From East to West

"We are looking for nurses working in U.A.E. or in India. The girl should be god fearing. Our boy, Male, 28, who is handsome, is working as a supervisor in an electrical company in Sharjah having family status. He belongs to a renowned family in Central Travancore. Interested parties do contact us." An ad on a matrimonial website.

Traditionally, not too many would advertise for a bride nurse. People thought they were dirty as they handled the sick and the poor. The society questioned their chastity as they touched strange men unsupervised. Attitudes haven't completely altered, but things certainly have changed for the Indian nurses, especially those from Kerala. As they get better opportunities in the western nations (particularly US, UK, Canada, Australia, or the new hot-spot Ireland), unlike the traditional destinations in the Middle East, and earn more money than many 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 eligible bachelors. What's more, she is even being wooed by the US government: on May 25 this year, the Senate approved immigrations reforms that would, among other things, eliminate the restrictions on the number of foreign nurses that can enter the country. That’ll open the floodgates for Indian nurses, who can now skip their stints in the Middle East and fly straight to the US. So, like the engineers and the doctors, a nurse can now hope to get a green card and American citizenship.

‘Life is full of choices…choose carefully,’ reads a poster at New Delhi’s Fateh Institute - which is the first stop for several nurses on their final course to the West. These nurses, the majority of whom are from Kerala, come determined to score high in English to get an easy entry to the US, which is witnessing a spiralling shortage of 100,000 nurses. They have seen this dream come true for the drones of didis. With such opportunities, the desire of these budding nurses to work in developed nations hardly seems like one that needs 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 the 25 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 manner that’s helpful in working in ICUs, where she wishes to work. "Nursing is a noble profession, people get a chance to go abroad and do work, and visit many countries", she says. And she quickly adds: "Abroad there are good working conditions and good hospitals and also we can met many people; it’s a good living, it’s a foreign country."

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

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

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

Meanwhile, Beena Joseph has already chalked out her future plans. She is confident she will ace the English test. She knows that she will find it easy to acclimatise in the US, even though she hasn’t been there. When she reaches America -- and Philadelphia is ideal -- she’ll bring her parents there after a couple of years. Probably before her parents move in, she will marry a man from Kerala. (Many nurses return home to marry, as the Keralites in the US are mostly engineers, and may not want to wed a nurse as the old stigma lingers there.) The husband will obviously move to the US too.

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

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

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

According to the American Nurses Association (ANA), 3.5 per cent of US nurses are foreign born - that was over 100,000 in 2004, of whom half are from the Philippines, and 1.3 per cent have an Indian diploma. In 2004, the average income was almost $60,000 (Rs 27 lakh) a year, which is substantial although recruiting agencies often take a cut. But the nurses usually complete their initial contract and renegotiate a much better pay, without any commissions involved, 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 easier because of the feedback she got from other nurse friends in the Middle East who emailed their experiences. "Arabic countries are very strict; there is a great difference between religions, especially Muslims, Christians and Hindus," she says of what she has heard about the region, particularly Saudi Arabia. "There is great discrimination between these religions."

Joseph says that her friends went to the Middle East as they didn’t want to take the tests required for the western countries."Those who are in Saudi Arabia will try to come back and settle here or go to another place." Dubai is full of Indian migrants, but they don’t mingle much with the locals. Percot saw first-hand the discrimination Indians faced in the Middle East. "It was complete segregation," she says. Her research shows that one of the main reasons nurses didn’t stay on in the Gulf was because they didn’t feel welcome to stay - not by the people or the law.

The first region that Kerala’s nurses ventured to was indeed the Middle East because the requirements weren’t out of reach. But since the Western countries opened up to India’s nurses, Percot says it has become the preference. "It’s easier to move to Christian countries," Kochar adds. "When you are moving and unstable, you are always looking for support - religion is one of the most stabilizing." Yet, Percot finds that the push from the Middle East 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 Mother Teresa and Florence Nightingale in aiding this migration. Many Keralite nurses told Percot that the two were an inspiration. Mother Teresa may have inspired the work itself, rising above any prejudices about helping the poor and the sick. And Nightingale showed the way to traveling around the world, including India, to gain respect in a male-dominated world. As Chandran says, "If we have knowledge and we are brave, we have confidence."