Nurses from Kerala are engaged in the UK’s fight against COVID

The WHO estimated that over 30 percent of nurses who studied in Kerala work in the United Kingdom and United States Stephanie McGehee / REUTERS
29 March, 2020

As healthcare workers fight the COVID-19 pandemic across the world, nurses from Kerala are on the frontlines of the battle. A 2017 report by the World Health Organisation states that “India is a major source of supply for nurses overseas.” Nurses who emigrated from Kerala comrpise a large part of that overseas workforce.

The WHO report added, “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% of nurses who studied in Kerala work in the United Kingdom or the United States of America, with 15% in Australia and 12% in the Middle East.”

In a British Broadcasting Corporation video that has recently been shared on social media, Anna Soubry, a former British parliamentarian, is seen acknowledging the contribution of nurses from Kerala to the country’s healthcare system. Until last year, Soubry represented the Broxtowe constituency in the UK’s Nottinghamshire county. She has previously served as the parliamentary under-secretary of state for public health. In the BBC clip, Soubry said, “I don’t have a problem with people coming to work in our country from overseas. Some of the best nurses, that we learn from actually, are nurses from south India, from Kerala in particular.”

I spoke to nurses from Kerala who are currently working in the United Kingdom. The country has over 14,000 confirmed COVID cases, and atleast 759 people have died from the virus. The nurses described what it has been like on the forefront of the COVID-19 pandemic.

Ancy Anto is a nurse working in a hospital in the city of Oxfordshire. She said that even one month ago, when COVID cases were coming in, there was a separate area set up, away from the hospital, for patients with COVID symptoms and for those coming from countries where the number of confirmed COVID cases were higher. “I work in a medicine ward where elderly patients are treated,” she told me. “Now there is an effort to increase the availability of beds in the hospital to contain the scenario. Along with that, the patients who do not need emergency care are being discharged from the hospital.” 

Anto added that ensuring her family’s safety is the biggest challenge that she is facing at the moment. “Keeping the family safe is the problem. We need to work anyhow, without knowing who is positive, that’s a big risk” she said. Anto lives with her child and her husband in Oxfordshire. She grew up in Kerala’s Thrissur district and migrated to the UK in February 2019. 

Remya R Krishnan, who moved to the UK last year and works as a nurse in a hospital in east England, spoke about the lack of protective gear. “It is really sad that the authority is not taking proper measurements to control the situation,” she said. “The main concern we Indian nurses have is that they are not providing protective equipments. Also, unlike in Kerala, they are refusing to do the COVID-19 test for the hospital staff.” She continued, “Actually we are comparing the situation with what is happening in Kerala, so compared to that, here they are not taking much precautions.”

I also spoke to a nurse from Kerala, who works in the London North West University Healthcare NHS Trust, a trust which provides hospital and community services. Speaking on the condition of anonymity, she said she had already nursed more than ten COVID cases in the past week. She added that the UK was not adequately prepared for COVID-19. “Looking at the current situation, I feel we were not fully prepared, a chaos due to that is evident everywhere,” she said. “This has also led to a lack of personal protective equipments, the management is still trying to make up for the shortage.” 

The nurse elaborated that most of the time, the screening of patients is done only after symptoms appear for a few days, by which time the health staff seems to have already been exposed. “Everything is gradually changing and there are some positive effects as the lockdown has been announced, but as a whole it is a terrifying environment,” she said.

She added that the challenge ahead will be to keep the staff from getting sick. “We could be carriers, which can affect our family,” she said. Refering to the hospital management, she continued, “There is a process started by them to provide hotel accommodations to health workers. The other main concern will be how do we deal with a situation where there is a shortage of staff. Currently, there is shortage of beds as well.”

The nurses were thrilled when told about Soubry’s acknowledgment of Malayali nurses. The nurse from LNWH told me that it is a proud moment that somebody recognised their work. “I think the compassion and care, that’s what makes Malayali nurses outstanding,” she said. “If any crisis arise, definitely there will be Malayali nurses as frontliners. In this situation as well, the majority proportion of Accident and Emergency team in London are nurses from Kerala. Unless there is a valid reason, these nurses do not back off.”

Anto pointed out that one reason for Malayali nurses doing good work abroad is due to their multi-disciplinary education. “We are trained to do multiple aspects in the four years,” she said. “In the first year you will learn the basics, then we study medical patients, surgical patients and we study maternity, paediatrics, mental health and so on. There is an opportunity for exposure in every aspect.” She said this kind of multi-disciplinary knowledge is lacking in the nursing graduates abroad.

Maya John, an assistant professor in the department of history at Delhi’s Jesus and Mary College, has studied labour issues surrounding the work of nurses. She said nursing has historically been a sought-after sector for Malayali women who wanted to enter a profession with a social impact. If earlier it was the bastion of women, recently men have entered it in large numbers as well. “One of the important factors for this change in the gender composition is there is a perceived high employability of nurses particularly abroad, so there is an attraction of quickly getting a job in the Gulf countries or other places which has in the recent years encouraged lot of men to join this profession,” she said.

John added that nursing has been a highly unrespected and underpaid profession in India. In the last decade, nurses have started organising themselves better, but exploitation in the private sector still persists. She said that the “private hospital lobby” in India has prevented relief measures such as standardisation of wages, which has forced nurses to migrate.

According to the 2018–19 annual report of the Indian Nursing Council, a national regulatory body for nurses and nurse education, there were 2.1 million registered nurses and midwives and 879,508 auxiliary nurse midwives in India. At present, there are atleast 1,544 institutions registered under the Indian Nursing Council that are offering nursing programs. However, severel graduates look for jobs abroad since India’s private sector hospitals do not pay well, and public healthcare spending is limited.

According to a working research paper titled, Emigration and Remittances: New Evidences From The Kerala Migration Survey, 2018, published by the Centre for Development Studies, a Kerala-based research centre, the emigration of women in Kerala is “vastly concentrated in the nursing profession.” The report further states that “The demand for Malayalee nurses all over the world is well known, and its supply from Kerala is still open. Five percent of the total emigrants are nurses.”

The nurse from LNWH said that her workplace had seen among the first COVID-19 positive cases in UK. I asked her about being a health worker dealing with an highly infectious virus. She replied that despite all the worries and uncertainties, “it is our job to do it and we will fight this out.”