22-year-old Mumbai-based Malayali nurse Beena Baby committed suicide by hanging herself. Just out of school, she was ready to become a nurse, but a gruelling contract killed her dream. The ‘bond’ system used by many hospitals governs the lives of thousands of young nurses across India.

“We swallow the abuse and break our backs doing tough 16-hour shifts just to obtain that one-year experience certificate from the hospital,” says 27-year-old Tiju Mathew. “We do it because it’s our only ticket to leave the country forever,” she adds.

This is how the system of bond contracts works. Most private nursing colleges are attached to a hospital. Fresh graduates are inducted and made to sign an agreement with the management stating that they will work as staff/trainee nurse for a fixed salary for one year, meaning 365 working days. At the end of this they are granted a certificate of experience.

“But this is nothing short of a trap,” says Beena Bhasan, president of Kerala Trained Nurses Association and principal of a private nursing college in central Kerala. “Overnight, these graduates become the manual-work force of the hospital. Their original certificates are withheld. If a student chooses to discontinue, she not only has to forego her experience certificate, but also to pay the compensation amount, fixed at will by individual institutes.” 

There are no days off and paid leave is non-existent during this period.

Expenses deducted
When Tiju caught a respiratory infection by putting in long hours in the Intensive Care Unit, she had no option but to quit. The Mumbai hospital where she worked for eight months paid her salary dues, but got her Provident Fund lapsed and told her that she would not get any ‘experience certificate’ because she hadn’t completed a year. The salary, although fixed at 4200 rupees (60 euros) in the agreement, turned out to be just 2700 rupees (40 euros). The reason cited: ‘expenses deducted for food and accommodation’.
 
Not only did Tiju have to work another whole year to make up for the requirements of experience, she will also have to explain the gap in her career to all prospective employers.

Going on strike
Twenty-four-year-old Mareena, a BSc nursing graduate from north Kerala, worked for the ‘mandatory’ one-year term after completing her course, only to be told that it was not a certificate of experience that she would be getting but a certificate of internship.

So she had to work for one more year at the same hospital to finally obtain the certificate that would qualify her as a staff-nurse with experience. In the agreement, the hospital management had stated that they would be paying the Calicut University-stipulated salary of 4500 rupees (65 euros) but the students only got 3500 rupees (50 euros) in hand.

 “Six months into the internship, we went on a strike,” recalls the young nurse.

The management eventually relented and Mareena and others were paid in full for the second half of that year. But Mareena faced more hiccups. In her second year as staff nurse, while her agreement stated that she would be paid her full salary, once again fixed on the basis of the Calicut University recommendations, she got only 5300 rupees (77 euros). “We went on strike again and got it hiked to 9500 rupees (138 euros),” she recalls.

Mareena quit the same month she got all her certificates back and is now trying to find work in Canada.

Extorting students
Bhasan, “The salary for General Nurse and Midwife graduates is anywhere between 1500 and 2000 rupees (20-30 euros) and Bachelor of Nursing graduates get up to 3000 rupees (44 euros).” Add to this the wilful withholding of certificates and an exorbitant compensation amount, and it becomes clear that the ‘bond’ system is nothing short of extortion. 

In Maharashtra, almost all private hospitals that work on the ‘bond’ system charge 50,000 rupees (730 euros) compensation in the event of a nurse seeking to break the contract. Beena Baby, the young nurse that took her own life, had worked in a prominent cardiac care hospital in Mumbai. She was reportedly charged with misplacing a CD containing a patient’s medical details. Beena was allegedly threatened by the management to pay up the compensation amount or work without pay for the rest of the year. Either way she stood to lose her experience certificate. So rather than face her parents – still toiling hard to pay off her educational loan – Beena Baby chose suicide.

In Kerala, private nursing colleges charge around 72,000 rupees (1050 euros) a year for the four-year BSc degree. Ninety per cent of students here – most of whom are from lower middle-class families – take out educational loans to raise this amount. “My students come from the poorest of families in Kerala," Bhasan says. “I can only plead for their sake to the management.” 

The Trained Nurses Association in Kerala has finally decided to tackle this exploitative system by going to court. “We want absolute abolition of the bond system,” says Kochu Thressiamma, president of the Association’s Kerala Chapter.

 “We are also asking for a salary revision and leave allowances.” Other demands include the shutting down of fraudulent nursing colleges and, more importantly, the dignified and respectful treatment of nurses.

A ticket out of India
“Humanitarian concern is hardly shown to us,” says Tiju. Any breakage of equipment, theft, misplacement and negligence are a cause of great fear and trauma for trainee nurses who are always at the mercy of the management.

Admissions in private nursing colleges today have come down by almost 50 per cent. And those who are still lining up to take these courses are doing so because they see nursing as a way to make it to the West. Cousins and friends, already settled in Canada, the UK and Australia, push them to get the certificate so they can make the move.

At a time when India needs trained nurses more than ever to run its faltering health care system, it continues to cheat bright, young women and men of promising career options in nursing, right here at home.

Women's Feature Service / Shwetha E. George