When I tell Nisha Wilson that through the pandemic I have heard of more than one family here in Calcutta seeking a nurse and settling for an ayah, she expresses a controlled surprise. “Is it so?” Later, she sends me a written note with a tabulated difference between an ayah and a nurse. Her summing up line reads thus: “Nursing is an art and science. The art part might be copied, but a nurse’s skill cannot be copied as it has to be learnt.”
It is an accepted fact that the Kerala nurse is omnipresent. Kerala churns out more nurses than any other state. And yet it does not have the highest number of nursing colleges — Andhra has 145, Karnataka 314, Tamil Nadu and Madhya Pradesh 188 each. Kerala has 132 nursing colleges and West Bengal 30. But to callously dismiss this phenomenon is to ignore history, culture and industry. To ignore all this is to edge closer to the precipice the coronavirus has already led us to.
Here are two narratives of two nurses, braided like a double helix and telling the story of a profession that is in Kerala’s DNA. Rosamma Dolfas, 77, from Ernakulam and Jibin Jose, 27, of Kottayam.
Rosamma joined nursing school after Class X. Her daughter Sonia Senu Thomas says, “Amma learnt about Florence Nightingale in school and decided to be a nurse.” Those days there were advertisements in Deepika newspaper inviting girls to join nursing schools that offered diplomas. Rosamma applied.
Jibin wanted to be a doctor but was told there were more opportunities as a nurse. She took the nursing entrance, joined a private institution and completed her degree. Private colleges charge anything between Rs 6 and 7 lakh for a four-year nursing course. Rosamma’s father, a farmer with five children, did not have to spend on her education; instead she received a monthly stipend of Rs 38.
In the 1960s, there were 12 girls in Rosamma’s diploma class. In 2018, in Jibin’s class there were 45 girls and a boy. The first three years of her nursing career Rosamma was a bedside nurse; next she was a public health nurse, and then, a tutor for public health nursing students. The last six years of her 33-year-long service she was a maternal and child health officer. Once Jibin graduated she contacted a UK-based recruiting agency. It gave her a list of UK hospitals to choose from, took care of the documentation work, ensured she had cleared the IELTS and CBT before departure and the OSCE once she had landed in the UK last year.
Rosamma’s sisters — Alekutty and Mariakutty — followed her into nursing. And Jibin followed in the footsteps of sisters Jubin and Mebin. Eleven years ago, Jubin had passed her nursing examination and moved to London. Last month, Mebin gave up her Dubai job and joined a hospital in the UK. After Brexit, apparently, there is quite a shortage of nurses
Rosamma Dolfas and Jibin JoseSourced by the correspondent
Rosamma and Jibin are separated by context but connected by common history. “Christian missionaries were responsible for the initial development of nursing in Kerala in the 19th century,” says Dr Latha Radhamony, former joint director of nursing education of Kerala. Prof. Nisha Wilson, who is principal of BCF College of Nursing in Vaikom, says her late mother Rita completed the auxiliary nurse and midwife programme before she got married. She says, “Most of these schools were run by government hospitals or Catholic institutions.”
At first, only Christian families encouraged their girls to take up nursing. It was mission first, then livelihood, at least purportedly. In the 1970s, when Dr Latha was ready to go to college, government nursing colleges had started offering BSc courses — the nursing schools offered diplomas. Dr Latha’s mother was a health inspector and despite the fact that they were Hindus, she convinced her husband to let their daughter explore this new field. Prof. K.T. Moly, who is principal of the Amrita College of Nursing in Kochi, is also Hindu. In 1980, Prof. Moly stood first in her graduation exams.
The older generations said they had been egged on or stumbled into nursing. But Captain Anjaly C., a 2006 nursing graduate who served with the Indian Army, says that in her village the done thing is to pursue engineering or nursing if you have decent marks. Prof. Nisha says, “Twenty years ago (in the 1990s), when I started out, nursing drew young women from the middle class. Many went abroad, did well, and inspired future generations. Today, a lot of children from working class backgrounds take up nursing.” Anjaly has a cousin who is an athlete. “That’s her dream, but she has joined nursing. Everyone has to live, no?”
In the 1960s, around the time BSc Nursing was introduced, some schools offered nursing diplomas to men. “But they were stopped and resumed in the 1980s,” says Sunil Moothedath, who is a professor in the department of child health nursing at the Amrita College of Nursing. In the mid 1980s, when Sunil graduated, there were three nursing colleges and 75 seats in the entire state. Of these, nine were reserved for boys. In 2019, when Ann Shilpa Roy graduated, there were 50 students in her class. Of these one was a boy.
I return to the table Prof. Nisha sent me. Some terms used for a nurse are “scientific training”, “rigorous training”, “certification”. Prof. Nisha has listed the four domains one has to straddle: preventive, promotive, curative and rehabilitative. After BSc Nursing there are specialty courses, PG courses and PhDs. Dr Latha says, “In the government nursing colleges, 60-70 per cent of the faculty have PhD. Some staff nurses also have a PhD.”
The state government, the Kerala Nursing Council and the University of Health Sciences all work together to ensure a certain standard of nursing education. “If a college accepts even one student beyond the stipulated capacity, it will be derecognised. We don’t allow non-attendance programmes. We insist on clinical experience.” According to Dr Latha, for all these reasons, a Kerala Nursing Council registration/licence is a coveted thing.
And yet something is off.
Prof. Moly had been ebullient while recalling her surgical postings. Dr Latha had spoken of the “gratitude and blessings” of patients. But the younger interviewees I spoke to commented about the “poor attitude towards nurses” prevailing within the Indian healthcare system and in society. Jibin said of her experience in London: “We can challenge the doctors and express our concerns and they accept our opinion. We receive more respect from the multidisciplinary team and patients, and the pay is high too.”
That’s the other thing — pay. Anjaly says her friend in New Zealand regrets even the one year she worked in India for a “pittance”. Prof. Nisha says, “It is a fact. Nurses are very, very, very underpaid.”
Rosamma’s daughter Sonia says, “Her job as a nurse gave Amma money and financial independence.” After her weekly call with her farmer parents back home, Jibin speaks to me about how she would like to educate herself further. I learn that after five years of service, foreign nurses become eligible to apply for permanent UK residency and nurses registered with the New Zealand Nursing Council are eligible to work in Australia. Jibin is happy. She says, “Till the world is around, there will be jobs for nurses. I can pick from the whole world.”