Professor Catherine Ceniza Choy

Catherine Ceniza Choy
Author, Empire of Care

Why the phil? Some observers claim it’s natural for US to look to the phil to recruit nurses. Some claim filipino women are nurturing and inately caring making them a natural target for nursing recruitment in the US.

My research emphasizes the US colonial presence in the phil beginning in 1898-1946. One of the proj in US colonialism was educ of filipinos. And this educ included americanized training hosp system that actively recruited young filipino women, specifically to train as nurses. That currciculum was modeled after US professional nursing curriculum. That also included the study of english language, both english grammar and colloquial english.

So both english language fluency as well as training in an americanized curiculum became preconditions for why US hops targeted nurses from the phil.

2:09 so US set up conditions for this pool of nurses? My research has shown that US colonialism, specifically est of americanized training hosp system in the phil did est preconditions that enabled filipino nurses to work in hosp and other health care inst in the US.

These preconditions included fluency in english lang, academic training similar to the training of american nurses.

3:28 and there were US policies that facilitated nurses to migrate? One of the interesting things about US colonialism in the phil is that it produced unintended consequences. When they US govt est nursing sch in the phil, from my research i believe it was not with the intention of recruiting them to fill nursing shortages in the US. However, after wwii, there were critical nrusing shortages in the US hosp.

Also soon after that time period in 1948 the US est a pgm called the exchange visitors pgm which facilated the exchange of students and prof from foreign countries into the US. The exchange visitor pgm became used by US hosp recruiters and administrators to fill nursing vacancies. And so US hosp administrators turned to the phil and specifically filipino exchange students to come the US under the auspices of this exchange visitor prgm.

Although the pgm was intended as a form of cultural exchange, it was intended so that the foreign exchange visitor would be able to train and study in the US and then return to his or her country of origin. Despite the initial intentions of the pgm, it became used by hosp administrators to recruit filipino nurses to work in their hosp and alleviate critical nursing shortages in the US.

5:40 if training of nurses in the phil not meant to create pool of nurses for US hosp, what were they created for? The idea of creating americanized training hosp system in the phil during the US colonial period in that country, was to create an image of the US in the phil.

Part of the colonial mission was to “uplift and civilize filipinos.” In order to do that, the phil and filipinos had to be under the tutelage of american colonial officials and that tutelage included public educ, from elementary to high school levels. And also it included training of medical personnel such as nurses modeled after an american system.

This was a way, and colonial officials believed to uplift filipinos and prepare them for self governance.

7:24 was the evp another way of planting image in the phil? I believe the evp during the late 1940s and early 1950s and 1960s is another eg of unitended consequences regarding migration and immigration to the US. When the us govt created the evp in 1948 that pgm was intended to be a cold war pgm. It was a pgm that faciliated the exchange of foreign students, professionals to the US so they could study and work here, but also so they could learn about the ways of life in the US.

And then upon their return to their countries of origin the US govt’s intent was that these exchange students would spread ideals of american democracy and that this would be an effective way to combat what they believed to be communist propaganda emanating from the soviet union. They did not expect the evp to become dominated by US hosp using it to recruit exchange nurses and primarily from the phil to aleviate nursing shortages here in the US.

9:15 sounds like the filipino nurses dominated evp? I think the numbers of filipino exchange nurses to the US during the 1950s and 1960s were approximately 11-thousand. There were also significant numbers of filipino physicians as well as engineers. But it became clear in the 1950s the filipino nurses specifically were numerically dominating participation in the evp.

10:04 for the filipino nurses, what was the draw? To understand filipino nurses’ appeal to participate in americanized nursing to participate in evp, to understand that, one would have to understand the hx colonial crossroads of both spanish imperialism and US imperialism in the phil.

The phil, prior to US colonization of the archipelago, was a colony of spain for approximately 400 yrs. In the 19th century under spanish colonial rule, only elite male filipinos were allowed to study abroad in european and primarily spanish universities and some of the prestigious things they studied was medicine.

For filipino women under spanish colonial rule, the oppty to pursue professions like medicine were unable. So when US colonizers replaced spanish colonizers, one of the things that was attractive to young filipina women was that a new occupation, a new profession related to the health field—nursing—became available to them and they flocked to nursing schools in part bec of the prestige attached to the nursing profession as a result of both spanish and US imperial colonialism there.

12:08 also during the US colonial imperialism, the US colonial govt est a pgm in the early 1900s called the pensionado pgm. Pensionados and pensionadas were filipino male and female US govt sponsored students who were sponsored to work and study in pretigious US universities and colleges during the early 20th century. And while most of the of the pensionados were filipino young men, there were a few filipino women who were able to study in the US. And some of these pensionadas were nurses.

After studying in the US in the early 1900s these filipina young women who were nurses would return to the phil and assumed supervisory roles in philippine nursing schools. They assumed supervisory roles in philippine hosp so the idea of work and study in the US became linked to professional and socio-economic mobility and advancement in the phil. When the US evp was implemented this pgm became a way for the first mass wave of filipino nurse migrants to come to the US.

13:56 there was certain prestige assoc with working in the US? There was a prestige associated with working in the US esp after wwii bec of the devaluation of the philippine peso in the relation to the US dollar. If a filipino nurse and intially an exchange nurse earning a salary or stipen in US dollars, this was considerably worth more in the phil in terms of pesos.

Another factor contributing to the prestige of workign abroad was the notion that going to the US was a form of travel and adventure. And filipino exchange nurses shared stories about going to major US cities such as chicago, nyc, and using their US earnings to travel to other places in the US or even to places in europe.

Also another form of prestige was their ability to send american goods back to the phil. So sending something like cosmetics purchased in the US became seen as a source of prestige, socio-economic mobility once these goods were brought back to the phil to be shared with friends, relatives and other nursing students there.

15:51 so diff factors that motivated nurses to participated? The major factor for filipino nurses to participate in exchange pgms like the US evp or to immigrate to the US are rooted both in economics as well in social mobility. So economics plays an impt role to the extent a filipino nurse could earn more money working in the US as opposed to the phil.

But there were social factors involved. Some of these include travel and adventure that was attached to going to the US, the ability to see places in hawaii, in ny, california that were unavailable to those who remained in the phil. The ability to particpate in leisure activities, for eg, seeing a broadway show in the nyc also contributed to the desire of filipino nurses to come to the US.

In other words, money played an impt role in motivating filipino nurses to come to this country. But almost as impt is the social prestige attached to being able to experience a diff place, being able to exp a diff way of life.

18:07 another pivotal US policy was the 1965 immigration act? The 1965 immig act was a watershed in US immigration hx. The 1965 act abolished the previous immigration system to the US which had been in place sine the 1920s and was referred to as the natl origins system of immg. That previous system of immgration favored immig from northern european countries and virtually abolished immig from asia.

What the 1965 act did was it established a more equitable immg system called a ceilings sytem of immig that enabled countries, esp asian countries, including the phil, which had been previously excluded from immg, now under the 1965 act there were immg visas available to the phil.

The other thing that the 1965 immg act did was created a preference system which determined the distribution of these immg visas, and this preference sytem had two preferences, third and sixth preference, which favored the immg of persons with needed skills and who were professionals. Combined with the fact that during this time period, critical nursing shortages continued in diff parts of the US, filipino nurses were able to immigrate under the auspices of the preference system of the immg act of 1965.

20:25 so the nurses who stayed temporarily under evp, nurses could come and stay as permanent resident under 1965 act? The evp mandated that exchange students including filipino exchange students, stay in the US only for a temporary period of time, up to a maximum of two yrs. After which they were supposed to return to their countries of origin so in the filipino exchange nurses case, she was supposed to return to the phil after two yrs. Some fo them did.

Many of them who returned wanted to come back to the US. And the preference system and immg visas available to the phil under the US immg act of 1965 enabled them to return as an immgrant on a more permanent basis.

21:53 some of the hosp recruited former exchange nurses? Filipno nurse migration to the US has a long hx. And it is also a transnational hx, meaning that both filipino nurses and US hosp recruiters crossed natl borders to create this phenomenon of filipino nursing presence here in US hosp and other health care institutions.

After the passage of the US immg act of 1965, US hosp which had sponsored filipino nurses in the 1950s and 1960s, some of those hosp did go to the phil, they had recruiters go to the phil, or they placed advertisements in philippine newspapers, phil journal of nursing, actively recruiting their former exchange nurses to come back to their hosp, but this time on a more permanent basis as immigrants.

23:32 one of the effects was brain drain? The impact of filipino nurse migration and then immg to the US was profound. This phenomenon had a profound impact on philippine nursing and phil health care delivery starting in the 1950s. Filipino nurses came to the US in such large numbers that some problems regarding the retention of filipino nurses in philippine hosp, the retention of philippine faculty in the philippine colleges and schools of nursing became pressing issues.

And there’s an ethical dimension to this form of international nurse migration which is that a developing country like the phil which has a greater need for nursing services in relation to its population is the leading exporter of prof. Nurses to a highly developed country such as the US.

25:20 and it’s something we continue to see today? In the new millenium the intl migration of phil nurses, specifically to the US continues. The phil continues to be the world’s leading exporter of nurses sending nurses to the US but also to canada, to other parts of asia, to european countries as well as the middle east. It is a phenomenon that does not seem to have an end in sight.

26:00 change in phil govt position toward brain drain? The phil govt position on the migration overseas of filipino nurse has changed over time. During the time of the US evp during the 1950s and 1960s the phil govt expressed pride in the desire of US hosp to recruit filipino exchange nurses.

However they were critical of those filipino exchange nurses, who in collaboration with US hosp and other health care inst wanted to remain more permanently in the US. And they were very critical of those filipino exchange nurses who did not return to the phil who in their eyes who did not return and were not serving the phil nation and filipino people.

However when ferdinand marcos declared martial law in 1972 he also committed the philippine govt to an export oriented economy, which included not just the export of goods but also the export of people in the form of labor. Phil govt inst. Devoted to the promotion of phil overseas labor were established. And the marcos regime observed that there was a high demand in some countries such as the US for filipino nurses.

28:47 instead of criticizing filipino nurses for wanting to remain overseas and to work in places like the US the marcos regime and its govt officials started to treat those filipino nurses abroad as new natl heroes of the phil. They were new natl heroes bec they were aleviating phil domestic unemployment, they were the new natl heroes bec they were sending much need foreign currency—US dollars back to the phil.

To this day the phil govt continues to receive billions of dollars of remitances from overseas workers, including overseas nurses. And although subsequent phil govt claim this is not a long term strategy it seems here to stay bec of the financial return.

30:23 did nurses’ exp match recruiters’ promises? Filipino nurses who came to the US had diff kinds of expectations, depending on when they arrived in the US. For filipino exchange nurses and the first generation of filipino immg nurses, there were expectations of travel as adventure, earning lots of money, of gaining a lot of new training and work experience in US hosp.

For some of these filipino nurses that i’ve interviewed, these expectations were met. They found their exchange work or permanent work was very rewarding work. They found they were able to obtain nursing exp working with children that they were unable to obtain in the phil. And for some of them they aslo fulfilled their monetary, financial expectations. They were able to earn more money and share their earnings with parents and other relatives in the phil. They were able to purchase american goods, such as stereos and televisions and sometimes to be able to send those goods back to the phil.

For other filipino nurses i interviewed, however, some of these expectations were not met. There are eg of US hosp exploitation of filipino nursing labor. Some US hosp under the exchange pgms were exploiting filipino nurses to do the dirtiest, the heaviest kind of nursing labor, to work on the most unpopular nursing workshift. For those filipino nurses who had those exp, these were tremendous disappointments.

Cases of US hosp and other health care inst abuse and exploitation of filipino nurses unfortunately continues in the new millenium. There have been cases in which US health care inst have not taken into consideration the previous and substantial work exp of filipino nurses in the phil, thus paying them at beginning nursing wages in the US. And there’s also been new cases in the new millenium in which US employers have compelled filipino nurses to do the heaviest work, the dirtiest kind of nursing work, to work on the most unpopular shift, the graveyard shift, thus repeating patterns of abuse that were experienced also in the in 1950s and 1960s.

34:20 that discrimination let nurses to org, and a big case galvanized the comm? In the 1970s two filipino immg nurses, filipina narciso and leonora perez were targetted by the fbi for poisoning, murder and conspiracy at the va hosp in ann arbor michigan. These nurses did not know each other prior to working in this hosp. They were also assigned to the intensive care unit where these crimes had taken place and so their presences at the scene of these crimes had to do with their work schedules.

Although there was no direct evidence connecting narciso or perez to these crimes they were targetted by the fbi, they were repeatedly interviewed and then tried and convicted on circumstantial evidence. Later thanks to the activism filipino nurses throughout the country and other filipinos in the US as well as in the phil, brought pressure on the US govt and the US court system about the injustice perpetrated against these two women, narciso and perez were acquitted.

36:13 but the case galvanized filipino nurses across the country to organize into associations and to better understand their rights as foreign trained nurses working in the US. What filipino nurses learned from that exp was unfortunately if a filipino nurse was placed on trial, there were effects on the perceptions of filipino nurses and their working abilities throughout the country. And so in diff parts of the US during the time the fbi had targetted narciso and perez, filipino nurses in diff parts of the US were harrassed, were susupected of perhaps doing something wrong on their jobs, nothing bec of any direct evidence, but bec they too happen to be foreign-trained nurses from the phil.

37:30 addendum: i think it’s impt for the US public to appreciate the contributions that filipino nurse migrants to US healthcare delivery. They have aleviated critical nursing shortages in the US, oftentimes in the most difficult places to recruit to retain nurses such innercity pub hosp. And oftentimes on the most difficult workshift and in the most intensive of nursing units.

I hope the US public learns to appreciate the impt work that filipino nurses are doing in this country. There’s often a perception that immg exploit the US, that they’re reaping benefits from the US and it’s impt to remember in the case of filipino that the US public is benefitting from filipino nursing training and filipino nursing labor.

The other thing i want to add is this: as much as i want to acknowledge the contributions of filipino nurses in US healthcare delivery, it’s also impt to remember the ethical dimensions of intl nurse migration. What we’re doing in this country in terms of actively recruiting nurses from developing countries, which have a greater need for those nurses, has a tremendous impact in healthcare delivery in places like phil. In order to rectify these global inequalities, both the US and phil govt, both US and phil nurses and patient advocates need to work together to address these grave inequities.