The south of India is known for its top exports: cashews, spices, rubber, wood and, apparently, highly educated nurses.
“Kerala is famous for the nurses it exports,” says Rose Mary Xavier, MS, RN, PMHNP-BC, a nurse who hails from Kerala, India—a state on the southern coast of the subcontinent. “Nurses are the state’s most valuable export product. Wherever Kerala nurses go, they excel.”
Xavier herself proves the point. An experienced psychiatric nurse practitioner and a doctoral student in nursing at Duke University, Xavier was named one of only 16 Robert Wood Johnson Foundation (RWJF) Future of Nursing Scholars this year. As such, she will receive financial support, mentoring and leadership development over the three years of her PhD program.
Now well on her way to the height of her profession, Xavier’s story is the stuff of the proverbial American dream. The daughter of a fisherman and a homemaker, Xavier was born into a life of grinding poverty on the shores of the Arabian Sea. She grew up in a small, one-bedroom shack with no running water and shared it with her large, extended family. An impoverished girl in a rigid caste society, Xavier was not expected to go far in school; most children in her hometown, in fact, drop out of school early to help support their families.
But Xavier’s grandmother wanted more for her granddaughter. One day, she walked to the local Catholic school—the best private school in the area—and asked the principal to admit Xavier and give her a tuition discount. To her great surprise, the principal agreed, and Xavier started classes at age 3. She was the only child of a day laborer in the entire class.
Three years later, Xavier’s grandmother died, but Xavier’s mother carried on her legacy, regularly visiting the school to beg administrators for tuition breaks for her daughter as she moved through elementary school, junior high and high school. “It opened up a completely different world for me,” Xavier says. “I’m pretty sure if my grandmother didn’t make this decision, and if my parents didn’t decide to stick with it, I wouldn’t be where I am right now.”
Lacking Health Care
Xavier excelled in school and, along the way, developed a keen interest in health care, in large part because it was so lacking in her family and community life. Xavier’s paternal grandparents died in their 50s of cholera and dysentery, both highly preventable diseases. Her sister was born with a congenital anomaly and died soon after because, Xavier suspects, her mother had not been warned of the danger of taking malaria medicine while pregnant. Her mother had suffered from a debilitating bone infection as a young girl. And death and disease, along with massive financial debt, were familiar guests in the community around her.
“When you are in poverty, you address health issues only when they come to the terminal point,” Xavier says. “People don’t look into problems until something is certainly wrong. And if something happens to the family breadwinner, it’s a crisis for the whole family. Witnessing that got me interested in health care.”
After high school, Xavier won a scholarship to the College of Nursing Thiruvananthapuram at Kerala University, one of the best nursing schools in the country, and earned her bachelor’s degree. After graduating, she worked for a short time in India as a staff nurse and a nursing instructor before moving to the United States so she could earn higher salaries and advance her career.
“I knew it would change my life,” she says of her move, and it certainly did. Xavier arrived in Arizona in 2005 and took a job as a registered nurse at St. Luke’s Medical Center in Phoenix, and applied to a master’s degree program at Arizona State University. In 2008, she became a nurse practitioner at St. Luke’s Behavioral Health Center.
While there, she cared for mentally ill patients who had undergone electroconvulsive therapy—a job that many nurses on Xavier’s unit disliked because the patients were “mentally ill” and at times difficult. But Xavier was drawn to the work. “Usually, when you think of schizophrenia, you think about homeless people walking the streets and pushing carts. But what I saw were regular people—and sometimes really amazing people—coming in for treatment and getting better.”
Other times, of course, patients did not recover. “I would see patients in all different aspects—when they were better, and when they were really sick. That’s what drove me to psychiatry.” But working in the field raised more questions than answers. “When I was in practice, I was confronted by the limitations of our knowledge of mental illnesses. The field has advanced, but we still know so little,” she says.
Xavier plans to add to that body of knowledge through research into schizophrenia, where patients “lose insight” into their illness. Many patients, she says, don’t believe that they are ill and won’t accept treatment, making recovery much less likely. Xavier plans to conduct research into the neurobiological and genetic basis of poor insight in schizophrenic patients, so that they can move past that psychiatric hurdle and accept care.
In the meantime, Xavier continues to support her family in Kerala and plans to “give back” to the people and to the place that gave her a way out of poverty. But after her long journey to the United States, she says she has no plans to move back to her home country or town. “It’s very hard to survive there,” she says. “For many people, it’s hard to lead even a decent life.”
As one of our nation’s most highly educated nurses and an emerging nurse leader, Xavier is, indeed, a top export from the south of India, and those who are struggling with mental illness in United States are fortunate to have her.