts worry is only making it harder for Africa to pull itself out of poverty.
Mujibi has spent the past four months studying in preparation for a U.S. nursing certification exam. She hopes to take advantage of proposed U.S. immigration laws that would allow more visas for nurses — part of America's latest strategy to deal with a growing shortage of primary health care providers in its hospitals, nursing homes and other health facilities. European nations experiencing similar shortages also are a destination for skilled Africans.
Mujibi is among thousands of overworked, unemployed and underemployed nurses and other health professionals leaving East Africa's largest economy.
"Poverty is one thing that is pushing us out .... I felt if I go out there I could be able to pay for my siblings" to get the best education and realize their ambitions, said Mujibi, who lives in single-room home that has space for only a bed, table, chair, suitcases and a pile of utensils.
"I just want to change life for my family," she said.
'The best and brightest leave'
"One of the main criticisms about migration ... is sometimes the best and the brightest leave," said Dilip Ratha, a World Bank senior economist and expert on the brain drain phenomenon.
"That has implications on the delivery of critical services, especially in the health sector, it has implication also for the intellectual capital that the country needs for its own development," he said. "If the best and brightest leaves, the country's brain is leaving in some ways ... and they can't take advantage of their own potential."
Still, the migrants are exercising their right to seek better returns for their labor, Ratha said.
Mujibi, 28, was inspired after watching a colleague go to work as a nurse in Colorado and save enough money to start building a house for her mother five months after leaving Kenya. That woman had nothing to show for the two years she previously worked in the country, Mujibi said.
Another nursing colleague, who left in 2004, has already built a two-story home for his parents, replacing a mud hut that had neither running water nor electricity, she said, her eyes wide with admiration.
No money to hire nurses
Kenya had 30,000 employed nurses at the beginning of this year, including 16,000 who were on the payroll of the biggest employer, the government. Another 7,000 registered nurses were unemployed, said Frederick Omiah, secretary of the National Nurses Association of Kenya.
"People believe that nursing is a profession for which you can never be out of work because there is always a demand for health care" in Africa, Mujibi said. "But people are not willing to employ because there is no money."
The government needs to double the number of nurses in its hospitals to meet demand in a nation of 34 million beset by HIV/AIDS, malaria, tuberculosis, respiratory and intestinal ailments as well as other diseases, Omiah said.
The health ministry this week announced it will interview to fill 1,630 health care jobs including registered nurses, community health workers and pharmaceutical technologists this year.
Kenya needs more nurses, but the government is unable to hire the required number because "we don't have the money," said the country's Director of Medical Services James Nyikal.
Appeal of the U.S.
For nurses, the United States is a major draw. Its quality of life as well as an aging nurse work force, low enrollment in nursing schools and increasing demand for nurses by the aging baby boomers have made America increasingly attractive to African nurses.
In 1980, 26 percent of America's registered nurses were under the age of 30, but the average nurse is now 46.8 years. About half of them are expected to reach retirement age within the next 10 to 15 years, and the average age of new graduates is almost 30 years, according to the U.S. National Council of State Boards of Nursing.
In December 2005, the U.S. Bureau of Labor Statistics projected that registered nursing would create the second largest number of new jobs among all occupations within nine years. Nurses' employment is expected to grow much faster than average for all trades through 2014 — generating about 703,000 new jobs by that date.
U.S. nursing schools, which are losing faculty, struggle to fill the gap. That crisis, Mujibi says, represents lucrative opportunities that are too tempting to pass up.
"I love Kenya and if I'd get a good job, I'd never go anywhere else," she said. "Going out there is a big risk. It is a new culture, you have to adapt, but you find the benefits are so big that it is worth it."