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A tribute to Filipino nurses all over the world
ARTICLE
By Gel
Santos
Published: January 25, 2014 | No Comments

Relos

By Gel
Santos
Published: January 22, 2014 | No Comments

Relos

(Part 1 of 2)
WE may have heard of some horrific stories of abuse committed by a few Filipino nurses, but I
hope we do not lose sight of the big picture.

It is important for us to appreciate the very big role our kababayan nurses play in the economic,
social and cultural system of both Philippine and American societies.
To help us understand the plight of Filipino nurses, let me share with you the speech delivered
by Atty. Arnedo Valera Legal Counsel of the Philippine Nurses Association in America (PNAA)
and Executive Director of the Migrant Heritage Commission (MHC). The speech was delivered
at the FIRST GLOBAL SUMMIT OF FILIPINO NURSES 2014 in Manila on January 16.
Nurses without borders (Atty. Arnedo Valeras speech)
In his State of the Union Address last year, President Obama hailed a Filipino nurse as a role
model.
Obama said in front of the most powerful men and women in the United States, the senators
and members of US Congress: We should follow the example of a New York City nurse named
Menchu Sanchez. When Hurricane Sandy plunged her hospital into darkness, she wasnt
thinking about how her own home was faringHer mind was on the 20 precious newborns in
her care and the rescue plan she devised that kept them all safe.
At that moment, Menchu represented the Filipino nurses highly skilled, efficient,
compassionate and caring. They are highly prized around the world for these outstanding
qualities. They speak English, are trained in American-caliber medicine, they are hardworking,
and they come from a culture where families take care of their own sick and aging relatives.
No wonder they have become a mainstay of many hospitals and nursing homes in the US and
other parts of the world. They are recruited in their homeland with perks like free airfare. Some
are offered thousands of dollars in bonuses to relocate.
The Big Picture
But, in reality, theres more to this rosy picture. We also have stories of labor trafficking. Ms.
Maria Socorro Reyes, (true name withheld) a nurse , found herself caught in a nightmare when
she landed in jail because of unscrupulous recruiters promised her a job that is different from
the contract she signed in the Philippines. After 9 months of detention in a Federal immigration
facility, the Migrant Heritage Commission upon referral by the PNAA ably represented him and I
was able to release her from detention. Though her story has a happy ending, it provided a
glimpse into the dark chapter of the upbeat story of Filipino nurses.
Most important, Id like to show you the bigger picture. As the Philippines has become one of the
worlds biggest suppliers of health care workers, the exodus of nurses and doctors for higherpaying jobs overseas has left the countrys own health system in a state of near collapse.
As the Philippine Medical Association said in one conference paper: The crisis in medical
human resources is now upon us. The delivery of health services is being compromised. We
have to address the problem before the health system completely collapses.
Lets look back to see how this all happened. In the 1900s, Filipinos were sent to the US to be
trained as nurses. They were supposed to apply their American training in the Philippines but
some stayed in the US Following the post-World War II economic boom, particularly in the
1960s, waves of Filipino nurses went to America to fill in nurse shortages. In the 1970s, when
martial law was declared, the government promoted labor export as a development strategy. In
the turn of the 21st century, the Philippines became the United States single largest source of
foreign nurses. Filipino nurses made up 50 percent of all foreign nurses. Today, there are
200,000 nurses of Philippine origin in the US.

Outside the US, Saudi Arabia and other countries in the Middle East emerged as popular
destinations for nurses in the 1970s. In the 1990s, as a result of a shrinking market in the US,
Filipino nurses, including doctors who re-trained as nurses, began to migrate to Canada, the
United Kingdom, Libya, United Arab Emirates, Ireland, Singapore, Kuwait, Qatar, Japan, and
Brunei.
From 1992 to 2009, the number of Filipino nurses who made an exodus to these countries
reached 160,000, according to the Philippine Overseas Employment Administration. From 2000
to 2008, the US had been replaced by Saudi Arabia as the leading destination of Filipino nurses
with an aggregate total of 53,771; and UK with 14,722; followed by the UAE, Ireland,
Singapore, Kuwait, US (with only 2,104), Qatar, Taiwan, and Canada .
Today the Philippines is the largest exporter of nurses globally roughly 25 percent of all
overseas nurses worldwide. About 85 percent of employed Filipino nurses work in more than 50
countries.
Why the exodus?
Low pay, poor working conditions, and the closure of many public hospitals have forced Filipino
nurses to work abroad. Filipino nurses in the US, for example, earn 15 times more than those
working in the Philippines. On average, Filipino nurses working abroad earn five times higher
than what the average lawyer or CEO makes back home.
This exodus has also been fueled by advanced economies demand for their skills. Since the
1970s, the export of human capital has served as a band-aid solution to the staggering
unemployment and a major source of remittances needed to boost the countrys GDP.
Remittances
Filipino nurses working abroad remit about US$1billion or roughly P44 billion to the
Philippines every year. Along with other professionals and skilled workers in the US, they
contribute nearly half of the 80 percent total remittances sent by overseas Filipinos from just 9
countries (namely, US, Canada, UK, UAE, Saudi Arabia, Singapore, Italy, Germany, and Hong
Kong). These remittances make up 13 percent of the Philippines Gross Domestic Product
(GDP), with the total amount increasing from $20 billion in 2011 to $21 billion in 2012.
Remittances sent by overseas Filipinos keep the Philippine economy afloat. This dependence
has become apparent in 2013 when super typhoon Yolanda devastated the Central Philippines.
Remittances represented hope for millions of surviving families facing the challenge of
rebuilding their lives. The total amount expected to be sent by Filipino nurses, other
professionals and contract workers to the Philippines was expected to rise by 5.7 percent to
US$26 billion by the end of 2013.
- See more at: http://asianjournal.com/editorial/a-tribute-to-filipino-nurses-all-over-theworld/#sthash.998owd6U.dpuf
(Part 2 of 2)
LAST week, I shared the first part of the speech by Atty. Arnedo Valera, Legal Counsel of the
Philippine Nurses Association in America (PNAA) and Executive Director of the Migrant Heritage
Commission (MHC), delivered at the FIRST GLOBAL SUMMIT OF FILIPINO NURSES 2014 in
Manila on January 16.

Part 1 discussed the big picture, which illustrates the significant role Filipino nurses play in
Philippine society and anywhere around the world, and why there is an exodus for these
hardworking kababayans to work abroad.
Here is Part 2 of Nurses Without Borders: What can be done to help our modern day heroes
and address the problem of brain drain in the Philippines?
Revisiting the Labor Export Policy
In recent years, however, the policy of commoditization and deployment of nurses for overseas
jobs has been revisited because of its social costs. Analysts found that this policy actually
aggravates instead of addresses unemployment in the nursing profession. The massive brain
drain it creates also contributes to the deterioration of the public health care system in the
Philippines.
The Philippine governments labor export policy faces the constant risk of uncertainty. It is
vulnerable to the imbalances or instabilities of the worlds labor market demand and supply. The
nursing sector, for instance, has been vulnerable to fluctuations in the US market and other
foreign destinations, owing to economic recessions and domestic pressures against the
importation of foreign nurses. Some host countries have been besieged by armed conflicts,
particularly those in the Middle East and North Africa (MENA).
Economic recessions in the US in the early 1990s and the latest episode that began in 2008
have led to a decline in demand for Filipino nurses. Jobs were being filled by locally educated
nurses. From 15,382 in 2009, the number of Filipino nurses who took the US NCLEX
examination for RNs or licensed practical/vocational nurses nose-dived by 37 percent to just
9,789 in 2010. In the first quarter of 2011, the figure plunged by 52 percent to just 1,454 as
against 3,024 in the same quarter in 2010.
As a result, the decline in the entry of Filipino nurses in the U.S., among other reasons, has
spawned huge unemployment in the nursing profession in the Philippines.
According to the Commission on Higher Education (CHED), some 400,000 Filipino nurses were
unemployed in 2012. Unemployment has driven some nursing graduates to seek other jobs
such as those in call centers. Others go back to school to pursue higher degrees or work as
caregivers abroad.
At the same time, the number of nursing schools jumped from 200 in 2006 to 491 in 2012, with
2 million enrollees. So intense has been the competition for the few available job slots whether
foreign or at home that board examination standards have also been raised to quality
competency that has taken a toll on aspiring RNs.
The number Nursing Licensure Examination (NLE) passers was a low 35.35 percent in
December 2012 (16,908 out of 49,066 examinees) albeit slightly higher than December 2011
(33.92 percent) and December 2010 (35.35 percent). In July 2013, 16,219 qualified out of
37,887 examinees or a slight improvement of 43 percent.
Amid the oversupply of RNs who remain in the Philippines, only 15 percent can be absorbed in
the health industry, mostly in government hospitals and other institutions as well as private
hospitals. Out of 1,600 national-based hospitals, only 90 are government-run.

The rest are private hospitals. Many of these hospitals face the constant threat of closures,
mainly due to the out-migration of experienced nurses and doctors. The push factors are low
pay amid inflation, lack of benefits, poor working conditions, government corruption, and
uncertainty in career development. In fact, more and more physicians train as nurses for better
opportunities in overseas jobs.
Brain drain
Medical researchers and social scientists agree that the brain drain out-migration and the
transnational marketing of Filipino nurses and other professionals are hurting the public health
care system. While the Philippines exports tens of thousands of its health professionals, 7 out of
10 Filipinos die without being attended by health personnel. At least 50 percent of the population
have no access to health care; only 30 percent of the countrys 42,000 barangays have health
stations.
Most alarming of all is the declining access to health services, indicated by the drop in
immunization among children from 69 percent in 1993 to 60 percent in 2003. Corruption, in
the form of kickbacks and absence of biddings, further restricts the availability of essential drugs
and facilities for the poor.
The Philippines already has one of the poorest public health care systems in Southeast Asia.
The governments total health expenditures in proportion to GDP is only 3.3 percent, based on
reports by the National Economic Development Authority (NEDA) or way below the WHOrecommended minimum 5 percent of GDP. The 2013 figure fell from 2009s 3.8 percent. The
Philippines public health expenditure is lower than Thailands 4.1 percent, Vietnams 6.8
percent, Chinas 5.2 percent and especially Cubas 10 percent, and the United States 17.9
percent. In short, the claimed GDP growth in the Philippines (7 percent) does not translate to a
proportional increase in public health expenditures.
Some public health advocates, like registered nurse and UP Staff Regent Jossel Ebesate, have
attributed the deterioration of the countrys public health service to the governments neo-liberal
and labor-export policies. These policies are blamed for the reduction of budgets for social
services, freezing of wages, unjust labor conditions, and failure to address the exodus of
professionals and skilled workers to foreign countries.
While it is true that remittances prop up the economy and allow some families to have more
spending power, the money is not transformed into national investments that can boost longterm development.
Additionally, analysts have concluded that being a perpetual supplier of human capital hurts the
countrys national development. It doesnt allow for a public health system where Filipino nurses
and doctors can serve with adequate compensation and benefits they deserve.
These are compelling reasons to support proposed policies and legislation boosting domestic
employment of nurses. The government should seriously also consider the proposal to hire
unemployed nurses and deploy them to provide urgent health care services in the countrys
poorest municipalities.
There should also be a strong resolve to protect the employment rights and benefits of Filipino
nurses abroad, amid reports of workplace abuses and discriminatory practices in many

countries. Proposed solutions include bilateral labor agreements to protect the Filipino nurses
labor rights.
Urgent appeal
As we reflect on these solutions, I would also like to make an urgent appeal that resonates with
the conference theme.
The devastation wrought by super typhoon Yolanda should serve as a wake-up call for the
national government. Eastern Visayas is the countrys third poorest region where the social
divide is also the widest, with the upper 30 percent earning eight times more than the bottom 30
percent.
The majority of its 4 million residents mostly of farmers and fisher folk has long suffered from
an extractive economy that depleted the regions logging and mining resources, with no
meaningful economic productivity for the people. Poverty has made them more vulnerable to
both natural and man-made disasters. It has left them without the capability to recover their
losses.
By the way, Eastern Visayas has seen many of its nurses going abroad. It ranks fifth in the
country for having the most number of nursing schools and fourth in term of enrollees.
The millions of displaced families urgently need medical assistance and infrastructures as they
start rebuilding their lives. They cannot rebuild their lives without their medical needs being
addressed first.
So I would like to appeal to all of you here today to use this occasion to join hands and come up
with short- and long-term plans to support the rebuilding of Eastern Visayas. This is a great way
of giving back to our country of birth.
After this conference, I am flying to Tacloban and Carigara, Leyte to discuss Migrant Heritage
Commissions project REVIVE (REBUILDING VISAYAS WITH VIBRANT ECOLOGY). We are
here for a long pull. We need to rebuild lives and rebuild the future of communities impacted by
Yolanda/Haiyan. Project REVIVE calls for addressing as its first task medical needs of
communities, livelihood projects and building of storm shelters which can also function as health
care centers.
As the saying goes, Charity Begins at Home. I would revise this slightly and say: Charity,
Compassion and Care Begin at Home.
***
Gel Santos Relos is the anchor of TFCs Balitang America. Views and opinions expressed by
the author in this column are are solely those of the author and not of Asian Journal and ABSCBN-TFC.
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- See more at: http://asianjournal.com/editorial/a-tribute-to-filipino-nurses-all-over-the-world2/#sthash.9fM1jVLZ.dpuf