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In October 2001 government chief nurses and other delegates from 66 countries met to discuss how best to deal with a common challenge—the global growth of nursing shortages.1 Nursing shortages in the United Kingdom and elsewhere have been a repetitive phenomenon, usually due to an increasing demand for nurses outstripping static or a more slowly growing supply.2 This time the situation is more serious. Demand continues to grow, while projections for supply point to actual reductions in the availability of nurses in some developed and developing countries. Some health systems are also coping with the legacy of ill conceived reform projects of the 1990s, which demotivated and disenfranchised nurses and other staff. Developed countries are facing a demographic double whammy. The United States, United Kingdom, Australia, Canada, and other countries have an ageing nursing workforce, caring for increasing numbers of elderly people.3–5 The challenge is how to replace the many nurses who will retire over the decade. Some countries also have to cope …

A whole government approach is needed to mitigate the impact of the brain drain In the linked study (doi:10.1136/bmj.d7031), Mills and colleagues attempt to quantify the cost to sub-Saharan African countries of investing in training but then not retaining doctors and nurses. They build on the limited analysis already conducted to assess the costs of “losing” scarce skilled staff to the developed world. They restate the debate about the real impact of the medical “brain drain.”1 A review of previous costing studies found that most lacked technical merit and focused on gross effects on African countries rather than net effects.2 Mills and colleagues try to look at some of the possible benefits that may accrue through remittance income and return migrants, but they focus primarily on assessing costs of training and the cost of lost return on investment as the health professionals leave the country that has funded their education. According to Mills and colleagues’ analysis, developed countries have “saved billions of dollars” by recruiting ready trained health professionals without having to bear the training costs. They cite the World Health Organization’s 2010 code on international recruitment as a mechanism for achieving a more equitable balance of the costs of training between …

We need to identify effective approaches to managing and moderating migration F or the United Kingdom, and some other developed countries, active international recruitment has become a solution to shortages of health professionals. However, one country's solution may become another's problem. The recent House of Commons report on migration and development1 and other commentators have highlighted the negative impact of international recruitment on the health systems of some of the main source countries, particularly in sub-Saharan Africa.2 The issue of migration of health professionals has become an important feature of international health policy debate symbolised by the passing of a resolution at the World Health Assembly.3 How important is international recruitment to the NHS? Estimates of the inflow of doctors to the United Kingdom can be derived from the registration records of the General Medical Council. Registration data highlight …

Orf, a parapox viral infection of sheep and goats, has been recognised for over 200 years. Human cases were first recorded in the 1930s.1 Transmission occurs by direct inoculation, commonly from the infected muzzles of hand reared lambs. The true incidence and prevalence of human orf is unknown, and workers familiar with the disease may not report infection. The typical target-like lesions most often affect the hands and heal spontaneously in six to seven weeks. Complications include secondary infection, erythema multiforme, and a generalised papulovesicular eruption.2 I recorded the morbidity from and the prevalence, seasonal variation, and complication rate of human orf in a farming community in mid-Wales, a population at risk of the disease. Questionnaires were sent to 292 patients at this practice who worked with sheep and …