WWhen Bright Ansah, a nurse from Accra, goes looking for colleagues who haven't turned up for their shifts at the busy hospital where he works, he knows where to look. “When you see 'In God We Trust' on their WhatsApp status, you know they're already in the US,” he says.
The US motto has been adopted by Ghanaian medical workers who are leaving the West African country in droves. Many believe their faith was finally rewarded when, after years of planning, they reached the promised land of well-equipped and resourced US hospitals.
As the Covid pandemic has wreaked havoc on global health systems, numbers of nurses, midwives and doctors have left the country. Ghana has grown exponentially. It is estimated that at least 6,000 nurses will leave the country in 2024 due to factors such as low wages, non-payment of wages and deteriorating infrastructure. While the US is hugely popular, nurses are also migrating to other countries including the UK, Ireland, Canada, Australia and the UAE.
Meanwhile, in May and October, Ghana's Ministry of Foreign Affairs signed agreements with Jamaica And Grenada send hundreds of nurses to the Caribbean islands, expanding 2019 agreement with Barbados. In July, the Minister of Health announced that more than 13 countries have expressed interest in creating similar recruitment mechanisms.
The government justifies these schemes on the grounds that Ghana has surplus of nurseswith tens of thousands of unemployed.
But Ghana is also one of the 55 countries on WHO Support and Advocacy Listwhich identifies countries facing the most pressing workforce challenges related to universal health coverage. And those working on the front lines of health care feel they are on the brink of a crisis.
“It’s a ticking time bomb,” Ansah says. “Ghana has a population of 35 million and the nurse to patient ratio is so high that the nurses are overworked and burnt out. Yet the government wants to export its most experienced nurses to a place like Grenadawhose population is 125,000 people.
“I agree that most of our nurses want to leave,” he says, “but we don’t need to deliberately force them out.”
The nursing profession has long been considered a desirable career in Ghana as it provides job security in a country where stable employment is scarce. It is also becoming increasingly attractive for other reasons. It is an established migration route and has seen a rise in new entrants as people seek to move, although the schemes are only open to experienced health professionals.
Three nurses who chose different paths explain why they decided to stay, leave, or wait and see what happens.
Remains: Bright Ansah, 36, nursing officer
“Personally, I'm very happy to stay because I still feel like I can do a lot for my country,” says Ansah, who receives daily messages from former colleagues now abroad showing off their modern equipment and comfortable lifestyle.
Although he understands the disappointment that led them to leave their jobs, family and country, he remains stoic about his decision to stay. “I believe I can help save lives. If we all leave, who will take care of our mothers and fathers when they need medical attention?” he asks.
Although he calls the average monthly salary of 3,000 Ghana cedis (£197) “demoralizing” and admits that some nurses resort to selling medicine to patients as a means of survival, he has managed to achieve success by taking an entrepreneurial approach to his career.
With a PhD in public health, he combines university teaching with nursing, hoping to equip the next generation with the skills and mindset needed to stay there. He also founded a medical consulting firm.
“We need a multi-sectoral approach. We should be interested not only in scoring political points, but also in solving problems. Why are they leaving? What can we do to retain as many of them as possible? Even those who emigrate are interested in returning to contribute to nation-building. These are things we need to look at.
“I had a couple of colleagues who vowed to stay in the country no matter what, but when the pressure became more than they could bear, they all left. We must do better.”
Care: Nana Yaa Mills39 years old, intensive care unit nursing officer
Nana Yaa Mills, a mother of three, happily takes her family and leaves Ghana forever, but her mother and sister are afraid to say goodbye. “They're so sad,” Mills says. “They say, 'But you're here every time we call. Now you're going, who are we going to call?' I tell them, “You can still call me. I'm leaving, but life goes on.”
For Mills, that life is now happening in the United States. Although she has spent the last 12 years caring for patients in various hospitals in Accra, she is fed up with the stress and chaos, and she is not alone. Of the 15 nurses she started working with at the hospital in 2017, only three remain in Ghana. “Most went to the United States,” she says. “Three are in the UK and one is in Ireland.”
This step has been a long time coming. In 2022, Mills traveled to South Africa to take part in NCLEX, a standardized exam required to work as a nurse in the USA and Canada.
The job offer came earlier this year, but Mills believes she can still make a difference.
“The authorities only respect you after you leave,” she says of her hospital managers. “We diaspora nurses have big plans to use our influence to improve the situation. We are organizing; we want to make a change.”
Mills is part of a group of more than 1,000 nurses that started as a WhatsApp learning platform but has since grown into a support forum for those looking to migrate. Many feel forced to leave and experience genuine bitterness and anger towards the system and patients.
“The people we stand for don't do it for us. When we go on strike, they insult us. So now it's everyone on their own.”
Although hostility toward immigrants in the United States is high, Mills is not concerned. “I'm just happy. Even here we face it. Relatives of patients just come and insult you, so it's normal. Racism is everywhere. We just have to develop a tough skin.”
Bidding in the wings: Afua Tetteh, 23, rotation nurse
“Sometimes they don’t understand how they put you through school expecting that when you graduate, some of the burden will be lifted from you, but you still depend on them for food, transportation and rent,” Afua Tetteh says of her parents. “And you work. So it just doesn't make sense to them.”
Tetteh is among a group of nurses who took to the streets in October to protest months of unpaid wages, although she herself was not involved despite her own grievances.
She had to wait nine months after graduating before she was admitted to hospital. Five months later, she had just been paid, but not in full, despite going to work every day, commuting 13 miles each way on public transportation, and returning home late after her shift.
Tetteh's aunt, who is also a nurse, was instrumental in helping her adapt and stay the course. One of the biggest problems caused by the exodus of experienced nurses is that new nurses like Tetteh have no one to turn to for advice and support. They have to learn processes and procedures on the job that are typically performed by senior employees.
“There are about 30 patients in the ward and only two nurses, plus two of us support staff and maybe one or two students. It's extremely stressful.
“I'm lucky to have an aunt, so if I have any problems, I just pick up the phone and call her. When you see the nurses, you realize how tired they are from all the work. I really don't want that to be my part of the job in this country.”
Tetteh's age and inexperience prevent her from leaving Ghana in the short term, so she is pragmatic about her immediate future. When asked if she had considered changing careers, she said that although the thought had crossed her mind and some of her peers had given up nursing for a less stressful job, she hoped to stick with the idea.
“Life is going the way God wants it to go,” she says, “but hopefully in five years I'll be able to leave the country or maybe start a side business so I can get my life together and know where I'm going. Right now, things look very unclear for someone starting out.”
*All names have been changed to protect identity.
