By Caroline Swinburne
BBC African Perspective, Zambia
Staff shortages mean that Tangu Mwanamoonga often works alone
Staff shortages within Zambia's health sector have reached crisis point as many nurses are driven to seek work abroad.
It is mid-morning in the male medical ward at the University Teaching Hospital (UTH) in the Zambian capital Lusaka.
As usual the ward is full, with 36 patients suffering conditions ranging from malaria and meningitis to HIV infection.
Ideally there should be six nurses on duty, but chronic staff shortages mean that as usual, sister-in-charge Tangu Mwanamoonga is alone, dispensing drugs, changing dressings and doing her best against the odds to monitor her seriously ill charges.
"You have to do everything for everybody," she says wearily.
"And if you don't do it - because you simply can't - you end up feeling guilty that you haven't been able to help."
Key election issue
Health will be a key issue when Zambia goes to the polls on 28 September.
Staff shortages have reached crisis point, with more and more nurses like Ms Mwanamoonga deciding to seek employment abroad.
In a country with about 9,000 nurses, the Zambian Nursing Council says 3,444 filled out the paperwork needed to work abroad between 1993 and 2005.
Many go to the UK.
The British National Health Service (NHS) has an ethical recruitment code which bans it from employing staff from many developing countries, including Zambia.
And so, at least to begin with, many Zambian nurses find work in the private sector, often at nursing homes for the elderly.
Maud Phiri came to the UK last October, after seven years as a staff nurse at Zambia University Teaching Hospital.
Back home she was sister-in-charge of the hospital's Burn's Ward, often caring single-handedly for as many as 50 surgical patients.
Now, her job is far less demanding, involving tasks such as washing old people, giving them their medication and generally helping to amuse them.
She is well aware she is not using her skills but does not feel guilty for her decision.
"To be effective as a nurse you need to be emotionally and physically well," she says.
"If you are always worrying about what you're going to eat, what you're going to feed your family, then you really can't do a proper job."
Zambia's outgoing Health Minister Dr Brian Chituwo [Dr Chituwo was recently moved to cover education affairs] says his government has made progress in improving conditions for medical staff.
There are not enough medical staff to care for Zambia's patients
To prove his point, he cites pay rises for nurses and a highly successful government-run programme aimed at encouraging doctors to work in rural areas.
If current President Levy Mwanawasa's party is re-elected, Dr Chituwo would like to see agreements with foreign governments, such as the UK, to allow a limited quota of nurses from countries like Zambia to work in their country, only for a limited period of time.
He would also like to make staff sign commitments to stay for at least three years, after being trained at tax payer's expense.
But Dr Chituwo is well aware that the basic problem is economic, asking: "You might say why not just pay the nurses more?'"
"Certainly, I can strongly lobby for the Ministry of Health, but there is only a limited amount of cash in the pot, and my colleagues may make a stronger case for agriculture or education.
"Our salvation can only lie in the economic growth of Zambia."
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