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Filipino_JulAug 11/29/11 10:09 PM Page 16 To understand and hopefully overcome these prejudices, nurses, physicians, and other healthcare workers must make an effort to understand the culture and backgrounds of their Filipino colleagues and the complex history, rooted in the U.S.-Philippines colonial relationship, that eventually led to waves of immigration by Filipino nurses. "Filipino nurses, as immigrants, have sometimes unfortunately been stereotyped as exploiting the United States and as being a detriment to the domestic nursing force," said Catherine Ceniza Choy, author of Empire of Care: Nursing and Migration in Filipino American History and professor in the department of ethnic studies at the University of California at Berkeley. "If you know that history and you know that U.S. hospitals actively trained and recruited Filipino nurses after World War II in large numbers, you would learn that Filipino nurses are making an important contribution to U.S. healthcare delivery." ilipinos have a long history of working as registered nurses in America. Many were recruited to work in areas or shifts where it was difficult to place nurses, such as in public, inner-city hospitals or rural areas and for night shifts. To understand that history, one must go back to 1907, when the U.S. colonial government first opened nursing schools in the Philippines. Teaching and training Filipino nurses was seen as a "benevolent" form of colonialism and a way to combat ailments such as tuberculosis and cholera. (The U.S. colonial relationship with the Philippines lasted from 1898 until 1946.) While that early training – the first Filipino nurses graduated in 1911 – was intended for Filipinos to work in the Philippines, it laid the foundation for the eventual mass migration of Filipino nurses to work abroad, according to Choy. Two major factors led to the mass migration of Filipino nurses abroad: facility in the English language, and a U.S.-based nursing education system. Nurses were taught in English within a nursing education system that was very similar to programs in the United States, and the best and brightest were encouraged to study abroad in America. This education in English and Americanized way of nursing, coupled with nurses' own desires to visit the United States, paved the way for future nurse migrants. Because it was seen as a booming, high-status field, particularly for women, girls from the most "respectable families" were recruited into nursing programs in the Philippines, where they lived in dorms in a strict environment. In 1948, the U.S. government created an exchange program called the Exchange Visitors Program, which was rooted in Cold War goals. This led to the first large wave of Filipino exchange nurses here. Between 1956 and 1969, 11,000 Filipino nurses participated in the program as exchange visitor nurses on two-year contracts. The vast majority of these nurses returned to the Philippines, though there were a number of nurses who remained in the United States through marriage, by going to Canada, or working with hospital employers to change their status, Choy said. Starting in the 1960s, recruitment agencies began recruiting these former exchange nurses to return, either as immigrants or temporary workers. Then in 1964, the value of the peso, the currency in the Philippines, plummeted. The incentive to work in the United States grew even greater. Now nurses from the Philippines could work here and make ten times as much as they did at home — even if they were F 16 N AT I O N A L N U R S E paid less than their American counterparts. By 1964, half of all Filipino nurses went abroad, according to Choy's research. When the Immigration Act of 1965 passed, it allowed for the mass, and permanent, migration of Filipino nurses to the United States. It gave preference to highly skilled, professional workers such as nurses. During the 1970s, the Philippines government focused on labor export as an economic strategy and relied heavily on remittances, or money sent back from workers abroad. Today, many Filipino nurses still send money to relatives in the Philippines and are expected to use their salaries to help support a much wider extended family than most Americans. Filipino nurses, in short, became one of the country's best and most valuable commodities for export. The growth of Philippine nursing schools reflects the demand: between 1950 and 1970, nursing schools in the Philippines grew from 17 to 140; by 1990, there were 170 schools, and today, about 300, according to Choy. The United States, coincidentally, had a severe nursing shortage; by 1967, there was a shortage of 125,000 nurses. Filipino nurses who came to the United States after 1965 qualified not just as "exchange nurses," but as temporary workers and immigrants. So while the original intent under the U.S.-ruled Philippines government was to create a nurse workforce to serve the Philippines, it set the stage for international migration: In the two decades between 1966 and 1985, at least 25,000 Filipino nurses migrated to the United States, according to estimates by Paul Ong and Tania Azores, researchers who have written about Asian American immigration. Teresita Supelana, 60, was one such nurse who came over to the United States during a nursing shortage in 1977 at age 24, after working in a government hospital in the Philippines for three years. "During that time in the Philippines, you don't earn that much. When you get a job, it's not even enough for yourself," said Supelana, a critical care RN in the coronary care unit at John H. Stroger, Jr. hospital in Chicago. Her father was a farmer and her mother a W W W. N A T I O N A L N U R S E S U N I T E D . O R G O C TO B E R 2 0 1 1 NICK UT/AP/CORBIS Elnora Cayme reacts as she discusses the lawsuit she and coworkers filed against Delano Regional Medical Center for applying an English-only rule only to Filipinos.