Healthcare workers in hospitals assign various reasons to the management’s preference patterns. They are not always aware how the management has been infusing conflicts and distinctions, thus preventing growth of identity and consciousness among them as a professional class of care service providers. The workers mirror and perceive hierarchies on the basis of perceived differences among themselves, which we have found to be either “ethnic” or “generational”. Nepali nurses prioritise their choice of work over alternative livelihood options in the urban informal economy, because in Nepali community, work associated with nursing or caring for people inside and outside the community has always been held in very high regard.

This came up in conversations with senior Nepali nurses, who outlined how nursing has always enjoyed higher social prestige in their communities. However, this community preference was the result of factors associated with availability of health facilities in remote villages and towns in the hill areas, which normalised community women’s participation in care work and made them subsidised community care suppliers. A number of them took up nursing because they had observed their mothers do nursing work, which encouraged them to follow in their footsteps.

Nursing being considered a noble profession, they received considerable encouragement from their families. However, currently this work is undergoing steady devaluation both within and outside the community and wider society. The older generations of Nepali nurses blame the attitudes of younger generations of nurses, who are supposedly less serious about learning the work and are more motivated by the glamour of city life.

Things have changed. When we joined, our first reason for entering nursing was related to earning livelihood in a decent way by joining a noble profession. I joined because my mother was also a nurse. This inspired me because by learning nursing, I would be able to help people around me. However, girls entering nursing homes to work as nursing aides nowadays have little thought about selflessly serving others. They are driven by aspirations to lead a city life, earning pocket money to sustain. They have little dedication to the work. Even while training young girls, very few among them are really serious about learning the job.

— Interview held at Nursing Hostel of M Nursing Home, Siliguri, February 2, 2017.

It is therefore interesting to find out how there are inter-generational differences in perceptions of nursing as a career option. Within the Nepali community, nursing was once considered the noblest job option for women. However, the present generations of young women understand nursing as just one among the various job options available in the cities. Nevertheless, apart from these generational distinctions, the presence of Bengali and Nepali nurses in the same workplace often leads to a tense work atmosphere.

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It is observed or insinuated by nurses from the Bengali community that the management prefers Nepali nurses not because of their hard work but due to “other attributes”. They are ready to work at very low wages, and, as they like to dress up, wear lipstick and make-up, it is assumed that this is done to gratify men at the workplace. There is also a belief that some of the Nepali women indulge in sexual practices with doctors and hospital staff to raise their incomes.

They know better how to “please” people around them, be it doctors, management or patients...They are always engrossed in the way they look, their dress and how well they can adorn themselves wearing lipstick, eye-liner, and hair-dos at work.

— Interview held at the residence of a senior Bengali nurse working in M Nursing Home, Siliguri, February 21, 2017.

This leads to the erroneous belief among Bengali nurses that Nepali women are to be blamed for degradation of nursing services in the eyes of the society at large, and they are responsible for reduced job options for Bengali women as well as for wage cuts. According to several Bengali nurses, Nepali men and women have strong community bonds and fellow feelings, so if the owner of the nursing home is Nepali, they generally prefer to put women from their community in top nursing positions like ward in-charge, irrespective of whether or not they have the required qualifications for the post.

They add that, in many cases, the degrees are not always cross-verified by the management while recruiting/promoting the women. A Bengali graduate nurse (GNM) said that she witnessed a lack of cooperation from Nepali nurses in the first year of service at her workplace. In her opinion, a few of the Nepali nurses were not prepared to listen to her because she was a qualified nurse from the Bengali community, considered a “rival” by them:

There were many Nepali nurses among the seniors, semi-seniors and junior nurses. Since they were in the nursing home before I joined, they were not prepared to listen to me. Even if they were doing something wrong, and I went to correct them, they disobeyed and even ridiculed my supervision. The first year was horrible here. I felt quite out of place. Now however, things have changed. With time, they also realised that I am better qualified to guide them. 

— Interview held at the residence of a senior nurse working in B Nursing Home, Siliguri, February 25, 2017.

On the other hand, Nepali women hold the opinion that the management prefers Nepali nurses because Bengali nurses are not ready to do whatever work is assigned to them. They guess that the reason for reducing numbers of Bengali women at the workplace is that they are unable to adjust to the low wages and abuses. Several of the Nepali nurses considered sexual abuse a part of the work that was difficult to avoid at the workplace and nurses need to adjust to these on a daily basis. These aspects of work have continued from the past, and retired nurses across Bengali and Nepali communities have mentioned having experienced sexual advances and requests for sexual favours from doctors. The mutual dislike and competition rob the nurses of the power to form a collective voice, and gives the management opportunities to create further divisions and fragmentations.

Excerpted with permission from “Hierarchization in Healthcare” Female Nurses and Ayahs in Private Healthcare in Siliguri, West Bengal” by Hemantika Basu, from Who Cares?: Care Extraction and the Struggles of Indian Health Workers, edited by Maya John and Christa Wichterich, Zubaan Academic.