Who Cares For The Care-Givers?

Number Of Nurses Going Abroad

• 2014 20,000

• 2015 2227

• 2016 740

Source: Indian Nurses Association

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It’s almost like a untended health problem that’s become a full-blown medical emergency—and it stalks the very core of the medical establishment. Nursing, the one thing in healthcare that everyone takes for granted, is in crisis. And Kerala, which almost functions as an organ that pro­duces this vital resource for the whole body, is at the centre of it.

Two stories express, in all their biographical drama, both the general elements—those always present as an underlying condition—and the specific turns it is taking. The first story, that of Marina Jose, is one of double betrayal by fate. This 42-year-old senior nurse from Palikkathode village, near Palai, was held hostage along with 45 other nurses by ISIS militants in Iraq—a dramatic episode that became the subject of Mala­yalam blockbuster film Take Off.

This is how it went. On June 11, 2014, when ISIS forces swooped into Tikrit, the hometown of Saddam Hussein, the city’s residents fled in hordes. No such luck for the 46 nurses from Kerala. Except for one nurse from Tamil Nadu, they were all stuck on the second floor of the Tikrit Teaching Hospital. Trapped in the middle of someone else’s war, they simply had nowhere to go. The hospital was all but abandoned by the doctors and all other staff. Before the kitchen staff fled, they left the stove and gas cylinder and some bags of rice, potatoes and tom­atoes for the nurses.

Then began the ordeal to survive, rec­alls Marina, who’d by then spent nearly a year in Tikrit. “The ISIS militants occ­upied the basement, we were on the second floor. We became the human shield. The ISIS knew that as long as we were there, the Iraqi troops wouldn’t bomb the building. But we still lived in constant fear that a bomb would fall on us. Every now and then we’d run for cover,” she says. “The air-conditioning was turned off. It became unbearable, sitting cooped up in the oven-like building with very little food and water. But strangely, the plug points worked and the communication channels were open. We could contact the Indian embassy, our relatives back home and the media. The embassy charged our phones.”

It was Marina who took charge of the situation. It was she who kept the Oom­men Chandy government and the amb­assador in the loop. For nearly 20 days of excruciating tension, all they could do was wait to be rescued as bombs fell all around them. Marina rec­alls how the nurses were called a couple of times by black-clad, armed ISIS militants to att­end to emergencies—though scared out of their wits, they were duty-­bound to do the nursing. Marina herself had to once attend an emergency caesarean section of an Iraqi friend. “I did it, tho­ugh I recall being scared to even venture from my room to the operation theatre because of the heavily armed militants standing outside.” On July 5, the nurses were rel­eased by ISIS and they flew back home from Erbil airport.

The next twist, which is of a piece with the general neglect that nurses face, happened after their Tikrit ordeal bec­ame the subject of Take Off, where Parvathy Menon played Marina’s character. She even helped with the film’s promotion but got no money for it. “We were promised that some of the proceeds would be used to help us nurses. Nothing came out of it. And I’m not going to ask for it.”

Jobless for three years now, Marina has re-entered the permanent nightmare that life is for nurses back home. Meagre pay, dismal working conditions, zero growth—everything that precipitated a month-long nurses’ strike in June-July. The state was facing one of its worst epidemic breakouts, but the nurses say they had no choice.

“I have two children, aged 9 and 11, and after years of being away from my family I’d like to get a job closer home. But things are dismal on the job front in: Kerala. I have 16 years’ experience but hospitals are only willing to take me in a junior position. The strike exposed the reality: hospitals are not even willing to pay a minimum salary of Rs 20,000. The very reason why I had to work abroad.”

Another nurse, another émigré’s story that ended badly. Lincy Philipose, 45, had worked seven years in Libya’s Ministry of Health before that day in 2011 when the embassy gave her and her family just hours to board the flight back to India. “We had to drop everything and flee. I lost most of my money and benefits. After a year, I went back to Libya alone. There were brief periods of peace but it became increasingly difficult… I had to pay heavy interest just to transfer my salary back home. I came back for good nearly a year ago but still haven’t found a job. Hospitals want younger staff so they can pay less. The cutoff age for an interview is 35. I may have to do something else.”

It’s not just the conflict zones. For lakhs of Malayali nurses, who join the profession hoping for work on foreign shores, the future looks tense. Earlier, they could look forward to higher pay abroad with some certitude after a year or two of toiling here post-graduation. Now those dreams have all but evaporated. The US has stopped recruiting Indian nurses for over five years. The Middle East space has shrunk too. Besi­des conflict, there is the naturalisation policy adopted by countries like Saudi Arabia. Add to that a skewed central government policy, since 2014, of permitting only a handful of agencies to rec­ruit nurses for Europe and the Gulf.

The Indian Nurses Association (INA) cites a steep drop in recruitment in the Middle East in the past three years. From a high of 87 per cent before 2014, Indians now make up under 12 per cent of nurses being recruited. And from 20,000 in 2014, only a mere 740 were recruited from Kerala in 2016.

Kerala, the largest exporter of trained nurses from India, has done little to improve conditions back home either. Salaries are far below that of even lab­ourers or unskilled workers. Trainee nurses get below Rs 6,000 per month—Rs 200 per day. And the “trainee” period is usually prolonged—most nurses are compelled to work 5-6 years like that. Unable to repay the education loans—the four-year BSc nursing course fee goes up to Rs 7 lakh—many trained nurses do other menial jobs.

Says a 30-year-old former male nurse from Kannur: “I’d taken an education loan of Rs 4.5 lakh, but my starting salary was a mere Rs 3,000. Forget repaying my loan, I couldn’t even make ends meet with that. After two years, my salary was hiked to Rs 5,000—still no good. I had to finally sell my land to pay off the loan. Very sadly, I had to turn to driving a minibus to support my family. Now I make anything from Rs 30,000 to Rs 50,000 per month. The promised min­imum salary of Rs 20,000 would be just about enough to survive. I don’t know if I want to go back to nursing.”

Says Sibi Mukesh, state vice-president of one of the nurses’ associations that organised the strike, “In many hospitals, there are no changing rooms or other facilities for nurses. In some hospitals, they don’t even have the space to sit. Not that they really have the time. Sometimes one nurse has to look after 30-40 pati­ents—and the highest recommended ratio is 1:6. Natu­rally, if they so much as rest, they are immediately called by HR and scolded. Only the salaries have been addressed now.” Even that, says state INA president Libin Thomas, is only in keeping with what the Supreme Court ordered in 2016, when it ruled that the Dr Jagdish Prasad committee report be implemented.

Till 2011, the nurses were a subdued lot hardly ever demanding their rights. The first batch of self-financing colleges saw many male nurses enter the profession by 2007—and low pay and abysmal working conditions soon left them restive. They say no hospital is willing to employ them because they have shown the temerity to demand their basic rights. Some female nurses too were dismissed after the strike. “The nurses will march to the hospital to take back the jobs. We have no go but to stand together and fight for our rights,” says Thomas.

Nursing care and training introduced over a century ago by Christian missionaries brought professionalism to the sector of unorganised care-givers. Initially, only Christian women took up the job in a deeply patriarchal society where caring for strangers or men was considered a taboo. But the spread of modern healthcare saw a proliferation of nursing colleges att­ached to hospitals, and Kerala nurses were soon being deployed to the farthest corners of the earth. That period of rob­ust health is now in the past.

By Minu Ittyipe in Kochi