Thou­sands of In­dian nurses send money home to their ageing par­ents but sel­dom see them

The Irish Times - Weekend Review - - NEWS REVIEW - Sor­cha Pol­lak

In Ker­ala and Dublin

Baby Paul al­ways knew her daugh­ter would end up abroad. She couldn’t stop her leav­ing; she un­der­stood work­ing as a nurse meant long hours and min­i­mal pay and she wanted a bet­ter life for her daugh­ter. More than 13 years have now passed since Smitha Paul left south­ern In­dia. Her brother also works abroad in New Zealand. Baby misses them des­per­ately but ac­cepts that, like nearly ev­ery fam­ily in her home state of Ker­ala, em­i­gra­tion is the norm.

“Ini­tially when they left, we felt anx­i­ety and fear, but once they started to call us and say it was fine, that they had churches where they lived, then we felt okay,” says Baby, sit­ting in the par­lour of the fam­ily home in the sub­urb of Anga­maly on the out­skirts of Kochi. Her hus­band, Paul Poulouse Mun­dadan, sits to her left, and above their heads hangs a large por­trait of their chil­dren and grand­chil­dren.

Smitha lives in Dublin with her hus­band, Jijo, and two chil­dren. Baby vis­ited Dublin for the birth of both her grand­chil­dren, but Paul has never been to Ire­land.

Like most Ker­alans who move abroad for work, both their chil­dren reg­u­larly send money home. But with­out the chil­dren and grand­chil­dren, the fam­ily’s gleam­ing white abode feels empty and quiet.

“Mov­ing abroad is a trend that is hap­pen­ing be­cause we are paid less here. With the money you earn, you can’t save any­thing,” says Baby in Malay­alam, the na­tive lan­guage of Ker­ala. But par­ents, she says, are left alone here. More than 8,500km away, in a semi- de­tached house in On­gar, west Dublin, Smitha is pre­par­ing din­ner for her fam­ily. Her two chil­dren at­tend the lo­cal schools, and her hus­band works as a care as­sis­tant.

The cou­ple used to visit In­dia ev­ery year but since the chil­dren were born, their trips have be­come less fre­quent. Her son Josh of­ten com­plains about mak­ing the long jour­ney to Ker­ala. “Ev­ery time we go he makes sure it’s just for the hol­i­days. He says, ‘Don’t ask me to stay in Ker­ala’. The kids ask, ‘Why can’t we go other places on hol­i­days?’ We can’t blame them be­cause they were never ex­posed to our cul­ture.”

Out of her class of 30 at nurs­ing col­lege in Ker­ala, 18 moved to Ire­land for work. Oth­ers moved to the US and Aus­tralia, seek­ing job se­cu­rity and bet­ter pay­ment.

In Ker­ala she worked six days a week. Here she can spend more time with her chil­dren. “You get more re­spect here as a nurse and you have dig­nity. And as a woman you have more free­dom. Back home you have to be very obe­di­ent to oth­ers, even though you are the earner in the fam­ily.”

Smitha’s voice be­comes in­creas­ingly un­steady as the con­ver­sa­tion turns to her par­ents in Ker­ala. They speak via What­sApp ev­ery day, but she hates the dis­tance that sep­a­rates them.

“My par­ents sac­ri­ficed ev­ery­thing for us, but now, at the time when they’re get­ting old, we can’t re­ally do any­thing for them,” she says, her face now streaked with tears. “We can just give them money. But what they re­ally need is our help.”

Smitha is just one of the thou­sands of In­dian nurses dot­ted across Ir­ish hospi­tals and care homes wor­ry­ing about their ageing par­ents back in In­dia. Nearly 21,000 In­dian-born na­tion­als live in Ire­land, half of whom speak Malay­alam – Ker­ala’s prin­ci­pal lan­guage – as their na­tive tongue, ac­cord­ing to the 2016 cen­sus.

Some 6,304 In­dian na­tion­als are reg­is­tered as nurses, mak­ing up nearly 9 per cent of the to­tal num­ber of nurses on the Nurs­ing and Mid­wifery Board. While no for­mal data is avail­able on where in In­dia these nurses were born, it’s be­lieved the vast ma­jor­ity come from Ker­ala.

The mi­gra­tion of nurses over­seas is a long-stand­ing tra­di­tion in Ker­ala, stretch­ing back to the 1960s, when Chris­tian nurses from the south­ern In­dian state be­gan look­ing for work in Europe. This was fol­lowed by a surge in num­bers trav­el­ling to the Mid­dle East dur­ing the 1970s oil boom.

While the Catholic Church played an im­por­tant role in sus­tain­ing the stream of nurses com­ing from Ker­ala to Europe in the lat­ter half of the 20th cen­tury, the re­li­gious back­ground of In­dian nurses has di­ver­si­fied, with Hindu and Mus­lim nurses in­creas­ingly mi­grat­ing over­seas.

Ker­ala boasts by far the high­est lit­er­acy rate in In­dia; an es­ti­mated 97 per cent of adults know how to read and write, com­pared with a na­tional lit­er­acy rate of 74 per cent.

How­ever, the state’s eco­nomic de­vel­op­ment is not keep­ing pace with its ed­u­ca­tional achieve­ments, and Ker­ala cur­rently suf­fers from an un­em­ploy­ment rate more than twice the na­tional av­er­age.

In July 2017 more than 80,000 Ker­alan nurses threat­ened to go on strike, de­mand­ing higher pay for the long hours they spend work­ing in pri­vate and gov­ern­ment hospi­tals. Un­til re­cently the ba­sic monthly wage for a nurse work­ing in a pri­vate hos­pi­tal was 9,500 ru­pees (¤ 112.16). The state even­tu­ally re­sponded to the strike ac­tion, which in­cluded a hunger strike, by com­mit­ting to raise the monthly fixed rate to 20,000 ru­pees (¤ 250) in all gov­ern­ment hospi­tals.

The start­ing an­nual salary for a grad­u­ate staff nurse i n Ire­land i s ¤ 28,768 (¤2,397 per month).

The num­ber of In­dian nurses work­ing in Ir­ish hospi­tals and care homes has steadily risen since 2000, when Ire­land be­gan ac­tively re­cruit­ing nurses in­ter­na­tion­ally.

More re­cently, the num­ber of nurses re­cruited from In­dia has risen sharply, jump­ing from 79 suc­cess­ful visa ap­pli­ca­tions in 2014 to 753 in 2017. Sharon Slat­tery, di­rec­tor of nurs­ing at St James’s Hos­pi­tal in Dublin, will be tak­ing part in the lat­est HSE re­cruit­ment drive this month when she trav­els to Ker­ala and New Delhi to help select nurses for the hos­pi­tal. Af­ter 18 years of re­cruit­ing over­seas, the hos­pi­tal’s staff now con­sists of 64 dif­fer­ent na­tion­al­i­ties while 7 per cent of nurses are In­dian.

The sec­ond gen­er­a­tion of these In­dian fam­i­lies liv­ing in Ire­land has also be­gun en­ter­ing the nurs­ing pro­fes­sion. “Our In­dian col­leagues in St James’s bring a gen­tle­ness to their work and they’re very re­spect­ful to their pa­tients,” says Slat­tery. “They also adapt well to west­ern coun­tries. From a per­sonal level, they share many of our so­cial val­ues; they un­der­stand the im­por­tance of fam­ily, they have great ban­ter, and they get the Ir­ish hu­mour.”

Lalu Paul, a so­cial worker liv­ing in Blan­chard­stown, runs one of the smaller re­cruit­ment agen­cies bring­ing nurses from the dis­trict of Anga­maly, where Smitha Paul grew up. He came to Ire­land in 2007 for stud­ies and, af­ter mar­ry­ing his wife (a nurse also named Smitha), set up a busi­ness to bring Ker­alan nurses to Ire­land.

Lalu says the high num­ber of grad­u­ates means Ker­alan hospi­tals have plenty of nurses. But if the num­bers mi­grat­ing con­tinue to rise, Lalu wor­ries the Ker­alan health ser­vice may suf­fer.

His wife, Smitha Se­bas­tian, came to Ire­land in 2006 to join her cousin, who was al­ready work­ing in Con­nolly hos­pi­tal in Blan­chard­stown. She en­joys her work but af­ter more than a decade in Ire­land is in­creas­ingly aware of the lack of staff avail­able in Ir­ish hos­pi­tal wards. “Com­par­ing the staffing lev­els in 2007 and 2018, there is a huge dif­fer­ence. Nowa­days it’s re­duced down to three or four nurses with a few stu­dents per ward.”

Liv­ing so far from friends and fam­ily is also a strug­gle. “I miss my par­ents be­cause they are all alone,” says Lalu. “I miss our fes­ti­vals, I miss dif­fer­ent mar­riage cel­e­bra­tions and when a friend or rel­a­tive dies. Ir­ish peo­ple who have left this coun­try will un­der­stand that.”

From a per­sonal level, they share many of our so­cial val­ues; they un­der­stand the im­por­tance of fam­ily, they have great ban­ter, and they get the Ir­ish hu­mour

Back in Anga­maly, a few kilo­me­tres from Smitha Paul’s fam­ily home, Lalu’s par­ents, TV and Lilly Poulouse, sit in the spa­cious par­lour of their own re­cently re­fur­bished home. The in­te­rior dec­o­ra­tions of the room were paid for by Lalu, while their son who lives in Italy paid for the sec­ond storey of the house. They also have a daugh­ter in Aus­tralia.

“Ini­tially it was very dif­fi­cult when they left, and we were wor­ried about how their fu­ture would turn out, but then you re­alise they’re go­ing to greener pas­tures,” says Lily, adding that all three chil­dren visit when­ever they can. “We miss them but we’re happy they have de­cent jobs and more in­come se­cu­rity.”

An hour south from the Poulouse home, in the bustling streets of Fort Kochi, Ed­win and Rose­lyn Bernard are still get­ting used to the ab­sence of both their daugh­ters in their small home. Their younger daugh­ter Avril moved to Ukraine more than a year ago to study medicine while Aneleen left for Ire­land in April af­ter se­cur­ing a job in an Ir­ish nurs­ing home through Lalu Paul’s re­cruit­ment agency.

Both girls call their par­ents each morn­ing to wish them good morn­ing and ev­ery night be­fore bed. Rather than sad­ness, they feel proud of their daugh­ter’s achieve­ments. “I know my chil­dren, wher­ever they go, they can bring the English lan­guage so they won’t have any problems. I know they are both ca­pa­ble and not fright­ened. Be­fore they jump they will al­ways think care­fully.”

Back in Ire­land Aneleen ad­mits that the first three months in Athy, Co Kil­dare, were chal­leng­ing. The fact that nine out of 10 of the nurses in the care home where she works come from Ker­ala helps a lot. “Cul­tur­ally it’s very dif­fer­ent here but I find the peo­ple wel­com­ing,” says the 26-year-old. “I’ve never faced any dis­crim­i­na­tion or racism here. There’s a lot of in­vest­ment in nurs­ing here and if you work in the HSE you can ed­u­cate your­self and up­date your knowl­edge.”

Un­like most Ker­alans, Aneleen al­ready spoke flu­ent English be­fore mov­ing to Ire­land. How­ever, the ma­jor­ity of young nurses must prove their lin­guis­tic skills by achiev­ing a high grade in the In­ter­na­tional English Lan­guage Test­ing Sys­tem (IELTS) or the Oc­cu­pa­tional English Test ( OET) be­fore reg­is­ter­ing for work over­seas.

Neena Gop­u­rath is cur­rently study­ing for the OET at a lan­guage school in Anga­maly. She says her hus­band, also a med­i­cal pro­fes­sional, al­ways dreamed of mov­ing to Ire­land and en­cour­aged his wife to study English and take the test. Neena, who is due to give birth to her first child in Jan­uary, says it was her fa­ther’s dream that she be­come a nurse but that she hopes to be­come a teacher one day. Down the road, the crowded emer­gency room of the Lit­tle Flower Hos­pi­tal in cen­tral Anga­maly is bustling with ac­tiv­ity. Sun­days are al­ways busy, nurse Anto Au­gus­tine ex­plains, as we walk by a line of adults and chil­dren stretched out on hos­pi­tal trol­leys.

Anto has worked in this hos­pi­tal for a decade where his salary re­cently in­creased from 13,000 ru­pees (¤ 160) to 25,000 (¤ 310) ru­pees per month fol­low­ing the 2017 nurses’ strikes. This is un­usual for a pri­vate hos­pi­tal, which usu­ally of­fers far lower salaries than gov­ern­ment-run hospi­tals. He is pre­par­ing for the IELTS and hopes to move to an English- speak­ing coun­try in Europe. If he se­cures a job, he will send most of his earn­ings back to Ker­ala. “They need the money, other­wise we can’t man­age.”

Della James and Ket­ziya Ge­orge have also spent the past few months study­ing for their English ex­ams. They’re now wait­ing to find out if they’ve scored the high marks nec­es­sary to reg­is­ter as a nurse over­seas. Della ( 23) hopes to move to Ire­land, where her cousin has lived since 2000.

Both women are ex­cited about the move but ner­vous about the cul­tural dif­fer­ences they may en­counter. “We don’t even speak the Ir­ish lan­guage,” says Ket­ziya. She lets a deep sigh of re­lief when I con­firm she won’t need to speak Ir­ish to con­verse with peo­ple in this coun­try. Back in Dublin, Jincy Mathews has started mak­ing prepa­ra­tions for her young cousin’s ar­rival. Set­tling in should be much eas­ier for Della than it was for Jincy, who first ar­rived in Ire­land more than 18 years ago.

When she ar­rived in Oc­to­ber 2000 she be­came one of only two for­eign nurses in Tal­laght Hos­pi­tal. Seven months later her hus­band moved over and they brought their son, Britto, to Dublin when he was a year old. Britto is now in his third year of medicine, and their daugh­ter, Brona, is study­ing for the Leav­ing Cert. Her hus­band, Baby Perep­padan, is pre­par­ing to con­test the 2019 lo­cal elec­tions as a Fine Gael can­di­date.

Jincy has no re­grets about com­ing to Ire­land and loves her work. But be­ing so far from fam­ily in In­dia never gets easy. A cou­ple of months ago she had to make an un­ex­pected trip home af­ter re­ceiv­ing word that her mother was se­ri­ously ill. She was stand­ing in Abu Dhabi air­port on the way to Ker­ala when she re­ceived a text from a cousin that her mother had died.

“I don’t re­gret com­ing, I’m happy here. But does it feel like home? I can’t an­swer that.” This ar­ti­cle was sup­ported by the Si­mon Cum­bers Me­dia Fund

Smitha Paul and her hus­band, Jijo, son Josh and daugh­ter Tia. Be­low: Della James and Ket­ziya Ge­orge in Anga­maly on the out­skirts of Kochi, Ker­ala; TV Poulouse and Lilly Poulouse; Baby Paul, right, and Paul Mun­dadan, par­ents of a nurse liv­ing in Ire­land, at their res­i­dence in Anga­maly, Kochi city, Ker­ala. PHO­TO­GRAPHS: ALAN BETSON AND SIVARAM V

Video The Ker­alans of Ire­land, by Bryan O’Brien.


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