Anyone who has spent time in hospital will know that it is the quality of nursing care that can help make an ordeal bearable. Always on hand to tend wounds, provide comfort and ease nerves, nurses are the human face of a technologically sophisticated industry. Yet of all the healthcare professions, nursing is the one with the lowest status.
There is a shortage of qualified nurses in the UAE and, as in much of the developed world, most nursing roles are filled by expatriates. The majority come from India, the Philippines or other Arab countries. Dr Abdulla al Khayat, the chief executive of Al Wasl hospital in Dubai, says it is important that this situation is reversed. "Areas like primary health care would benefit a lot from having UAE nationals," he says.
"It is about people seeing the positives in the profession from the beginning. Nursing is very rewarding and is very important to the way the health sector works." The most recent Ministry of Health figures, released in 2007, show there were about 18,000 nurses in the UAE. At a session of the Federal National Council last month, the ministry said Emiratis accounted for only four per cent of that total.
Dr Hanif Hassan, the Minister for Health, said nursing was not a job that parents encouraged their daughters to take up. The ministry puts their reluctance down to a combination of low salaries, status and working conditions. According to the ministry, a typical starting wage for nurses is about Dh10,000 (US$2,700) a month. However, according to officials from the Philippines Overseas Labour Office in Abu Dhabi, Filipina nurses in government hospitals receive a minimum monthly salary of Dh5,500. Even doctors, it says, earn only about Dh10,000 a month, excluding allowances.
Dr Punitha Ezhilarasu, the chairman of the RAK College of Nursing, says: "We have quite a lot of expatriate nurses and the drawback in terms of understanding the culture or [a lack of] acceptance by a national group may be there. But in terms of work and quality and skills, expatriates are fine. "The advantage of Emirati nurses is mainly to cater to the needs of the national patients. It fills the gap in terms of cultural needs and sensitivity for nationals."
To attract Emiratis to the job, Louise Bain, the Nursing Services Head at SEHA Ambulatory Healthcare Services in Abu Dhabi, says hospitals and clinics must first improve the perception of nursing and the actual job role. According to Ms Bain, the focus must be on patient care, autonomy and an expanded scope of duties. Staff development should be offered, and nursing must be viewed as a respected profession by other health-care workers.
"It is very challenging because the traditional role of the nurse is seen as being the doctor's assistant," Ms Bain says. She says the career development of Emiratis who take nursing positions with SEHA should be a priority. "We need them to be trained to be in senior positions as early as possible. It doesn't mean we make a new graduate a manager, we just make sure that they have the right exposure and they are on a career track where they are given the mentorship and support, and often more post-graduate education, so that they can take on these roles competently as soon as possible."
A "completely indigenous workforce" is unlikely in the near future, says Ms Bain, but she believes that senior positions can be occupied by Emiratis, and second-generation UAE residents, over the next five years. Eman al Mansoori, 25, has recently finished her Science in Nursing degree at Sharjah University and is working as a registered nurse in the maternity ward of Al Wasl Hospital. She says there are "cultural and religious" reasons that make it harder for Emiratis, herself included, to take jobs in health care. For example, her family in Ras al Khaimah prefer her to work on the morning shift.
But, she says, health authorities and private hospitals are becoming more accommodating. Ms al Mansoori works predominantly with women and hopes to undertake further training to become a midwife. "I think there are not more nationals working as nurses because of our culture and religion," she adds. "Women should not really be exposed to the male [environment] very much, and in the culture women traditionally should be housewives, caring for the husband and children."
Ms al Mansoori is one of nine children. Her sister is also a nurse and although her family were supportive of her career choice, they still placed certain restrictions. At her family's request, she turned down a scholarship to study in the United States. "I will stay working in the UAE of course," she says. "My family would like me to work in Ras al Khaimah but I like working at this hospital so it is good for me."
Her colleague and former classmate, Maryam Abu Aloula, 23, faces similar restrictions but has no regrets about choosing nursing as a career. "I was dreaming of working in health care when I was a child," she says. "I think in the region people see nurses in a low image; it's a cultural thing. This will change, I hope." She says many of the local female patients she works with make a point of saying how comfortable they feel being treated by an Emirati nurse. Like Ms al Mansoori, Ms Abu Aloula's family want her to work morning shifts.
She is getting married in January, and she does not expect her shifts to change. "Everyone is very supportive but they want me to only work in the mornings, especially when I marry." For men who want to go into nursing the general perception of the role can be even more problematic. Ms Abu Aloula recalls a male student who was forced to change courses when he wanted to marry because his career meant that he was not seen to have sufficient prospects.
However, she is optimistic. "I think it will change." Dr al Khayat says his hospital, along with the Dubai Health Authority, is trying to interest schoolchildren in all aspects of health care and encourage them to view a career, particularly nursing, as an attractive option. He acknowledges the scale of the challenge and the perceived lowly status of nursing. "In my opinion as a doctor, you need nurses just as much as you need anyone else. Without nurses you don't have services. It is very simple," he says.