Caring Across Distance—One Call at a Time

SOON AFTER I ARRIVED in Kerala in 2014, I met Alice, a widow living alone. [1] [1] All names in this story are pseudonyms to protect people’s privacy. Her daughter, a nurse, lived in Australia, and her son, who had a different profession, was in Dubai. But, despite their absence, Alice was cheerful and talkative. Her children and their families visited annually and sent her money regularly. But even more importantly: They called. Her son phoned once or twice a week, and her daughter called her every day.

Sitting in the living room of her renovated and neatly arranged two-story house, I asked Alice how she felt about her children living abroad. She responded matter-of-factly: “Because my children are abroad, I am living happily here. If they lived here and had no jobs, or earned a very poor salary, would we all be happy? No!” Her eyes filled with tears only when she spoke of her late husband. I realized that migrating nurses’ families didn’t interpret migration as abandonment—but as a form of care. Despite the importance of remittances, a phone call could rival money in terms of perceived value.

My ethnographic research on elder care through digital technologies among migrating nurses’ families from Kerala, a state in South India, reveals that a simple gesture—picking up a phone to call a family member—can mean many things at once. It can be an act of care for an aging parent, but also a duty, a form of self-care, a way to support other family members, and, at times, an attempt to surveil and control. The difference lies in the motivation behind the call.

Back in 2014, when I first mentioned to a Keralite that I wanted to speak with older people like Alice whose adult children had migrated abroad, he laughed and said, “Impossible, they will never talk to you.” Parents of migrating nurses were often lonely and isolated, yet they would never admit to it, he opined. Acknowledging such feelings, he argued, would be seen as a sign of weakness, an admission that their children were “bad children” who had abandoned them—or worse, that they themselves were “bad parents” who had raised individuals more oriented toward cash than care.

Among India’s 28 states, Kerala stands out for its exceptionally high literacy, female empowerment, and advanced health care. It is also home to a distinct Syrian Christian minority, many of whom—especially women—pursue careers in nursing. Historically, professional employment for women was rare and often met with criticism. This has been especially true within Hindu communities, where nursing tends to carry a lower status than in Christian communities, who tend to view nursing as a noble profession.

Since the 1960s, thousands of Keralite nurses have migrated to the United States, the Middle East, Europe, Australia, and beyond. Migrating for work became accepted among Syrian Christian families, largely due to church sponsorship. Nursing is often seen as highly lucrative because it offers opportunities for labor migration and the ability to support extended families through remittances. Over time, nursing migration became the norm, creating not only a gap in Kerala’s health care workforce but also in family structures. Adult children, most often daughters, are typically the primary caregivers for aging parents. I wondered what happens to elder care in this context of mass migration.

I was worried at first about the impossibility of finding people who were willing to speak openly about their experiences. But during my fieldwork, nurses and their families all conveyed a common theme: calling is not just about picking up the phone and dialing a number. Many of us do this without a second thought—these kinds of connections have been possible for decades with the help of landlines, calling cards, and laptop videos. But newer and more accessible digital technologies like smartphones, combined with decreased costs of international communication, have transformed calling across borders into a complex and deeply meaningful way of caring.

“I think care is the understanding, it’s trust, it’s not touching … it’s not giving money,” as Anthony, a nurse who had been working in Britain and Australia for several years explained to me in an interview while visiting family in Kerala. “I call my parents every time, but I don’t tell them, ‘Mommy I love you, Daddy, I love you,’ but I call them daily. That’s a gesture. That’s how I show my love.”

THE POWER OF A PHONE CALL

Caring through phone and video calls, nationally or internationally, has become a regular part of life for many families around the world. In my research with over 30 transnational families, I conducted over eight months of intensive fieldwork in India and Oman (a major migration destination for Keralite nurses) followed by several years of remote data collection with Keralite nurses around the world.

I found that most children in these families called their parents every day, sometimes multiple times a day—and none of them complained about it. Once calling became established as a new care practice for them, made necessary through geographic distance, the children fulfilled it dutifully, in an effort to remain good children even across continents. It became a new filial responsibility—a way to reciprocate the care they had received from their parents as young children.

At the same time, calling was also a form of self-care for those who lived abroad alone. Sara, a nurse I visited in Oman, had a structured daily routine of calls to her family in Kerala. She called her husband, daughters, and both parents multiple times each day—carefully scheduling calls around her children’s school hours, her parents’ prayer time, and their favorite soap operas. Unlike her brothers, who also lived in Ireland and the United States, she had no immediate family around her, so calling was also a way to soothe her own feelings of loneliness and make sure she stayed connected to her family: “They are all busy with their own families. But I’m free, no?” she explained to me. “After work, I have no other obligations, I’m free and I can call. That’s why my parents know I am always calling. What else is there for me to do?”

In many cases, calling wasn’t just about children caring for their parents—it was also about parents caring for their children and grandchildren abroad. With the rapid spread of new communication platforms across India in the last decade—especially WhatsApp, which reached over 535 million users by 2025—older adults became increasingly comfortable with the astonishing ease of video calls made straight from their smartphones, a shift I observed over the course of my research.

During the COVID-19 lockdowns in 2020 and 2021, this proved to be especially important as the focus of care could shift. Several nurses I spoke to said they were not primarily worried about their parents’ safety, as many lived in low-density suburban neighborhoods with relatively low risk of COVID-19 transmission. Instead, their biggest concern was their own young children, who had few opportunities to socialize and struggled to develop their mother tongue, Malayalam. As a result, video calls with grandparents—especially grandmothers—became essential.

As one nurse told me: “I think it’s very helpful for my daughter’s speech development that my mom calls every day, sometimes twice a day. She speaks with my daughter for at least 20–30 minutes on WhatsApp, on the webcam, so they know each other quite well. They speak a few words, often my daughter likes to dance when she’s on the phone. She’s very happy to see that my mom is calling.”

CROSSED WIRES

Were calls between family members in my study always positive and heartwarming?

Of course not.