Kerala nurses' endless quest

For a brief moment the media's gaze fell on them — these women who inhabit the anonymous, disinfected spaces of hospital wards. It needed extraordinary circumstances to bring them to the nation's consciousness, including captivity in a war zone and capture by the ISIS. After all, the last time nurses from Kerala had caught anyone's attention was because of a jibe from a too-clever-by-half politician. Kumar Vishwas's observation that Malayali nurses were called "sisters" because they were too dark-skinned to be attractive may have been shockingly crass but faithfully reflected the general callousness that has marked popular attitudes towards these ancillary workers.

Yet the story of Kerala nurses — despite the denigration, stigma and discrimination that have come their way — is a worthy addition to the annals of women's employment in India. Opinion on how this story began may vary. Some academics have pointed to the setting up of medical infrastructure in Travancore under a beneficent raja in the second half of the 19th century as a turning point in the evolution of health care professionals, including nurses, in Kerala. It is also told that around 1906, eight Swiss nuns began work as nurses in Trivandrum and went on to train local women, although it took another two decades for formal nursing training to be made available in the local hospitals of Travancore and Cochin.

By the time the country got independence, Travancore and Cochin — which was now forged into a new state — reported the presence of around 400, largely Malayali, nurses. It was at this time, too, that the 1948 Nursing Council Act came into force, marking a milestone in the professionalisation of the teaching of nursing in India. From 1950 onwards the number of women in this region entering the nursing profession recorded a steady rise. By 1971, there were 3,542 nursing professionals in Kerala, growing to nearly 5,000 nurses over the next 10 years. Certainly universal schooling and the growing aspiration among women for a paying job played their role, but an important reason for this was the mushrooming of nursing schools. As the Canada-born professor, Robin Jeffrey, has pointed out, in the 15 years between 1977 and 1991, these institutions more than doubled — from 26 to 62. By 2010, 97 colleges offered a four-year Bachelor's degree in nursing and 218 institutions conducted a three-and-a-half-year diploma course in general nursing and midwifery. Education in nursing being profitable began to attract private capital. The state government, conscious of the high long-term returns to the state exchequer of such an enterprise, actively encouraged the trend even at the expense of the quality of the education being offered. For instance, AK Antony, in his second term as Kerala Chief Minister, allowed the setting up of 19 private teaching institutions in nursing in 2003 alone. Today the number of nursing graduates emerging every year in Kerala is estimated to be around 10,000.

Competition for placements, a very real job squeeze at home, high personal ambition and a search for higher salaries were the push factors that saw Malayali nurses consciously choose to re-locate themselves in other parts of the country and abroad. The 46 nurses who went to Tikrit were promised a salary of Rs48,000 a month — a five-to ten-fold increase of the salaries they were earning in India. Sreelekha Nair, of the Delhi-based Centre for Women's Development Studies, in her paper 'Multiple Identities and Migration Dynamics of Nurses', has observed that for these women nursing was more than a 'livelihood', it was a 'life strategy', and migration for work was 'an inevitable consequence' of such a strategy.

They were prepared to do what it took to succeed, whether it was sitting for rigorous examinations like the NCLEX- RN (National Council Licensure Examinations for Registered Nurses) and the CGFNS (Commission on Graduates of Foreign Nursing School) or paying huge sums to recruiting agents. They painstakingly collated documents, made arrangements for the family members left behind, which included young children, and headed for locations that were considered inhospitable, even hostile. The Iraq episode was not the first crisis of its kind. In 2011, when the Libyan crisis flared up, among the Indians trapped in Benghazi were 200 nurses, most of them from Kerala. In 2013, there was the case of Renu Thomas, who was killed during the suicide attack at Yemen's Defence Ministry complex in Sanaa.

For the women themselves this movement out did not come cheap. The relief those 46 young women felt on reaching home safe after their traumatic three weeks in Iraq was clearly tinged with regret over loss of opportunities and anxieties about the future. As it turned out, they came back without having earned anything and after having paid recruiting agencies amounts of around Rs1.60 lakh to get that Iraqi job — sums they could only have procured through high interest loans which would now have to be paid back.

For reasons that have to do with geography, history and household economics, the Gulf countries have always been a privileged source of employment for Malayali nurses despite the fact that they did not hold out the prospect of permanent residence. In her 2006 study, Marie Percot estimates that 60,000 Indian nurses, predominantly from Kerala, worked in the Gulf. Their jobs, interestingly, remaining unaffected even during phases when local governments had attempted to nationalise their workforce or in times of recession when unemployment stared workers in other sectors in the face — powerful evidence of the gilt-edged value of the labour power of the humble 'sister'. The remittances they sent home contributed hugely, not just towards family income, but that of their state and country, a contribution that continues to remain unaccounted and unacknowledged.

Those 46 nursing assistants, now back from Iraq, need our support, and not just because they were victims of circumstances beyond their control. As SK Sasikumar, senior fellow of the VV Giri National Labour Institute (VVGNLI), Delhi, had argued in a different context, it is time that the migration of Indians came to be viewed through the prism of gender, so that policy making became more sensitive to the rights and vulnerabilities of migrant Indian women. It is also time to give this courageous, often faceless, tribe the respect that is their due.

The writer is a senior fellow with the ICSSR