Angels abroad from Kerala

Malayali nurses working in different regions of the world speak to TNIE about their journeys and experiences
The lack of recognition and low wages deter nurses to return back to India.
The lack of recognition and low wages deter nurses to return back to India.Express illustrations | sourav roy

KOCHI: Eami Saji Philip (31) Operation theatre nurse, Nairobi, Kenya

I flew down to Nairobi in 2019, after marrying a male nurse who works at a private hospital here. Surprisingly, many Malayalis work in Kenya’s healthcare system. Most private hospitals here are run by Indians or Pakistanis. Contrary to my initial concerns, working here has been much easier compared with India. In India, nurses often handle three patients at once, with constant pressure from doctors. In Kenya, nurses are usually assigned only one patient each. Moreover, salaries here are significantly higher, with the average monthly earnings exceeding Rs 1 lakh. There is decent insurance coverage as well.

Here, nurses are respected as healthcare professionals and treated as equals by patients and superiors alike. Indian nurses, especially Malayalis, are valued for their skills. However, some Indian doctors who get posted here try to make nurses feel inferior.

I am proud to say that Malayali nurses handle vital tasks and assist in complex procedures here, thanks to our education system, which provides us an intensive and hands-on experience as a students. Malayali nurses, in particular, are usually willing to go beyond what’s expected from them, perhaps because we value the job more compared with others.

I faced intense pressure during the onset of the pandemic. Usually, about 25 staffers work in the surgical department. However, as many went down with Covid-19, there were times when there were just four of us doing all the work.

Despite the allure of working abroad, many of us long to return home. However, the lack of recognition and low wages deter us. Some nurses with over 20 years of experience here, returned to Kerala. But they were getting paid only Rs 20,000 a month. Ultimately, all of them came back to Kenya.

Amrutha Susan Manayil (26) clinical research coordinator, Oxford, UK

As someone in her 20s, I was eager to step out of my comfort zone and explore opportunities outside. I wasn’t satisfied with my job in India. There was a rigid hierarchy. Also, be it the patients or superiors, nurses are treated as if we chose this job because of our misery and that we aren’t knowledgeable enough. I recall testing positive for the virus while working in the Covid ward at an Indian hospital. My emotional state and physical health were at rock bottom. No one bothered. They wanted me to continue serving other patients, as I was already Covid positive.

In the UK, the well-being of the nurses is prioritised. Be it any department, our emotional state is given due consideration. Also, in case of any dissatisfaction, we can confidently raise the issue. We are encouraged to speak up, regardless of our designation.

Indian nurses are valued for their readiness to work, initiative, and comprehensive education. Subtle racism still exists. However, we have a cell to report such cases. I transitioned from the emergency department to clinical research for career advancement, as promotions can sometimes be influenced by factors such as nationality and colour. Nevertheless, there’s flexibility to switch between nursing specialities, offering growth opportunities.

Monisha Koovappally Aji (32), nurse, Msida, Malta

I have been in Malta for two years. Work stress is less compared with India. Here, duties such as blood tests and ECGs are handled by designated staff, allowing us to focus on patient care. Maltese hospitals value Malayali and Filipino nurses for their hard work and dedication. Salaries are over 10 times higher than in India, with bonuses every three months.

Malta extends several benefits to pregnant nurses. Their medical expenses are covered, and duties are adjusted for maternal care.

I have never worked in Kerala; my initial three years were spent in Uttar Pradesh. Many Malayali nurses opt to work in UP and Delhi, considering the ease of migration procedures. While working in UP, I got to see cases such as homicide and femicide. It used to be hard to handle villagers. I have encountered a near-death experience when some villagers came with guns and threatened some of us to comply with what they said.

Despite such issues, I must say, there’s a sense of comfort in our country. No other country can match that. Also, there is subtle bias. Sometimes the patients or superiors might prefer taking the opinion of nurses who speak their language.

Joby Baby (36) , a nurse with Kuwait’s ministry of health

Having completed my diploma in general nursing in India and working there for five years, I found myself at a crossroads. Facing low salary prospects, I made a pivotal decision to pursue B.Sc in nursing. After graduating, I came to Kuwait for better opportunities.

I have been working for nearly eight years. I discovered a more satisfying career path with improved working conditions. Despite initial concerns about being a male nurse, I found no difficulty in providing patient care. The friendly atmosphere in Arab countries boosted my confidence. Better pay, lower workload, and provisions to bring family along are the reasons why many Indian nurses choose to work abroad.

My journey, however, has not been without its challenges. I had to push myself to the limits during the pandemic. Separation from loved ones weighed heavily on me. The anxiety of witnessing the devastating effects of the virus and hearing about the struggles of friends and colleagues added to the emotional trauma.

Looking back, however, I am proud to have played a role in combating the epidemic, tirelessly working to provide care and support without counting the days and nights.

Boby Joseph (42), registered nurse, Queensland, Australia

After completing my nursing degree in India, I worked with a hospital in Kerala for a year. Seeking new opportunities, I moved to England and worked there for three years. Eventually, my journey led me to Melbourne, Australia, where I completed a three-month mandatory course before getting into a job. After working in various departments, I finally ended up working in forensic mental health.

It was a significant shift. I have dealt with patients who have been engaged in long-term drug usage. However, the support system within the hospital was exceptional.

I moved to Australia in 2008. At that time, the nurses in India were in a difficult situation. The workload was overwhelming, wages were insufficient, and interpreting verbal orders from doctors posed risks.

In contrast, working in Australia has given me a sense of relief and security. Here, nurses just need to give the medicine that doctors have prescribed and signed for.

While I respect the professionalism and skills of nurses in both countries, I can see clear differences in how they work. In India, nurses engage directly with real patients, honing their communication skills and understanding patient preferences. In Australia, nurses undergo simulated training.

I have been working in Australia for 14 years now. What I have noticed is teamwork is highly valued, and everyone is supportive.

Lovely Varghese (60), registered nurse, Chicago, US

I moved to the US after marriage in 1990. Those days, America was the ultimate dream for many Malayalis. Once I got a job here, I was amazed at the dignity and respect given to nursing as a profession.

Unfortunately, nurses are not treated well in India. The majority of the youngsters leave the country because they have loans to repay.

In the US, one can take up any role according to comfort. Many Malayalis opt for nurse practitioner job roles where they can run their clinics. We also get the opportunity to advance our careers by taking up several courses. Nurses have the liberty to choose the shift they want to work in. If we work for 12 hours three days straight, we get to keep off the next four days.

Despite working here for three decades, I never faced any challenges that weren’t beyond my control – until Covid struck. The healthcare system in the US came to a standstill. For the first time, we faced a shortage of personal gear, and equipment, including ventilator systems, and oxygen cylinders.

I had to look after Covid patients who had severe bed sores and wounds. Since we were short of beds, some patients had to be directed to their houses with a support system. The nurse in charge had to guide the families of such patients. It was hard to manage those times.

Unfortunately, racism exists in every country. I have experienced it here, particularly with patients. I recall a 20-year-old accident victim who refused treatment from me based on my colour and accent.

Despite our superior’s explanation, the patient’s demand for a ‘white nurse’ persisted. That included disrespectful behaviour like throwing food. While such incidents were once prevalent, strict measures are now in place to prevent/address them.

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