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Shortage of Doctors and Nurses Affects AIDS Treatment in Africa

he United States.

Mpumelelo Mantangana, a nurse at the clinic, says her workload has soared as other nursing staff have left for better-paid jobs in the private sector or abroad. She understands why the work is exhausting and the pay is peanuts.

"I work purely because of passion for what we are doing. People come in and they are very sick and we see them get better. That is the only thing which gives us strength," she said in an interview at the clinic, where long lines of people waited patiently on wooden benches.

In tiny Lesotho, which is also ravaged by AIDS, there are just five doctors and 63 nurses per 100,000 people. In Malawi, there are two doctors and 56 nurses, and in Mozambique three doctors and 20 nurses.

The Doctors Without Borders report, which focused on the four southern African countries, made grim reading. It said that in the Thyolo district of Malawi, a single medical assistant sees up to 200 patients per day. In Mavalane district in Mozambique, many patients died during the two-month wait to start treatment, while in one of Lesotho's main hospitals, more than half the nursing jobs were vacant.

The report said that countries would only be able to cope with the crisis by "task-shifting" allowing nurses to do work normally assigned to doctors, medical assistants to do the work of nurses and using more community workers.

Malawi is already doing this, and a new AIDS plan recently adopted in South Africa also shifts treatment away from hospitals to community-based care. Lesotho also has nurse-based treatment but there simply aren't enough nurses.

The report also pointed the finger at donor countries, which pay for antiretroviral drugs and new clinics but don't provide for health workers' salaries to operate them.

It said the U.S. Millennium Challenge Account has committed an $140 million to improve physical infrastructure at health facilities. But no plans have be
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