Nursing, the Philippines, and COVID-19: An Intricate History

By Hanna Fernan ’24 for Fall 2021

Growing up Filipino, I would see many of my relatives do nursing as a career, whether they were my Titas (aunts) in the Philippines or my cousins in Torrance, CA. At one point, a lot of relatives asked me if I wanted to pursue nursing in the future, which is a question I always hesitantly said yes to until I discovered more of my interests in high school and now at Wellesley. However, I still see so many of my Filipino friends choose nursing without further thought, which is something I’ve always been intrigued by. This focus on nursing also takes more meaning in the COVID-19 pandemic, as many of my loved ones
are continuing to risk their lives through these jobs. This prompted me to sit down and reflect on a few questions, mainly: how did Filipino nurses become so prevalent in the U.S.? And how does the COVID-19 pandemic affect Filipino nurses overall?

For context, in the U.S, Filipino nurses make up “4% of the nurses in the country” (Glover) and “1 of 4 Filipino working adults are frontline health care workers” (Oronce C. I. A. et al.). However, “[since 1960, over 150,000 Filipino nurses have migrated to the U.S…[and] 24% of surveyed nurses who died from COVID-19 complications were Filipino” (Cachero). To fully understand these negative impacts on Filipino nurses, it is important to reflect on the extensive, complex history of Filipino nursing in general.

“The root of Filipino nurses’ large presence ties back to the U.S.’s colonization of the Philippines in 1898.”

The root of Filipino nurses’ large presence ties back to the U.S.’s colonization of the Philippines in 1898. Catherine Ceniza Choy’s book Empire of Care covers this in detail, analyzing the relationship between US colonialism and the mass migration of Filipino nurses to the US over the 20th century. Choy first discusses how the U.S.’ tactics of “benevolent assimilation” and “friendship” were used to justify their colonial interventions into Filipino communities “suffering” from cholera and leprosy in the early 1900s (Choy 49). The introduction of nursing schools and English-oriented curriculum westernized Filipinos and in doing so, added to the status of Filipinos who pursued nursing as many were recognized by Westerners and had the opportunity to go abroad. Given the different stories nurses heard (and specific advertisements
by media), they were drawn to working outside the Philippines for different reasons, like significantly better wages, better working conditions, and the ability to make more individual choices (113)—qualities that still remain apparent today.

For my relatives, some were motivated because of the environment they grew
up in, as my cousin Kristie got accustomed to the hospitable character of the nurses while being taken care of. As she has been a nurse in the Philippines for a while, she enjoys the job but also agrees with past sentiments that nurses are being underpaid severely in the Philippines. My Tita Mary Lou was also driven to become a nurse as “it was a more affordable career than being a doctor,” in addition to her own Tita being a nurse, highlighting how Filipinos themselves contributed to the idealization of going abroad, which took many different forms over the 20th century.

There were many types of sponsored and endorsed forms of migration to the
U.S that contributed to the presence of Filipino nurses in the U.S. The first was the pensionado program that had the US colonial government sponsor an elite group of Filipino students to study at US colleges, return to the Philippines and work at institutions established by the US (Choy 69). This pattern would exist again through the 1948 Exchange Visitor Program, where foreigners could study
in the U.S. for two years with the intention of returning back to their home countries to work. However, as more Filipino nurses went abroad, more wanted to stay in the U.S., kicking off a mass migration. In 1965, the Immigration Act made it easier for immigrants (Choy 169) to stay with visas and permanent residencies instead of being exchange visitors, increasing demand for nurses in the U.S. and also increasing turnover of nurses in the Philippines. Furthermore, the importance of this migration would be emphasized by the Filipino government in 1972, when President Marcos promoted a labor-export oriented economy, with Filipino nurses using their foreign remittance to support the Philippines economically. Later on in 1989, the Immigration Nursing Relief Act was passed, allowing H-1 visa nurses who worked for 3 years to permanently reside, ridding of previous limitations like waiting periods, disputes, and backlogs (Choy 300). Coincidentally, this was also the year Mary Lou arrived in the U.S., having passed the travel requirements and the U.S. nurses board exam—with her reiterating to me that it was a relatively smooth process since the U.S. was in dire need of nurses at the time.

A lot of these historical trends in these mass migrations continue now, especially with COVID-19. More specifically, the high turnover of Filipino nurses and their migration to the US continues today. This turnover, leaving
a shortage in nurses in the Philippines, have led to several caps on workers working abroad, like the “annual cap of 5,000 health worker deployments [increasing] to 6,500… amid high demand for its health professionals” (“Philippines raises cap…”). This turnover is deadly, as cases continue to rise, making the Philippines one of the Southeast Asian countries with the highest cases of COVID-19 and also among the 20 countries worldwide with the highest active cases as of October 2021 (Casinas). As of August 2021, “nearly 7,000 nurses have moved abroad, including to the United States and Britain” (Morales and Lema), as motives like better pay and working conditions stay relatively the same—making these circumstances more difficult for nurses overall.

COVID-19 in the U.S. has also negatively impacted Filipinos, as “Filipino Americans account for at least 35% of COVID-19 deaths in the [CA]’s Asian population” and “just under half of registered nurses of color who have died to date have been Filipino” (“Sins of Omission..”). This puts Fil-Am nurses at higher risks, like in California where “Filipino Americans represent three in
five COVID-related RN deaths” (Glover). These impacts altogether have made it hard to grasp the toll Filipino nurses have gone through, more specifically relatives and my close friends’ family. For Mary Lou, COVID-19 has prompted her to retire in September of 2020, having been diagnosed with it in June 2020. For my cousin Kristie back in the Philippines, she has slowly gotten used to the PPE and being extra careful to not get COVID-19 and spread it to her family. Hence, COVID-19 has negatively complicated the role of nursing for Filipinos, as these nurses continue to increasingly risk their lives—regardless of location.

Given these conditions, more nurses are beginning to speak out like in the Philippines, where nurses and other healthcare workers protested “outside the Philippines’ Department of Health, demanding better wages and benefits” (Portugal). Filipino American nurses have also shown their resilience within their community, whether that’s by taking mental health breaks or bonding with other Filipino nurses (Constante). It is thus key for the public to acknowledge Filipino nurses’ longstanding importance to the U.S. and the Philippines. To do so, we need to also recognize the urgent need for an improvement of wages and better quality conditions as Filipino nurses continue to fight on the frontlines of the battle against COVID-19.

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