Natalia Ruiz Díaz

ASUNCIÓN, Mar 10 2009 (IPS) – Graciela Samaniego has her bags packed. Along with a number of fellow nurses, she is ready to leave her job at a public hospital in the Paraguayan capital and fly to a city in northern Italy, where she will work in a nursing home.
I m going because I want to build a house. With what I earn here, despite all the years I ve been working, it s simply impossible, she tells IPS.

The group of nurses recruited to work in Italy mention different reasons for going, from the dream of having a home of their own to ensuring financial stability for their children.

The preparations for their departure have been kept under close wraps since an attractive job offer began to make its way through the ranks of nurses in this landlocked South American country in 2005.

Representatives of Italian companies, like Obiettivo Lavoro, the European country s largest human resources management group, came to Paraguay seeking to hire health workers.

The first contingent of nurses consisted of more than 100 people, nearly all of them women.
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Around 95 percent of the health workers who have left since 2006 were nurses with a certain level of seniority in their workplaces, and with degrees from respected local universities like the National University of Asunción, where education is tuition-free.

This is an eminently female profession in our country, which faces gender discrimination on a daily basis, María Concepción Chávez, president of the Paraguayan Nursing Association, told IPS.

Now new groups of workers are getting ready to head halfway across the world in search of better working conditions. But this time around, the hires include recent graduates from nursing school.

One of the reasons for emigrating is the lack of recognition of our profession in this country, where wages and benefits are far below the level of the work required of us, said Chávez.

A professional nurse with 20 years experience and a master s degree in nursing earns around 2.9 million guaraníes (equivalent to 450 euros or 570 dollars) a month.

In Italy, by contrast, the nurses will be earning between 1,800 and 2,000 euros (2,300 to 2,600 dollars) a month.

In Paraguay s public health institutions, health care professionals get a raise for each academic degree they hold but that does not apply to nurses.

In addition, the salaries paid to nurses working on contract in the public health sector are up to 50 percent lower than those earned by staff nurses, who also enjoy pension benefits that contract nurses do not have. Furthermore, the latter face the risk that their contracts will not be renewed.

These are some of the factors prompting nurses to find work abroad.

After a large group of nurses emigrated in 2006, a significant wage hike for the sector was approved. There was a long-needed raise, which had been put off for around two decades, but it was not sufficient, Blanca Mancuello, director of the Nursing Directorate in the Public Health Ministry, told IPS.

Mancuello said the Health Ministry is adopting measures aimed at curbing the exodus, which is having a direct effect on the quality of care provided. Institutions like the Clínicas and Nacional hospital and the Instituto de Previsión Social (social security institute) have been hit the hardest by the brain drain of nurses.

Within these institutions, critical services like the intensive care units (ICU) have suffered the most, due to the loss of experienced, specialised nurses.

One illustration of that is the Luque state hospital, located in an outlying suburb of Asunción, which has been unable to open an ICU because of a lack of qualified staff a situation similar to that faced in other hospitals around the country.

When we tried to expand the pediatric wing and ICU in Clínicas (the teaching hospital of the National University s School of Medicine), we couldn t find pediatric nurses, because there were no experienced ones in the country anymore, and we had to hire new graduates, said Chávez.

The large numbers of qualified nurses, midwives and female doctors heading to richer lands from the developing South are one of the biggest challenges posed today by international migration flows.

According to studies by the United Nations population fund (UNFPA), the growing numbers of skilled workers from poor countries turning to emigration as a means of improving the living standards of themselves and their families has given rise to an unprecedented crisis in health services in the developing world.

The World Health Organisation (WHO) recommends a minimum of 10 nurses for every 10,000 people. But many poor countries come nowhere near that ratio.

Paraguay has an average of just under two nurses per 10,000 people, while in neighbouring countries where there is also talk of a shortage of health professionals, the ratio is around 20 per 10,000.

For Samaniego, the decision to leave was not easy. She has two young children who will be left in the care of their father and grandmother. But this is an opportunity that I don t want to lose, and I see that many of my colleagues and friends are doing well, she says.

The four-year contract of the large contingent of nurses who left in 2006 expires in 2010.

Now they re getting ready to apply for permanent jobs, which would ensure them pensions and other benefits, said Chávez.

The Paraguayan Nursing Association has closely followed the labour situation of the more than 300 nurses who are working in Italy, mainly in the northern part of the country.

In March 2008, Chávez met with Paraguayan nurses in a hospital in the Italian city of Parma to exchange ideas, observe the working conditions there and explain the labour advances made in Paraguay, where a Law on Nursing was passed in May 2007.

The meeting was very positive. It helped us get a clearer idea of the situation there, she said.

The president of the Association said that in a majority of cases involving married nurses, their marriages broke up after they left. And although many have managed to bring their children over with them, many boys and girls are still separated from their mothers.

They are my biggest concern, my kids, but it s also for them that I decided to leave, says Samaniego. For her, there is no turning back: her suitcases are packed, her documents are in order, and she has a plane to catch.