%0 Journal Article %T Nursing brain drain from India %A Michael Hawkes %A Mary Kolenko %A Michelle Shockness %A Krishna Diwaker %J Human Resources for Health %D 2009 %I BioMed Central %R 10.1186/1478-4491-7-5 %X Migration of trained nurses from resource-poor countries to wealthier countries experiencing nursing shortages may exacerbate global health care inequities [1]. We wish to draw attention to the significant drain on India's nursing labour force due to "circular migration," using selected results from a recent survey.We administered anonymous written questionnaires to a convenience sample of 99 nurses at a private hospital (Malankara Orthodox Syrian Church Medical College) in Kerala, India, in September 2007. Study participants had a median age of 27 years (range 22 to 57) and 96% were female. In terms of educational background, 98% of respondents had obtained a three-year nursing diploma while 2% had a four-year bachelor's degree in nursing. Of note, 20% of respondents had worked abroad, for a median of six years (range 2 to 15 years). Career time spent outside India accounted for 145 person-years (19%) out of a total of 621 person-years of total work experience reported in the survey. The receiving countries were: Oman (n = 4), Saudi Arabia (11) and Singapore (1). Working abroad was associated with older age (median 38 years versus 26 years, p < 0.001), more work experience (median 16 years versus four years, p < 0.001), and nursing seniority (44% of charge nurses versus 11% of staff nurses had worked abroad, p = 0.004).With its high literacy rates and progressive education programmes, the state of Kerala trains a nursing workforce that is highly sought-after in the global labour market [2]. More than 50% of new nurse registrants in the United Kingdom in 2001 were from India, representing 0.21% of India's total nursing stock, and a comparable and increasing number of Indian nurses migrate to the United States of America annually [3]. The nursing workforce of Saudi Arabia, where most survey respondents had served a term abroad, is composed 83% to 95% of foreign nurses [4], many from South Asian countries [5].Previous authors have noted that the Eastern Mediterranean %U http://www.human-resources-health.com/content/7/1/5