On the 200th anniversary of Florence Nightingale, and the year of COVID-19, the spotlight falls on the life-saving force that is the Malayali nurse
We are back to singing the praises of our homegrown Ladies in White, our newly consecrated frontline COVID-19 warriors. In the usual scheme of things, in the minds of Indians everywhere, the Indian nurse = the Malayali nurse.
And here’s the irony: she is not too difficult a persona to deconstruct. For the purposes of this article, let us take a close look at her, our Sister Florrie Nightingale Thomas.
She has a clear complexion, the colour of cappuccino, with masses of thick, electrically curly hair, usually neatly tucked out of sight under her cap. Her large brown eyes look at you directly; she has a slight smile playing on her lips, and her watchstrap glints dark on her slender wrist.
She is impossibly young, just in her early twenties and looks even younger, but has been a nurse ever since she passed out of the private nursing college closest to her hometown in south Kerala. There is no romance behind why she became a nurse. It was a needs-must decision, made solely on a practical basis, factoring in a less than comfortably placed family situation and the disinclination to become a teacher or factory worker.
Then again, the decision was not totally bereft of dreams. Sr. Florrie intends to work for a few more years in the private hospital she is in, then head out to Australia, becoming part of the whopping slipstream of 30-50,000 nurses who leave India for foreign shores. Most of her friends are already working in hospitals in London, in New York, in New Zealand. The ones in Canada are most happy but the accredited bridge programmes for foreign nurses there are lengthy and expensive, and the Middle East is on a drastic nationalisation-of-jobs spree. Sr. Florrie’s BFF Lissymol works at a hospital in Melbourne, and has told her enough about life Down Under for Sr. Florrie to be convinced that that is where her future lies. She wants to earn well, send some of it home, get that extension built to the family home, buy the small piece of land abutting the compound where her father can grow tapioca, put her brother Sijin through college. These are big dreams but not impossible ones, for Sr. Florrie and her ilk.
An illustration of Florence Nightingale at a hospital. May 12, Nightingale’s birth anniversary, is celebrated as International Nurses Day.
That is her future plan. The present follows a very prosaic path. Wake up, go to work, put in long arduous hours, try not to think about how dreary and menial some of the tasks are, cram in a hurried lunch most days, return to the hostel/rented accommodation for dinner, have long chats with her fellow nurses, share some laughs, make the call back home, and on her day off, see a Malayalam film (Dulquer Salmaan and Fahadh Faasil are hot favourites). Being underpaid and overworked are the routine badges of her tribe, facts she takes in her stride.
But that is in the normal course of things. When an epidemic comes along, like the H1N1, Ebola, Nipah, now COVID-19, life is suddenly fast-tracked for Sr. Florrie. She continues to minister to patients calmly, quietly, efficiently, but this is a crisis situation, a matter of saving lives. And she is well aware of that.
Overall, the stats show that emigration of women in Kerala, a figure of around 21 lakh, is largely concentrated in the nursing profession. An estimated 7,000 nursing graduates enter Kerala`s workforce every year. In 2017, a World Health Organisation report stated that over 30 per cent nurses who have trained in Kerala work in the US and UK, 15 per cent in Australia, 12 per cent in the Middle East. Family indigence, the desire to see the world, and the private hospital situation in India, which has not seen much standardisation of wages or amelioration of working conditions, also play their part in the migratory wave.
Dr Deepa Das, Senior Consultant, Pulmonology and Critical Care at a hospital in Bengaluru, says, simply and succinctly, that caring is in the Malayali nurse’s DNA. She stands out among her compatriots because of three traits: sound common sense, a firm sense of responsibility, and a genuine concern that goes beyond the hours of her shifts. They do have delicate egos and have to be handled with tact, says the doctor, but then that is part of the Malayali psyche, and well worth the effort.
Photo: Indranil Mukherjee / AFP
A nursing sister arrives at the King Edward Memorial (KEM) hospital in Mumbai.
An army doctor posted up north of the country, remarks that he is always struck by their remarkable resilience, their adaptability and their exceptional managerial capabilities. And yes, there are any number of Sr. Florries in the Military Nursing Service, mainly because of the respect it imparts to them, as well as the healthy pay and perks. The doctor concludes by saying that fears are an inevitable part of their profession and COVID-19 has brought no new anxieties. Do they drag their feet? No, siree; in Armed Forces parlance, it is equivalent to a soldier deserting his post during an enemy attack.
Dr Latha Nair, a developmental paediatrician working in Brunei, has no qualms about saying that Malayali nurses are head and shoulders above others. Their level of understanding, their innate sense of discipline, their grasp of calculations of medications are all superior, and so the incidence of errors are significantly less, she says.
Dr KS James, Director and Senior Professor at the International Institute for Population Sciences, Mumbai, states that when he thinks of the Malayali nurse, Gandhiji`s quote “Where there is love, there is life,” comes to mind. Many thousands of Malayali nurses work in India and abroad, trying to save millions of lives in very adverse conditions, with meagre pay, and it is not part of public discourse, says Dr James, underlining that this is the time to recognise their invaluable service to society, and to make sure their status is elevated to a ‘decent work’ category, as embraced by the ILO.
An illustration by Shivani Kochewad depicting the contribution of nurses in the current pandemic.
Sr. Florrie is in now the thick of it, dealing with panicked COVID-19 patients, trying to keep them, as well as herself, calm. There is a spike in positive cases among healthcare professionals, the supply of proper PPE is hopelessly inadequate. When food fetches up, it is stale. Antsy landlords are ruthlessly kicking them out of rented accommodation. When the nurses have to go into quarantine, they are put up in semi-squalid hotels, while it is ‘premium accommodation’ for doctors. They don’t get enough sleep. All of them are working at a frenzied pace, not really allowed their 14-day quarantine break before being deployed in the general wards. Medical safety protocols are being breached dangerously, and it is Sr. Florrie and Co who are bearing the brunt. Staff crunch, PPE crunch, work rotation crunch, it seems as if Sr. Florrie’s life is defined by crunches right now.
But the bar for the Malayali nurse is set very high and she wears her halo lightly. Sr. Florrie has heard Anna Soubry, a former British parliamentarian, in the BBC video that went viral (in March). “I think the compassion and care, that’s what makes Malayali nurses outstanding,” Ms Soubry had said. “If any crises arise, definitely there will be Malayali nurses as frontliners. In this situation as well, the majority proportion of Accident and Emergency team in London are nurses from Kerala. Unless there is a valid reason, these nurses do not back off.”
Daily conversations with her colleagues prove both encouraging and insightful. Sr. Baby tells her how it has always been her aim to create and spread goodwill around her workplace. This virus, the older woman says, will become a part of our life like all the other viruses, so we have to learn to cope with it. Sr. Deena is even more frank. Developing a fear of this virus will be problematic for us nurses, she tells Florrie. It will make us hostile and fearful in our dealings with patients, and that is the last thing a good nurse should be. Anish, Florrie’s male nurse friend, is emphatic when he states that nursing is a noble job, a job with both value and worth.
Come out, girls, the Supervising Sister tells them now. They are commemorating us with flower petals showered from helicopters. Sr. Florrie exchanges a telling look with Molly, Mini and Sheeja. Do they really have time to go turn their faces up to falling petals? Then, she gives a pragmatic shrug, and all of them head outside.
Banner: (L-R) A postal stamp depicting a nurse that marked the 50th anniversary of Indian Red Cross Society; Nurses leave at the end of their shift at the King Edward Memorial (KEM) hospital in Mumbai on May 12, 2020, as the world marks International Nurses Day, celebrated on the birthday of Florence Nightingale.