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'Where Are My Nurses?'

When anthropology major Sarah Kutten '09 got married in Salem, she hoped her half-sister in Ghana could attend. Then her sister said she might not be able to obtain a visa to make the trip because she is a nursing student. Ghana has such a problem with nurses and doctors leaving to work in other countries that the government carefully watches these students' foreign travel.

"I was outraged," says Kutten, whose father and husband are also native Ghanaians. "Just because my sister has decided on a career that's in high demand in Ghana, she shouldn't be prevented from leaving. If students know when they go into nursing school that they can't leave the country, then no one will want to go to nursing school, and the problem will become worse."

Kutten ran head-on a critical issue that plagues many of the world's poorest countries, particularly in sub-Saharan Africa: brain drain. The exodus of highly skilled health care professionals leaves poorer nations with an inability to provide medical care to their own citizens. In 2000 about 500 of Ghana's nurses left the country - double the number of graduates that year from all the nation's nursing schools combined.

Anthropology Associate Professor Joyce Millen, a nationally known global health expert who researches brain drain, encouraged Kutten to explore Ghana's nursing shortage. Kutten won a Carson Summer Undergraduate Research Grant from Willamette which allowed her to travel to Ghana to interview nursing students and doctors.

"What is really cool about the Carson Grant is that it allows students to do paid research before grad school," she says. "Through this experience I realized how much I love research, and that research has the potential to really make change."

She examined Ghana's nurse bonding program - the government pays for students to attend nursing school, and the students must sign a bond promising to pay back the loan by working in a Ghanaian hospital for five years. The idea is that after five years, the nurses will want to stay in their country.

But when Kutten met with health professionals, she discovered the program wasn't always successful. "If bonding is working, where are my nurses?" asked a surgeon, one of just three doctors in a hospital that saw at least 200 people a day and relied on a limited number of nurses.

Kutten questioned nursing students about why they chose the profession, and many said they wanted to save the lives of their fellow citizens; however, about half also said they hoped to work abroad.

"When I visited the hospital, I saw about 500 people with serious health issues sitting in the reception area, and I learned that some of the individuals would die before they could receive treatment. The doctors and nurses were completely overworked. It's understandable that they might want to go somewhere else. Even with all the humanitarian heart in the world, you can only take that for so long."

Kutten also learned that the U.S. and other powerful countries actively recruit doctors and nurses from sub-Saharan Africa. The U.S. trains only 75 percent of the health professionals it requires, then looks to other countries to fill the remaining positions. For example, until recently more Ethiopian doctors worked in the city of Chicago than in the entire country of Ethiopia.

"Why is it OK to take nurses from Ghana and allow people to die there?" Kutten asks. "We are turning a blind eye to this issue. Something has to be done."

As an anthropologist-in-training, Kutten does her part by contributing ethnographic research, and she'll be presenting her work soon at the National Conference on Undergraduate Research in La Crosse, Wis. "Ethnographic research allows people to have a voice, whereas statistics make blanket statements. International organizations want to hear statistics, but the personal voices are important to provide a soul behind the numbers."