We end up in hospitals or care homes in the UK, together with other workers from all over the globe. Currently the state increases the pressure on our international fellow health workers and we have to find ways to oppose this. We started a series of conversations with nurses from India, Africa and Spain, which we will document on this blog and in the print version of Vital Signs Magazine. If you want to share your story and thoughts on work and migration, please get in touch!
Below you can find an account from a colleague about working in and migrating from Kerala, India. The report mentions struggles of student nurses against exploitation. This struggle continues. Currently thousands of nurses in private hospitals are on strike in Kerala, fighting for a significant wage increase. Private hospitals have largely stopped new admissions, and non-emergency surgeries are on hold. At one of the private hospitals, patient numbers dropped dramatically from 450 to 70. The nurses strike for a minimum wage of Rs 40,000 a month, which is around £320. “Nursing is increasingly becoming commercialised. The sector is witnessing a brain drain, with many professionals migrating overseas in search of better salaries and living standards,” a protester stated. We will try to interview one of the nurses in Kerala and publish it on this blog.
Studying and working in India
I grew up in Kerala, India, and studied nursing there in a missionary hospital. I was interested in charities and nuns like Mother Teresa. I had to pay for the fees and we had to work in the hospital while studying. My father had to support me by paying the fees and we really struggled during that time. I started studying in 1998 and at the time the fees were 30,000 Rupees a year (current exchange rate: £255) . We had to stay in the hostel of the hospital, that was compulsory. It was intensive training, we were rotating every three months in different departments. It was so nice to learn there, but the workload was too much. We had lots of responsibilities and a low income. We were on call, so if they had a lack of staff they would call us at the hostel and we had to come in. Those days the hospital didn’t have much income, so they ran it with students. From the first year onwards, after three months we were working on the wards. We also could only take holidays in batches, they would decide when Year One or Year Two can go on holiday. The Sisters who ran the hospital were very strict, they also deducted annual leave, so sometimes you had to stay and work, while others were already on holiday. There was two years compulsory service after completing the studies, in the same institute.
These were the two years that I worked as a nurse in India. Things have changed since then. Now there is no more compulsory service anymore and you don’t have to stay in the hostel now. The unions have changed that, we have a lot of unions in India. They started to speak up and they gathered together. They empowered the nurses and they started to talk with management. There were strikes and lots of discussions with management. It was mainly male nurses who started this, so I heard they stopped recruiting male nurses. It was difficult for many of them to find a job after studying, because they were members of unions and they spoke up for their rights. Many of them tried to go to other states or abroad and some of them choose different jobs other than nursing.
Working in Dubai
Everybody at the time wanted to work abroad, because of the low income in India and you don’t get any respect from the doctors.I was also searching for a job abroad. In 2001 I earned 2,400 Rupees (£20.50) a month, that was the starting salary. You can’t even pay back the loan with that income. Then I got married and my husband was working in Dubai. He is a plumber and he worked for a maintenance company there. In 2003 I went on a visit visa to Dubai and there to attend the Ministry of Health exam. I had to pay for flights, the visa and the exam fees myself. I spent a lot, but because my husband was already working in Dubai, we could survive. As soon as I got the pin number I started working in a private hospital. In Dubai ,private hospitals pay less and the government hospitals pay more. So everyone’s dream is to get a government job in the United Arab Emirates. It took me one and a half years to find a government job. I didn’t want to take the visa from the private hospitals where I worked, because then they pay you less and you have to work for them for two years. They take your nursing degree certificate from you and keep it, so that you stay with them. So my husband and I struggled a lot.
We took visit visa from a different visa company. In total I took six visit visas during these one and a half years. Each time, when you want to renew your visa, you have to leave the country and come back. I used to travel to Iran, sometimes stayed there for two or three weeks, then went back to Dubai. I saw many nurses struggling with that, and the pay in private hospitals is too low. Still, even the wages in the private hospital in Dubai were 20 times higher than the wages in India. That sounds like a lot, but we also have higher expenses, for the rent, the flights, the visas.
When I arrived in Dubai for the first time I noticed the authoritarian ways, it’s a monarchist culture. They treat people differently, depending if they are nationals and non-nationals. For the nationals, when they come to hospital as patients, they don’t have waiting time, they will get the most expensive things, the nicest rooms and all the service. Their medical folders have a different colour. They are treated by the senior nurses and even by the beautiful nurses. I have seen there is that kind of discrimination, that’s how I felt when I was in Dubai. In the government hospitals we mainly had national patients, there were no western or foreign patients. We had a surgeon from the UK, though, who did knee replacements there every year for one week, because they lacked local specialists. The head of departments were mainly from Egypt. The nurses came mainly from Pakistan, India, the Philippines, from all kinds of countries. When we first met in Dubai, there was interest in each other. We asked the others about life in their countries. We mingled and it was friendly. Now in the UK I don’t feel the same friendly atmosphere and nurses from abroad are more separate from each other.
It was nice to work in Dubai with the other multinationals and I learned lots about international standards. Also because the hospitals are eager to display accreditations, so they make you learn a lot of things and do a lot of audits. The working conditions in theatres were different from the UK. We only had one scrub and one circulating nurse, no extra health care assistant, like in the UK. But then we had cleaners and porters in theatres, so we don’t have to clean the theatres between cases. Here in the UK, our patients walk into theatres, but in Dubai, they admit them on the previous day and they will get some pre-medication. So they will have some sedatives. A nurse will bring them on a trolley and there will be a handover from nurse to nurse. Here in the UK it’s the anaesthetist team who gets the patient and checks them. There was discrimination in Dubai, as well, as national nurses get two to four times higher pay than the migrant nurses. But not only the nationals get more, also nurses from the UK who work in Dubai receive four times as much as nurses from Asia, I have seen this in 2020. Also many of the doctors in Dubai didn’t treat us with respect. They speak in their own language, they yell, they shout, they throw instruments on the floor. It is a disrespectful atmosphere, they use bad words when speaking amongst each other in Arabic, thinking that we don’t understand. They don’t make any unions there. We don’t have any unions in the UAE. Instead people get favours by grassing on others. Your wages don’t increase with years of experience, but through favouritism. There are yearly appraisals, the maximum is 4 points, but we never get more than 2.5. If you get 3 points you get a promotion.
Other workers from India live in labour camps, for example construction workers. They live eight people to a room, in triple bunk-beds. They don’t have much money to spend on health. They often sit in A&E and wait for treatment. Outside work life is good, because there is nightlife, we have loads of shopping malls. And on a four hour flight we can go back to our home country. The childcare is more affordable, too, there are private nannies in each apartment building. The rent, on the other hand, is expensive and you have to pay school fees and you pay for medical treatments. I paid for the maternity birth support for all my three children. After 45 days, I had to go back to work after a caesarean. For nationals, the maternity leave is six months. Rents are high, but recently, because loads of nurses move from UAE to UK, they started providing accommodation. To stop them from leaving.
Loads of nurses quit Dubai immediately after the Covid. During Covid the government hospitals stopped all elective cases and distributed nurses to different areas. They didn’t consider where they live. They just distributed nurses to different hospitals and temporary camps. We struggled to find a home. At the beginning they gave us accommodation in hotels. So we used to stay in the hotel and go to work and come back to the hotel. I had worked in theatres for 20 years, but they put me in charge of a ward. I was so scared. Patients came in on high-flow ventilators and so many other issues. Lots of responsibilities and that was so stressful. We were scared to go back home to our families. We used to take baths at work and then again at home. This experience during Covid made a lot of nurses move from Dubai to the UK.
Going to the UK
My children had already reached high-school age and that is really expensive in Dubai. I couldn’t afford to educate three children there. Many people send their children back home to India when they are that age, but I didn’t want to be separated from my kids. In India my wage would not have been enough to pay for higher education. So I decided to move to the UK and stay together here. Here you can also buy a home, send them to university and settle. They get high quality education and they are independent here. While still at school, they started doing small part time jobs and earned pocket money. My son already got a driving license. He finished his A-levels. He is waiting for indefinite leave to remain (ILR) and then wants to go for engineering. We had lots of recruitment interviews for the UK in Dubai. They were coming regularly from NHS Yeovil recruiting agencies. They were really nice. In Dubai they gave us a lot of training in the hospital, so it was easy for me to answer their questions. I passed the interview and then they said, if you can pass the English test, we will prioritise you. They paid for my flight ticket and refunded me for the test fees. It was lockdown in the UK, they also paid for three months’ accommodation. We also received free OSCE support.
There were nine new people in our group, from different parts of India and Pakistan. We were in isolation together for ten days, after arrival, then we had the OSCE training together. We had a contract with a specific trust and they said that if we had to stay and work there for two years, otherwise we would have to pay back all the money. Now they have introduced a new rule, that if you work under one manager for a year you don’t have to pass an extra English test. That also is meant to keep people attached to a job. Because I worked around 17 years in UAE, I had some bank balance. With that money, I came to the UK and could support my family. It was so difficult to find accommodation. My house owner said, if I pay six months rent in advance he will give me the house. Thank God I had money. Then my husband got a job. He couldn’t work here as a plumber, because he would have had to do additional exams. He started doing parcel sorting jobs. He left for work in the evenings from 4pm to 1am, because I have a ten year old daughter and he will take care of the school timings, sending and taking her back. And I’m working in the daytime. In theatres we don’t work nights and weekends, so I have more time with them than before. Sometimes I would work Saturday shifts and slowly we got the money for a mortgage together. Within four years we could buy a house. In some families it creates family issues that the husband earns less money than the wife, once they arrive in the UK, but my husband is happy. I came to the UK from Dubai, which is a very developed country, with the most advanced technology. In the UK the houses are small and the rooms are too small, the roads are narrow. But then the UK is a developed country and there is a reason for everything. I understood that the rooms are small, because you have to heat them.
Gradually I understood and people were treating me with respect, they were talking kindly. When I joined theatres, the surgeons said please and thank you and asked before taking instruments from the trolley. They listen to us and we can discuss things, for example during briefing before surgery or during debriefing. They don’t do team briefings in India and Dubai. So I was like, ‘Oh my God, this is nice’. It was different from my previous experiences in India and Dubai. We have a lot of associations of Indian nurses in the UK. We are members, but don’t participate in them much. We have active communities and also the church in the neighbourhood. A lot of the Keralites go there for religious studies. My husband says that in the associations there are a lot of business-minded people who want to sell people things.
I am worried about the current anti-migrant demonstrations. I was never worried when my son went out alone. Now that people are protesting I’m really worried until he reaches home. They don’t know who we are, if we are legal or illegal migrants. They just see the skin color and react. And if the government extends the indefinite leave to remain period to ten years that would be a hard time for us, because children would have to wait to start their studies. They cannot get a student loan and would have to pay for international student fees, which is three times as high. Lots of nurses are now trying to go to Australia, because of all these things. I’m already 46, I don’t want to move again. I miss India, but flight tickets are so expensive now and we only get a two week holiday. You have to ask for special permission to get three weeks and you won’t get it over school holidays. I only went to India once in five years. We video call our family back home daily and I pray for their good health, because now I have to pay £3,500 for the indefinite leave to remain for myself. This and the mortgage doesn’t leave any extra money to send back home. We pay a lot of taxes here, so we should get some benefits. We get free medical treatment, and my children get educated. I stayed 17 years in the UAE, but I couldn’t buy a house. I still think coming to a developed country is a good thing. Lots of other nurses still want to come here, but now it’s not that easy to find a job. So everybody stays in their position, because so many are waiting to find a job.
