Generations of Kerala nurses have carried their skills across oceans, sustaining hospitals, remitting billions, and raising families that anchor the South Asian American story. Their journey reveals that labor is not only measured in wages but in lives sustained and futures built.
A Global Care Pipeline
Today, the World Health Organization projects a shortfall of 4.5 million nurses by 2030, yet Kerala’s workforce remains among the most adaptable and sought-after in meeting this need.
Since the 1960s, Kerala has invested in one of the world’s most robust nursing infrastructures. English-medium colleges graduate nearly 8,500 nurses each year, far more than local hospitals can employ. Roughly two-thirds migrate abroad, propelled by English fluency, global demand, and professional ambition.
Kerala-trained nurses now form a significant share of the U.S. healthcare workforce. From New York and Philadelphia hospitals to long-term care facilities across the Midwest, they have become essential to patient care, bringing both technical expertise and the resilience forged through decades of migration.
Women at the Center of Care
Nursing migration is overwhelmingly a women’s story. In Kerala, nine out of ten nursing graduates are women. Globally, women account for 80% of the profession. In the diaspora, their contribution is doubly profound, as trained professionals in healthcare systems abroad and as family builders at home.
These women raised children, cared for elders, and built cultural institutions, ensuring that caregiving became both a livelihood and a legacy. Their labor underwrites not only American hospitals but also the intergenerational growth of South Asian American families.
Economic Bridges
The impact of Kerala’s nurses is as economic as it is humanitarian. India received $129 billion in remittances in 2023-24, the highest in the world. The United States is the second-largest source of these flows after the Gulf, sending tens of billions annually.
A significant portion comes from the earnings of healthcare workers, nurses who fund schools, support small businesses, and invest in healthcare ventures back home. The global “care economy” is thus both local and transnational: wages earned in Queens or Houston ripple outward to villages in Kerala, fueling development and dignity.
Networks of Care and Leadership
Kerala’s global nursing presence rests not only on individual sacrifice but also on institutions and leaders who ensured migration remained safe, dignified, and future-facing.
NORKA Roots, Kerala’s State Agency for Non-Resident Keralites, pioneered safe-migration training and ethical recruitment programs.
INANA (Indian Nurses Association of North America), founded in 1978, became an early anchor for guidance, mentorship, and cultural support.
NAINA (National Association of Indian Nurses of America), established in 2006, continues that legacy by advocating for thousands of Indian-origin nurses across the U.S. and amplifying their voice in healthcare policy.
Leaders such as Dr. Latha Mangat (NAINA President), Dr. Leela Muttath (a pioneering advocate for South Asian nurses in the U.S.), and R. Sreelekha IPS (former NORKA CEO) remind us that the labor of care is also the labor of leadership. Their work built structures so compassion could cross borders, ensuring Kerala’s nursing legacy remains ethical, resilient, and enduring.
Raising Roots Across Continents
Kerala’s nursing diaspora shows us that labor is also legacy. Their story is one of families raised while working double shifts, of cultural identity maintained while navigating new worlds, of global healthcare systems strengthened by steady discipline and care. They are not only frontline professionals but also the roots of resilient communities, bridging continents through compassion and competence.
Labor Day Dedication
On this Labor Day, honoring Kerala’s nurses means recognizing them as professionals, caregivers, mentors, and leaders. Their contribution extends far beyond hospital wards into the homes, communities, and economies they sustain. Their work is central, enduring, and unbroken, an architecture of care that links Kerala to America and beyond.
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