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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It바카라�s almost like a untended health problem that바카라�s become a full-blown medical emergency바카라�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 elements바카라�those always present as an underlying condition바카라�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 Iraq바카라�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 city바카라�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 else바카라�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, who바카라�d by then spent nearly a year in Tikrit. 바카라�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 wouldn바카라�t bomb the building. But we still lived in constant fear that a bomb would fall on us. Every now and then we바카라�d run for cover,바카라� she says. 바카라�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.바카라�

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 emergencies바카라�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. 바카라�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.바카라� 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 Marina바카라�s character. She even helped with the film바카라�s promotion but got no money for it. 바카라�We were promised that some of the proceeds would be used to help us nurses. Nothing came out of it. And I바카라�m not going to ask for it.바카라�

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 growth바카라�everything that precipitated a month-long nurses바카라� strike in June-July. The state was facing one of its worst epidemic breakouts, but the nurses say they had no choice.

바카라�I have two children, aged 9 and 11, and after years of being away from my family I바카라�d like to get a job closer home. But things are dismal on the job front in: Kerala. I have 16 years바카라� 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.바카라�

Another nurse, another émigré바카라�s story that ended badly. Lincy Philipose, 45, had worked seven years in Libya바카라�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. 바카라�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 difficult바카라� I had to pay heavy interest just to transfer my salary back home. I came back for good nearly a year ago but still haven바카라�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.바카라�

It바카라�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 month바카라�Rs 200 per day. And the 바카라�trainee바카라� period is usually prolonged바카라�most nurses are compelled to work 5-6 years like that. Unable to repay the education loans바카라�the four-year BSc nursing course fee goes up to Rs 7 lakh바카라�many trained nurses do other menial jobs.

Says a 30-year-old former male nurse from Kannur: 바카라�I바카라�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 couldn바카라�t even make ends meet with that. After two years, my salary was hiked to Rs 5,000바카라�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 don바카라�t know if I want to go back to nursing.바카라�

Says Sibi Mukesh, state vice-president of one of the nurses바카라� associations that organised the strike, 바카라�In many hospitals, there are no changing rooms or other facilities for nurses. In some hospitals, they don바카라�t even have the space to sit. Not that they really have the time. Sometimes one nurse has to look after 30-40 pati­ents바카라�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.바카라� 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 2007바카라�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. 바카라�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,바카라� 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