Kottayam is the 'nursing belt' of Kerala. Christian missionaries played a big role as mediators for nurses to travel abroad in the area. (HT photo)
Caritas nursing school is one of the oldest nursing schools of Kottayam. (HT photo)
A photo of Jasminsha M, president United Nurses Association. Around 2.75 lakh Kerala nurses have joined it in the past 2 years. (HT photo)
Nurse Marina Jose at her home in Kottayam after coming back from Iraq. (HT photo)
Marina on the way to her hospital in Iraq. (HT photo)
Nurse Marina Jose on duty at a hospital in Tikrit, Iraq. (HT photo)
Sunita Gopi, who comes from a poor family, went to Iraq to repay financial debts. (HT photo)
Smitha Mol went to Iraq to repay her student loan. (HT photo)
On Kottayam’s streets, the coconut palms are in shock, not a gust of wind moves their leaves. When it rains lightly for a half hour, no one goes indoors; it stops nothing. The water barely muddies the paddy fields; the sun stews the canals; the days just don’t end.
The rains are weak this year in Kerala and everyone was talking about it. Then they started talking of something else — the rescue of the 45 nurses from Iraq, and the scandal of another batch that wants to go right back.
The return from Iraq has lobbed certain questions at the Kerala nursing fraternity. It believes it has to answer them, both for self-clarification and to explain why things are the way they are.
The questions are: Should they allow themselves to be ill-paid and stay safe? Or should they, before all else, go after the money? According to the Indian Nursing Council, there are 20 lakh registered nurses in India of which 18 lakh are in Kerala.
Veteran nurses say 75% of all Malayalees have at least one nurse in their family. Both veterans and freshers say a Kerala nurse struggles under the pressure of ‘being good,’ and ‘obedient’ — on the job and for the family — without complaints, more than her counterparts from elsewhere in India.
“No matter the risk, the lack of pay… once a nurse from Kerala is on duty, she’ll be fully on,” says professor Ambika CV, principal at the Government College of Nursing, Kottayam.
“Kerala is known for giving the finest theoretical and practical training to its nurses but there is no value for their specialisation,” says Mary Joseph, a teacher. “Hospitals are filled with diploma holders. A post graduate and a Bachelor of Nursing join at the same designation, almost the same starting salary of Rs 25,000 in the state government sector.
At the Caritas Nursing School, founded in 1962. Caritas is one of Kottayam’s oldest nursing schools. (Saumya Khandelwal/HT Photo)
There is educational empowerment, no doubt, because of the number of colleges, but they create aspiration but no commensurate professional opening.” She says nurses are leaving India because it’s getting near-impossible to manage the workload. “In a 90-100 bed general ward, two to three nurses are on a duty shift,” says Joseph.
Private nursing jobs may pay more but there is no job security, says Jasminsha M, president, United Nurses Association (UNA), a body that 2.75 lakh Kerala nurses have joined in the last two years since the suicide of Beena Baby, a nurse at a Mumbai hospital.
Several private nursing institutions “sign on staff nurses without an appointment letter, pay them no salary for the first one-and-a-half years on the grounds of enabling them to gain experience, and demand resignations if they get pregnant,” he says.
In this scenario, the economic returns of a foreign assignment seem, and are, immediate, but not without minefields. Take the career graph of Marina Jose, one of the nurses back from Iraq: In ’97, she was paid Rs 3,500 as nurse in a private hospital in Pune; she made Rs 25,000 in Jeddah, Rs 55,000 in Malaysia, and Rs 50,000 in Iraq. But at what price?
Marina looks as if she is back from the dead. Her eyes are too big for her face and her voice shakes as she tries to rationalise her complicated domestic arrangements: “My husband works in Doha; I was in Iraq. We would meet for a month in a year. My kids are at boarding school in Kerala.
Sometimes I cry and I cannot stop. When people ask if we wouldn’t be happier staying together, I’m stumped. If I had a better job here, would I go?”
Smitha Mol S, also an Iraq returnee, has now set her sights on a hospital in Oman. Her life, so far, is a knot of debts. The daughter of a poor family, she paid Rs 2 lakh to agent for the Iraq job and is yet to repay her educational loan of Rs 3 lakh. Her Delhi job paid her Rs 12,000 a month. When Iraq called, she went.
Nurses from Kerala have been going to Iraq for at least two decades, and to Libya for four. “The information brought back was that Libya, till the time of Gaddafi, was a peaceful place. The reconstruction of Libya also meant there would be openings.
With loans to repay and salaries five times higher than in India, it made sense to go,” says Praveena Kodoth, a gender scholar with the Centre for Development Studies, Thiruvananthapuram. “There are stories of people who made it good, so a nurse may well think she would be one of those.
You don’t enter a job expecting to fail.” This, more or less, is the reason behind the Iraq-going story. There are success stories too. Thresia Dias, 53, who now runs three health centres in Kuwait began her Iraq stint during the Saddam regime as a staff nurse while her engineer-husband was part of the team that built the dictator’s underground palace in Basra.
“I was respected, had no complaints about food and accommodation, and was recognised for my work. The Iraq-Iran war was on at the time and I ran through the wards, 24 hours each day.”
The German connection
It isn’t just West Asia that beckons. The first batch of Kerala nurses who went to Germany in the 1960s had the pioneers’ advantage. Translated Lives: A Migration Revisited, a film by documentary filmmaker Shiny Jacob Benjamin, talks of this undocumented phase of Kerala’s social history.
Teenagers Sosamma Jose and Freddina Edward, among others, were selected by their bishop after a German bishop requested him for nurses. With practically no training except for a ‘Good morning’ and ‘Good night’ in German, they set off for Germany.
Now settled abroad, they come to Kerala to escape the German winter. Indeed, Kottayam’s German connection runs through many institutions. Father Thomas Animoottil, director of Caritas Hospital, one of Kottayam’s oldest nursing schools, says the first nurses there were trained by Dr Peter Rode, a German.
Malayalam writer Paul Zacharia (Read his brilliant story on a home nurse, A Day’s Work, on the web) who wrote the text for the film’s voiceover hails the journey as the foundation of the Malayalee European diaspora. He rues that a state known for its feminist movement has not treated this as significant and percieves a certain discrimination at work.
“An uppercaste attitude towards nurses has deemed them as inferior because they work with bodies, wipe someone’s butt.”
The stigma that originally surrounding the profession is perhaps what makes nurses across class, caste and religion mouth the ‘good girl’ discourse as a reflex.
While dominated by women from Christian communities, Hindu women and Muslim men too now form a sizeable part of the nursing population. Questions about what motivated them to opt for this particular profession prompts nursing students to throw the examples of Mother Teresa (not a nurse) and Florence Nightingale (who was one), back at you.
Kerala’s care ethic, says Kodoth, follows from its respect for its ‘care-sectors’ such as health and education that are now seen as being suitable professions for its women in particular.
There is also a general disdain for jobs within the manufacturing sector. Not surprisingly, ‘sacrifice’ is so much part of the general vocabulary that it makes any talk of money, or the desire to want it, seem sacrilegious. This is the background that has contributed to the uniqueness of the Kerala nurse, and perhaps, also to her bad fortune.
Religious institutions of all beliefs have played a role in defeating nurses’ movements for better pay all over Kerala. “In the Angamaly strike in 2012, a religious organisation sent word to the nurses families that their social functions would be boycotted unless their daughters withdrew the strike,” says Jasminsha.
UNA has even campaigned among students and urged them to stop opting for nursing courses unless service conditions for the profession change. The next generation has its escape route planned, if only to the First World.
Ashwathy, a nursing undergraduate whose sister is a nurse in the UK, says she will go to the US. She sucks in her breath and her eyes glaze at the happy prospect.
In an instant, she is somewhere else, mentally in flight from a world that may pull her down — away from a future with a measly job, an escape from matrimonial columns in which “people want girls, except nurses… away from films where nurses are shown giving a sponge bath…” Her senior Asha Nair, a more serious Cassandra, predicts a crunch of staff nurses in Kerala in the next five years. She is not going to endure pesky patients asking her about blood sugar levels “while perfectly well knowing the answer” for much longer. “No staff nurse for me, I’m turning teacher. And I’m not the only one.”