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  • The Philippines has a problem.

  • On top of fighting the spread of coronavirus,

  • hospitals are facing another crisis. They are more than 20,000 nurses short.

  • But the thing is tens of thousands of nurses graduate every year in the Philippines.

  • This 2010 oath-taking ceremony included more than 35,000 graduating nurses.

  • And this is a graduating class from 2017.

  • And this one is from 2019.

  • So how can the Philippines have so many nurses...

  • And be dealing with a shortage at the same time?

  • This story starts in 1898, when the Philippines became a US colony.

  • Filipinos fought back but were ultimately conquered by American troops.

  • More than 200,000 Filipinos died.

  • As part of the colonization of the Philippines,

  • the US created a policy calledBenevolent Assimilationthat claimed to protect Filipino

  • rights and liberties.

  • They use this to justify the colonization

  • of the Philippines by arguing that this was a different kind of colonialism and imperialism.

  • This was a good kind of colonialism that would bring education, infrastructure and public health.

  • The US started taking over institutions and education.

  • And began developing a medical labor force in the Philippines.

  • They built more than ten nursing schools in less than a decade.

  • Filipino nursing students had to learn western medical practices from American teachers.

  • And they were forced to learn in English.

  • Year after year new classes of American-trained, English-speaking Filipino nurses graduated

  • from nursing schools.

  • What this did was that it inadvertently prepared Filipino nurses to work in the United States.

  • The nursing training system went on until the Philippines gained independence in 1946.

  • The independence of the Philippines as a separate and self-governing nation.

  • But even though the Philippines broke free,

  • America soon found a way to bring Filipino nurses over.

  • Starting in 1941, after the US entered WWII, millions of Americans joined the armed forces.

  • And thousands of nurses enlisted to treat injured soldiers in the field.

  • And American hospitals started emptying out.

  • So the government funded programs like the Cadet Nurse Corps to fill the gaps.

  • They provided millions of dollars for a “lifetime education for freeand encouraged American

  • women in particular toenlist in a proud profession”.

  • As a result, nearly 200,000 American women became nurses for the army and civilian hospitals.

  • All working with the same purpose. To ease the pain of war. To help save lives.”

  • But all that changed in 1945, when the war came to an end.

  • Once the fighting was over, there was less support for nurses.

  • Government funding dried up and many women quit nursing.

  • Hospitals started seeing a rise in vacancies.

  • And that meant America needed to find nurses to fill the void again.

  • Instead of improving pay and working conditions to encourage American nurses to return

  • the US looked beyond its borders to fill the jobs Americans wouldn't take.

  • It turned to a new temporary visitors program as a solution.

  • U.S. hospitals started to use the Exchange Visitor Program in order to recruit Filipino nurses

  • because they had Americanized nursing training already.

  • And it worked. Filipino nurses dominated the program.

  • For about a decade, more than 10,000 Filipino nurses came to the US to work.

  • But the real reason so many left their homes

  • has to do with what was happening in the Philippines at the time.

  • After centuries of oppressive colonial control and their own World War II battles, the Philippines

  • economy finally started to stabilize.

  • Cities were flourishing and tourism was booming, but wages, particularly in rural areas,

  • were still low for nearly everyone. And that included nurses, who despite having

  • formal training were often paid less than janitors or messengers.

  • And that pushed many of them to go abroad in search of better opportunities.

  • But when they came over to the US, many sponsoring

  • hospitals just used them as inexpensive labor.

  • They assigned them extensive nurse work, and only paid them a minimal stipend.

  • After their temporary placements ended, many Filipino nurses went back to the Philippines.

  • While many others managed to stay longer and build a life in the US, where they formed

  • strong Filipino communities.

  • But the exchange visitor program wasn't the end of America's hold on Filipino nurses.

  • It was just the beginning.

  • The 1960s brought big changes to America.

  • There are certain historical events. New Great Society programs such as the establishment

  • of Medicare and Medicaid.

  • There are civil rights and women's social movements.

  • American women have more opportunities to enter other kinds of occupations.

  • All of these things converge to increase

  • the demand for nursing services, but also to result in even more nursing shortages in the US.

  • In just three years, nurse vacancies nearly doubled.

  • Nearly one in every four nursing jobs was vacant.

  • To fill the new shortage the US turned to the Philippines again.

  • But this time it was different.

  • Immigration policy in America changed drastically

  • in 1965, with the Immigration and Nationality Act.

  • For the first time, people from all over the world could apply for immigrant visas.

  • Then, on top of sponsoring hospitals -- labor recruiters and travel agencies started targeting

  • Filipino nurses with ads that promised bright futures in America.

  • One particular ad featured a basket that was decorated with the Philippine flag.

  • It's addressing the Filipino nurse saying, Dear nurse, if you're not happy where you

  • are right now, contact us. And we can't promise you happiness, but we can help you chase it

  • all over the place.

  • So Filipino nurses began filling the shortages around the US.

  • But soon many experienced discrimination.

  • The American Nurse Association added licensing requirements to limit their entry to the US.

  • The nurses who did pass those requirements, came to the US and ended up in underpaid,

  • lower positions.

  • Still, it's this phase of migration that lasted through today and transformed the US

  • healthcare industry.

  • The temporary pathway established 20 years earlier, became a permanent migration route.

  • And hospitals now had a way to draw nurses whenever they wanted.

  • But focusing on what pulled so many nurses to America, overlooks the forces that continued

  • to push them out.

  • Which brings us back to the Philippines.

  • This is Ferdinand Marcos who ruled the Philippines with an iron fist.

  • In 1972, under martial law, he began to rule as a dictator.

  • He was behind more than 3,000 extrajudicial killings,

  • and tens of thousands of tortures and incarcerations.

  • As a result of the unrest, the economy that was starting to pick up fell into a recession

  • and unemployment skyrocketed. But instead of addressing the lack of jobs...

  • The Philippine government actively promoted and publicized labor export the export of

  • Filipino workers to countries throughout the world.

  • That's because Filipino workers overseas were starting to send hundreds of millions

  • of dollars back home to their families.

  • And the Filipino government wanted to keep that money coming.

  • Over time, that government push led to global

  • migration, making the Philippines the largest exporter of nurses in the world.

  • Nearly 20,000 nurses leave the Philippines every year.

  • They go to Saudi Arabia or Australia. The UK. Germany.

  • But many of them have ended up in the US.

  • Where nearly one-third of all foreign-born nurses are Filipino.

  • With the US recruiting nurses on one end

  • and the Philippines pushing them to work abroad on the other,

  • both governments have benefited from Filipino labor.

  • Over the decades, a total of 150,000 Filipino nurses have come to work in US hospitals.

  • And after years of exploitation and discrimination, Filipino and Filipino American nurses

  • have organized in the US.

  • They pushed back on exploitative practices

  • and have fought for better working conditions.

  • But surveys show that a large number of Filipino nurses are still concentrated in bedside and critical care.

  • Some of the most dangerous and strenuous nursing work.

  • It's the kind of work that's put them disproportionately on the frontlines of the

  • fight against the coronavirus.

  • The pandemic has taken an outsize toll on

  • Filipino healthcare workers.

  • Of the 318 health care workers lost to the

  • coronavirus as of May, at least 30 are Filipino.

  • And still thousands remain on the frontlines.

  • In April 2020, as the coronavirus spread in the Philippines, and the shortage of nurses

  • across hospitals became a problem, the government temporarily banned healthcare workers from

  • leaving to work abroad.

  • And while it might seem like an appropriate

  • idea for Filipino nurses to remain in the Philippines,

  • It's also important to remember that Filipino nurse overseas migration is a longstanding

  • phenomenon that has been actively promoted by the Philippine government.

  • Even though the ban was eventually lifted, it points to the instability that Filipino nurses have

  • have to live with on both sides of the migration route.

  • Pushed and pulled between countries

  • Filipino nurses continue to get caught in the middle --

  • even as they strive to work on the frontlines,

  • providing critical care...

  • like they always have.

The Philippines has a problem.

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為什麼美國有那麼多菲律賓護士? (Why the US has so many Filipino nurses)

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    林宜悉 發佈於 2021 年 01 月 14 日
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