Kerala takes pride when it comes to the global appeal of their celebrated nurses and the remittances these women and men send back home. However, the recent unfolding of events across the state in the private healthcare sector does not present a similar optimistic image.
The nurses in the private healthcare sector in Kerala went on an indefinite strike; demanding better pay and working conditions. The appalling remuneration these professionals receive in their own state has shocked many. While the salaries of doctors went up exponentially through the years, that of the nurses took the reverse direction. This has gradually decreased the status of their profession in Kerala.
Shaimol Reji, a nurse with 16 years of professional experience pointed that her salary was Rs 2,500 in 2006 in Kerala while other cities in India offered about Rs 10,000 during that period and her starting salary in a private hospital in a Gulf country was above Rs 30,000. Rising up for the first time in huge numbers, the nurses succeeded in leading a series of strikes in 2012 under the leadership of United Nurses Association (UNA), resulting in a hike in their minimum basic salary to Rs 9500. But that's still a much lower pay considering their professional qualifications and in comparison to other trained professions or even manual labourers.
The situation of the nursing profession is just a microcosm of the larger society and to a certain extent of women and their everyday experiences of gender inequality and how their position in society interacts with their profession. Hence, it is impossible to approach the issues within the nursing profession by isolating them from the larger issues faced by women in the society.
Though the literacy rate figures and gender ratio of Kerala garner applause in the country, the reality is that even when a Malayali woman is educated, a professional worker and an earner, she still lives under the subordination of men.
An attempt to understand the issues by analysing the salary scale alone of the nurses will only give one part of the picture. What is happening to the nursing profession today is a result of not just those times when nurses decided to accept a lower wage for the sake of experience; it has deep roots in how nursing was predominantly viewed as a women’s work, its unskilled beginnings and the way the society has always and still looks at women’s labour.
Historically these nursing women have been coming from the lower strata of the society too, adding to the strong power relations of gender and class in the medical field. Even though the nurses in Kerala are trained heavily to perform even on par with the doctors themselves, they are still seen as less empowered in the largely masculine hierarchy. It is because of this subordinated idea of lower class women nurses also that men in nursing are seen as a threat to the ‘smooth’ running of a hospital in Kerala these days.
It is also important to note that, until recently the nurses could not come together as an influencing workforce in the form of a trade union, particularly in the context of Kerala where trade unions have a very strong political hold. Part of the explanation lies in the education of the nurses. As women in a private nursing college, they are conditioned in such a way that they remain subdued, for that is how polite women are supposed to behave. This subdued and polite nature is fostered in them by college management with the aid of teaching staff and more notably through their compulsory hostel life.
"Nursing students are parroted that they study a syllabus almost similar to MBBS, they are not allowed to use mobile phone or even call parents from hostels; they can’t have holidays for more than 4-5 days in a year and notably even within the institute they can’t participate in students' union activities because there aren't any students' union bodies," says Reji.
The few colleges which have some kind of students’ bodies are heavily supervised by the teachers. On the other hand, MBBS or BDS students in the state do not have even half the restrictions of a nursing student residing in hostels. After all, how much can the management control the elite kids who take admissions by paying lakhs of rupees as compared to the nursing students. As per a report in 2012, more than nine lakh out of the 11 lakh nursing students have taken bank loans to complete their studies.
Parents send their children to nursing colleges with the hope of an assured job at the end of the course. After the course, with few years of work experience in India, they hope to fly abroad to earn enough so that they can repay their bank loan. But with the Gulf crisis, the number of nurses going abroad has fallen considerably, and with their low pay in Kerala, it is almost impossible to repay the educational loan. Raji who started working as a nurse in the year 2010, has been repaying her educational loan for the last eight years and she says not even half of it is covered so far.
Girija, a senior nurse with 27 years of experience said, "It was difficult for us to protest, most of us are women. Because of our household responsibilities we were forced to work even for a petty salary."
Caught in family responsibilities and lack of recognition as a workforce because of their predominant women population, nurses remained vulnerable to fight against the managements. But with due credit to their resilience, the United Nurses Association (UNA) was formed in November 2011 which organised and led the struggle for an increase in pay and other benefits. For the first time, nurses in the state had a union to stand for them. After their successful set of strikes in 2012, hospital management in the following years failed to maintain the minimum basic salary setup by the state government.
The two-month-long strike started by UNA in June 2017 demanded that the recommendations of the Supreme Court appointed Jagdish Prasad committee should be implemented. When the strike began, the private hospital management representatives gave an emotional statement saying that the nurses were striking not against them but the patients. This selective paramount compassion and empathy that the pseudo-do-gooders wear, was a clear manifestation of their outright denial towards paying any attention to the demands of the nurses.
Many hospitals run by godmen/godwomen and other religious organisations also failed to live up to what they preach. The management of these hospitals tried all means including threats, abuses, and religious sentiments to suppress the strike. Even the other staffs (including those in their affiliate educational institutions) were unable to overtly show their support to these striking nurses.
Withstanding all the odds, the United Nurses Association and the Indian Nurses Association succeeded in pressurising the state government to implement the Jagdish Prasad Committee recommendations which will result in an increase of more than 100 percent hike in salary, an amount at par with government hospitals.
The increase in salary of the Nurses can truly be acknowledged as a success of their struggle for years. But until the women are freed from the subordinate position within the profession and from the society, their professional life will remain a debacle.
Updated Date: Oct 11, 2017 14:12 PM