India Exporting Nurses to UK and US
Guardian News Service
September 23, 2004

New Delhi: From hearsay and a single photograph, staff nurse Sabitha Nambiar has a mental picture of Antrim, in the north of Northern Ireland. It is soon to be her home and, in her mind, it is very much like Shillong - a hill station in Meghalaya, north-east India's tea growing region - with Victorian bungalows, the world's wettest championship golf course, and daily power cuts. All she knows for sure are the maths. In Britain, nurses earn in one year what in India takes them a decade to earn.

Before her night shift, over sweet tea, the din of car horns and a monsoon downpour in central Delhi, Nambiar explains that the idea of working in Britain came from her cousin, a nurse who left India to work in a private nursing home.

"My cousin in Surrey (south-east England) told me the experience is better than working in India," she says.

"There's a higher standard of living. I also thought I'd benefit from mingling with different sorts of people. I'm totally ignorant about Ireland. I'm told it's not like London. That it's much slower. That it's green and pleasant."

Nambiar, who is planning to arrive in Antrim by the end of the year, is fast becoming the modern face of nursing in Britain. Four years ago, just 30 Indian nurses were registered to work in the UK.

Today, more than 2,000 have registered. For the UK's health service (NHS), India is one of the main areas where it can poach health workers.

Britain imports nurses because it does not have enough, and because India, according to its government, has too many - more than 8 million today, against 3.8 million 10 years ago.

The country also has an edge over many other developing nations; English is widely spoken and it has a "youth bulge," with more than half the population under 30.

Getting to the UK is not easy. With guidance from her cousin, Nambiar jumped with relative ease the two crucial hurdles that enable Indian nurses to apply for jobs in Britain - provisional registration with the UK's Nursing and Midwifery Council and achieving the necessary grade in an international English language test.

While controversy in Britain over poaching nurses from the developing world last month prompted health ministers to accept that the NHS should leave sub-Saharan Africa's scarce supply of health workers alone, India's nursing workforce - thanks to an intergovernmental agreement - is still fair game. India has, officially, a surplus of nurses. But even so, some hospitals are beginning to feel the strain.

To work in the NHS, nurses need at least three years' general nursing experience.

Several nursing directors in India stated that poaching means hospitals are perpetually training nurses they barely get to use. "I feel we train them, then we lose them," says Sudesh David, nursing superintendent of the prestigious Christian Medical College hospital in Ludhiana, Punjab.

In the past four years, the hospital has seen at least 50 of its 430 nurses go to the UK each year.

The migration of nurses may have costs for India's health system, but it is also becoming big business. Outsourcing and nursing labour are new corporate buzzwords.

Private hospitals are setting up companies for the sole purpose of grooming Indian nurses for foreign export. There has been a huge increase in the number of training schools in India compared with a decade ago, when there were only 60.

Companies have built centres and hired language and cultural etiquette coaches to school local nurses in the ways of developed world nursing. They are chasing contracts - big ones - and making deals to supply nurses to hospitals thousands of miles away.

One hospital group, Apollo Life, has contracted a company that prepared IT and call centre workers to teach nurses headed for the US in "voice and accent neutralising," "presentation skills" and "dining etiquette." Britain, which has long dominated the poaching game, will face stiff competition for nursing labour.

Among Indian nurses, the US is increasingly becoming the country of choice. It grants them the elusive green card and, it is believed, a better living standard than in Britain.

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