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 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 Keralites 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.
‘They need our help’
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 Keralite 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 in Ireland is €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 Keralite nurses to Ireland.
Lalu says the high number of graduates means Keralite 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.”
‘Initially it was difficult’
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 Keralites, 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.
‘They need the money’
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 offer 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.
‘I don’t regret coming ... but’
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