Nightingales from across the seas

They seem no different as they move about briskly in their crisp white uniforms, administering an injection to one patient or monitoring the blood pressure of another. A doubt comes to mind only when they speak a few words to the patients. Their heavily-accented English leaves one startled — no it cannot be. But yes, it is.

Foreign nurses in Sri Lanka. That's nothing new, because with the influx of foreign heart surgeons and plastic surgeons quite frequently to the country, come foreign medical teams too. But this is different. These are nurses from Kerala who have sought greener pastures across the Palk Strait, for one or more years. Fifteen have joined the 400-cadre nursing staff of the Nawaloka Private Hospital to bolster the dwindling numbers.

"We are a 300-bed hospital and sometimes we have to close about 20 beds due to the lack of nurses. This is an acute problem faced by both state and private hospitals all over the country," says Nawaloka Director Professor Lal Chandrasena.

After much discussion and thought, Nawaloka was "reluctantly" compelled to recruit foreign nurses as the local numbers were not in keeping with the demand. "It is a manpower problem, nothing else," explains Prof. Chandrasena adding that in 1996 the government too realised the gravity of the situation and appointed a deputy director general to be in charge of education, training and research for the health sector.

The state-run Nurses' Training Schools have not produced adequate numbers even to run government hospitals. Health Ministry Director General Dr. A.M.L. Beligaswatte conceded that there is a major shortfall of nurses even in the state sector. "The requirement in government hospitals around the country is 30,000 due to expanded services, but we have only 14,500."

So individual private hospitals have devised their own in-house training programmes to meet their needs, but have not been able to overcome the dearth. Prof. Chandrasena explains, "Nawaloka has a three-year training programme. The only problem has been recognition, because they cannot sit the state examination. We advertise regularly in the newspapers and take in those with two or three subjects at the science Advanced Level. After the first year they get on-the-job training. But it's very difficult to attract young people to this job."

Why is it that this noble profession doesn't have any takers? "Nursing is not an easy profession. The turnover is quite high. The girls have to do night shift. Most do the job until they marry and have children. Then pressure builds up at home. Who will look after the children when the mother is on night duty at the hospital? Then they give up or take to teaching. Each year, we try to take at least 80 trainees, but find it hard to get people," he says.

"It was a difficult decision to recruit foreign nurses. We come under the Board of Investment and have to provide specialised services like the intensive care unit etc. We also realised that our services were stretched to the maximum. Due to lack of staff our nurses had to work over 12 hours. The only way out was to recruit trained nurses from abroad."

So the Nawaloka Hospital authorities explained the situation to their staff. "We also told them that as foreign nurses are leaving their homes and loved ones behind, we would have to pay them a little bit more. We pay them a small extra bonus. However, we assured our girls that as soon as the shortage could be overcome we would stop such recruitment," stresses Prof. Chandrasena.

The recruitments are finalised once the Sri Lanka Medical Council (SLMC) issues temporary registration to such nurses. "Whenever a hospital asks for foreign personnel, we check their credentials and grant temporary registration for 12 months," says SLMC President Dr. H.H.R. Samarasinghe, while acknowledging that there was a severe dearth of nurses in the country.

A good example from the state sector was the inability to run the teaching unit of the Colombo South (Kalubowila) Hospital because of the lack of nurses.

The complexities of running hospitals are not of major concern to Bindu John (24) and Ronamol Joseph (23) from Kerala. For them "it's a job where we have come to earn a little bit extra".

The work is no different. They trained in Bangalore and worked in Delhi. Ronamol took to nursing because "it's in my family".

"It provides an instant job. We can also go abroad," says Bindu, while Ronamol nods in agreement. Both work in the surgical intensive care unit of Nawaloka. They are provided accommodation on the hospital premises itself, so they do not have to worry about travelling. They only venture out to the Infant Jesus Church across the street and have one yearning. "We miss idlis, thosais, chapatis and puris," says Bindu.

But what of the language? "We speak to most patients in English, and to some in Tamil. We are learning a little bit of Sinhala. Patients are very cooperative. Sometimes a few of them shout at us, but we take it in our stride," says Ronamol. They speak to each other in Malayalam.

Nursing sources outside Nawaloka were not too happy. Sounding a word of caution, they cited the not too successful examples of Cuban and other foreign doctors who were brought down a while ago to work in rural hospitals in Sri Lanka. "Though they were paid much more than the local doctors and provided all facilities, they didn't fit in very well. One of the major problems was language. We must look long-term at this problem. For foreigners, the Sri Lankan training and experience are a stepping stone to brighter futures. They are also paid three or four times more than our people, with other benefits thrown in. Why not give higher salaries and more incentives to local nurses to get more numbers?" these sources query

Maybe that's the answer to the shortfall, when considering the fact that hundreds of young girls and also boys are joining NGOs like Sarvodaya and St. John's Ambulance Brigade, to name a few, as volunteer health workers. Shouldn't the health auth-orities, both state and private, improve the image of this vocation to attract these volunteers who have a longing to care for the sick and feeble?

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