Simply Not There: The Impact of International Migration of Nurses and Midwives—Perspectives from Guyana


  • Barbara A. Anderson CNM, CHES, DrPH,

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    • Barbara A. Anderson, CNM, CHES, DrPH, FACNM, is Associate Dean for Academic Affairs at Seattle University College of Nursing in Seattle, WA. She has worked extensively in maternal and child health in low-income countries, including Guyana, South America.

  • Alexander A. Isaacs CHES, MPH

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    • Alexander A. Isaacs, CHES, MPH, is currently the Director of Health for the non-governmental organization, Adventist Development and Relief Agency—Guyana. He formerly served in the Health Sector Policy & Institutional Development Program in the Guyana Ministry of Health, Guyana Ministry of Health, Georgetown, Guyana.

Address correspondence to Barbara A. Anderson, CNM, CHES, DrPH, FACNM, Associate Dean for Academic Affairs, Seattle University College of Nursing, 901 12th Ave., Garrand Hall 200C, Seattle, WA 98122-1090. E-mail:


The shortage of nurses and midwives across the world and the migratory trends of these scarce professionals—primarily from low-income countries to fill staffing needs in high-income countries—are critical international health care issues. This article reviews some of the demographic, educational, and socioeconomic factors driving this global trend, the impact on health care delivery in low-income countries, and the effect on the implementation of global public health initiatives. Nurses and midwives migrate from low-income nations while concurrently qualified applicants are rejected from educational programs in high-income countries. The impact of migration on the viability of the health care delivery system in Guyana, South America, is presented as an exemplar nation within the broader global context of ethical dilemmas, pressures on educational systems, and the anti- and promigration arguments.