Florida Native

I've been where you are. Corporations generally refuse to provide reasonable accommodation and instead look for ways to terminate. After the ADA was passed the US Supreme Court kept deciding in favor of corporate interests rather than following the law. Congress eventually passed new legislation that was written in a way that the court could no longer legislate from the bench. Still it remains difficult to deal with corporate greed. When I was younger after I had been discharged from the military I had a conversation with an underwriter for a major US insurance company who did not know my disability status. Like you I had an invisible disability. We were discussing insurance companies get stuck with fraudulent life insurance applications. She related that they once had a small business client who hired an individual with a history of heart disease. She said if they had known they would have advised the client not to hire the individual. I ended up working minimum wage jobs because back then companies were allowed to require an insurance application along with the application for employment. Needless to say I never got called back. I applied for a job with the Postal Service with my Veterans Preference. I completed the machine qualification with time to spare. I was then told they couldn't hire me because my condition might reoccur and it wouldn't be fair to the taxpayers for my to have 2 disability pensions. There were 2 others who were told the same thing. Years later that was changed. The ADA did get me into nursing school. My career had its ups and downs. A few years ago I finally gave up fighting the system. I keep my license but no longer work. I would suggest you consult an employment law attorney. Most practice on a contingent fee basis. They would be able to better advise you on your options. Good luck to you.

You might check with Flagler in St. Augustine. I believe they have a current opening in psych. St.Augustine is a nice area. Flagler only hires BSN nurses for most positions so your education would likely fit in with their philosophy. Another option to improve you chances of hire would be to take a clinical refresher. There is a company (Capscare) in Lake Worth that offers clinical refreshers. Good luck.

I suspected as much. Several years ago I was involved in a start up that paid all expenses for nurses seeking to immigrate. CGFNS drove the final nail into our coffin. They either refused or were incapable of processing applications on anything resembling a timely and accurate basis. Since we were unable toprocess our nurses the overhead destroyed us. We were sufficiently capitalized too. In 2004 the Philadelphia Inguirer did a Sunday front page story on the CGFNS situation. I can still be found on the interet. Do a Google search using the terms, "Foreign Nurses Decry". Unfortunately Senator Arlen Specter had allowed a lobbyist for CGFNS to insert language into an immigration bill giving them a virtual monopoly on deciding whose credentials were accepted and whose weren't. Despite the evidence uncovered by the Inquirer reporter, Homeland Security rubber stamped their approval on CGFNS' operation. Too bad. Those requiring large fees survived while those trying to ethically recruit were largely destroyed. There are a few ethical recruiters still in business. Since I cannot name them here I suggest that nurses in the Philippines spend some time researching recruiters on the internet before signing any contract. With a little work you can find one who will assist you in an ethical manner.

Are recruiters still charging fees to nurses in the Philippines or has it finally stopped?

As everyone should be aware, Medical tourism is becoming a hot topic with the media. Most the articles are written by journalists with a limited medical background. Some have no medical background. Yet the media appears to be eager to publish what is written. Many articles appear to be more promotional in nature and not well balanced. Currently India is the media darling because of rock bottom pricing. According to recent news articles, several US corporations are now considering adding Indian hospitals to their health plan and offering employees a discount for choosing them. There is no doubt India has some excellent physicians and nurses. India has several new state of the art hospitals built to try an attract patients from developed countries. What is lacking is proper sanitation and infrastructure outside the hospital. The Indian hospital corporations, the Indian government and the Confederation of Indian Industry don’t seem too concerned about the problem. They have elected to press forward without first fixing the sanitary and infrastructure problems. Crime is also a problem is also a problem beyond the hospital walls. None of the news articles address these problems nor do they provide guidelines for making an informed decision on medical travel. The US State Department’s Consular Information Sheets provide valuable information to persons contemplating surgery abroad. The CIA World Factbook contains on environmental factors that should be considered. The Centers for Disease Control offers guidance to travelers on the medical risks posed by travel to other countries. As examples of the risks in India, the US Consular Information Sheets specifically warn travelers to India to take safe food and water precautions and to take steps to avoid malaria. There is a link to the CDC website later in the text. The CIA World Factbook states that, “Tap water is not potable throughout the country”. The US Embassy also advises travelers to India Travelers not to travel alone, particularly women. Women run the additional risk of “Eve teasing”. “Eve teasing” is a form of sexual harassment that can include unwanted touching and groping. The Embassy states such reports have increased recently. A visit to the CDC website provides further information on the medical risks in India. Specific instructions are given regarding malaria. The instructions include, “All travelers to malaria-risk areas in the South Asia region, including infants, children, and former residents of the Indian Subcontinent, should take one of the following anti-malarial drugs (listed alphabetically): •atovaquone/proguanil, •doxycycline, •mefloquine, •primaquine (in special circumstances). Note: Chloroquine is NOT an effective antimalarial drug in South Asia and should not be taken to prevent malaria in this region.” According to the CDC the malaria risk areas of India are, “All areas, including the cities of Delhi and Bombay. Risk in areas at altitudes Travelers are advised to take the antibiotics before, during and after travel. A dosing schedule is provided. There is substantial information on India public health risks on the internet. In a 2005 Power Point presentation, the head of the department of community medicine and epidemiology at an Indian medical school gives example after example of the risks to public health in India. The risks are related to the poor sanitary conditions in that country. The University of Pittsburgh School of Public Health has published the information on the internet. The University of North Carolina School of Public Health has published on the internet a graduate thesis on India’s plague outbreak in 1994. It seems a majority of India’s population believes the rat is a god. In some parts of India including major cities, rats are fed in the public parks. According to a USA Today article last September, rat catchers in New Delhi haven’t caught a rat in years despite there being an abundance of the creatures in that city. The lack of a national infection control policy for hospitals in India is still another problem. A 2004 graduate thesis from Australia also published on the internet states that several sources suspect the nosocomial infection rate in India to be approximately 30% vs approximately 5% in the United States. No one can say for certain because there are no reporting requirements. All hospitals in India decide what to track, what to report and who to report to on their own. One Indian newspaper article from February of this year quotes a physician at one of the tourist hospitals as saying India has no MRSA problem. The article claimed the few cases discovered probably came from medical tourists. The article was trying to encourage the medical tourism industry in India to play on the MRSA fears in the UK. A little research will reveal that MRSA has been well established in India for some time. Both community and nosocomial infections have been discovered. With the lack of mandatory reporting no one can say what infection problems exist in hospitals. While people may choose to travel to India for treatment even if they are aware of the information, I feel they should at least be allowed to make an informed choice. At present this information is not provided and organizations like the Confederation of II Indian Industries as well as the Indian government and the hospital corporations themselves continue to work the international press to favorably spin medical tourism to India. Without complete information potential travelers cannot make informed decisions. I have been unable in my attempts to get the media to publish basic guidelines for potential medical tourists. Below is a copy of a short, simple set of guidelines I prepared. The information should help enable persons considering treatment abroad to find information on any country promoting medical tourism that would be helpful in making an informed decision. When I suggested to several newspapers that they consider publishing my information of or something similar, the editors balked. Apparently the media still believes that one should never let the facts get in the way of a good story. The only response I received was from the LA Times. They did admit the information was useful but said they would not publish it. I contacted one travel writer who gave a glowing report on medical travel to India. She suggested the University of North Carolina School of Public Health did not know what they were talking about. She did not comment on the consular information sheet. I don’t know if anyone here has any contacts with the media. If you do, please consider passing the information on. As medical tourism continues to grow, and it is predicted that it will, we will likely start to see adverse outcomes related to the problems mentioned. If the patient chooses to go to a high risk area for treatment after they have the knowledge to make an informed decision there is nothing we can do. But at least they should be given the tools needed to make an informed decision. http://www.cdc.gov/travel/regionalmalaria/indianrg.htm http://www.ucis.unc.edu/resources/pubs/carolina/Plague.html http://www.cdc.gov/rodents/diseases/index.htm http://www.usatoday.com/news/offbeat/2005-09-13-rat-catchers_x.htm http://72.14.203.104/search?q=cache:7NS-S20EEuYJ:www.publichealth.pitt.edu/supercourse/SupercoursePPT/18011-19001/18811.ppt+open+defecation+india&hl=en&gl=th&ct=clnk&cd=11 (Open Power Point presentation from link at top of page. HTML version is available but Power Point provides easier to read detail.) http://travel.state.gov/travel/cis_pa_tw/cis/cis_1139.html http://www.cia.gov/cia/publications/factbook/geos/in.html http://adt.lib.uts.edu.au/public/adt-NTSM20040913.150110/index.html Medical Tourism: How to be a Safe Consumer By Neal R. Yerkes, RN Medical tourism is a term seen more frequently in the news these days. Americans and others are traveling abroad in search of quality, low cost surgery and other medical treatment. Much of the travel is to locations in Asia. The number of medical tourists to is expected to grow by 30%-40% per year over the next few years. Already nearly two million people travel to Asia in search of search of surgery and other medical procedures. But how do you know if the offering by a medical tourism company is of the quality and safety you want? In addition to questions about the quality of the physician and hospital, there are other factors to consider. Does the company employ people with a medical background to assist you in making wise choices about medical travel? Before you decide on a medical tourism company ask about the medical education of its staff. Know who you are talking to and know their qualifications. According to a recent book, only two of the several hundred medical tourism companies operating in the United States actually employ people with a medical background. Most are started by people wishing to cash in on the growing medical tourism boom. Ask yourself, would you call computer programmer for legal advice? Relying on the advice of someone whose only background in medicine is the promotional material they read from the overseas hospital is about as good as asking a programmer for legal advice. You might get good advice but more often you would not. Other factors to consider are the level of development of the country where the medical services are offered and conditions outside the hospital. Medical tourism operators are in business to make money. What they tell you may not reflect the actual conditions in the country you will visit. If a hospital offers higher commissions to the medical tourism operator then the country where that hospital is located will likely be given top billing. Be a smart medical tourism consumer. Do a little research on your own. The US State Department’s Consular Information Sheets on the countries you are considering for medical travel contain a wealth of information. General advice on the quality of the healthcare system in the country you are considering is included in this publication. The US Centers for Disease Control's website provides country and region specific information for persons traveling overseas. The CIA World Factbook contains valuable information on environmental factors such as water pollution that should be considered. Both sources are published on the internet. Internet searches using the country name and sanitation should also be conducted. Such searches can reveal what the promoter may not be telling you. Conditions outside the hospital should be carefully considered. While the price of the treatment may be low and the hospital and staff of good quality, what awaits you after you are discharged from the hospital? Most patients will be discharged into the community while their surgical wounds are not yet completely healed. They will remain there for follow up care and rehabilitation. Are there sanitary problems that might place you at greater risk for infection? Are you at greater risk of being the victim of a crime? Is the food and water safe? Are there diseases endemic to the country that might pose an additional health risk? These are questions that should be considered before deciding on a medical tourism destination. The lowest priced location may not be the best bargain when other factors are considered. What happens if there is malpractice? Legal systems in other countries especially developing countries are substantially different than those in the US. While it may be possible to seek redress in the local courts of the country, the amount of the award for damages will likely be based on the local economy. In many countries this will only be a few thousand dollars. The amount might not be an adequate to redress the damage done. It is also like the medical tourism operator will require you to sign a paper releasing them from any responsibility if things go wrong. Medical tourism can offer a safe low cost alternative to expensive local hospitals or long waiting periods. Be safe. Check the credentials of those offering medical tourism services, the countries where those services are offered and the credentials of the physicians and hospital. With a little research you can become a smart medical traveler.

Hi Dave, I was diagnosed with fibromyalgia in the mid 1990s. The symptoms had existed for years. I am fortunate that my disease is now well controlled though I do have several minor exacerbations a month. In the course of researching the disease I discovered the Center for Complex Infectious Diseases in California. There were once part of the U.C. Davis medical school but opened independently after obtaining suffieient funding. They have been studying CFS and FMS as well as other conditions. A virus that is not detectable in routine lab tests has been found in a significant number of cases. If you are interested their website is at http://www.ccid.org/ . It has been a while since I last visited the site. To navigate to the scientific papers follow the S3 Support link. When that page opens click on "Information Area" on the tool bar at the top.

Unfortunately new regulations eliminate the NAFTA exemption even for nurses already practicing in the United States. In July Canadians will have to complete CGFNS Visa Screen in order to continue practicing. Looks like CGFNS gets a cut on every foreign nurse entering the U.S. now. With their monopoly they will take in over fifteen million dollars this year.

Yes, there are plenty of nurses out there but it is unlikely they will ever return to the active practice of nursing. Historic data indicates they will stay in the professions they entered when they left nursing.

When I was a student in the early 1990s there was a glut of nurses due primarily to workplace redesign. Consultants, primarily accountants with no healthcare practice background, advised hospitals to cut staff and increase nurse patient ratios. They were considered heros. By the end of the 1990s they could have been tarred and feathered. During the 1990s the shortage of the late 1980s disappeared due to the staffing cuts. Nurses who remained in the profession faced the added stress of unrealistic patient loads. More nurses left the profession. When the hospital industry discovered the error of their ways in the late 1990s the nurses were gone. The average age of a nurse had jumped to about 45. I was the co-author of the 1994 NSNA resolution calling for a modification of the Immigration Nursing Relief Act which at that time was being used by consultants to further supress wages and working conditions. The act was allowed to sunset in 1996. During the course of my research I discovered that nurses who left the profession during previous gluts seldom returned to the profession when conditions changed. The nurses who left were lost forever. When I graduated from nursing school in 1994 NCLEX pass rate percentage for new graduates educated in the United States was in the 93 to 96 percent range depending on the type of program the nurse attended. ADNs had the highest percentage passing on teh first attempt. BSNs the lowest. But all groups were passing above 90%. Today the first time pass rate is about 7 to 10 points lower. I asked an educational consultant I know if the test was more difficult. Her answer at that time (2002) was that the quality of the students entering nursing had dropped. Students were being admitted who would have been never been considered before. Though I suspect that has changed with the economic down turn, it will likely return once the economy recovers unless the hospital industry has learned from their past mistakes. We are now facing the most serious shortage in history. It is projected to continue through at least 2020. The present shortage is compounded by the lack of nursing instructors. The average age of a nursing instructor is even greater than that of practicing nurses. For the immediate future the United States will need to continue to bring nurses from overseas to avert a crisis in healthcare delivery.

While it is a positive move that BCIS is finally going to review CGFNS' operation, it would be better if a full outside audit were conducted. Far too many nurses outside the U.S. have faced the cold, uncaring attitude by those in charge at CGFNS. Many of the nurses I work with came from countries where they earned about eighty dollars per month. Many borrow money on the black market to try and pay CGFNS fees. When CGFNS receives the money nothing happens for months. I am personally aware of nurses who have waited for years for CGFNS to get it right. Unfortunately, most nurses from outside the U.S. do not know who to complain to. CGFNS by its own admission drops between a third and one half of the calls placed to their company everyday. Many of these are placed from overseas. Any other business would be facing Federal Trade Commission action for similar behavior. The monopoly at CGFNS must end and those responsible for taking money and not providing the service paid for must be held accountable. Regarding the return of nurses to the bedside after leaving the profession, in the 1990s I was a leader in the student movement to reform the then Immigration Nursing Relief Act. The act was ultimately allowed to sunset. In the course of developing supporting data for that project I discovered several studies on nurses who had left the profession during previous periods of oversupply. When conditions changed, the nurses seldom left their new careers and returned to nursing. Ideally it would be good to see them return but as a practical matter generally they do not.