Dr. Omana Russel (Rtd. Professor,
Senior Academic FellowICHR, Delhi)
The service of the nurses is needed by every human being from their first to last breath on earth. Nurses are considered real angels who sacrifice their lives to serve the sick and needy people. The emigration of Kerala nurses to the USA is a fascinating saga of people from God’s own country who have pitched their tents in the furthest corner of the globe.
The greater demand for nursing professional skills in the United States of America and the increasing unemployment in Kerala enabled Kerala nurses to migrate to the United States of America in the 1960s. Many factors such as low salary, unemployment, poor parking conditions, poor career prospects, poor standard of life, unhappiness with the prevalent social attitude towards nurses as dirty and polluting, low status in society, etc acted as the push factors where as attractive salary, high standard of life, better status in society, economic and personal independence, flexible working hours, the elevation of gender position, better career prospects and other fringe benefits like the green card, good housing, and other infrastructure facilities, spouse visas, better education for children, etc. were the motivating factors that encouraged female nurses to migrate from Kerala to the USA. Nurses educated in India make up one of the largest groups of internationally educated nurses in America.
All migrations have changed people on account of the giving and taking of cultures and beliefs. Migration has its cultural, literary, social, demographic, anthropological, political, and economic impacts and international relations are to a great extent determined and encouraged by migration. A bond prevails between India and the United States of America because of the migration of nurses from Kerala. Both the United States of America and India benefitted through the migration of female nurses from Kerala to the United States of America. The cultural exchange between these two countries became possible and easy because of this migration.
Migrated nurses could understand the culture of the American people and vice-versa with this migration and one-to-one cultural exchange became possible. The first generation of female Kerala nurses faced greater cultural shock and identity crisis compared to the second and third-generation migrant nurses. The migrated nurses of Kerala in the USA are very keen to keep their national identity, cultural identity as well as religious belongingness in the USA also. At the same time, they had a feeling of living in between the Indian and American cultures i.e., hybrid culture.
These nurses, in making a space for themselves daily, had to negotiate an identity that satisfies the two contradictory poles in their lives. On the one hand, the dominant Western traditions that mark their new home, and on the other, their traditions and values that are carried with them as Indian women.
Kerala nurses have a positive impact on American society with their hard work, sincerity, and service-mindedness. They are so gentle in caring for the patients and gained a reputation for their benevolent care and professionalism. Kerala nurse migration is a living example of intermingling with US culture without fully losing their culture and social cohesion. Kerala nurses patiently answered the questions educating Americans of Indian culture, customs, and family values, and learning from them the norms of the American life and culture. There is a one to one based cultural exchange between the working nurses in their workplace in the United States of America because of the Kerala nurses’ migration. With time, each group learned to accept accommodate, and tolerate reciprocally their differences.
Adjustment to a new culture was a great problem faced by first-generation nurses who were adult migrants. The alien culture and manners posed challenges to the Malayalee immigrants and it was very difficult for them to adapt to a new society. They struggled a lot in understanding the culture and adjusting to the new environment, socio-economic factors, etc. Laws supporting abortion, lesbian marriages, dating, more divorces compared to India, etc. made the nurses quite uncomfortable in the USA.
Other problems faced by these nurses were communication problems, lack of driving skills, racial prejudice from the American nurses etc. From 1971 onwards, nurses had to pass the examination conducted by the state Board and obtain the license to practice as a registered nurse in the US. Before that, they could become a registered nurse after passing the State Board Examination.
All these added to the psycho-emotional problems of the migrated nurses from Kerala to the United States of America. Their struggles to establish a new life for themselves, new careers for their spouses, rearing their children, adjusting to the new environment, and financial and socio-cultural changes were all challenges that made the nurses stressed. Healthcare culture is entirely different in the US compared to India.
US patients and their families are perceived as being needier and more demanding than patients in their home country. Patient rights and customer satisfaction were new concepts requiring new ways of approaching patient care. Patients have questions and rights and a lot of legal and ethical issues that the nurses have to be aware of. Legal issues involved in health care made nurses personally accountable, and vigilant. Discharge instructions, medication, reconciliation, customer service, and patient advocacy were new to their vocabulary and added to their responsibilities. In India, their roles as staff nurses were with basic nursing care. The ability to practice more independently, to question physician’s orders, and to advocate for patients is new to these nurses.
The stress of settling into a new life in the United States of America had some impact on their confidence and job performance. Over time, the transitional stress decreased, and their knowledge and self-confidence increased as a result of which their personal and professional lives became less stressful. It seems that the nurses’ early struggles and sacrifices reaped rewards in the long run as Kerala Nurses value achievement and education. Dealing with humans holistically gave satisfaction to the nurses. They found that a nursing career in the US is far more lucrative than one they left behind in Kerala.
Elevation of the status of Kerala nurses in the US is a welcome change in their lives. In Kerala, nursing is considered a low status and dirty job. Once they reach the US, the nurses become professionally valued people with elevated status and income. As women came first as breadwinners and their husbands followed them, the reversal of migration took place in the case of nurses who migrated to the USA. The nurses think that the USA is indeed the best place with opportunities for personal and professional advancement open to all who are willing and hard working. The move to the US was marked by opportun-ities for upward mobility in their careers.
They strived for both using the opportunities they had in the country and reached the heights of the nursing profession, such as hospital administrators, nurse practitioners, managers, directors, profess-ors, deans, educators, etc. Many of them obtained NP and DNP certifications and Ph.Ds in nursing. Children of the Kerala nurses in the USA are highly educated and hold prestigious positions now.
The growth of the Malayalee community in the United States of America primarily can be traced to the emigration history of ONE nurse from a single family who sacrificed much for the subsequent growth of that family over the years. The vibrant economy with a high standard of life, educational opportunities, and a free and flexible society was made possible for the family members by the one nurse who was ready to take risks. Hence, the Malayalee community in the US must ever be grateful to the nurses who migrated first to the US and made life easier for younger generations.
Courtesy: AGIFNA SOUVENIR 2024- USA
