Not All That Glitters is Gold by Farah Karim

As of writing, the United States has seen over a total of 7 million cases of COVID-19 with 209,000 deaths since the beginning of the pandemic. According to the National Nurses United, the country’s largest nurse union, nurses of colour make up more than half of nurse deaths due to COVID-19 . The largest group in this pool to die of the disease was Filipino nurses at 31.5% – nearly a third of total registered nurse deaths nationwide.

Since the 1960s, nurses from the Philippines had become a fundamental part of the American healthcare system, as the Philippines had become the main source of foreign-trained nurses in the United States . In states such as California, where Filipino nurses make up 20% of the nursing workforce, they account for nearly 70% of the deaths associated with COVID-19 according to the California Nurses Association . Nationally, the statistics are similar to those of California with over 30% of the 205 nurses who died being Filipino American despite only making up 4% of the entire nursing workforce . This brings about the question, why are there so many of them coming to the United States and why are so many of them falling victim to the pandemic?

Group portrait of a Maryknoll Sister and student nurses Manila, Philippines, ca. 1920-1940

American Imperialism in Post-colonial Philippines

The examination of Filipino nurses and the brain drain resulting from their migration to the United States sheds light onto American neo-imperialism. It further points to how despite the abolition of settler colonialism and advocacy of independence, the nuances of imperialism still exist to this day in the form of imported labour. The 4th of July 1946 marked the formal end of American colonialism in the Philippines. However, the ramifications of World War II had left the country in infrastructural shambles – leading to a health crisis throughout the country. The creation of the Department of Health and Public Welfare, alongside the increased desire for education saw the rise of nursing into the tertiary education setting. However, despite the Philippine’s boom in nursing students, the ratio of public health nurses to the country’s population was 1:12,000 due to the lack of employment opportunities in their home country. In conjunction with a lack of employment opportunities at home, , countries around the world, including theUnited States were experiencing a shortage of healthcare employees post-World War II. When it came to the mid-1960s, the United States saw thousands of Filipino nurses entering the country under the new occupational preference clause of the 1965 Immigration and Nationality Act where shortage of skilled labour encouraged migration from areas that could provide them. With the greater opportunity to travel overseas for learning and work, many nurses took up this chance for a life in the West. In a study by Joyce and Hunt (1965), it was reported that these immigration decisions were heavily reliant on the availability of opportunity in the Philippines compared to the United States. In comparison, those working in the United States were met with an average salary of $800 to $1500 per month compared to ₱550 to ₱1000 (roughly $70 – $140) per month. This mass exodus fueled by better economic conditions continued throughout the next few decades, as this demand and supply of nurses had created a highly efficient and institutionalized system of recruitment and placement. On the basis of this mass migration and entrance into the field of healthcare in the United States, the Philippines had become known for its labour export economy, priding itself as the “Home of the Great Filipino Worker”. However, embedded within this narrative was a form of American imperialism that had barely left Philippine soil.

On American Soil: Discrimination, difficulties and endangerment

Filipino volunteer nurses tending a young girl Tarles Provincial Hospital, Luzon January 1945

In a scramble to meet the demand for healthcare workers in America, turning to Southeast Asia as a solution to the shortage in labour had resulted in a sizeable population of Filipino migrants who were undocumented. According to the United States Department of Homeland Security, the Philippines is among the top five countries in which undocumented migrants come from. Legislation like the Immigration Act of 1965 had created this occupational preference that allowed Philippine nurses to enter the country in order to fill in this gap, but at the cost of being unable to sustain their employability for extended periods of time as many end up overstaying their visas. Yet those who do become employed longterm at their chosen location, aren’t as better off as you would expect. According to a 2018 study, negative discrimination and difficulties often arose once these new nurses arrived in their respective clinics. Many of them had to continually prove themselves as being competent to their peers despite being trained and educated in a foreign country. Stereotyping from fellow staff members is a common occurrence as many Philippine nurses felt that they were not respected to the same degree despite clear evidence of previous clinical experience. Working long hours to support their family back in the Philippines, many of these nurses often take longer shifts in order to make the most of their time in the United States . In the context of COVID-19, the situation has worsened. The shortages of personal protective equipment coupled with long working hours and extended exposure to patients throughout the day has heightened the endangerment for those nurses who came to the country seeking better opportunities. Despite the higher risk of infection, discrimination and long work hours, many still choose to migrate to the United States in search for better opportunities that the United States has up for grabs. But while doing so, these nurses are kept in positions that leave them vulnerable to the perils of working in the healthcare industry and in a foreign country where they are given little support. With the pandemic exposing the underbelly that is the treatment of Philippine nurses, there is some hope that these circumstances will result in tangible change in the near future. Many Americans owe their health and lives to them, and it’s about time they’re given the credit that they deserve.

World Health Organisation (2020). COVID-19 Weekly Epidemiological Update. https://www.who.int/docs/default-source/coronaviruse/ situation-reports/20201020-weekly-epi-update-10.pdf

Akhtar, A. (2020, September 29). Filipinos make up 4% of nurses in the US, but 31.5% of nurse deaths from COVID-19. Business Insider Australia. https://www.businessinsider.com.au/filipinos-make-up-disproportionate-covid-19-nurse-deaths-2020-9

Philippine Nurses in the U.S.—Yesterday and Today. (2013, March 30). Minority Nurse. https://minoritynurse.com/philippine-nurses-inthe-u-s-yesterday-and-today/

California’s Filipino American nurses are dying from COVID-19 at alarming rates. (2020, October 4). The Mercury News. https:// www.mercurynews.com/californias-filipino-american-nurses-are-dying-from-covid-19-at-alarming-rates

Brush, B. L. (2010). The Potent Lever of Toil: Nursing Development and Exportation in the Postcolonial Philippines. American Journal of Public Health, 100(9), 1572–1581. https://doi.org/10.2105/ AJPH.2009.181222

Joyce, R. E., & Hunt, C. L. (1985). Philippine Nurses and the Brain Drain. Philippine Quarterly of Culture and Society, 13(4), 297–318. JSTOR.

GUEVARRA, A. R. (2016). The Legacy of Undesirability: Filipino TNTs, “Irregular Migrants,” and “Outlaws” in the US Cultural Imaginary. In M. F. Manalansan & A. F. Espiritu (Eds.), Filipino Studies (pp. 355–374). NYU Press; JSTOR

Montayre, J., Montayre, J., & Holroyd, E. (2018). The global Filipino nurse: An integrative review of Filipino nurses’ work experiences. Journal of Nursing Management, 26(4), 338–347. https://doi.org/10.1111/ jonm.12552

COVID Exacts High Toll Among Filipino Nurses. (2020, September 27). https://dailynurse.com/covid-exacts-high-toll-among-filipino-nurses/