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Why Tikrit is still better than home
Nurses brave risks for pay

Thiruvananthapuram, June 22: Bursts of gunfire punctuate the eerie silence around them. The packets of biscuits supplied by NGOs are running out. They haven’t been paid for two months.

Yet two-thirds of the 46 Kerala nurses holed up in their hospital in civil war-torn Iraq’s Tikrit town would rather not return home if evacuated.

Conditions are so bad back in Kerala that they want to stay on in Iraq if some sort of security is assured, they have told reporters.

Their families in India are deeply worried but appear to understand.

“It’s not easy being a nurse in India. They don’t receive fair pay, nor respect,’’ said Joseph, an Ernakulam resident all of whose daughters — Dona, Sona and Veena — are in the Tikrit hospital.

“For the moment they are fine. We hope things will improve,’’ Joseph, a driver, said.

Had he not been afraid to send them to Iraq?

“What other option did we have? I had to take bank loans for their training in nursing. The loans are pending. Besides, we have to pay less to the agents for jobs in Iraq — only about Rs 1.5 lakh per head. For other countries, the costs are much higher,’’ Joseph said.

In the Tikrit hospital, the division is clear. The 15 nurses recruited last August want to come back. At monthly salaries of Rs 35,000-40,000, they have earned about enough to repay the loans their parents had taken for their training and to pay the agents — although the brewing trouble stalled their last two paycheques.

The remaining 31 had arrived in Tikrit in February this year. They have hardly earned anything and are ready to risk staying back. One of them is the younger of the two sisters of Jinto, a resident of Kothamangalam.

Both Jinto’s sisters are nurses — the elder is in Kuwait. “Four years ago, we had to pay an agent Rs 12 lakh for my sister’s job in Kuwait,” he said. “Now the rate is Rs 18-19 lakh.”

This includes the ticket fare, visa processing fees and other expenses — apart from the agent’s hefty commission, of course.

Vargheese from Angamaly in Ernakulam district is a farmer. He sold a part of his land to send daughter Sylvie to nursing school and then to Iraq.

Suffering sisters

Nurses’ representatives agree that life is tough for these caregivers in Kerala, a state that boasts healthcare of European standards and whose nurses have made a mark across the world.

“Employment opportunities for nurses are very low in the state. And in the private sector, the pay is pitiable,’’ said P.K. Thampy, president of the Kerala Government Nurses Association.

While a freshly recruited government staff nurse earns Rs 20,000-25,000 a month, her sister in the private sector is paid not more than Rs 10,000.

“Now, private hospitals have started a trainee system for new nursing graduates. They receive only about Rs 6,000 a month,’’ said R. Latha, registrar of the Kerala State Nursing Council, a regulating body.

Nurses say many private hospitals force them to sign a bond for a specific period of service and seize their certificates.

In 2012, a government-appointed committee inspected many hospitals across the state and found that nurses were forced to work 18 hours at a stretch in many of them. Some had CCTVs installed everywhere — even in rooms where the nurses changed in the absence of designated changing rooms.

That year, nurses at several private hospitals in Kerala had struck work demanding better pay and work conditions. The agitation reached a peak when three nurses climbed onto the roof of their hospital in Kothamangalam threatening to jump unless they were paid adequately.

The trio had unpaid loans that they had taken for their studies, and the bank had issued notices for attachment of the properties of one of them.

But all hell broke loose after the government-appointed committee, headed by Dr S. Balaraman, recommended pay hikes. It suggested that the basic pay for staff nurses be fixed at Rs 12,900 with a yearly increment of Rs 250, and that for nursing officers at Rs 21,360 with an increment of Rs 500.

The association of private hospital managements threatening to down shutters if the hikes were implemented, arguing the report was one-sided. Under pressure, the state cabinet appointed a sub-committee with the health minister as the convener to study the committee report.

The net result: Balaraman’s recommendations are still in the freezer.

Too many nurses

Latha suggested the demand-supply inequality in Kerala was one factor for the nurses’ plight.

“Close to 10,000 nursing students graduate in Kerala every year. Thousands more study outside the state. In 2012, over 27,000 nurses registered with the state nursing council while in 2013, the number was about 25,000,’’ she said.

Healthcare industry sources could not immediately say how many nursing jobs are created every year in the state but stressed that it would be far less than the registration figures. So, most of these nurses’ only option is to move out of Kerala.

Latha said the number of nurses travelling to the US and Canada had fallen “drastically” in recent years — probably because of a decline in the number of jobs available for Indian nurses there.

“However, the movement to Gulf countries like Saudi Arabia and Kuwait is rising again,” she said.

Saudi Arabia had sent back hundreds of nurses during the Nitaqat drive that started three years ago, when it encouraged the private sector to employ local people.

“The Gulf now seems to be favouring BSc nursing graduates over those who have taken the general nursing diploma. Now almost half the diploma seats in the private nursing colleges in Kerala go vacant,” she said.

Latha said the nurses’ most favoured destination was the West. “In the UK or Ireland, a nurse earns between Rs 1.5 lakh and Rs 2 lakh a month. They also have better working standards and learn more on the job. Most of those who travel to America or Europe never come back,’’ she added.

Those in Tikrit had all been working in Delhi, from where they were recruited for Iraq.

How it started

Father Paul Thelekkat, spokesperson for the Syro-Malabar Church, offered an insight into why Kerala has so many nurses.

“It’s linked to the spread of the Syrian Christian community. Initially, the community had high child mortality rates and this forced many nun congregations to associate themselves with medical services,” he said.

“Subsequently, they also started hospitals and many of the nuns became nurses. These hospitals opened nursing colleges and many Christian families found it the ideal way to combine service with their livelihood. They began sending their wards to these nursing colleges.’’

Even a few Church-run hospitals, however, faced protests from nurses demanding pay parity in 2012.