Despite promises of higher salaries, almost every nurse I talk to has her sights set on Canada or New Zealand

Radhika’s parents, both daily wage workers in Changanasserry in Kerala, were always keen that their daughter should train as a nurse. They took an education loan, and once Radhika graduated, she found work in a reputed private hospital in Kochi. But her two-year stint as a nurse turned out to be nothing short of a nightmare, says the 28-year-old, who is now married and on maternity leave.

Gruelling shifts and strenuous work for a pittance of a salary convinced her that the only way ahead was to enrol for IELTS (International English Language Testing System) coaching and find work abroad. “My education loan and my family’s debt from dowry had both to be repaid.”

Radhika was a staff nurse in the ICU. “It was back-breaking work caring for senior citizens, who I often had to physically lift to wash or treat. I had three shifts a week — 8 a.m. to 2 p.m.; 2 p.m. to 8 p.m.; and 8 p.m. to 8 a.m. But even though my duty hours were officially six to eight hours, by the time I was done, I would have put in 10 hours.” The salary was ₹12,000 (₹10,000 in hand). “My paying guest accommodation, LPG and electricity expenses together amounted to ₹6,000. What I managed to save, I sent home.”

Sicily, 25, joined a Kochi hospital, where she worked more than 12 hours a day as a staff nurse in the ICU. She was also responsible for stock-taking and administration. But her salary was ₹13,000, of which ₹5,000 went for hostel fees. “How do you expect a girl like her to pay off her educational loan,” asks her mother Annamma. “Even a maid earns more than my daughter in Kerala.” She is now looking to find work abroad.

The exodus

The months-long agitation by nurses across Kerala ended in July with the State government’s decision to hike the minimum salary of a registered nurse employed in a 50-bed hospital to ₹20,000. But while this may be a victory for nurses in the State, is it enough to stem the exodus of this indispensable part of the medical community to countries where working conditions are better and career prospects more exciting?

Every year around 5,000 nursing students graduate from 99 nursing colleges in Kerala that offer the B.Sc Nursing courses. The State also has 200 nursing schools that offer General Nursing and Midwifery (GNM), from which another 6,000 nursing students graduate every year. But of the 5,000 B.Sc nurses, a staggering 3,500 find placement abroad in Commonwealth countries and the Gulf, says E.A. Mohammed Shihab, state general secretary of the Indian Nurses Association set up in March 2012.

An ironical phenomenon in a country that draws droves of people for ‘medical tourism’, a $3 billion sector that is set to nearly triple by 2020. But, as Shihab says, the shortage of staff in hospitals is a harsh reality and likely to continue until hospitals follow some new standards and improve work conditions.

The new proposed salary is not about to stop the migration either. Says Shihab, “The nurses are not just looking to make more money; it’s the combined incentives of better lifestyle, better education for their children, and a higher standard of geriatric care that’s pushing them abroad.” Here, nurses get neither their due salaries nor the respect due to their education. Besides, nurses say that private hospitals are unlikely to pay the promised ₹20,000 a month. “They will cite umpteen deductions such as transport, food, and so on,” they claim.

Nurses from across Indian cities recount their ordeals — harsh working conditions, staff shortage, salaries that will not repay their education loans — and much like Radhika and Sicily, almost every nurse I talk to tells me their sights are set on Canada, U.K. or New Zealand. Mariam, 26, from Kottayam, had a harrowing experience as a CCU staff nurse in a top Chennai hospital.

“The patient influx at our cardiac unit was 13 to 14 a day, and the ratio of staff to patient was 1:4 when it should be 1:1. Our seniors wouldn’t allow us to leave until we had completed not just the nursing duties but all the paperwork as well.”

One December, she remembers having to work double shifts for five days in a row because most senior employees were on leave. “It was psychologically and physically exhausting.” Mariam gave a written complaint against the gruelling work schedule, staff shortage and verbal abuse by doctors. In reply, she was told she was being paid for her extra hours, so there was no need to complain.

Resigning wasn’t easy either. “My wedding was fixed, but the hospital authorities asked for a letter from my family as proof. Then they wanted to speak to my fiancé, also a nurse, working in New Zealand. They called him and asked him to send a letter as well.” Mariam had to go to every department she had worked in those three years and get clearances from each that she had not damaged any hospital equipment. Her salary was ₹15,000 (₹13,000 in hand) when she resigned. She is now preparing for the IELTS test and hoping to join her husband in New Zealand.

Likewise, Reji, 28, from Idukki worked for a monthly stipend of ₹3,000 (she was left with ₹1,500 after hostel and food expenses) as a trainee at a private hospital in Mangaluru. She worked two shifts — 8 a.m. to 6 p.m. and 6 p.m. to 8 a.m. “I did this for three months because I was desperate to get the certificate of experience,” says Reji, who has begun IELTS classes.

Debt, harassment at work, poor pay and exploitative travel agents who ‘fix emigration’ at ₹20 lakh — the flowchart of a nurse’s life has been the same for the last 50 years. So why would a young girl still opt for a career in nursing? “Because they are highly employable. A nurse can get a job any time, anywhere,” says Shihab. “Nursing can be one of the most satisfying professions. And if employed in countries like Canada, she is the only professional, who at 25 years of age, can earn more than ₹4 lakh a month.”

Reforms needed

A salary hike doesn’t solve the larger issue of physical and financial exploitation, says Shihab. “Several reforms are needed,” he says. The registration processes at respective State Nursing Councils should be transparent and easy, so that young nurses are not forced to look for work abroad. It is the government’s responsibility to create initiatives that help this hugely employable sector realise opportunities both in the country and abroad.

For now, the grass does look greener on the other side. Lissy, 38, has seen it all, and is happy for the way her story eventually unfolded. She graduated in GNM from Lady Hardinge Medical College in New Delhi in 1995 and earned ₹4,500 a month at a leading private hospital in the city as trainee nurse. In the emergency unit, she bore the brunt of back-to-back shifts, which she could no longer endure.

As soon as she got her certificate of experience, Lissy left for Saudi Arabia — after she paid ₹2.5 lakh to an agent — and worked for the health ministry for three-and-a-half years. “I was paid ₹30,000 after the three-month probation. Food and accommodation were free. I would keep aside a little money to call home and for basic shopping and send the rest home.”

Now, she works for the National Health Service in Wales — where her husband also worked as a nurse — as a staff nurse. She earns approximately £1,700 a month.

“I got three of my younger sisters educated. I paid off all their loans. I rebuilt our old house for my parents,” says Lissy, now a mother of three. In many ways, Lissy’s life is the ultimate success that the overworked and underpaid nurses here are striving for.

(Some names changed to protect identity)

The writer lives in Kottayam and happily flouts the Syrian Christian conventions of cooking and baking.