New Zealand’s intense drive to hire more doctors and nurses has contributed to shortages of medical staff in neighbouring Pacific islands.
While the brain drain of medical staff from the islands has been a longstanding issue, it has accelerated dramatically since the Covid-19 pandemic.
“The trend jumped up rapidly last year,” said Dr William May, Dean of the College of Medicine Nursing and Health Science at Fiji National University.
Since 2018, 300 doctors have left the country - half of them in 2022. Similar increases have been reported in the Cook Islands and Kiribati.
At a high-level summit in Berlin last month, Dr May told attendees that many doctors, nurses and allied health workers left as soon as borders reopened, some of them disillusioned by the lack of recognition for their work during the Covid-19 pandemic.
He told the Herald that medical workers were drawn to New Zealand by the large Pasifika population, career opportunities and higher incomes.
The exodus had left large gaps in the local health system, especially in acute areas. One Fijian hospital was operating at 50 per cent capacity because of workforce shortages.
The problem was not limited to Fiji. World Health Organisation director-general Tedros Adhanom Ghebreyesus warned earlier this year that after the Covid peak, poorer countries were increasingly losing healthcare workers to wealthier countries which were attempting to fill workforce gaps.
Dr May said New Zealand had been helpful in training doctors in Fiji and growing its workforce. But it had an ethical obligation to do more to “give back” to smaller countries which were supplying it with medical graduates, he said.
This might include sending academics to assist with training programmes, reviewing existing programmes, and the Ministry of Health engaging more on capacity-building, especially in specialised areas of health.
Sir Collin Tukuitonga, Associate Dean Pacific in the University of Auckland’s Faculty of Medical and Health Sciences, said that New Zealand did not actively poach doctors from the Pacific, but once graduates or doctors had made a decision to leave, they might be given generous offers.
While income was only one factor in leaving the islands, most migrants could double their income by moving to New Zealand.
“It is one of those ethical dilemmas,” Tukuitonga said. “They wish to do better for themselves and their families, sending money home, but at the same time when they leave, it leaves a big hole in a small workforce.
“They’ve tried different things over the years, bonding for example, but nothing has really worked. As long as there are differences in workplace opportunities, I guess it will continue.”
One approach which had shown promise was encouraging migrants to return home to the Pacific after upskilling - either on a temporary or a permanent basis. This strategy had helped Tonga lift its doctor numbers in recent years, Tukuitonga said.
Dr Kiki Maoate, a paediatric surgeon and urologist at Christchurch Hospital, makes regular visits to his birthplace, the Cook Islands, and other Pacific nations to train, advise and work.
He was more optimistic about the departure of doctors to other countries. Many of those who left returned to leadership roles in their home countries, which helped encourage further growth in the sector, he said.
“If a person is offered a job at a smart institution in the UK or the US, we need to be careful about what we say. Because they may go from the Pacific to become the top cardiac surgeon in the US. And you don’t want to stop potential from developing.
“So we’re going to encourage people to train … and let them go. If you do that, they’re more likely to return.”
In the past year, 811 people have gained visas to work for Te Whatu Ora - Health NZ in New Zealand, though it is not known how many came from Polynesian countries.
Te Whatu Ora does not target the Pacific Islands for recruitment because of concerns about undermining those countries’ health systems.
“However, this does not stop doctors or nurses from the Pacific coming to work here where they have a right to work – for example, because they are a citizen of the Cook Islands, Niue or Tokelau or have an applicable visa,” said chief people officer Andrew Slater.
Slater said New Zealand collaborated with several Pacific countries to grow their workforce, including Fiji, Kiribati, Samoa, Tonga, Tuvalu and Vanuatu.
Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics, and social issues.