Every time she opens her email, 35-year-old Caroline Mutama looks for a notification from US government officials to see if they have set the date for her visa interview at the US Embassy in Nairobi, Kenya. She hopes to work as a nurse in Illinois. Mutama has already processed the travel documents for herself, her husband, and her two children.
Now all she can do is wait.
On weekdays, Mutama wakes up early, feeds her children, and prepares her oldest child for school. Then she walks five kilometers (about three miles) to her job as a registered nurse and midwife at Shiyunzu Health Center in Kakamega County. Like many nurses in Kenya, she works long hours for low pay.
Kenya’s frequent worker strikes—due to poor salaries and benefits—have undermined her efforts to make a living. She owes money to her bank, to her friends, and to her microloan savings group. Her husband has been unemployed since the COVID-19 pandemic shut down his company.
With her future in Kenya looking grim, Mutama has joined a rising number of Kenyan nurses hoping to immigrate to the United States or Europe in search of better pay and working conditions. In 2023, she began the application process for an EB-3 visa, which allows skilled workers and professionals to immigrate to the United States.
In February 2025, the Kenya National Union of Nurses raised alarm over the “acute shortage of nurses” in the country, a shortage that’s forcing some health facilities to close. In some cases, chronic understaffing has led to rationing care and to patients’ deaths in some emergency situations.
About 4,000 doctors and nurses leave Kenya every year, said Ouma Oluga, former secretary general of the Kenya Medical Practitioners, Pharmacists and Dentists Union. TruMerit, an organization that processes nurses’ credentials to see if they are eligible to emigrate, reported that Kenya accounts for 6.5 percent of African nurses applying for VisaScreen certification—a key requirement for foreign-trained nurses in the US. This places Kenya first in Africa and third in the world after Philippines and Canada. In July 2021, Kenya signed a bilateral labor agreement with the UK to send 20,000 nurses to UK hospitals. By April 2024, 280 Kenyan nurses had immigrated to the UK via this program.
Kenya’s public hospitals can’t afford to lose these nurses, but they can’t afford to keep them either.
“While we are complaining we’re having a brain drain of doctors and nurses who are going to the Western world, we as a government are not able to afford to employ them because we do not have the resources,” Tharaka Nithi County governor Muthoni Njuki told a national news network.
Kenya president William Ruto admitted last year that the country only absorbs 200,000 of the 1 million qualified workers who enter the job market each year. This includes recent nursing school graduates. Nationwide economic struggles since Ruto’s government took power in September 2022 haven’t helped. Kenyan nurses continue to live and work in subpar conditions, despite frequent nurses’ union strikes.
Nurses have long struggled with high workloads and poor resources. For example, one study showed that a single neonatal nurse may be responsible for up to 40 sick babies at a time—all requiring a high degree of care.
In 2024, the council of governors in Kenya raised concern over the high rate of health workers leaving the country because the government couldn’t pay them well.
Some estimates place registered nurses’ salary range at 23,000 to 140,000 Kenyan shillings per month (about $178–$1,084 USD), including nursing directors. Kenya’s minimum wage is 15,200 shillings per month (about $118 USD). The median pay for a nurse in the US is $7,800 per month.
“We train our students for the international markets,” said Eunice Nyasiri Atsali, a nurse trainer at Kenyatta University. “The situation [in Kenya] is worse today because government has relocated the nurses to the counties and most of the counties have no capacity to pay the nurses. A degree-holder nurse is now earning 25,000 Kenya shillings [about $194 USD].”
Some nurses have fallen into debt. Traditional banks may deny loans to nurses if their account balances are too low, forcing them to look elsewhere for credit. Ruto’s government has also introduced new taxes—such as a those imposed on all public employees in Finance Bill 2024, sparking antitax demonstrations by Ruto’s critics last year.
Because of these challenges, many nurses do not want to remain in Kenya.
Mutama worries about family obligations in addition to her debts. Family funds helped her through school, but she hasn’t been able to repay them. Her three sisters and brother are now unemployed. Mutama said she feels guilty she can’t support everyone on her salary.
“[When I get to the US,] I will do my best to see that I support my siblings,” Mutama said. “I need their prayers so that I succeed. And when I move to the US, I will not forget them.”
Mutama’s application process hasn’t been easy. She’s had to prepare for nurses’ licensing exams and an English proficiency test, fill out visa applications, and wait endlessly for approval.
“Going to the US is not a joke. There are no shortcuts for nurses,” Mutama said. “The process is quite complicated, as you must be qualified to work as a nurse in the US.”
She has stayed up all night reading online materials on her laptop to prepare for licensing exams. Night shifts at her small health center receive fewer new patients than daytime shifts do. She said she took those shifts whenever possible so she could study while at work.
In early 2024, she raised money for an airline ticket so she could travel to South Africa to sit for her licensing exams. Three days prior to travel, she had only half the money she needed. A friend loaned her the remaining money at the last minute.
“This was the hand of God,” Mutama said.
She passed the exams for licensure—valid in the state of Illinois—but many of her friends did not. Eighteen months later, Mutama passed her English proficiency exam in Kenya.
But immigration policies have complicated the process. In 2020, the US slowed visa retrogression due to COVID-19. Processing backlogs at the US Embassy in Nairobi continue.
Mutama still waits for that all-important email, but she prays to God for the visa process to reopen soon and end her waiting.
“I hope that God will open the way for me,” she said.
