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A Pre-decision Kit”: bitter-sweet pill for nurses and Fiji [The Fiji Times, 4 March 2010]


Not so long ago I was honored to be asked by the Fiji Nurses Association (Mrs Taraivosa Kolinivalu and Mrs Kuini Lutua ) to launch “A Pre-Decision Kit”- a brochure to assist nurses who were leaving Fiji to work abroad.

The pamphlet stated that it was an “Information Passport to Workers and Trade Union Rights on Migrant Workers”.

This launching surely had to be an extremely bitter-sweet exercise for the Fiji Nursing Association.

Bitter, because this “Pre-Decision Kit” was a response to the decades old trend of Fiji nurses flowing abroad because of the “push” factors in Fiji and “pull” factors from abroad.

It must also be a “sweet” experience for nurses as they would not otherwise go.  And Fiji may benefit from their remittances.

This Pre-Departure Kit tries to prepare departing nurses from a multitude of angles, both from their own personal interests, and others for whom they have responsibility.

The push factors

Despite the considerable skills that nurses have and the vital nature of their work, nurses’ salaries in Fiji have remained scandalously low while the hours of work have been long.

The Nurses’ Association’s many efforts over the years to improve the working conditions have at times been ruthlessly beaten down by the authorities.

There has even been the bitter experience of callous public demands that nurses must be self-sacrificing “Florence Nightingales” and not think “selfishly” of their pay.

Such demands forgot that Florence Nightingale was a well-off woman from the upper classes, and no comparison to the typical nurses who come from working class back-grounds, and who have families to feed and clothe and children to educate.

Indeed no other profession is ever asked to make such sacrifices- certainly not accountants, economists, lawyers or businessmen.

The tragedy for Fiji has been that a long- stagnating economy, plagued by political instability, just has not had the sustained economic growth and healthy government revenues that could have allowed necessary improvements in salary to be made.

What are we wasting our public expenditures on?

Are there are some categories of civil servants whose working conditions have been significantly improved recently, yet our tax-payers would not see them as useful and productive as our nurses?

The local costs

Of course, the outflow of nurses puts great pressure on our public health system and the health care we can provide our patients in the public hospitals.  Look at the ratio of patients to nurses in Fiji.  Look at the state of our public hospitals.

And of course, those who leave must be extremely sad that their departure will make things harder for those who remain (except the new appointees).

But nurses also have families to feed, clothe and educate.

If Fiji is not able to create an environment in which our nurses feel comfortable with their employment conditions and standards of living, then the global “pull factors” will have their inevitable impact.

This applies not just to nurses, but most of our technical and professional citizens:  the global labour market offers miles better salaries and working conditions than does Fiji.

For nurses and their families, working abroad can be an extremely sweet experience and has proven so for large numbers of nurses, with an extremely positive impact on their families’ welfare.

They can also have a large positive impact on Fiji’s welfare.

We must not forget that Fiji’s balance of payments over the last decade would have been in serious trouble, had it not been for the large remittance earnings sent home by nurses, care-givers and security guards working abroad.

And of course, our nurses working internationally may make their departures permanent if they find hospitable working environments abroad and comfortable decent lives for their families.

What Fiji has to do, of course, is to keep training extra nurses, to replace those who are leaving, with the nurses paying for some fair share of the costs of their training.

But also bitter experiences

But not every departing nurse has had a 100 percent sweet experience.  Some have had extremely bad experiences when the reality of their working conditions did not match what they had been promised or what they expected.

Which is why the Nursing Association of Fiji and the PSI Oceania Women’s Committee have prepared this “Pre-Decision Kit” for nurses who are contemplating working internationally.

The nurses are given check lists to ensure that they have full information about the recruitment or employment agency, the credentials of likely employers, the terms and conditions of employment, including formal legal contracts, salaries, hours of work, and protection in employment through unions.

Nurses are warned to avoid exploiting recruitment agencies.

They are given useful organisational contacts abroad.

Perhaps a next version of the kit should also remind health workers to obtain information on the cost of living in the destination country- high salaries may sometimes be an illusion if the cost of living is very high.

They also must know who or what will be there to back them up should they get into difficulties of any kind.  And foreign workers inevitably have their share of problems, without the family and other backup that they can expect at home..

For health workers taking their school age children with them, the kit should also warn the potential migrants to obtain information on education possibilities and conditions.  Often children of foreign workers may not be entitled to free education or health services.

Nurses are also reminded by the Pre-Decision Kit to make provision for all their existing personal responsibilities in Fiji- for their families and dependents, as well as financial responsibilities such as loans and mortgages.  Nurses are warned not to act irresponsibly by “running away”, as it were, from their personal responsibilities.

The Kit very sensibly also reminds nurses to think ahead and prepare for the possibilities when they return to Fiji, whether to work or retire. Did they know what to invest in were they to bring their savings back? Or would they be better off investing their savings abroad, with better returns than in Fiji, and possibly safe from possible future devaluations of the Fiji dollar?

Useful for all workers going abroad


While the booklet is presented as “Health Workers Migration Information Passport” it is surely also useful for any worker who is contemplating working abroad or emigrating.

That of course is an inevitable trend in globalisation.

There are many academic critics of globalisation, many of whom are the biggest beneficiaries of globalisation- conference travel, computers, easy access to jobs and Permanent Residences abroad.

But it is surely quite positive that low paying Fiji occupations, like nurses and plumbers, who may not have been mobile thirty years ago, are very much on the move today, with a promise of great benefit for the workers and their families concerned.

All those agencies who have helped to produce this booklet are to be commended: Public Services International, the Oceania Public Sector Trade Unions Women’s Committee and of course,  the Nursing Association of Fiji.

After all, nurses know only too well, that pills given to patients must be taken, bitter or sweet.

And the Pre-Decision Kit is a bitter-sweet pill for both nurses and Fiji.


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