MOTHERS-TO-BE in Malawi face a healthcare system rapidly heading back towards the same standard as in medieval Scotland, and much of the blame is being placed on the NHS for recruiting midwives and nurses to fill British skill shortages.
That message, from the southern African country's leading obstetricians yesterday, emphasised the bleak picture of healthcare laid bare for Jack McConnell as he faced criticism that essential staff are being attracted to jobs which pay as much as 60 times more than in their homeland.
One clinician, wishing to remain anonymous, said the staffing crisis ref lects the old colonial approach - except that instead of mining for gold and diamonds, Europeans are now going to Africa to "mine for nurses".
Although the first minister has made the attraction of "fresh talent" to Scotland one of his key policies, he promised there will be no further active recruitment from Africa into the NHS, but added that he cannot stop Africans applying for jobs.
"We don't, we shouldn't and we won't directly recruit from Africa, " he told the country's deputy health minister and a gathering of students in the capital, Lilongwe. "If people want to come and work in Scotland, we can't stop them, but we won't recruit."
Yesterday was the second of five days Mr McConnell is spending in the former colony, in which he is setting out a new partnership aimed at mobilising Scots to embark on a concerted movement to tackle poverty here.
The day's focus on health took him to Bottom Hospital, the country's leading public maternity clinic, where more than 11,000 babies are born each year, roughly 2000 of them with serious complications.
It had been spruced up, partly for his visit, and partly because a team of Scottish midwives and an obstetrician arrived 10 days ago to train staff, and have scrubbed and painted the labour ward. Their efforts were rewarded yesterday with pounds-360,000 of Scottish Executive support over three years, to continue the training programme and to train local midwife instructors. The group said, only a week ago, that they found dead babies awaiting burial, stacked on shelves intended for storing drugs.
Many women have to wait to be treated while lying on filthy, concrete floors. There are few sheets and hardly any equipment. The hospital has no blood-pressure monitor, and caesarean sections have to be carried out without gloves or swabs.
Dr Graeme Walker, an Edinburgh obstetrician on the midwife training course, said the conditions when he arrived last week were "appalling beyond belief.
"There was blood caked on the beds that had been there for months, and rusty razor blades they use to cut the umbilical cords also caked on to the floor. There was blood on the walls. Sinks were blocked. It was absolutely appalling."
He added: "I've been at Simpson's (the Edinburgh maternity pavilion) for eight years and never seen a maternal death. Here, a woman dies every six days."
Staffing is woefully inadequate. Bottom Hospital, named to distinguish it from the Central Hospital at the top of one of Lilongwe's hills, should have 20 midwives, but it has only seven.
Dr Grace Mary Chiudza, the senior local obstetrician, says it has lost them to attractive foreign salaries, mainly in Britain, even though they would prefer to remain in Malawi.
As the biggest individual donor to Malawi, the UK government has recognised the problem, and is funding it to double clinical salaries over three years. But that will still leave some midwives on well under pounds-100 per month.
Tarek Meguid, an EgyptianGerman doctor, has worked at Bottom Hospital for a year, during which there have been 68 maternal deaths.
"This is outrageous, and it's a human rights issue. This is like medieval times. The maternal mortality rate is like Edinburgh in 1500."
He said it took a political decision to set about reducing maternal mortality in Europe and America, and it will take the same in Africa: "Money goes to the people who cry loudest, but these people have three common characteristics: they are poor, voiceless and female."
Part of that political response came from Mr McConnell, who said his anger at African poverty had been increased by what he saw: "What we've seen here, in terms of human resources and training, is the scale of the problem. And we in Scotland can make a contribution, with skills, experience and generosity that I'm sure can touch some of the challenges."
In the face of such compelling evidence that migration of its qualified people is damaging African economies and public services, he defended his Fresh Talent initiative, as seeking to attract only those who have already decided they want to emigrate.
He wants a two-way traffic, with Scots working in Africa and helping, as the midwifery team is doing.
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