Working Abroad in India and the Middle East
Wednesday, March 11, 2020
Posted by: Kanaka Sathasivan
By Jolly M. Punchamannil, DNP, RN, CMSRN, NE-BC
The World Health Organization has declared 2020 to be the Year of the Nurse! In recognition of nurses everywhere, we asked nurses with international experience to share their experiences. This is the first story in that series. Read more stories in the first 2020 Texas Nursing magazine, including our President's experience responding to a crisis in the air, a nurse's experience in China, and a chief nursing officer's experience in the Middle East!
Nursing is a service-oriented profession with compassionate care at its core. Advancements in science and technology have changed nursing science and practice, however, the art of nursing remains the same, regardless of what country you are in. Nursing practice can differ from place to place, and culture has a huge impact on how nursing is practiced as a person’s perception of health and health care is based on culture. Nurses modify their practice appropriately to relate it to the cultural needs of society.
I studied nursing in India about half a century ago, worked there for 9 years followed by 17 years in the Middle East. In 2004, I came to the United States and have since practiced here. I initially earned a Diploma in Nursing and Midwifery from a faith-based Hospital in India run by the American Missionaries. My coursework included studying three years of general nursing and nine months of midwifery. I lived in the hospital campus, attended 5-6 hours of class daily and worked a minimum of 40 hours a week during the student period.
After graduation, I worked for the organization for 18 months to further grow in my knowledge, skills and attitude, which could be compared to the current residency programs in the US. Even now, most nursing colleges in India require students to stay on campus and follow a rigid schedule with limited freedom and then complete a year of service with them. The school has all the “rights,” and students have a minimal voice.
Nursing is still considered menial to many other jobs, and nurses do not get the trust and respect that they get in other countries. Graduates often migrate to other countries for better working conditions. It is difficult to balance work and life for nurses in India, due to the working hours, traveling, and the demands of the families. Nurses in India are not involved in health advocacy or policymaking.
Middle Eastern Experience
Nearly three-fourth of healthcare providers in the Middle East are expatriates, and they come from all over the world. While there, I had the opportunity to work with people from Asia, Europe, America, Australia, and African continents. Health care supplies always exceeded the demand, but people often did not seek care due to other constraints such as traditional practices or issues with transportation.
Some hospitals have mid-level and upper-level nurse managers who are from the western countries who keep nursing standards, policies and procedures updated. However, I experienced a prevalence of the idiom about older “nurses eating their young,” and promotions could be influenced by a superior’s preference or favoritism.
In Middle Eastern countries, nurses are well paid and respected. They enjoy freedom, high living status, and benefits. Nurses were provided with on the job training and continuing education classes. Expatriate nurses could travel anytime, anywhere safely, alone or in a group. They could get together and enjoy their religious traditions. One practice that fascinated me is that the employees give a three-month notice of resignation, which allows for a conversation with the employer to see how they can address the situation.
Differences Among Countries
One interesting fact about nursing students in India is that most of them select their professional courses immediately after passing the higher secondary schooling, and hence most of the entry-level nurses are in their early twenties. Another fact is that nurses do not sit at the patient’s bedside and customer satisfaction and therapeutic relationships are not considered important. I still find it hard on following the policy of “committed to sitting.” Nursing homes are unheard of in India and the Middle East.
While working conditions in the Middle East were fine, I found it hard to work in an environment where there was no strict policy on medications and medication errors. There were few quality improvement projects and there were no committees or boards for supporting evidence-based practices. Individual accountability is less than in other countries, which could lead to unreported negligence and errors. Since there are no accreditation or healthcare maintenance agencies, the policies, procedures, and practices may vary from facility to facility. The physicians had an impact on nursing practices and had preferences on how their patients need to have cared.
Some care practices also differ from country to country. In 1984, I was working in the neonatal intensive care unit in Bahrain. Maintaining an incubated infant’s temperature was vital and we were permitted only to give top and tail care (face and bottom care): “A dirty baby is better than a clean corpse.” Another fascinating area was the newborn discharge process. The nursery calls public health and informs the nurse about planned discharge. The public health nurse visits the home, advises and assists the parents on getting ready to receive the baby. Then, when the baby is discharged, the home health nurse comes with the parents to take the baby home. The home health nurse visits on a weekly basis and gives a report to the nursery.
Similarities Among Countries
Nurses around the world are required to pass a prescribed examination by a licensing board and be registered with a governing board in that country to practice as a registered nurse. While nursing in America is guided by a written Code of Ethics, the nurses in India and the ME countries practice the same unwritten ethics. Nurses are passionate about human caring and are empathetic, compassionate and courageous.
Different countries also followed similar themes common to nursing practice. The majority of nurses are women and consider nursing to be a female-oriented profession. In both India and the Middle East, nursing is practiced in the medical model, and the physician is considered the person of authority. Regardless of location, teamwork and collaboration among various disciplines of healthcare are well evident in these countries.
In short, nurses around the world are selfless, and have a love for their fellowmen, and possess universal virtues such as empathy, compassion, kindness, loyalty, courage and confidence.