At 8pm, Christeena Rajan completes her six-hour shift at a small nursing home near Shadipur Depot in West Delhi. She walks down to her room, which she shares with a fellow Malayali nurse, and soon starts making porotha for dinner. Twenty-five-year-old Rajan, who came to Delhi in 2008, has been trying to settle her visa papers for the last six months. She had paid Rs 30,000 to a visa agency, handed them her passport, school and college certificates, hoping they would reach her to Jordan. The agency disappeared with her money and documents that charted and totted her entire life. She filed a complaint with Usha Krishna Kumar, president of the Delhi-based Nurses' Welfare Association of India.

Krishna Kumar locates Rajan's complaint amidst a pile of 20-odd brown files and thousands of punched A-4 sheets, where neat cursive handwriting spell out agents who vanished or hospitals that turned tyrants. Hospitals often hold certificates and crucial documents, turning staff into "bonded" labour by preventing their departure. But Rajan got back her documents and money, with Krishna Kumar's intervention. Today, she is hoping to leave for Malta, "a small island", she says, by way of explanation. When one nods, she asks aghast, "You've heard about it?" "What do you know about it?" one asks in return. "I don't know anything at all," she says, giggling loudly, "It's a Christian country."

Rajan left her hometown of Kasargod, where the streams run swift and palms grow tall, to study a B.Sc in Mangalore. Relying on a network of family and friends, she made her way to Delhi and now hopes to move abroad for better opportunities and more money. Her story is one of enterprise and resilience; and while it is hers alone, the lives of tens of thousands of nurses from Kerala share similar strains.

The Malayali nurse is a ubiquitous brand. Around 12,000 nurses register in Kerala every year. There is no comprehensive data on how many move out of the state and country annually. But close to 80 per cent of nurses in cities like Delhi and Pune originate from Kerala. While doctors prod and prescribe, nurses cajole and treat patients. Specialists rush through wards but the bulb burns on at the nurse's station. She is always on duty and forever anonymous, and her name makes the news only when she perishes in a hospital fire.

The Malayali nurse, of tell-tale accent, who stumbles upon Hindi's hard consonants in the north, today epitomises high-quality healthcare. When Joyleen Jonahs, nursing director of Pune's Ruby Hall Clinic, says, "Malayali nurses are known to be dedicated, sincere and goal-oriented," she echoes the sentiments of innumerable doctors and patients.

Each Malayali nurse has his or her individual purpose and unique trajectory, but their countless tales create a picture of a people and a region. They leave Kerala in their early 20s, taking their state everywhere they go. As 37-year-old year Shaila Reji, who has been a nurse for close to a decade at the Lok Nayak hospital, Delhi, says, "My state is my state, but I don't want to work there."

They choose nursing because it guarantees a job. In a state where the unemployment rate in urban areas stood at a disturbing 19.9 per cent in 2004-05 (and dropped to 8.3 per cent in 2009-10, National Sample Survey Organisation), assured employment separates a life of dignity from one of desperation. They leave their home looking for better incomes, aspiring to improve the quality of life of both their natal and post-marriage home. Dr Sheba George, assistant professor at Charles Drew University of Medicine and Science, California, and author of When Women Come First, Gender and Class in Transnational Migration (2005), says, "The story of the Kerala nurse and her immigration is connected to another story about the transformation of women's worth in Kerala."

Bahrain-based author Benny Benyamin, who tells the stories of Malayalis who live in the Gulf in his award-winning short stories and novels, says, "Girls from Kerala want to stand on their own feet. They like to work hard and earn well." Sister Lily Verghese, who has worked for 25 years at south Delhi's Sama Hospital, and where all 15 nurses originate from Kerala, adds, "Girls form Kerala want to be independent. And this is a noble profession." A search for this independence has spurred the "transformation", as Dr George has noted . Her book, an ethnographic study over three years in the mid-1990s, focused on a group of female nurses who moved from India to the US before their husbands did. She says, "Whether they took up nursing to ease the financial difficulties of their families or to fulfill their own dreams, they challenged the traditional equation of women as equal to burdens. They became assets to their families because they used their autonomy to act in collective ways towards collective ends."

The dominance of nurses from Kerala has social, economic and historic roots. In 1914, the British under Florence Nightingale recruited the first Indian nurses into the Indian Military Nursing Service. With Hinduism enmeshed in ideas of pollution and impurities, most of the nurses recruited at the time were Christians. "The relative openness of Christian communities to nursing has much to do with the active role that English missionaries and mission hospitals took in representing nursing as a noble Christian service," says George. Even today, close to 90 per cent of Malayali nurses follow Christianity (while Christians make up 20 per cent of the population in Kerala), as noted in Transcending Boundaries: Indian Nurses in Internal and International Migration, a 2007 paper written by Sreelekha Nair and Marie Percot.

Over the years, however, there has been a significant change in the public's perception of nurses. Author and researcher Marie Percot, who started working on Malayali nurse migration 10 years ago, says that a decade ago nurses, especially migrant nurses, were looked down upon and seen as "loose women" in foreign countries. Today, she notices a real change, most noticeable in the grooms they can attract. While earlier, they were matched with men in blue-collar jobs, today men with advanced degrees line up for them, as they are seen as "prestigious" alliances.

The field has opened up, especially after the Sixth Pay Commission increased salaries for nurses in government hospitals substantially. The improved scales have attracted many youngsters from diverse backgrounds. Rakhi Das, who has been working with Lok Nayak Hospital in Delhi, says, "Nursing, from a serving profession, has become a paying profession." But that is the story of only a rare few. In Kerala, starting salaries range between Rs 3,000 and Rs 5,000 a month, the shifts often run for eight hours, and unions are discouraged.

More nurses have started to join from Rajasthan and the Northeast. Sister Besenee, the oldest nurse at Patna Medical College and Hospital, recalls that in the early '80s, 90 per cent of the nurses in the hospital came from Kerala. Now, it has come down to little over 10 per cent. Krishna Kumar started the Malayali Nurses' Welfare Association in Delhi, six years ago, after helping a nurse who had filed a complaint against a doctor who misbehaved with her. That incident revealed the many problems faced by nursing staff. Since then, Krishna Kumar has represented their case, both in hospitals, courts and the government. But acknowledging the change in the demographic, she removed "Malayali" and changed the name to the Nurses' Welfare Association two years ago. The number of men in the field has also increased but Krishna Kumar says, "Male nurses are treated worse than ward boys. They are not shown any respect." Nikhil PG, a male nurse who works in Delhi, feels that this applies to Kerala where patients "expect male nurses to run behind them with a tub," but outside the state, he believes he hasn't faced any obvious discrimination.

For nurses Berly Lawrence, working at a critical care unit in Canada, and Mithun Thampi, who works in emergency services at an Essex hospital in the UK, the atmosphere in Kerala where "doctors are god and nurses are the slave," compelled them to leave. Thampi is in his mid-20s and has been working since 2009 in the UK. "Nursing in India and in the West are (as different as) chalk and cheese. In India, it is slave work. But it's a professional job in the West. Male nursing is a taboo in India (at least for some) but here it is an equal job," he says. Lawrence provides a more tempered response: "I have heard of instances where male nurses are rejected in Kerala, but I don't know of direct discrimination."

When students in their late teens and early 20s decide to study a B.Sc or a general nursing and midwifery degree, they choose a life of movement. It could start with a medical college outside Kerala, it then leads to an acclimatisation period in the metro cities of Delhi and Mumbai, followed by a quick stopover at the Gulf and finally a green card in the US. Fifty-nine-year-old Rachel Thomas, born and brought up on the slopes of Munnar, is an early example of this movement. She studied at the Christian Medical College, Vellore, and moved to Ludhiana. On March 24, 1980, she reached Philadelphia, US. Today, she works in emergency medicine in a large community hospital in the same city. As a first-generation nurse to the US, she had to earn enough money to sponsor and provide for her husband and children, paying for their education and welfare, while also sending money back to her family in Kerala. She says, in those early days, "We suffered a lot but we also knew how to make use of opportunities."

While this has been the traditional dream trajectory of nurses, some have chosen to return. Elizabeth Thomas, the eldest of five siblings, with a farmer-father is today nurse manager at Dr LH Hiranandani Hospital, Powai, supervising 88 nurses, four floors and 120 patients. She says, "Like most Malayalis, I too wanted to work abroad and earn some money. But having stayed all my life in Kerala, I didn't have enough exposure." She worked in Mumbai for two years, picked up Hindi, and left for Muscat in 1991. She worked for eight years in Muscat, while her husband worked in Dubai and her sons remained in Kerala with her parents. She returned to India when her husband moved to Mumbai. "Muscat was professionally satisfying but I was missing my family," she says. Similarly, Sister Besenee, who has lived in Patna for close to three decades and enjoys her litti-chokha, plans to return to Kerala, where her husband and daughters live, once she retires in 2015.

The nurses successfully adapt to their postings both professionally and personally. With language and communication providing the crucial link between aliment, treatment and diagnosis, nurses pick up the local language soon. Twenty-six-year-old Jeena Varghese from Kollam, working at the Downtown Hospital, Guwahati, picked up Assamese in two years. "I can speak five languages: Assamese, Hindi, English, Tamil and Malayalam," she says.

Even while they have adapted, the Malayali nurse has maintained a strong sense of regional identity, across the globe, through various organisations, the church or the temple. They return to India once a year and stay in touch through Skype. Berly Lawrence celebrates Onam with the Malayali Association in Canada. Anju Chacko, from Kozhencherry in the Pathanamthitta district of Kerala, came to work in Pune two years and eight months ago, and says that her parents derive strength from the fact that there are many other nurses from the state in her hospital. Elisamma Rajan, matron of the maternity ward in the Central Hospital of Northeast Frontier Railway in Guwahati, keeps in touch with Kerala through the Kerala Samajam and Kerala Association. She met her husband in Guwahati, has spent 33 years in the city, but has no plans of living here post-retirement. "I don't want to settle in Guwahati. Nor do I want to stay with my children. I will go back to my ancestral village," she says.

Valsala R Nair, a nurse for 23 years at a Delhi nursing home, and chairman of the Nair Service Society, Pushp Vihar, Delhi, insists that her children speak Malayalam at home and that they read the Malayalam Mathrubhumi along with English newspapers. "My (teenage) daughter came to Delhi when she was six months old, but she speaks and writes Malayalam perfectly," she says with pride. Has Nair created her own little Kerala in Delhi? Breaking into a loud laugh, she says, "No, we have made a big Kerala everywhere."

(With inputs from Nisha Nambiar, Vidya Prabhu, Samudra Gupta Kashyap, Santosh Singh and Shaju Philip)

ALSO READ Light as Air, Just as Fast

Please read our terms of use before posting comments