Mechell, a Filipina nurse, strides into an upmarket restaurant in Sheikh Zayed City, Greater Cairo. She casually makes a request of a waiter in Egyptian Arabic, and then transitions immediately into speaking impeccable English. She appears totally at ease in her foreign surroundings.
Mechell has travelled a great distance to work as a nurse on the outskirts of the Egyptian capital. Around 9,000 kilometres lie between her native Philippines and her current employer, a leading private hospital on the outskirts of Cairo.
At present, Egyptian private hospitals employ a significant number of foreign nurses, from locations as far-flung as India, Bulgaria and Algeria. Three quarters of Mechell’s nursing unit are from the Philippines.
Egypt currently faces a chronic nursing shortage. A 2015 World Health Organisation report found there are 14.8 nurses and midwives to every 10,000 Egyptians. This ratio amounts to barely half of the global benchmark figure of 28.6 nurses. By comparison, Egypt does not suffer from a human resources shortfall as severe as this with doctors, pharmacists or dentists. In this climate, Egypt’s private medical sector has turned its gaze overseas to fill nursing job vacancies, even though these foreign nationals usually command much higher salaries than their Egyptian counterparts.
At first glance, this trend of hiring non-Egyptian nurses appears puzzling. Egypt’s overall unemployment is currently around 13 percent, with youth unemployment exceeding 30 percent. Tertiary educational institutions throughout the country offer nursing training courses. Labor laws protect Egyptian citizens against competition for jobs from foreign nationals and, in theory, companies may only employ non-Egyptian workers if no appropriately qualified local citizen has applied for the same position. For these reasons, Egyptian nurses have little difficulty obtaining employment after graduation. Mohamed Fakih, chief nursing officer at Cairo’s Al-Salam International Hospital, issues a “challenge … to find any nurse in Egypt who is not working.”
Given high unemployment rates and job availability in the field, why do Egyptians shy away from careers in nursing? Ayman Sabae, right to health researcher for the Egyptian Initiative for Personal Rights and a trained doctor, traces this widespread aversion to social stigma.
The work of nurses, he says, is undervalued. “They are often seen as second-class citizens, who provide services similar to a maid or cleaner.” Sabae sees this social bias manifest in popular cultural portrayals of nurses, who usually feature in films and television shows as lazy, crass and “completely incompetent” characters. The Nurses Syndicate railed against this hurtful media image in 2010, unsuccessfully lobbying the Ministry of Culture to cancel a Ramadan soap opera that featured a corrupt and unethical nurse.
Salaries are also low. Egyptian nurses typically earn between LE1,200 and LE2,500 (approximately US$135 to $280) per month in public hospitals. This lowly remuneration provides little incentive for Egyptians to enter the nursing profession. The government has not satisfied its obligation under Article 18 of the Constitution to allocate at least 3 percent of Egypt’s gross domestic profit to healthcare, despite proposals to do so in the 2016-2017 Financial Year. Sabae suggests that this combination of social and economic concerns tends to drive young Egyptians with ambition away from a career in nursing.
Hassanat Naguib, dean of privately funded nursing college Gouna Technical Nursing Institute (GTNI), concurs that adverse perceptions of the nursing sector stem from “ignorance regarding the nurse’s role.” She adds that a lack of proper nursing training has compounded this trend. Most Egyptians receive healthcare in public hospitals. This often brings patients into contact with inexperienced nurses, many of whom have completed only basic technical training. Naguib argues that, until the quality of training improves at this technical level, public confidence in nurses is unlikely to increase.
Social perceptions of nursing in the Philippines are markedly different from those prevalent in Egypt. Mechell describes the deep respect commanded by nurses in her home country. Her mother dreamed that her daughter would enter the profession, financially supporting Mechell on a long path to becoming a registered nurse. Filipino students must do four years at nursing school, before completing — and paying for — various medical licensing courses. The student finally becomes a registered nurse upon passing a standardised bar exam. Mechell has a straightforward answer as to why Filipino families go to such lengths. In her country, “When you are wearing the white uniform, you are respected.”
Unlike Egypt, the Philippines has an oversupply of qualified nursing practitioners. Due to extreme competition for jobs, Filipinos typically begin their careers by paying a local hospital for the privilege of working as a volunteer nurse, which Mechell did for 10 months before working for the Phillipine Department of Health for two years. She views her Egyptian placement as a “stepping stone” for other overseas nursing opportunities, which she hopes will take her to countries such as the United States and Australia.
Naguib advocates improving training standards as the most direct way of changing how much of society perceives Egyptian nurses. Her privately funded nursing college, GTNI, founded in April 2010, aims to provide theoretical nursing training that conforms to international best practice. Naguib strongly encourages her graduates to pursue careers in the private healthcare sector, where hospitals tend to provide updated training to nursing staff, whereas public hospitals often fall back on antiquated nursing practices.
Fakih, chief nursing officer at Cairo’s Al-Salam International Hospital, concurs that public and university hospitals must progress away from practising an “old school” type of nursing. But the problem comes down to a lack of financial resources, especially in the university hospitals responsible for training the majority of Egypt’s nurses. Nurses in these institutions usually do not learn with up-to-date medical equipment, Fakih says, limiting the quality of care that publicly trained nurses can provide to patients.
Fakih thinks there are a number of ways in which Filipino nurses stand out — their professionalism, their responsiveness to patients and their usually excellent grasp of English. These skills make Filipino nurses invaluable to hospitals in caring for patients who do not speak Arabic. Mechell’s fluency in English places her services in high demand where she works. Naguib’s program at GTNI seeks to address this comparative disadvantage for Egyptian nurses — instructors conduct all lessons in English and students must take dedicated English language classes.
Despite their misgivings, both Naguib and Fakih praise the ongoing efforts of the Egyptian Nursing Syndicate to promote better training practices. Over the past decade, the British University in Egypt has also developed a state of the art Faculty of Nursing and Dar al-Fouad Hospital has its own plans to open a nursing academy in the future. Sabae applauds the efforts of non-governmental organizations such as Misr al-Kheir Foundation, which aims to provide educational support to nurses working in university and government hospitals.
In a country rife with unemployment, nursing stands out as a field that can potentially provide jobs. But without significant funding and investment, a dearth of nursing staff will likely persist. Fakih acknowledges this inescapable reality, observing that “any hospital that has the resources to get foreign nurses will get them.”
This article has been slightly amended on October 6, 2016.