The Woman in White

The Indian nurse stands by the side of the wretched and the remote, from Saudi Arabia to Senegal. With the world’s attention on the 46 nurses who returned home last week, India’s Nightingales continue to fly to foreign shores

Look to the side of the frame and you’ll see her: white coat, white cap, curls escaping the brim, a trace of Cuticura powder misting it all. The Malayalee nurse: steadfast protector, noble vassal, human footnote. She finds her way to the headlines at the unlikeliest times. ‘AAP has the highest respect for Malayali nurses’ we heard earlier this year, in response to the kind of derogatory remarks she is often subjected to; nurse jokes are a common subset of this. ‘Her family told police that she was not happy as she had been transferred from ICU to general ward in the hospital,’ says Mathrubumi, a popular Malayalam newspaper, of a suicide, as if this were a natural fallout. And last week, she was in all the newspapers and constantly on television as India rose to bring her back from Iraq.

She is brought up with the idea of leaving little villages and towns in Kottayam for the big city, or adopted homes in Delhi and Kochi for foreign salaries; her parents are aspirational yet helplessly lower middle-class; she will stay single long enough to earn enough to send the requisite remittances, but marry quickly once she decides to, having planned more meticulously than the bride whose parents are paying for the wedding.

“One peculiarity was their interest in buying gold,” says Dr Mathew Antony, a Malayalee doctor who worked in the Middle East for 15 years. “They were frantic about making as much money as possible in the shortest period. Most were young and unmarried, and during their stay, they tried to marry boys in nearby countries and then land jobs in a country where they could be together. They were able to tolerate very difficult working conditions, unaccustomed-to food, difficult patients; they could cope with it all.”

There are whispers of steadily accumulated wealth; stories of nurses who own prime property in Kerala and pay for expensive surgical operations (albeit after decades of work). There is even the odd nurse who goes abroad despite a certain amount of personal wealth purely because working conditions are better there, or she wants the experience of living in another country. But for the large part, nurses who go abroad have little choice; they are the ones leaving three month-old babies behind to be raised by their grandparents, like the women we spoke to in Dubai years ago, sending their earnings home like all the other migrant workers there. They live away from family and in closely-knit communities formed anew, yearning for home. Once in a while, a crisis like the one in Iraq shakes them, and makes them question the foundation of their lives away from their homeland.

Thirty-year-old Smitha Surendran was working as a nurse in Delhi for five years before she went to Iraq four months ago, looking for the better life immigrants always assume is waiting. Originally from Thuruthikkad village in Kerala’s Kottayam district, which sends many young women like her out into the world to make their living as the Great Indian Nurse, she was hoping for better treatment for her cancer-stricken father and asthmatic stepmother. They occupy a shack-like house on abandoned government land, unable to continue work as farm labourers; living largely at the mercy of neighbours. Last Saturday, Surendran returned, like 45 others, without a single rupee in hand; via Mosul, on to the Kurdish town of Erbil and at last to Bombay, freed by Iraqi insurgents as the world watched.

“I have always been unlucky in life,” she says. Surendran earned a BSc in Nursing in Visakhapatnam, Andhra Pradesh, taking an educational loan of Rs 1.15 lakh. In 2009, she found a position at a Delhi clinic as nursing assistant, at a monthly salary of Rs 3,500. By the time she moved to Iraq in February 2014, four jobs later, she was earning Rs 12,000 per month. This was much less than the Rs 40,000 the new land promised, a promise for which she paid Rs 2 lakh in visa costs. However, like others, she has not received a single dinar for the last four months, in the wake of the conflict. Meanwhile, though, her educational loan had grown to Rs 1.60 lakh, despite paying interest for three years.

“If the threat that the Tikrit Hospital would be bombed was not there, I would have loved to stay there. Do not blame me, I did not have any other option,” says Surendran. “I was even ready to relocate elsewhere in Iraq, rather than returning. But finally, when the issue escalated to a choice between death and life, I decided to fly back.”

Already, UAE-based businessman BR Shetty has advertised an offer for the 46: placements in his hospitals and clinics across the Gulf, Bhutan, Nepal and India. Guess which part of the world they will probably choose?

“The Iraq incident will have no [repercussions] on international migration. In fact, it will enhance the emigration prospects in safe countries in the Gulf as well as Europe. Most of the nurses’ experiences are good and it provides them with both social and economic mobility. Migration failures, such as the 46 nurses from Iraq, are very few in this profession,” says S Irudaya Rajan, Chair Professor at the Centre for Development Studies’ International Migration unit and author of six migration surveys conducted in Kerala. “There is no scope of increase in internal migration until the wages offered in other states of India improve drastically, which is not likely to happen.”

According to World Bank data, India receives the most remittances: $69.8 billion in 2012, followed by China at $66.3 billion; India had 11.4 million emigrants and counting that year. Half of these migrants have over 10 years of education, according to Rajan’s study; among them, lots and lots of nurses.

An International Labour Organisation report last year puts a sixth of the 640,078 nurses who emigrated from India as originating from Kerala. Records of the Indian Nursing Council, an autonomous body under the Union Ministry of Health and Family Welfare, are quoted as showing 2 million nurses registered in the country, of whom 1.8 million are from Kerala (up from about two-thirds of the total in 2012). Roughly, around 375,000 nurses work in Kerala, while the rest have gone abroad.

“Do you know that there are nurses still working in Iraq who are not ready to come back? They are worried about huge education loans and other financial liabilities,” says Jasmin Sha, president of the United Nurses Association (UNA), an association of registered nurses in Kerala. “The scale of pay here was in the range of Rs 1,500 to Rs 3,500 even for those who have been in the profession for seven to ten years. I know nurses working for Rs 5,000 over a period of 15 to 20 years. There has been little intervention [by] the Government to regulate and control recruiting agencies. They are making huge profits by literally robbing us. For recruitment to the Ministry of Health in Kuwait, an agent demands Rs 20 lakh.” Sometimes, a country with lower fees to be paid may be a better option for a nurse looking for a foreign job, even if it is a less desirable or relatively unsafe place.

Political parties and trade unions supported the UNA with an agitation it launched in 2012, covered by Open (‘India’s Own Jasmin Revolution’, 4 February 2012) at the time as they issued notices to hospitals asking for minimum wages (Rs 15,000 per month), an end to the ‘bond’ system that forced nurses to serve under threat of losing large sums of money, health insurance and eight-hour duty limits. In other cities across India, strikes and protests have been reported for years. Kerala nurses have migrated to countries like Liberia, Senegal, Norway and Italy, apart from the US and Middle East countries, says Sha—and continue to do so.

What explains the ubiquity of the Indian Nurse? Where does the legend of her prowess as caregiver come from? “Last year, a team from USA visited us to trace the history of nursing movement in Kerala. They told us that Malayalee nurses are very caring. They show little hesitation in ‘touching’ people. They are not reluctant even in handling body fluids, despite the exposure to health hazards,” says Sha.

There is a kind of nurse who stays in India to profit from their skills. “I wanted to learn cardiac nursing,” says 28-year- old Anu Susan Varghese, a Malayalee who grew up in Bahrain and returned to India to study at Apollo Hospitals Group’s training facility and then work at its hospital, in a reverse migration that is not uncommon with plum placements like this one. “There is no difference here and abroad; there are patients from around the world there and here. Apollo Hospital has brought the world to us.”

Varghese’s mother is a nurse; her colleague, 28-year-old Smitha Chacko, had grandmothers and aunts who were all nurses, and is one of the other 90 odd Malayalee nurses who make up a large part of Apollo’s staff. In this calling, many nurses spread out across three or more generations, passing on their nursing cap to the next in line. “My picture was clear from the outset,” says Chacko, who grew up in Bangalore and has worked for five years at Apollo. “But money being a focus is history, everything [now is] about the kind of exposure you get.”

Her narrative, full of upbeat remarks on worklife (“We rock, everywhere!”), comes naturally to someone who has made it in a part of the private sector that can be rewarding long-term, as also less gruelling; these nurses say they work not more than eight to ten hours daily and are upholders of a public image the private hospital can afford to maintain.

Yet, even these privileged nurses have their reservations. “Most nurses go for Saudi [Arabia] and places like that, I don’t know if they have as much freedom and dignity as we have here. But especially here in Delhi, people don’t understand. They think we are just caregivers, housekeeping [staff],” says 26-year-old Apollo nurse Lavina D’Souza, from Goa. “One patient asked my colleague, ‘Either you’re the last child or your parents had lots of children so you are in this field?’ But it is changing. We feel very proud to work in this field; 24 hours, the patient is in our hands. At the first call, we are the responders.”

These nurses have the luxury of choice, which is ultimately what immigrants crave, whether they stay or leave. “The velvet touch—it pays to use it,” says Varghese, of successful nursing; adding: “There is a saying in Kerala: ‘Malayalees are born to fly’.”

“Since the beginning, we were not allowed to go out. We were staying inside the hospital, had food from the hospital canteen. Life was smooth till the end of May. The war started in early June. We often heard bomb explosions and were thoroughly scared. On 28 June, there was a huge explosion right in front of the casualty [wing]. Thereafter, the hospital was taken over by ‘them’,” says Veena Joseph, a 24-year-old nurse who, along with her twin Sona, has just returned from Iraq.

The young women had little access to information, other than hearsay; Veena still doesn’t appear to know who ‘them’ refers to and what they want. Veena and Sona come from Ettumanoor, a large town in Kerala’s Kottayam district that is a big supplier of nurses. Their father is a lorry driver. They worked at a teaching hospital in Tikrit, the epicentre of the current crisis in Iraq, where they migrated ten months ago, following elder sister Dona, who had been working at a hospital in Alsamawah, around 300 km away from Tikrit, for two years.

Dona is not home yet, but is trying to return as soon as possible; none of them wishes to return, though they faced no ill treatment. None, that is, except the fear of death. “We had no idea where we had been heading—life or death,” says Veena.

All some nurses need is a reason to stay. After Surendran’s penniless return from Iraq made its way onto television, offers of help are coming in for her (in addition to Shetty’s, which was meant for all 46). The CPM district committee gave her Rs 3 lakh, and Kerala’s finance minister KM Mani visited her house. She hopes his assurance of a government job is made good. Efforts are on to identify a five-cent parcel of land for a house. At last, she may not need to look for yet another way out.

(With inputs from Shahina KK in Kerala)

Indian nursesKeralaoverseas service