Learning from the Iraq crisis: When will we treat our nurses better?

Even before the jubilation on the return of Kerala’s 46 nurses from the conflict-hit Iraq, the state’s media reported another interesting story: a girl getting ready to leave for Iraq and how she is worried if she will be prevented by the emigration officials from boarding the plane in Kochi. The angst and the terror that the nurses who returned went through is no deterrence for this girl because her socio-economic conditions are quite dismal. She has paid a hefty sum for this job and if she doesn’t take it up, her family will not only be able to make both the ends meet, but will also be in a terrible debt trap. Although the girls who returned from Iraq have reportedly said that they would never go back, they also don’t conceal that their relief would soon turn into a nightmare at home. All of them have educational loans and the hefty agency fees, that they paid for the jobs, to pay back and if they don’t start working abroad again, they would be in trouble. Some of them are apparently are facing action by banks from which they have taken the loans. The 46 girls might tide over the situation easily because many of them have been offered jobs in Middle East, but what goes unnoticed is that there are thousands who are in similar socio-economic conditions. The state churns out thousands of nurses every year, who get a pittance as salary. Some of them brave risks and go overseas - like the nurses who went to Iraq did - while a large number of them fan out into different parts of India to take up jobs in private hospitals. India’s private hospital industry will collapse if the state stops producing these nurses. [caption id=“attachment_1604673” align=“alignleft” width=“380”] The nurses after they were rescued. PTI[/caption] In recent times, the financial and occupational hardship faced by the nurses came into media focus in May 2012 when they went on spontaneous strikes in different parts of India. In places such as Mumbai, Chennai and several towns in Kerala, the hospitals found it difficult to function because the nurses were out on the streets demanding better salaries and better working conditions. The strike was spontaneous because the hardship was really bad. Just a spark in one of the hospitals was enough for them to come out without the backing of any political party or organisation. Instead of listening to them, the hospitals tried strong-arm tactics: physical threats, cutting supplies and water to their hostels and even en block dismissals. None of the hospitals were willing to offer them decent hikes when their average salaries varied between 5000 and 10,000. Except in rare cases, nurses are paid extremely poor salaries and are subjected to bonded conditions in most of India. It is almost a routine practice across the country to bond them for a few years at very poor salaries. To ensure that they remain bonded and silent, the hospitals retain their educational certificates. The revolt in 2012 more or less died down when the hospitals finally entered into pacts with the nurses. However, there was no uniform government intervention that would have ensured a decent minimum wage for them. Most of the deals were between the nurses and the hospitals they worked for, often mediated by the state’s labour department. Either the government of India or the state governments failed to make strong interventions. Government of Kerala, the state which is the main catchment area for the nurses, appointed a committee to suggest a wage structure. The committee recommended minimum wage rules which ensured that nurses with three years of service will get Rs 13,500 and head nurses Rs 15,150. Their annual increments, according to revised wages, would be Rs 300 and Rs 350 respectively. A nursing officer would get Rs 21,360 with an annual increment of Rs 500. The committee also recommended guidelines for leave, housing, bonus, working hours and various allowances including for additional working hours. The maximum working hours are to be capped at 48 hours. But it’s highly unlikely that all the private hospitals in the state are following the new wages. Had the hospitals been sticking to the new wages, the state wouldn’t have seen the distress migration that is continuing. In India, there is a 50 percent gap between the demand and supply of nurses because most them ultimately leave the country. The demand for the nursing courses among the girls of Kerala is by-and-large because of of such a brain-drain. With a few years of work in India, they can manage jobs abroad - mostly to Gulf, north American and western European countries; but nobody warns them about the impending dangers as they faced in Iraq. India needs a large number of nurses - according to a WHO calculation, 2.4 million in 2012 itself - to improve its healthcare standards; but the country is treating them shabbily and losing them out to the rest of the world. It’s hight time that uniform guidelines and rules ensured better working conditions and salaries for them.