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Nepali nurses gone and going to the UK

News of Nepali migrant workers being <a href="https://www.nepalitimes.com/banner/migration-not-a-wish-but-necessity-for-nepalis">cheated, abused and exploited</a> make headlines every day, but they overshadow stories of many who return with earnings and exposure to start anew back home, or contribute from afar. &nbsp;
Recruitment and employment malpractices obscure the predictability of emigration outcomes. It can be transformative, but in many cases it is not.
We have in this paper previously <a href="https://www.nepalitimes.com/editorial/the-lottery-of-migration">likened it to a lottery</a> in which desperate Nepalis are <a href="https://www.nepalitimes.com/banner/no-country-for-young-men">forced to gamble with their future</a>.&nbsp;
Bilateral labour agreements between Nepal and host countries can ensure a better managed migration process in which there is a greater guarantee of worker welfare. One such government-to-government (G2G) agreement is between Nepal and the UK.
Since 20 July, Britain and Nepal have started accepting <a href="https://www.nepalitimes.com/here-now/nepali-nurses-gone-and-going-to-the-uk">applications for nurses under the bilateral scheme</a>. In its pilot phase, 100 nurses will be recruited at zero cost, and enjoy equal benefits and protection with others in the UK.
Such transparency can allow more predictable consequences for workers seeking jobs overseas. A bonus is their ability to take their spouse and children along, and that the agreement will benefit mainly female workers.
<a href="https://www.nepalitimes.com/here-now/new-uk-job-options-for-nepalis-2vckaq2m">Nurse emigration</a> also highlights the sorry state of their employment conditions in Nepal. One nurse listed three problems nurses face: lack of respect, low wages and overwork. Indeed, nurses have to work for as little as Rs15,000 a month in private hospitals in Nepal after spending millions on their degrees.
These are all results of neglect of the nursing profession by the state. It is therefore hardly surprising that nurses are moving overseas to meet a global shortage of healthcare professionals.
If not the UK, Australia or the US, it is the UAE or Saudi Arabia. A Saudi-based nurse said she left because she had to do one full time and one part time job to make Rs23,000 a month in Nepal, while she saves more than four times the amount in Saudi Arabia for an 8 hour shift with all expenses covered.
If working conditions and salaries do not improve, the more apt question may soon be why nurses stay, rather than why they leave.
There are challenges abroad as well. Britain is itself facing strikes over pay disputes for nurses. But as one UK-based nurse told us, despite the struggle, earning and learning prospects are better there.
<a href="https://www.nepalitimes.com/editorial/human-flight">Emigration</a> is linked to aspirations and desires. And improving the domestic labour market and outmigration are not mutually exclusive. What nurses are escaping from merits attention, but so does what they will be facing abroad.&nbsp;
Those who choose to leave can then maximise the <a href="https://www.nepalitimes.com/here-now/making-overseas-migration-better">benefits of overseas opportunities</a> that are rife with high recruitment fees and insufficient protection.
In the UK, there are also voices being raised about importing nurses for cheap from Red Zone countries with fragile health systems like Nepal.
A managed bilateral agreement makes migration better for nurses who will benefit from the scheme as they can compete in a fair environment.&nbsp;
But Nepal should also go <a href="https://www.nepalitimes.com/here-now/nepal-and-malaysia-rewrite-rules-for-migrant-labour">beyond traditional labour agreements</a> to enter into mutually beneficial skills partnership models that would also support health training and infrastructure back home. This requires proactive diplomacy, thinking outside the box and a realisation that benefits of migration can go beyond remittances.
Nepal needs to view its diaspora as its strength and seek ways to engage those abroad. As UK-based nurse Binod Simkhada says, “To contribute to Nepal, one does not need to be in Nepal.” At the Nepal Nursing Association in UK, he was involved in establishing a birthing center in Jumla that was recently handed over to the local government.
In many cases, Nepalis can provide more help from outside than from within Nepal, given better access to resources and networks. And for those who come back, reintegration policies are overdue to leverage the social and financial remittances returnees bring home.
As the <a href="https://www.nepalitimes.com/here-now/nepali-family-spread-across-kuwait-cyprus-uae">Nepali Times Diaspora Diaries series</a> show, good migration can be transformative and help families break out of intergenerational poverty. Because the government took a proactive initiative on managed migration of nurses to the UK, the 100 nurses could have life-changing stories.
But that by no means absolves the Nepal government from its responsibility of ensuring that nurses here are treated with respect and earn liveable wages. It is the least the state can do.

Nepal’s nurse flight

<figure><img width="1440" height="1080" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912114/636b89d69c7e80680e06b20bjpeg.jpg" alt=""/><figcaption>Photo: ALISHA SIJAPATI</figcaption></figure>Even before the two-week lockdown, more and more Nepali families with elderly relatives hired nursing care at home. Several companies had started up as demand from the Nepali diaspora added to the need for home caregivers. The COVID-19 lockdown had accelerated this trend.  Srijana Paudel (pictured above), 21, a certified nurse has been looking after a bed-ridden elderly woman in Lalitpur for more than six months. But on 23 March, when Prime Minister K P Oli went on television to announce a nationwide lockdown from 6 AM the next morning, she was in a fix.While hospital workers and ambulances are allowed on the roads, many nurses taking care of elderly or sick family members could not commute to and from their own homes anymore. So, Paudel has been forced to stay over at her patient’s home for the past ten days, without being able to take care of her own family.<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/banner/protecting-nepals-elderly-from-covid-19/" target="_blank" rel="noopener">Protecting Nepal's elderly from COVID-19</a>, Alisha Sijapati<a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/" target="_blank" rel="noopener">Protecting those who protect us from the epidemic</a>, Ramu Sapkota“I feel bad not being able to return to my home and be with my family, but looking after someone more vulnerable is my duty as a nurse and I will make my best effort to protect them,” Poudel says. “It would make me feel more guilty if I stayed home. I have become close with my patient’s family, so that helps.” There are over 200 nurses and caregivers like Srijana Paudel from various home care services in Kathmandu working in private residences of elderly patients. Seniors and patients with pre-existing medical conditions such as asthma, diabetes, or heart disease are more vulnerable to becoming severely ill with the novel coronavirus, making the need for the home caregivers even more critical.  <figure><img width="1000" height="662" src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/2022110912114/636b89d99c7e80680e06b20cjpeg.jpg" alt=""><figcaption> </figcaption></figure>Rupa Joshi of Bag Bazar has two elderly relatives to look after in her household: a 105-year-old grandmother-in-law and a mother-in-law who is 90. Both require special assistance. “We had been on self-quarantine even before the lockdown to protect elderly family-members and reduce the risk of contamination,” says Joshi who has asked her mother-in-law’s caregiver to stay with her own family until the lockdown is lifted to avoid contamination. Another caregiver has been asked to live-in so she does not catch the virus during her commute. “Our caregivers are like family members now, and in this difficult situation we have to help them, and accommodate their needs too,” Joshi adds.  While some <a href="https://www.nepalitimes.com/business/caring-for-those-who-cared/" target="_blank" rel="noopener">home care services</a> had drawn up a contingency plan two weeks before the lockdown, other health providers have had to change their schedules overnight to cater to patients since the shutdown.  <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/here-now/8-ways-to-keep-well-during-a-lockdown/" target="_blank" rel="noopener">8 ways to keep well during a lockdown</a>, Marcia ChenAt Patan based health care service Medilink, Sushmita Khanal has been working non-stop from her home to cater to her clients and also address the needs of her caregivers who look after older patients. “We knew COVID-19 and the lockdown was inevitable, but I wish we had more time to buy equipment and medicines and plan effectively,” Khanal said over the phone. <a style="font-size: 15px; letter-spacing: 0.01em;" href="http://archive.nepalitimes.com/article/Nepali-Times-Buzz/need-to-prepare-for-ageing-society,3624" target="_blank" rel="noopener">Home care</a> had already become a trend in Nepal even before the pandemic scare as family members worked fulltime, and there was no one to take care of elderly relatives. The job has become even more challenging and necessary during the lockdown.  <a style="font-size: 15px; letter-spacing: 0.01em;" href="https://www.nepalitimes.com/opinion/home-work-during-the-lockdown/" target="_blank" rel="noopener">Work from home during the lockdown</a>, Saniaa ShahBishal Dhakal was a resident surgeon in Pakistan, and returned to Kathmandu in 2009 to start a health service provider, Health at Home. Although his clients need services now more than ever, he says the economic downturn may affect the ability of families to hire services like his.  “We have clients from all backgrounds, but since most of them work on monthly salaries we can foresee many clients cancelling their contracts in the next couple of months,” says Dhakal. Fearing a slump, Dhakal’s Health at Home, Sushmita Khanal’s Medilink have put off expansion plans in their businesses. However, their central focus continues to be in giving best possible service to existing patients during the lockdown, and communicating virtually with caregivers and nurses on preventing the virus from infecting the elderly. While most caregivers and nurses are trapped in the homes where they work, the service providers have managed to get limited transport permits to pick and drop some staff who have families to take care in their own homes. Like Rupa Rai, 22, a nurse at Medilink Health Care who finally got back to her own family after being trapped in her patient’s house for nine days. She says: “I didn’t bring spare clothes, but now I am more prepared mentally for an extended lockdown.”

Home health care during a lockdown

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