From East To West

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Traditionally, not too many would advertise for a bride nurse. People thoughtthey were dirty as they handled the sick and the poor. The society questionedtheir chastity as they touched strange men unsupervised. Attitudes haven'tcompletely altered, but things certainly have changed for the Indian nurses,especially those from Kerala. As they get better opportunities in the westernnations (particularly US, UK, Canada, Australia, or the new hot-spot Ireland),unlike the traditional destinations in the Middle East, and earn more money thanmany other professions, they have gained success and unexpected leverage.

Today, a woman can get more from nursing than almost any another career.Enough to change her and her family’s life. She’s being chased by eligiblebachelors. What's more, she is even being wooed by the US government: on May 25this year, the Senate approved immigrations reforms that would, among otherthings, eliminate the restrictions on the number of foreign nurses that canenter the country. That’ll open the floodgates for Indian nurses, who can nowskip their stints in the Middle East and fly straight to the US. So, like theengineers and the doctors, a nurse can now hope to get a green card and Americancitizenship.

‘Life is full of choices…choose carefully,’ reads a poster at New Delhi’sFateh Institute - which is the first stop for several nurses on their finalcourse to the West. These nurses, the majority of whom are from Kerala, comedetermined to score high in English to get an easy entry to the US, which iswitnessing a spiralling shortage of 100,000 nurses. They have seen this dreamcome true for the drones of didis. With such opportunities, the desire ofthese budding nurses to work in developed nations hardly seems like one thatneeds to be made carefully - many of them feel it’s a no-brainer.

Beena Joseph never flinched from her plan to move to Philadelphia since the25 year-old heard from a friend that this historic US city makes a good home.Her pleasing warmth could never overshadow her persistent confidence - a mannerthat’s helpful in working in ICUs, where she wishes to work. "Nursing is anoble profession, people get a chance to go abroad and do work, and visit manycountries", she says. And she quickly adds: "Abroad there are good workingconditions and good hospitals and also we can met many people; it’s a goodliving, it’s a foreign country."

This unwavering certainty about the wonders of life in the west worriesSuneet Singh Kochar, CEO, Fateh Institute. While he makes his money by helpingnurses pass the English test, he tries to get them to think realistically aboutthe choices they make. That’s why he has that poster to caution them. Many ofthe nurses return to tell him about their contracts, proud of the promisedsalary. Kochar laments that the salary looks deceivingly high in rupees. It’sgood pay, no doubt, but those dollars can’t buy much in the US.

Kochar has also been researching the future changes that can make itdifficult for nurses to find overseas jobs. He predicts that language standardswill get stricter because of a lesson learned by the United Kingdom. "Patientscan’t understand Indian nurses there," he says. "And now they [in the UK]can easily get nurses from the Eastern European countries." Australia hasalready set high standards for allowing nurses into its hospitals and Irelandmay follow suit. Within the next two years, Indian nurses will need to improvetheir language skills, accent and training in the western way of nursing.

But Kochar still sees a huge potential for Indian nurses and plans to expandhis business to help nurses get jobs abroad. Currently, they have to go throughrecruiters after his institute helps them score high on the test. "Filipinonursing skills are not up to the mark…and China has a language barrier," hesays. "The world needs nurses and the biggest pocket is in India."

Meanwhile, Beena Joseph has has already chalked out her future plans. She isconfident she will ace the English test. She knows that she will find it easy toacclimatise in the US, even though she hasn’t been there. When she reachesAmerica -- and Philadelphia is ideal -- she’ll bring her parents there after acouple of years. Probably before her parents move in, she will marry a man fromKerala. (Many nurses return home to marry, as the Keralites in the US are mostlyengineers, and may not want to wed a nurse as the old stigma lingers there.) Thehusband will obviously move to the US too.

Researcher Marie Percot has seen several Josephs. She says that Kerala’snurses now create a "life strategy" based on the experience of the nurseswho went before them. Percot, of France’s National Council for ScientificResearch, spent ten months doing field research in India (Kerala and Mumbai),Oman and the United Arab Emirates, and she studied almost 300 migrant orto-be-migrant women. She went into her research thinking money was the nurse’smain drive, but found that over the decades their reasons became much morecomplex. "There is an equation of money," she says. But, "more and more Iunderstand that it is more and more an individualistic need."

She sees the women, especially the younger women, using nursing as a way toopen the doors for their families and to empower themselves to have more say intheir lives. "They are able to negotiate in the couple," Percot says. Manyof the women she studied were adamant that their money be spent on their ownchildren, not a distant cousin. But Percot qualifies the findings of herresearch. "I won’t say it is a revolution," she says, "but atleast they are able to negotiate certain things".

Nurse Smitha Chandran doesn’t hesitate to give some money to her own familyfor holidays or if someone is ill. "If I am earning, I can ask my husband withcourage to help my family. He has never objected", says the 26 year-old whocame to Delhi several years ago with the intention of going abroad. She wants tosettle in Florida because she has friends there. She says nursing will be hardwork in the U.S., but she’ll get paid for it.

According to the American Nurses Association (ANA), 3.5 per cent of US nursesare foreign born - that was over 100,000 in 2004, of whom half are from thePhilippines, and 1.3 per cent have an Indian diploma. In 2004, the averageincome was almost $60,000 (Rs 27 lakh) a year, which is substantial althoughrecruiting agencies often take a cut. But the nurses usually complete theirinitial contract and renegotiate a much better pay, without any commissionsinvolved, the next time.

More than the money, the attraction of the west, as opposed to Middle East,is driven by other factors. Joseph’s choice to move to the US was made easierbecause of the feedback she got from other nurse friends in the Middle East whoemailed their experiences. "Arabic countries are very strict; there is a greatdifference between religions, especially Muslims, Christians and Hindus," shesays of what she has heard about the region, particularly Saudi Arabia. "Thereis great discrimination between these religions."

Joseph says that her friends went to the Middle East as they didn’t want totake the tests required for the western countries. "Those who are in SaudiArabia will try to come back and settle here or go to another place." Dubai isfull of Indian migrants, but they don’t mingle much with the locals. Percotsaw first-hand the discrimination Indians faced in the Middle East. "It wascomplete segregation," she says. Her research shows that one of the mainreasons nurses didn’t stay on in the Gulf was because they didn’t feelwelcome to stay - not by the people or the law.

The first region that Kerala’s nurses ventured to was indeed the MiddleEast because the requirements weren’t out of reach. But since the Westerncountries opened up to India’s nurses, Percot says it has become thepreference. "It’s easier to move to Christian countries," Kochar adds. "Whenyou are moving and unstable, you are always looking for support - religion isone of the most stabilizing." Yet, Percot finds that the push from the MiddleEast was stronger than the pull of the Christian dominated west.

And all of this has contributed to the movement of nurses around the globe.But one shouldn’t discount or forget the role played by MotherTeresa and Florence Nightingale in aiding this migration. Many Keralite nursestold Percot that the two were an inspiration. Mother Teresa may have inspiredthe work itself, rising above any prejudices about helping the poor and thesick. And Nightingale showed the way to traveling around the world, includingIndia, to gain respect in a male-dominated world. As Chandran says, "If wehave knowledge and we are brave, we have confidence."