REPORTER: Aaron Lewis

Dr Robert Ayella is on his way to work at Mulanje District Hospital. It's one of the busiest hospitals in Malawi. He's been the only doctor working here for six months. He knows that each morning he'll confront the inevitable toll from the night before.

DR ROBERT LAPYAM AYELLA: When we start the morning report, there are always deaths that are reported. The worst thing you'd want to hear in a morning report is death.

Dr Ayella is solely responsible for hundreds of critically ill patients.

DR ROBERT LAPYAM AYELLA, VOLUNTEER DOCTOR: So we're thinking she has……

As he goes from bed to bed, patients and staff clamour for his attention.

DR ROBERT LAPYAM AYELLA: Any pain in the limbs?

Dr Ayella is a bone specialist, and he's the only one in Malawi but here he performs every kind of surgery. Dr Ayella doesn't even speak the local language because he's from Uganda.

DR ROBERT LAPYAM AYELLA: It's a bit traumatic, eh?

He came to Malawi as a UN volunteer to help with the doctor crisis.

DR ROBERT LAPYAM AYELLA We are working under very difficult conditions. It's like we are in a war. We are fighting a war, and fighting on all fronts. You need to be really a person who is there for the community that is willing to serve at all costs.

Malawi's own doctors and nurses have left for better jobs in hospitals in the developed world. Malawi now has only one doctor left for every 50,000 people.

DR ROBERT LAPYAM AYELLA The doctors who are working in Africa are really tired. Really, you cannot see all those.. you can't serve that population. So you are stretched beyond your limits, your body gives up.

Dr Ayella's first surgery today is a patient with third-degree burns to most of her body. There's no morphine, so they give her ketamine, a horse tranquilizer, as an anaesthetic. She can't feel the pain, but she hallucinates the entire time. Hospitals in Malawi often run out of basic drugs like antibiotics, leaving doctors powerless to fight infection. In the middle of the surgery, Dr Ayella is told there's a problem with another patient.

DR ROBERT LAPYAM AYELLA: What's the problem?
They told me there is a man who has a stricture and we don't know what is happening. So in that instance I can't even think coherently to tell them what to do. I would need to see the patient. So if I tell them "OK, I think maybe he has this disease condition," and I just tell them, "Go", so I may make a mistake.

Dr Ayella finishes up the burn surgery, and without a break, he rushes into the hallway where the man is clearly in pain. He has both HIV and tuberculosis, a deadly dual epidemic. Half of all new TB cases are co-infected with HIV. 90% of AIDS victims die within months of contracting TB. While I'm filming, the man has a heart attack and gets pushed into the operating room.

DR ROBERT LAPYAM AYELLA: There is no pulse! He just cardiorespiratory failure, and aspirated.

REPORTER: He just died?

DR ROBERT LAPYAM AYELLA: He died. You feel bad when you lose a patient. You go home and you touched a life, you've lost a life. It is painful. Like the patient we lost today. It's so painful, because you think maybe you could have done something if the patient had come earlier, or you could have done something if you had all those assistants or the equipment, or everything at hand.

MARJORIE NGAUNJE, MALAWI HEALTH MINISTER: We know that everyone has got a right to health and as government we are making sure that that provision is there.

Malawi's Health Minister seems almost in denial about the country's crisis.

MARJORIE NGAUNJE: Yes, we may have problems, but we are not unique in that area because there are many other countries that have got problems.

Ruth Makhembera knows all about Malawi's health problems. As the only nurse-midwife for miles, she has delivered more than 10,000 children. Mrs Makhembera retired five years ago but she returned to work when the village had no nurses left.

RUTH MAKHEMBERA, NURSE-MIDWIFE: When I visited my health centre and see how people were suffering here, I thought I would assist them for a few years, because I'm on contract for three years.

Mrs Makhembera practically lives at this rural clinic. She sleeps here four nights a week, and she wakes to a sea of faces. Today, pregnant women are being given HIV tests to see if they and their unborn babies have become infected. The women offer me the same advice that they've received.

PREGNANT GIRL, (Translation): I suggest you and your wife should be tested together, because then you'll know your status and you can plan for the rest.

The clinic is run by the NGO Medecins Sans Frontieres, MSF, who provide most of the HIV drugs to Malawi. Malawi is under seige from HIV/AIDS, with 100 new infections every day.

MAN, (Translation): Did the doctor ask you to come for a blood test? Why did he say you should have one?

WOMAN, (Translation): To find out the problem.

MAN, (Translation): Right.

Health care workers here have double the chance of becoming infected than the general public. 25% of Malawi's health staff are expected to die of HIV/AIDS in the next decade.

RUTH MAKHEMBERA: When we I started working there were no gloves at all. We were delivering babies with bare hands and it's just through God's grace that I'm alive without infection.

Some villagers have given up making the long journey to the nearest hospital. Naveson is a 7-year-old boy who lives with crippling convulsions. When his grandmother does go to the hospital, they often send her home empty-handed.

GRANDMOTHER, (Translation): The hospital has no more pills, so we are biding our time.

Naveson was given sleeping pills but wasn't ever properly diagnosed.

GRANDMOTHER, (Translation): Some say that it’s epilepsy, but the way this child reacts is different. The doctors say this disease isn’t epilepsy. It’s a different disease from epilepsy. If you look at these marks, we don’t know what causes them. He hasn’t had a wound or anything. They just appear on his body.

Stories like Naveson's are common. Foreign aid donors are often more willing to pay for drugs than for the wages of doctors and nurses, so overworked doctors often just write a prescription without a proper diagnosis. Thyolo District Hospital is shared by Malawi's Ministry of Health and Medecins Sans Frontieres. To make up staffing shortfalls, Malawi has put clinical officers on the front line.

STANLEY CHIMABAUI, CLINICAL OFFICER, Translation): That is what I want to find out, where he bears the water.

People like Stanley Chimabaui, a clinical officer with only three years training, he's not a doctor, but he's expected to act like one.

STANLEY CHIMABAUI: Today I will work, I think for 24 hours, because I am on call. So usually I work 24 hours in emergency and admissions department.

(Translation): When did you last bring her?

WOMAN, (Translation): She’s here for something in her throat I can’t remove.

REPORTER: How much sleep do you get in that 24 hours?

STANLEY CHIMABAUI: It depends on how much work you have that day. Sometimes when you are busy, you don't get any sleep at all.

Clinical officers now double as surgeons, even though they haven't been trained for it.

DR ROBERT LAPYAM AYELLA: Is she on any medication, any special drugs for any illness?

Dr Ayella says that given these conditions, he's not surprised that doctors and nurses leave Malawi.

DR ROBERT LAPYAM AYELLA: With limited resources, you reach a point of frustration and you say “What am I doing here?”

The United Kingdom. For decades, when doctors have left Africa in search of better lives overseas, this has been their first port of call. I've come to meet with Dr Aubrey Makhilira, a Malawi-born doctor who now works in a UK hospital. His entire graduating class left for better opportunities in the West. He says it's not just about the money, this is the first time that he's been able to see Western medical techniques first hand.

DR AUBREY MAKHILIRA: My name is Aubrey, I'm one of the doctors. Pleased to meet you.

When you come over here overseas we work in very good hospitals and these hospitals train us sort of like to do membership exams and that's the only way that we get to see what we read in books. They talk of a lot of investigations in there, equipment and all that which we've never seen in our whole lives.

Dr Makhilira now works at the Royal Blackburn near Manchester. He is completing his speciality in paediatrics, this ward is a world away from Malawi, it's clean, has modern equipment, and a manageable caseload. But Dr Makhilira will never forget his early days on the wards in Malawi.

DR AUBREY MAKHILIRA: It was a daunting experience and it keeps haunting me until now because you see the ward is full of patients, some of them sleeping under the bed. There's only one nurse around, one doctor to attend all these patients. Some of them are screaming, some of them are dying. It is very, very terrifying because people are suffering and there's nothing much that you can do to help them out.

The National Health Service in Britain employs more than 50,000 foreign doctors, most from the developing world. For years the Western press has accused Great Britain of "doctor poaching".

REPORTER: What do you think of when you hear the term "doctor poaching"?

FOLUKE AJAYI, UK NATIONAL HEALTH SERVICE: Um, I don't know that I necessarily agree with the term doctor poaching, because I think that people make individual choices. When you talk about poaching, what that conjures up means, taken somebody against their own will, taking an individual against their own will. Actually that's not the case. People are making the decision whether or not they want to make that move. We can't limit an individual's right for migration and for movement.

But things are changing. The United Kingdom recently agreed to stop actively recruiting doctors from the world's poorest countries. It's the first and only Western country to take action to fight Africa's deadly brain drain. But Dr Makhilira believes that the changes in the UK will not keep doctors and nurses in Malawi.

DR AUBREY MAKHILIRA: What you should realise as well is that we are marketable all over the world and we've got the potential and all that. And the question is if you've got the potential to work anywhere else in the world and you can earn better money, why not go to those areas, earn a good living? Who doesn't want good living?

There was a time when there were more Malawian doctors in Manchester than in all of Malawi. That community has now spread throughout the UK, but tonight expatriate Malawi health professionals have gathered near London to hold a fundraiser for their failing system back home. When I arrive, I find that there are more Malawian health workers in this one room than I met in any public hospital in Malawi.

DR EDWARD LIZI: I earn quite a good wage here, why should I go back to Malawi to suffer?

I would assume it's because some people would say you should go back to Malawi because there are no doctors left, because for financial reasons all the doctors have left, and there are 2 doctors left for 100,000 people.

DR EDWARD LIZI: Everybody's view, any profession, first is to look after your personal interest first. And then you can extend that to Malawi, or to any country for that matter. I'm helping my relatives, and that's what I care for.

DR HENRY MATITTI: I can see the dilemma, because Malawi is not a very rich country, and the amount of money that nurses get in the UK, the amount of money that doctors get in the UK, Malawi can simply not afford to do that.

Mrs Makhembera stayed in her home village while most of the nurses of her generation left for better lives overseas. She believes that those who have left have turned their back on Malawi.

RUTH MAKHEMBERA: They're not assisting their own people. You go to UK and work there while your brothers and sisters are suffering having no treatment, no medicine and no assistance in the hospital, which is sad to me.

Malawi's best hope is here at the country's only medical college. Until recently, the graduating class each year has been less than 20 doctors, but there are plans to increase that number dramatically in the near future. But the challenge isn't just going to be training new doctors, it's going to be keeping them in the public health system. And of the students I've talked to, most still have a keen eye on what they call the greener pastures of countries like the UK, America and even Australia.

REPORTER: If you were offered a job in the United Kingdom, would you take it?

PRIACILLA PHIRI, MEDICAL STUDENT: I would. I would take it. Because I know it would be more promising in terms of financial nature as compared to Malawi.

But not all of these students plan on leaving. The few who plan on staying seem to have strongest ties to family life back home.

BENJAMIN BANDA, MEDICAL STUDENT: I really love a simple lifestyle, and really I want to be among people I know and love.

REPORTER: You know if you go to the US, you would be making 200, 300 times the salary that you would make here?

BENJAMIN BANDA: I know that. Yes, it's true.

REPORTER: Do you think about that?

BENJAMIN BANDA: I do, but still I don't think that would outweigh the benefits of staying here. I've always wanted that and I don't think any monetary gains would make me have second thoughts about it.

The college administration says that it's doing its best to encourage students to stay in Malawi, but that the West needs to do its part.

ROBIN BROADHEAD, PRINCIPLE, MALAWI COLLEGE OF MEDICINE: I think the West has a moral obligation to not make it easy for doctors and health professionals who have been trained abroad in their home countries to leave without very good justification. But I think it needs good faith on both parts and we don't want to make places a prison, we don't want to make people should enjoy their profession.

MARJORIE NGAUNJE: It's left to the people that are sent for training to decide otherwise, to come back home and work for the nation. There's need for that kind of patriotism in each and every nation, that's the way I feel.

REPORTER: Malawi is training a whole lot of new doctors. Do you think that those doctors will stay in the country given the conditions that they're expected to work in?

DR ROBERT LAPYAM AYELLA: I think heroes wouldn't quit. And heroes confront situations where nobody can go. Those who are heroic will remain. Those who think they want a job then they will leave the country. Because I believe many times people who move away from reality, their hearts are not really for the patients. They are not really touched by the suffering the population is undergoing.

And now Dr Ayella is also preparing to leave, back home to Uganda. His contract as a volunteer doctor expires at the end of the year.

DR ROBERT LAPYAM AYELLA: My worry is, in a few months time I'll go back to my country. So if I go, for instance for my district hospital, who will come?