For Kerala nurses, long working hours, no overtime and, in some cases, wages worse than those of unskilled labour.
Representative Image of Covid 29 vaccine drive (Wikimedia Commons)
They have been hailed by the WHO and celebrated in a BBC documentary for their selflessness and skill. Malayali nurses have, in fact, even been called Kerala’s most noteworthy export not just to the rest of India, but also to every corner of the world.
Yet, in the state where their talents are nurtured and groomed, their plight is pitiable. Nursing professionals in Kerala — especially those working in private hospitals — have to endure terrible working conditions and long hours for extremely low wages.
Little wonder, the matter is now in court.
The Kerala High Court will, on Thursday, 22 September, hear a petition relating to the working conditions and the wages of nurses in private hospitals in the state.
And the nurses will be hoping for a favourable ruling directing the Kerala government to implement the recommendations of the Prof Jagdish Prasad Expert Committee, which has laid out the broad contours of what a nurse’s salary should be in different categories of private hospitals.
The expert committee was set up by the Supreme Court in 2016 after the Trained Nurses Association of India (TNAI) — one of the oldest and most prominent associations representing nurses — moved it seeking clear guidelines on their working conditions and pay scales in the private sector.
While setting up the committee, the apex court ruled that the states have to abide by its recommendations, which were submitted the same year.
According to Siju Thomas, joint secretary of the Indian Professional Nurses Association (IPNA), another nurses’ body that subsequently took the case forward: “As the committee’s report was not being implemented, we filed a case in the Delhi High Court, asking the Delhi government to implement the report.”
“In 2019, the court gave a verdict in our favour, but the Delhi government said in court that the report cannot be implemented as it would put too much of a financial burden on the government,” Thomas told South First.
Thomas said, on 25 August, a similar case was filed in Kerala High Court considering the significant number of nurses coming from the state. Given that politicians in Kerala are more sensitive to the issue, IPNA is hoping not just for a favourable verdict, but prompt implementation of the report, he added.
The petition filed by the INPA seeks a direction from the high court to the principal secretary of the Kerala government on the implementation of the Jagdish Prasad Committee report that was submitted to the Supreme Court in 2016.
The Jagdish Prasad Committee had collected data from various states and concluded in its report that that salaries and basic facilities provided to the nurses in private hospitals and nursing homes were inadequate.
Recommending better working conditions for the nurses, it also laid down the broad guidelines on their remunerations.
The committee recommended that in hospitals with more than 200 beds, the salaries should be on par with those at state-run hospitals.
In hospitals with more than 100 beds, the salary should not be less than 90 percent of the state government salaries, while in hospitals with 50-100 beds, it should not be lower than 75 percent of the salary of the state government nurses.
The committee also said the salary should not be below ₹20,000 even in hospitals that have less than 50 beds.
“We are now waiting for the High Court ruling, we hope that the recommendations are implemented in Kerala at the earliest,” Thomas told South First.
South First’s conversations with nurses show the majority of the private hospital nurses in Kerala work in extremely difficult conditions and at starting wages that are in some instances even lower than that of unskilled labour in the state
Dhanya, a nurse who works in a private hospital in Kannur, said the working hours are too long and working conditions inadequate.
“In most private hospitals there are no changing rooms or washrooms made exclusively for the hospital staff. We are suffering here because a job is required to survive,” she told South First.
According to Dhanya, in some of the smaller hospitals, a fresh nurse receives no more than ₹7,000 as salary, with annual increments as low as ₹100.
Divya ES, the treasurer of the United Nurses Association (UNA) and an employee of a private hospital in Thrissur, told South First that the pandemic has only worsened the working conditions of nurses.
“Usually, if we work on public holidays, extra wages are paid. However, since the start of the Covid-19 pandemic, private hospitals have stopped paying.”
According to Divya, the generally accepted staff-to-patient ratio is 1:5. In private hospitals, however, this can go up to 20 patients per nurse.
“As more and more nurses from Kerala go abroad, the resultant shortage here will increase burden on the ones working in private hospitals. The working hours can increase by 2-3 hours due to the workload,” she said.
Overtime is another issue that agitates nurses in Kerala’s private hospitals. They simply don’t get it.
We have six-hour shifts in the morning and these usually extend up to eight hours or more due to the workload. No extra wages are paid for the extra hours we work,” said Divya.
“The hospitals in Thrissur usually have three shifts. In the morning hours, we have two shifts that are six hours each and there will be seven to eight days of night shift in a month, where the working hours are 12 hours.”
Vipin Krishnan, a social activist and a nursing professional who works with AIIMS, New Delhi, told South First: “This needs to end; it is a human rights violation. The problems of private nurses are going on for a long time without getting any attention from the government.”
Krishnan alleges that there is “an unholy alliance” between private hospitals and the government.
“There is a minimum wage which is set at ₹20,000. If there is a hospital where even minimum wage is not being paid for all these years, isn’t the government responsible for it? Nobody is interfering in the issue because there is an unholy alliance between the managements of private hospitals and the government.”
“India is a major source of supply for nurses overseas,” said a 2017 report by the World Health Organisation (WHO). The report states that nurses who emigrated from Kerala comprise a large part of the nursing workforce in several countries. The study also found that Kerala’s migrant nurses work predominantly in the private sector.
“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 United Kingdom or the United States of America, with 15 percent in Australia and 12 percent in the Middle East.”
And with good reason: They earn far higher wages in these countries than they would in India, and enjoy far superior working conditions.
Arun Karyat, a Kannur native who works in a private hospital in New Zealand, told South First that the country doesn’t have the kind of pay gap between private and public sector hospitals seen in Kerala. He added that the working conditions are far better and the staff has the option to choose their working hours, and they are paid for the hours they worked in the hospital.
Krishnan, who is also the former secretary of the AIIMS nurses union, said there is an acute shortage of nurses in various countries. In the UAE, even nurses who don’t have experience are being hired for the job.
“Our resources are being stolen by the service sector of foreign governments, isn’t that something we all should worry about?” he added.
While Malayali nurses receive generous praise abroad for their professionalism and dedication, the service delivered by their counterparts in Kerala is rarely recognised, unless it is exception circumstances like the Covid-19 pandemic.
A BBC video clip of Anna Soubry, a former British parliamentarian, praising Kerala’s nurses was widely viewed during the pandemic.
Soubry, who represented the Broxtowe constituency from 2010 to 2019, also served as the parliamentary under-secretary of state for public health. In the BBC clip, Soubry said, “Some of the best nurses, that we learn from actually, are nurses from South India, from Kerala in particular.”
The ex-pat Malayali nurses are also a significant contributor to Kerala’s exchequer. As reported in the Outlook, former Kerala finance minister Thomas Isaac has called the nightingales the “unsung heroes behind the state’s economic growth”, stating that “nobody has recognised their contribution”.
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