(The Namibian, July 25 2008).

I want to thank the writer for bringing this issue to light and apologise that he and many other patients/clients had and every day have to wait for a long time for medical services in the hospital.

I wish to confirm his/her concern as a reality and a concern to all of us.

It is good when the community brings up such issues.

It might assist policy makers to review some of the maybe necessary, but cumbersome bureaucratic processes in recruitment.

There are many issues involved than the recruitment itself.

The following are some of the administrative and environmental challenges we experience in Catholic Health Services (CHS).

Others may also have these challenges but I am talking from our experiences.

Administrative: We can only recruit when there is a vacancy.

Employees are only obliged to give notice of 30 days and we cannot get a replacement within that time.

We recruit doctors and nurses from other countries who also need to give notice.

We first have to make sure applicants are registered with the Namibian Medical and Dental Council.

Proof of registration and the advertisement of the position, together with the application, qualification and other documents sent to the Ministry of Home Affairs to request for a work permit and visa.

Home Affairs will not issue a work permit or visa without these documents.

A successful recruitment process takes about three to four months.

There are those applications, which take up to one year before we get response from Home Affairs.

If the doctor is not yet registered with the Medical and Dental Council we ask them to apply for registration.

This process has been a big problem as the Council was busy with restructuring.

I know that Nurses have only twice a year to write examination for registration with the Nursing Council of Namibia.

This happens in January and September only.

Imagine when nurses resign from the end of January until August they cannot be replaced unless a local nurse or a registered nurse applies.

The process of obtaining work permit is a long one.

We all know the delays in Home Affairs that I believe are sometimes legitimate and sometimes not.

Applicants apply to many facilities/organisations/countries.

It happens many times that while we are waiting for the work permit/visa the person informs us that he or she has been offered a job somewhere else.

Then we have to restart the whole process all over again.

You can imagine the frustration! Advertisements cost a lot of money too.

Environmental: In CHS we have two facilities which suffer heavy staff turnover.

It is Andara district hospital in Kavango Region and Aroab Health Centre in Karas region.

Andara is 200 km from the nearest town Rundu.

There is no bank, no post office, no shops accept for the two mini-markets in Divundu with unbelievable high prices indeed.

These shops cater only for the basics (food, drinks, household).

Rundu is the nearest town to do the necessary shopping.

Imagine payday when employees receive their checks which can be cashed only in Rundu! Accommodation for staff in general is a problem.

We make provisions for doctors of course, but other staff categories cannot bring their families.

Some bring their children and endure the situation of overcrowding.

Then they look for greener pastures in other districts, regions or even other countries where they can work and accommodate their families better.

Transport from Andara to Rundu is a problem.

Even if you get a minibus six o'clock in the morning you can only return late in the evening.

There is no other opportunity to come earlier unless you have your own car.

The primary schools in Andara district are indeed a challenge especially for those from outside Namibia.

The medium of instruction is Thimbukushu, maybe very little English.

The quality of teaching in relation to school in towns, and not to mention the countries from where the kids come from is just not comparable.

Medicine and nursing are dynamic professions.

One needs updating and upgrading of knowledge, skills and attitudes constantly.

Health issues are changing everyday and one needs to read to be able to keep up with new developments and information on health issues.

In some of our facilities and especially Andara it is even a big challenge when staff members working want to study while working.

There is no library for reference books.

Rundu does not even have one.

The only way would be the Internet.

People who need and want to advance will not stay longer in a place like Andara.

Some of the applicants are aware of the situation but take the job just to come into the country, and leave after a year or two.

There are times that we cannot communicate with Andara for a week or two.

Sometimes the phone is down, the fax is down and even the e-mail is down.

The poor communication in this area also causes frustration because people cannot communicate to their loved ones back home for a week or two.

The breakdowns happen quite regularly.

Aroab is 172 km from the nearest town Keetmanshoop and has similar problems with nursing staff.

In conclusion I want to thank those committed colleagues in CHS, both Namibians and Non-Namibians who endure these circumstances.

I also want to assure the people that despite all these difficulties we are really doing our best to recruit doctors and other health workers.

The issue of retention remains a challenge.

It needs combined efforts - from us, the community, traditional and political leaders.

Proclaiming Divundu a town and bringing development and services to Divundu will help a lot although not all problems will be solved.

Ottilie M.

Kutenda Director, CHS

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