Nepali nurses caring for the world

This is the 67th episode of Diaspora Diaries, a Nepali Times series in collaboration with Migration Lab providing a platform to share experiences of living, working, and studying abroad.

Alpana Adhikari, UK

Back in Nepal, I had worked as a nurse for a decade, but I had my heart set to go overseas.

My reason for wanting to migrate, however, was a bit different as it was for my son. He has a disability, and considering his situation from multiple perspectives—including societal attitudes, the preparedness of schools, and the availability of facilities for individuals with his condition—Nepal did not feel safe for my baby. 

I had to migrate, no matter what, for his sake. The facilities here in the UK for children with his condition are significantly better, and I am glad he and my husband will join me in a few months. 

I was applying via private routes like everyone else when the Government to Government pilot program between Britain and Nepal was announced. Even though the initial program targeted 100 nurses, only 40 of us were able to meet the criteria. 

I made it to the UK  in February 2024 without paying a single paisa to any broker. The G2G scheme was unique as we were treated with dignity and valued for our skills: they covered costs for the ticket and visa, reimbursed us for exams we had taken and costs involved in the preparation and testing of the Objective Structured Clinical Examination were also covered. 

I started work in March last year, and currently am based in the respiratory ward of a hospital. I am enjoying my work a lot. In one year, I have received 26 WOW nominations which are notes of appreciation from patients we have served.

‘Alpana is one of the kindest nurses I have seen. Awesome and talented … always smiling, never appears tired and helps everyone,’ one patient testimonial said. Another: ‘You can see clearly that she cares about her patients…She was cool amidst great stress and ALWAYS with a smile which gave me confidence.’

I am also the International Educated Nurses Advocate which means I can raise issues with management about issues facing international nurses here. 

Recruitment from NHS linked hospitals is free but when we migrate through private routes, agencies either charge upfront costs or in some cases, there is wage deduction once the nurses start earning. 

I have met Nepalis who have paid up to Rs 1 million for the same job. These costs can go even as high as Rs3 million for work in caregiving or nursing homes. I am lucky not to have to pay anyone for my posting. 

But beyond costs, I think there is also a reputational advantage of coming through the government selection process at the hospital. Such programs need to be expanded more because nurses are migrating anyway and it would save people a lot of unnecessary costs and hassles.

I will always be protective about Nepal and am grateful for the experience I gained, but it is true that nurses lack dignity in the workplace back home. Nursing is laborious work and completing the education takes a fortune but the pay for nurses in Nepal, other than at a handful of hospitals, is unfairly low. 

It naturally makes nurses want to migrate. People often ask me what the difference in the UK and Nepal is. Work is similar but in terms of technology, there is less paperwork here as everything is digitised. Treatment is also more nurse-led and we have more say while making recommendations about medicine and discharging decisions which can be empowering.

I am not sure what it is about nursing but I am always in high spirits and energetic about showing up to work every day. To be a good nurse, you have to have the passion for patient care. 

Sometimes people tell me it is because my family has not yet joined me which has freed up my time to singularly focus on work, but I do not believe that is true. Back home, too, I used to be as passionate about my job. 

What fuels my passion here is the appreciation we get. It is not just about the income. Sometimes after long hours at work when it has been a particularly busy day, a phone message from my manager and colleagues appreciating me for a job well done can go a long way. 

Likewise, the WOW recommendations from my patients have boosted my confidence. One of my elderly patients who had a mental illness and I bonded, and she felt comfortable enough to open up with me. She would then refer to me as her friend with everyone. 

It is little things like this that can make a big difference. Perhaps that is why my flat mate and colleagues often question why I don’t look tired even after a long shift.

Binu Subedi, Japan

It has been five-and-half years since I came to Japan under the Specified Skilled Workers (SSW) visa in the nursing category. I had previously come to Japan as a language student as well. 

I grew up in Ghandruk and had just started my Bachelor’s course when a friend suggested we try to go to Japan so I just followed the trend and stayed here for three years as a student. 

Two years after returning to Nepal, I re-migrated to Japan under the SSW scheme which was at its early stages and only open to nursing initially. 

I take care of the elderly Japanese who are mostly above 80 years of age, a few even above 100. I try not to get too attached to patients but it is of course not always easy because of the nature of the job and patients we serve. 

Patients dying of age is common as it is not a care facility where patients recover to return to their homes. Just recently, an elderly lady who had been here from the day I joined 5.5 years ago passed. 

These leave you a bit खिन्न and emotionally drained. Most are dementia patients who do not  even recognise their family members. Some elderly patients are reserved and do not feel comfortable as the work entails helping with personal care tasks like using the toilet or bathing and they can be irritable. 

Building trust and rapport takes time, patience and familiarity. I do not think there is a way to explain how happy I feel when they are happy with the care we provide and thank us in smiles like we are their own family members. 

My own grandmother back in Nepal was in a similar situation requiring care before she passed and I am able to extend that kind of care to many patients.

I know that this job is not for everyone. That is why some nurses who come to Japan because they want to just migrate overseas at any cost without considering the kind of employment realise that caregiving might not be for them. 

You have to be mentally, physically and emotionally prepared for it. If you are short-tempered by nature, for example, it may not be the best fit. However, for those who are genuinely interested in care work like I am, there are many growth opportunities in nursing which are also financially rewarding. 

While working under the SSW visa, I was able to take training classes on the side and passed the national exam for nursing. I was then able to change my visa from SSW to nursing caregiver visa. My son joined my husband and I recently in Japan and has started school.