Nursing a foreign dream

Unhappy with wages, working conditions, nurses are leaving the country in hundreds every year — bad news for a health care system facing a shortage of nurses report Jaya Shroff Bhalla & Meher M Ali.

Leeja VR (25) came to Delhi in 2005 from Cochin, Kerala, in the hope of finding work in a good hospital. She joined Mata Chanan Devi, a west Delhi hospital, in 2006 as a ward nurse.

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Now, with three years' experience behind her, she’s migrating abroad for "better salary and better living conditions".

"A relative is there (in the United Sates)," Leeja said.

"She asked me to come."

The relative, a cousin, is also a nurse.

Low wages, a heavy workload, bad working conditions and a sense of sometimes not being treated with respect are making Indian nurses migrate to the US, the UK and other countries, in thousands.

This, in turn, is increasing the shortage of nurses in the country ­­ a gap nurses coming out of nursing colleges are not being able to fill quickly.

Leeja, along with other nurses of Mata Chanan Devi Hospital, went on strike on February 2 to protest low wages and alleged bad working conditions.

Nurses from Chanan Devi are demanding that their basic salary –– Rs 4,075 –– be raised to make it at par with government nurses’ salaries, which improved considerably after the Sixth Pay Commission.

"New recruits (among government nurses) take home around Rs 30,000 a month. The basic pay of a staff nurse is Rs 9,300," said Satya Jatav, nursing superintendent at Lok Nayak, a Delhi government hospital.

Nurses also want a healthier nurse-to-patient ratio, which is one nurse for every 14 patients at Mata Chanan Devi (the WHO norm is one nurse for every six patients). The strike at Mata Chanan Devi was the fifth by nurses employed in the private sector in the capital during the last six months. Earlier, nurses from the Metro group of hospitals –– Maharaja Agrasen, Batra and City –– had boycotted work citing low salaries.

"Although private hospitals are not within our ambit, we are forced to intervene many times," said Delhi’s health minister Kiran Walia. "The extent of exploitation in smaller hospitals and nursing homes is unimaginable."

Deepa George (23), a nurse at Batra Hospital who plans to migrate to New Zealand, said: "Seventy per cent of patient care is in our hands. Then why don’t we get respect?"

The issue of attrition In the private health sector, especially in bigger hospitals such as Max and Apollo, the average attrition rate (for nurses) is about 35 per cent.

"Our median salaries (for nurses) are in the range of Rs 15, 000 to Rs 16, 000 per month," said Surajit Banerjee, director, human resources, Max Healthcare. "Our attrition is around 28 per cent, but that is possibly the lowest in the market."

Anup Leons, owner of Good Luck Agency in Cochin, Kerala, specialises in sending nurses abroad. He charges Rs 1-1.5 lakh as initial processing fee for Gulf countries and "more than Rs 5 lakh" for European countries. Most nurses prefer to go to Kuwait and Bahrain (in the Gulf) because they earn Rs 50,000 to Rs 1.25 lakh per month there, he said.

Deadly domino effects If a country has less than 2.5 health personnel (including doctors, nurses and midwives) per 1,000 population, it faces what the WHO calls a "human resources for health" crisis.

India has 1.87 health personnel for every 1,000 people. It’s one of the 57 countries facing such a crisis, as per WHO’s World Health Report, 2006.

"In these 57 countries, there is a high prevalence rate for diseases such as HIV-AIDS, Tuberculosis and Malaria," said Dr Jean-Marc Braichet, WHO coordinator for health workforce migration and retention. "Migration (of health personnel) increases the crisis in these type of countries."

WHO studies have shown that maternal deaths can be reduced if a nurse or a midwife is present during childbirth. There is a "big need for midwives and nurses (since) they are able to take care of mothers", Braichet said.

A meeting ground? Hospitals claim they take good care of their staff, including nurses.

"Our salaries match most other corporate hospitals’ like Apollo and Ganga Ram. Our fee structure is based on expertise, work experience and education. So, I see no reason why anyone should complain," said Dr Sanjeev Bagai, chief executive officer of Batra Hospital and Medical Research Centre.

Rajinder Kumar, executive vice president, corporate communications, Mata Chanan Devi Hospital, Janakpuri, said the hospital offered better salaries than neighbouring ones. "However, we improved their (the nurses’) salaries after they protested."

But nurses from private hospitals say they have reason to be sceptical.

"If our living conditions and salaries were better, we would like to stay in our own country," said Levin.