Part one of this series, an interview with a nurse from Kerala, can be found here. This series is not about how multi-cultural and inclusive the NHS is, but about the global inequality that forces people to work abroad, it’s about the difficulties of migrating and what it means for the general struggle of workers for better pay and conditions. This is about the UK state trying to put pressure on international nurses by tightening the visa regulations and about the necessity to stand up for ourselves. If you want to share your story, feel free to get in touch.

I grew up in Ghana and I did all my basic education there. I wanted to go to university to read law, but it didn’t work out. My cousin said: “Oh, why don’t you go into nursing”, and I thought that if it pays off in the end, then why not. I worked as a nurse for eight years in Ghana before I migrated to the UK.

To study nursing in Ghana you have to go to college for three years and it’s fully funded by yourself, nobody else. Your family needs to have a bit of money to support you through nursing studies. The government colleges tend to have accommodation attached to the school. At least till year three you can stay there. It’s like it’s a community. The government also used to give you a small allowance, but it’s not really a lot of money, it’s basically pocket money. The flipside is that when your school is completed, you are bonded to serve the government for about three years. 

The colleges are attached to hospitals, so they are literally like a teaching hospital. You do clinical placements for blocks of eight weeks. When we finish we write an exam that is conducted by the Nursing and Midwifery Council of Ghana. So we do something like the OSCE here in the UK. What the government does then is to post you into either the villages or anywhere else to do your national service for one good year. I was sent to the capital of the region. After one year, I moved from the regional capital to Accra, the capital of Ghana. 

There is the biggest hospital in West Africa, it’s a teaching hospital. There are beds for around 2,800 patients. We do 7-hour day and 12-hour night-shifts. The wages are low, but 50% of the staff live in the nurses quarters that were provided by the government, both single people and families. There they only took 10% of your pay for rent. After a while people can afford to build their own houses and new people move in. Most public hospitals in Ghana have nurses quarters attached to them. In some village areas these quarters are free, you don’t pay rent.

There are of course also private hospitals, for example of the big companies that own cocoa plantations or mines, like gold mines, which are the big export goods of Ghana. Or the company that runs the national electricity grid, or even the military hospitals or the hospital of the Bank of Ghana. These hospitals pay much higher wages, but it is difficult to get into them. You basically need connections. It might be easier to go to the UK than getting jobs in these hospitals.

We have nurses’ trade unions in Ghana. I’m part of the Ghana Registered Nurses Association and I’m also part of the Ghana Registered Perioperative Society. I still pay my dues. They speak on behalf of the nurses in terms of salary adjustments and condition of service. There are strikes. Even this year there was a strike for better working conditions. I only experienced one sit-down strike while working in Ghana. But I was attending to emergency cases, so I could not take part. The strike only affected the wards and the outpatient departments. It only lasted for a day, then the issue was resolved.

At the university hospital in Accra there are all the specialties in nursing, so I started doing perioperative nursing. That’s a university program and I did that for two years. You get to work with all the big professors. It was okay in terms of knowledge, learning and applying knowledge for myself. The problem I had in my professional life was promotion. I wasn’t promoted properly. When I went to perioperative school to specialize as a theater nurse, they should have promoted me to senior staff nurse and then to nursing officer. But that didn’t happen, due to a lot of bureaucracy and all of the politics in management. My promotion only came through in the month when I relocated to England.

Leaving Ghana

I left Ghana, because the pay is very low and I also wanted my children to experience the Western world. I was thinking about their future. The future of my kids was the main reason. It was hard. You leave your family, your loved ones behind. You leave your support system and everything behind. At some point you have to experience racism, you have to experience hardship. I had aunties here and cousins, but they didn’t live where I was getting a job. I left my two kids behind, only brought them over six months later. 

In order to migrate I used a company, an immigration lawyer. In the UK he’s well known. To come to the UK at the time in 2021, they were charging £1,800. They mainly recruit for private care homes. I found the company on Facebook. You have to pay £100 in advance to take part in a webinar. When you joined the webinar, they explained to you what their program is all about. The fee doesn’t include the flight, you have to pay for the flight yourself. We also had to pay for the hotel, where they put us in quarantine for two weeks due to Covid. The company gets you a job in a care home. Then they help with the English tests and so on, though you have to pay the test fee yourself. They basically help you to get ready to get a job in the NHS.

My expectation was that the UK is a land of milk and honey, but I was disappointed. I worked in domestic care for two years before starting in the NHS and it was terrible. You have to drive a lot, but they don’t pay for the driving time. You have to pay for the UK driving license, you have to pay £380 for insurance. You have to work hard to buy your own car within the first four months. They didn’t explain all that. I worked from 6:30 in the morning till 11 at night. My older child had to help take care of the little one during that time. He himself was on a care worker visa, so he had to work, too. It was difficult. My contract said that you have to stay with the company for three years before you can move on. I informed myself and legally they couldn’t do that. I also got the union involved. So I moved after two years, but the company then refused to give me a reference. 

I then started in a NHS hospital. They first put me on a health care assistant contract. Compared to Ghana I found the doctors here can be disrespectful. Sometimes it breaks my heart the way we relate to us. Some look down on you and question your competency. The doctors I worked with in Ghana are also my friends. They send messages, they check on me, they call me still. Here we experience racism every day, from day one. When I worked in domestic care, sometimes the clients stopped you from entering their house. If you are a black person coming to take care of them, they don’t want you to come in. Sometimes they insult you and tell you to go back to where you came from. My children also experience racism, for example at school. At the hospital, some of the doctors, when they enter the theater, their behavior and the way they look at you… we are human beings and we know these things. But then others are nice and polite. They say please and thank you. 

When I had the job interview with the NHS hospital they said that they will support us through the OSCE program and we would not have to work on Band 3 for long. This was strange because other workers with similar experience were already working on Band 4, while waiting for their pin, the confirmation of their professional registration. I asked if I could also start scrubbing and being paid Band 4, but it was denied. That didn’t make me happy at all. I paid for the OSCE exam myself, it was about £900. And on top of all the other money that you spent to go for onsite training, which cost me £1,500. When moving to the NHS I expected that the Trust would help with all this, for example there are relocation packages. I applied for it, but it was denied. Some people were paid £800 as support, until they found accommodation. I had to stay with a cousin of mine. Then I still try to send money home, recently £500 for a surgery of a relative in Ghana.

There are not many official connections between nurses from Africa. We only connect on an individual basis, we exchange pleasantries, that’s it. I think Indian nurses have more connections, they help each other. The local nurses don’t know much about our problems, I can’t blame them. But for the Africans and the Indians, we’re all immigrants. You expect that people exchange ideas or people tell you things and help each other. It doesn’t work like that. 

The current moment

I don’t have to change my visa now because I’m on a two year contract with my Trust now. In three years I should qualify for my indefinite leave to remain. But with the current changes, I am worried. I am considering actually moving to another country, perhaps Australia, Canada or America. If the changes are going to affect me in any way. If you have to wait ten years, you might never become a citizen. So if the UK doesn’t want us to be here, we’ll just move out. Because we are paying tax here, we are workers. We are legal. We are not entitled to public funds. Because our taxpayers money is what they are using to pay people’s benefits, to pay white people’s benefits. We do not take anything from the government. We pay for everything. At the end of the day we are working hard, but we help the system. The UK is not the place that we thought it is, and now the politicians are making it worse.

I don’t think there’s any way to change it. We don’t have so much faith. I mean there are 1.4 million people working in the NHS. That’s quite a lot of people. If everybody can unite, that would change things. If we shy away from these things, they don’t change. New immigration rules every day in the UK. We have to stop the fear, because it’s draining, it’s demoralizing.