With Kerala's nurses on frontlines of coronavirus fight, a brief history of nursing profession in the state

Historically, intrepid nurses from Kerala travelled to remote corners of the country and the world — a trend that continues today, as they are on the frontlines of the fight against the coronavirus outbreak.

Gita Aravamudan April 13, 2020 09:46:36 IST
With Kerala's nurses on frontlines of coronavirus fight, a brief history of nursing profession in the state

When several nurses — all hailing from Kerala and working at a Mumbai hospital — recently tested positive for the coronavirus, Kerala chief minister Pinarayi Vijayan took cognisance of the situation immediately. He wrote to Prime Minister Narendra Modi as well as the chef ministers of various states asking them to provide proper protective equipment and care to these frontline health workers from Kerala.

Vijayan had reason to be concerned: Kerala has the maximum number of registered nurses in India, and they can be found all over the world. According to the Indian Nursing Council, of the 20 lakh registered nurses in India, 18 lakh are from Kerala.

Historically, intrepid nurses from Kerala travelled to remote corners of the country and the world — a trend that continues today. A WHO report noted that “nurses trained in India form a significant portion of internationally educated nurses working overseas, second to nurses trained in the Philippines. It is estimated that over 30 percent of nurses who studied in Kerala work in the UK or the US, with 15 percent in Australia and 12 percent in the Middle East.” A significant number work in other parts of India, with Delhi, Bengaluru and Mumbai being among their favoured cities.

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In the 1970s, while researching an article on the nurses and nuns of Kerala for a Government of India publication, I met an elderly Swiss nun living in retirement in (then) Trivandrum. She had come to India in 1906, along with a group of nurse-nuns from Switzerland, to work in the Trivandrum General Hospital, which was patronised by the Travancore royal family at the time. The nuns took in young girls from (mostly Christian) families living around the area and trained them as helpers; the idea of service was inculcated in them as part of their religion. It was only in 1934 that nursing was formally recognised as a profession.

Perhaps because of these roots, for a long time, the emphasis for nursing as a profession was on service rather than service conditions. In its early years, young women, especially from working class families across religions, eagerly signed up to become nurses because no specific educational qualification was required and jobs were easy to secure. Over the years, the nursing community grew. While it still was not a well-paying profession, it did provide these women opportunities to travel and see the world, and the assurance that they would always find employment.

With Keralas nurses on frontlines of coronavirus fight a brief history of nursing profession in the state

For a long time, the emphasis for nursing as a profession was on service rather than service conditions. Getty Images

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The beginning was difficult to be sure: there was the stigma attached to nursing because the idea of young women handling male patients was not socially acceptable. Then there was the uniform, which attracted the wrong kind of attention. And because nursing involved handling the bodily fluids of others, the profession was considered ‘lowly’.

Over the years, however, these perceptions changed as hardworking nurses proved that they could often bring in more money than their male partners. Veteran nurses encouraged others from their extended families to join the profession and they formed their own network. And to begin with, there was barely any competition from men.

The numbers of male nurses has since seen an upswing; they now form about 21 percent of the nursing workforce. A research study on male nurses from Kerala indicated that their motivations were different from the service or religion-centric reasons women nurses cited for taking up the profession. More than their female colleagues, male nurses tended to perceive the profession as favourable due to better employment opportunities and pay, with a chance to migrate to more prosperous/developed countries. Many had defied their families to become nurses as the profession isn’t considered a “manly” one.

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In 2011, a nurse from Kerala called Beena Baby committed suicide in Mumbai, where she worked. Baby’s parents were casual labourers, and she had worked hard to enter nursing training. She was still repaying her education loan when she died.

The agent through whom she had got the job in Mumbai was taking a commission from her salary; Baby had signed a two-year employment bond which stipulated a penalty of Rs 50,000 if she broke it. When she got a better job offer she couldn’t take it up because she was still serving out her bond. Frustration drove her to take her own life — a development that triggered a series of protests by nurses against the bond system. It also led to the formation of the United Nurses Association, which soon acquired a large membership.

The Association was the brainchild of Jasmin Sha, a male nurse who had worked in the Gulf. Last year, the organisation was in the news when four of its top officials (all men), including Jasmin, were booked in a case of forgery and cheating, accused of siphoning off Rs 3 crore of the UNA’s funds.

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For nurses from Kerala, the sisterhood provides a sort of canopy that holds them in good stead when living and working in difficult conditions. Mothers and daughters, aunts and nieces form networks. Some young women use their earnings to shore up their dowries, marry educated husbands, and settle down comfortably to raise families.

But wars and epidemics test their mettle and resilience. Take the case of Marina Jose, the courageous nurse who led a group of her colleagues out of Iraq in 2014, after being held captive by the Islamic State for 23 days. Despite their harrowing ordeal, many of Jose’s colleagues have returned to work, in other locations. They needed the money: some were paying off loans, others had children’s expenses to meet.

Nurses from Kerala are now fighting the coronavirus pandemic in various countries, not only across India. In the UK, they have been at the forefront of the COVID-19 battle, a Caravan report notes; former British MP Anna Soubry observed in an interview that “…some of the best nurses that we learn from actually, are from South India, from Kerala in particular”.

For nurses from Kerala, it’s all in a day’s work.

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