996 views as of May 6 2013
Update April 2013
If you found this blog, go look at a very interesting YouTube clip first. it will give you something to think about.
Update August 22nd, 2012:
This entry is among the most-read in the entire series. There is not much country-specific information as to the ins and outs of nurse migration from Nepal, though we are now having a diaspora of educated persons leaving the country. You may also want to read my blog about foreign nurses who come to USA.
I am always eager to talk with people who wish to learn about the health system of Nepal. If you are a student doing a paper on this subject, feel free to contact me.
please consider subscribing to my current blog, Nursing in Hawaii.
Update April 7th 2014
My book, The Sacrament of the Goddess, gets published May 1st. the people in it are making a decision as to whether to stay in Nepal or not. Buy a copy!
Wages in Nepal
A nurse told me how much she is paid: 15,000 rupees per month. That works out to 212.164 US dollars per month.
If she gets her BN degree, she could go up to 20,000 rupees, which is 282 US dollars. To get a nursing education usually involves loans of 250,000 rupees or more.
Wages in USA
Every Nepali nurse has heard how much the nurses of USA are paid. If a USA nurse is making 60,000 US dollars a year, that is 4,270,799 rupees per year. More thsn four million rupees. Fortytwo lakhs!
355,899 rupees per month. Given the alternatives between 15,000 rupees per month and 355,899 rupees per month, which would you choose?
International Nurse Migration? or diaspora?
I get asked on a very frequent basis, about ways to get to USA, the land of opportunity. My usual answer is that the amount a nurse is paid does not reflect the cost of living in a place. For example, most young nurses here live in a multigenerational family unit and do not pay rent. Or own a car, let alone drive. I have given talks where I laid this out, so much for rent, so much for gas, so much for insurance, etc. this dampens the enthusiasm a bit. I have given this talk so much I should make a powerpoint about it.
Clarification about cost of living in USA May 2013
let me expand on the above. If you get to USA and finally get a USA nursing job, you think you are rich… but are you really?
first, what if you earn $60,000 per year?
1) that is before taxes. the typical American will pay $8,000 in taxes, which is withheld by the employer. you can’t hide it. that leaves you $52,000.
2) next, you will need to rent a place. the cost of this depends on where you are, but if it is New York City it may be $1,000 per month for a one-bedroom place, which is $12,000 per year. that leaves you $40,000
3) do you want a car? if you buy a new one you will need a monthly payment and insurance. this can be $600 per month – so $7,200 goes out the window, leaving you $32,800.
4) in many workplaces, you are required to deduct your group health insurance contribution from the wages, this can be up to $800 per month depending whether you have children and a spouse. so – say goodbye to $9,600. the pile is now shrinking to 23,200.
4) food is more expensive here.
and on and on. If you have school loans, they too need to be paid.
Compare all this with the idea of living in a house owned by your family and having less expenses, even though you don’t bring home as much. is it really and truly an improvement?
Don’t judge by the Americans you meet in Kathmandu
The only Americans the Nepali nurses come into contact with are those fortunate enough to get to Nepal, such as me, or such as the Christian missionaries they meet. They think all USA nurses are wealthy.
Dowry System and arranged marriage
When I first arrived in Nepal four years ago, an American nursing faculty took me aside and said of the TNS students “you realize that most of these kids will never practice nursing, they are mainly here to improve their marriage prospects.” The official “dowry” system, (in which the bride’s parents pay the groom’s parent some money) has been outlawed, but the traditional system of arranged marriage has not. Here is how the reasoning goes: a woman with an education is more valued when it means she will be a potential wage earner if the couple goes abroad. The education serves in lieu of a monetary dowry. Okay, so this means that there is economic incentive to invest in the daughter’s education which may not have previously been there ( not entirely a bad thing if you ask me. After all, women need to be educated, no matter who they are). The few nurses who actually go abroad and succeed serve as beacons of hope, positive examples of the success of this strategy. It’s only within the last ten years that a “nice” upper caste girl might consider nursing, and the idea that it is tied to overseas work imparts more status. All kinds of factors in play, here.
The possible husbands are rank ordered according to desirability of occupation and earning potential. Marrying a Gurkha is a terrific match, the man will retire from British Military service and have a lifetime pension in Nepal at the age of forty. Then, next on the desirability scale would be a man with an MBA, who will go into business. Do nurses marry doctors? Generally no. Doctors are relatively low on the list of desirability, they have too much schooling debt themselves.
Bonded Labor and a new twist on Human Trafficking
In Asia, there still exists a system of “bonded labor”, meaning that you sign an agreement which is not all that far from slavery. A friend told me that she knows a Nepali guy who is in medical school in Singapore and signed a bonding agreement for eight years. He will not be able to return to Nepal to work until that time is over. I knew an orthopedic surgeon in Tansen who worked there because he signed a ten-year bonding agreement in order to pay for his school. There are stories that some of the nurses that go to USA or UK are forced to sign bonding agreements with the agency that sent them. The exploitation of nurses is a whole another story…..
Some destinations are more desirable than others
There is status accorded to where you went abroad for further study. Right now Australia is considered to be the best, I think. A friend of mine ended up going to Cyprus instead, because she couldn’t qualify for Oz; she was bitterly disappointed and did not want anybody to know her ultimate destination. Even for those persons who have every intention of returning to Nepal after graduate education, there is pressure to get a their graduate education from one of the more respected countries. “credentials are everything here and they have to be spotless” I was told. Some of the most progressive nurses I have met, though, got graduate education in Japan or the Phillipines, not the USA. Come to think of it, I don’t think I have met any nurses in Nepal who got a grad degree in USA and returned here. Oh sure I know some presently enrolled…. It will interesting to track them longitudinally…. Where will they be in five years?
Triple-reverse further study
There are a number of young Nepali women who have never worked in a Nepali hospital, now getting nursing degrees in USA under student visas. Here are people whose nursing education includes clinical practice in Dallas, Manhattan, Seattle, Philly, or Honolulu. Now, I have been in both Nepali and American hospitals…. And the two are… different….. Most Nepali hospitals are deeply invested in what we would call “functional nursing” – the type of setup that would drive an American nurse crazy. it will be utterly fascinating to me to see how their role socialization into nursing fits with the role expectation of working in a Nepali hospital, if the nurses with USA nursing educations ever return here. I don’t know how to say this but I think these persons are in for a shock.
what do the leaders think?
In Nepal, there is a spectrum of views among administrators about further study abroad. One the one hand I have heard people say “why bother training anybody? As soon as a nurse gets trained they will move away from here, or go abroad” There is an old saying here that more education does not lead to more productivity in Nepal, due to the system of delegating labor. We’ll go into that at some other time.
On the other end of the scale, I met with one doctor who said “we need to encourage as much as possible, the idea of possibly going abroad, whether they go or not. It means that they will study more and invest in lifelong learning when they have such a goal” he said “there will inevitably be a reverse brain drain when the economy improves, such as is now happening in India. These nurses will return here, bringing new expertise.”
Training at the wide part of the funnel
I considered some of these things when planning my own program, and the strategy to attract students was to train the largest possible number with the most wide-open enrollment system that I could devise ( thank you, FaceBook!) in an effort to counteract some of the factors. Still yet, the students want a certificate – why? To make their portfolio more desirable when they apply abroad….
The World Health Organization has studied the phenomenon of International Nurse Migration. Their conclusion? It’s complicated.
Travel Outside the Kathmandu Valley – to the Terai again.
Tomorrow morning I get up bright and early to go to the Tourist Bus Depot near Thamel and get on a Tourist Bus to Bharatpur. It will be air conditioned, nobody will ride on the roof, no critters or vegetables being conveyed, and they will have a little white sheet on the headrest to soak up any sweat. Classy!
We will ride downhill the whole way along a river gorge. ( of course, the return trip will be uphill…) I will be accompanied by two nurses from Bharatpur, but I expect to sit with lots of other short-term tourists on their way to see elephants, tigers and the one-horned rhinoceros at Chitwan, the world famous wildlife reserve that is nearby. To be in the company of that many tourists, will be a first for me. Maybe I will wear the topi and only speak Nepali with my friends the whole trip…..
I will spend three intense days with thirty enthusiastic nurses from the 400-bed hospital there, doing my tried-and-true program already tested out at Bhairawa. They have a very nice facility and they are committed to service excellence. Bharatpur is the center of the district where the largest number of the Tharu ethnic group reside. This is a fascinating subgroup of Nepal. I am told I will stay at the best hotel in the city. It is raining in the Terai now, is cooler because of the rain. Rice has been planted. I am sure to see a working elephant or two.
Q. “where do you park your elephant when you are doing errands downtown?” A: “wherever you like”
See you on the flip side.