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NickLaing

Country Director @ OneDay Health
5784 karmaJoined Working (6-15 years)Gulu, Ugandaonedayhealth.org
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Bio

Participation
1

I'm a doctor working towards the dream that every human will have access to high quality healthcare.  I'm a medic and director of OneDay Health, which has launched 35 simple but comprehensive nurse-led health centers in remote rural Ugandan Villages. A huge thanks to the EA Cambridge student community  in 2018 for helping me realise that I could do more good by focusing on providing healthcare in remote places.

How I can help others

Understanding the NGO industrial complex, and how aid really works (or doesn't) in Northern Uganda 
Global health knowledge
 

Comments
780

For sure. Not only the lack of funding to handle the pipeline, but there seems to be increasing concern around the benefits to harm tradeoff of technical AI research too.

Perhaps like with the heavy correction against earning to give a few years ago which now seems likely a mistake, maybe theres a lesson to be learned against overcorrecting against the status quo in any direction too quickly...

Due to my borderline forum addiction, you probably have a disproportionate influence on on me haha. Will probably never earn to give though so no harm done here ;).

Yep was about to ask the same question, it's such a glaring omission I imagine there might be reasons it has not been shared?

Even if there are it might be good to know what those reasons for not sharing are, otherwise it might draw even more attention.

Nice one I love that response. 

Makes sense that you aren't confident about this particular change yet, are discussing improvement with the team and that you are concerned about the overall situation that on balance you think your numbers are too low and you probably want a increase rather than a decrease.

To reiterate I love that you have a model which can actually be scrutinised and meaningfully iterated - I still can't really get my head around GiveWell's but maybe I haven't tried hard enough. 

No matter what system is used error's are going to be massive, so why not make it more understandable and editable?
 

Thanks so much yes you are right that the Nigerian Government planned to bond nurses for a couple of years to stay in the country, but it looks like it may not happen. I didn't discuss it in the post here, as I was primarily intending to correct the CGD article rather than debate in detail the situation in Nigeria - which I'm glad has happened in the comments!

https://punchng.com/nurses-plan-showdown-as-fg-moves-to-slow-down-process/ 

I love your comment here "This enables the Nigerian public to enjoy the services of the nurses before they emigrate. When they travel out, another corp comes in and compulsorily serves the public before emigration."

I think you're right its very reasonable (especially when people are trained in subsidised government institutions) to bond people to work in-country for 2-5 years. I think this can help buffer a country's nursing resources, and allow training institutions time to ramp up their training. When considering opening a nursing school here in Uganda, perhaps in connection with a foreign government I thought a system like bonding some students for 3-5 years in Uganda before we connect them to opportunities abroad might be a decent way to operate.

 

@Mo Putera love the graph! Why is something being a small change a reason not to include it?

I don't buy your line of argument that just because what you do "crude approximation" or "scratching the surface" (which I agree with and many commentators have pointed out) is a reason not to include new variables to your model. That seems like conflating two issues. Obviously assumptions and errors are massive, but that's not a reason not to continuously be improving models. 

 Like @Larks says its not about a constant 10% reduction, but taking something extra into account which makes sense could meaningfully be added to the model.

Just because it might not be the most important thing right now or "low down your list" isn't a reason from my perspective not to include it. 

I agree that you are probably underestimating rather than overstimating in general, and I actually prefer AIM/CEs approach to GiveWell's partly for the reason that this post exists - it is a bit easier to scrutinise and criticise, and therefore potentially easier to improve.

As a side note your response (probably unintentionally) feels just a little unnecesarily defensive but I might be reading too much into it.

Thanks so much for raising this, I sometimes get a bit overwhelmed by guilt thinking how unfairly amazing my life has been, I won the life lottery in so many ways

I think there are so many layers of unfairness here that it can be hard to factor it into decision making . Like you say it’s horribly unfair that these nurses can’t migrate for far better jobs when many high income nurses freely move around the world for marginally better working conditions.

But It’s at least as unfair that millions of poor subsistence farmer patients are now more likely to suffer and die because of the worse medical care caused by the exodus of their more well off nurse compatriots, who had the opportunity to leave for greener pastures.

And It’s horribly unfair that most Nigerians didn’t have the opportunity that these nurses had to study and get a decent job in their own country. Millions would even have got good enough grades but at some point didn’t have yet money to continue. just by becoming a nurse you are always in the luckiest few percent of Nigerians.

Its also unfair that many Nigerian lower skilled workers who are more badly off than Nigerian nurses as can’t migrate to countries that could benefit hugely from their labor.

It’s unfair for most Nigerians that they were born there and not in England in the first place. Terrible luck but we don’t usually try and remedy that in any way unless we are Give Directly or similar.

Thinking about fairness/unfairness really makes my head spin and I would be interested if anyone had a way of thinking about this that could help guide this kind of decision. I find it hard to sort through so usually revert back to benefits and harms frameworks.

Yep agree with all of that. Nigeria has been losing quite a large number of nurses for 5 years now, but maybe the compensation will happen like in the Philippines like you say

Shall we check in here again in 5 years and see what happens ;).

Thanks that makes a lot of sense, especially the comment about getting a job at a regular org and I’m also heartened to hear that the AI governance space is more developed as well.

Didn’t realize the “EA brand” might be a negative that’s sad.

Also I didn’t find the answer boring at all ;)

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