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The Unspoken Heroes of the American Healthcare System

Growing up as a Filipino-American, I’ve always been aware of the phenomenon of Filipino nurses. The characterization of friendly, hard working nurses seem to be at any hospital. Unfortunately, I failed to realize the deep history and context that let this happen in the United States. Behind this perpetuation of the nice Filipino nurse, there are roots of colonization, immigration and ultimately, Filipino nurses used to fill the major gaps in the American healthcare system. To truly understand the story of Filipino nurses, we have to understand the history that brought us to this point.


The Philippines was first bought by the United States in 1898 in the Treaty of Paris, at the end of the Spanish-American War. The American President at the time, President McKinley, called the colonization of the Filipino people a “benevolent assimilation” and promised full rights to citizens to appease the general public. Specifically, the United States military started to build a healthcare system as the Spanish, who previously colonized the Philippines, did not create a strong system leading to infections and communicable diseases being rampant during wartime. The colonial government and missionaries continued the work of the military, leading to the creation of many hospitals and health care facilities such as Iloilo Mission Hospital School of Nursing, Saint Paul’s Hospital School of Nursing and the Philippine General Hospital School of Nursing. While on the surface, this seems like progress for the Philippines, the creation of these facilities were justified through the thinking that the Philippine people were “uncivilized” and that the Americans, the colonizers, were “civilizing” them through the implementation of a sophisticated healthcare system.


Photo from the Philippine General Hospital School of Nursing Ninth Annual Announcement and Catalogue, 1915-1916, U.S. National Archives, College Park, MD.

So how did all these nurses from the Philippines get to the United States? At first, visas were very limited to the United States, so only a select elite group of Filipino nurses were able to travel to the States. However, this opportunity gave them more training and helped them establish their status in the United States. These nurses then were able to use their new found status to get higher positions, and even beat out American nurses working at certain hospitals. In 1948, the United States established the Exchange Visitor Program (EVP) which allowed foreigners to work and study in the United States for 2 years before they had to return to their home country. This policy was created during the Cold War, encouraging foreigners to learn about American ideology and culture, which they would then take back to their home countries to spread it to different parts of the world. The launch of the program also happened to coincide with the shortage of nurses in America after World War II. Many American nurses wanted to stay home, citing low wages and bad working conditions. To fill this gap, Filipino nurses were used and in 1965, the Immigration and and Nationality Act (INA) allowed these nurses to petition and to stay in the country permanently.


The INA policy coincidentally was passed during a growing need for nurses again. American women were starting to explore careers outside of the gender norms, creating a shortage of nurses. Simultaneously, Medicare and Medicaid were established in 1965. In 1966 alone, 19 million Americans enrolled in Medicare. Soon after, in 1967, the Philippines became the lead exporter of nurses to the United States. Another immigration amendment in 1970 allowed foreign workers to use an H-1 visa, a working visa, for temporary employment. This created even more recruitment of Filipino workers, and from 1972-1978, 60% of all nurses who entered the country using H-1 visas were educated in the Philippines.


The United States was not alone in this effort, as the Philippine government also capitalized and facilitated the export of Filipino medical workers. The Immigration and Nationality Act in the United States overlapped with high unemployment in the Philippines and created an incentive for nurses to get a higher salary in other countries. The Philippines, who gained independence in 1946, dealt with economic problems that caused the Philippine peso to drop in value from the mid- to late- 20th century. Many workers felt an economic promise that coming to the United States would improve your socioeconomic status and livelihood. The Philippine President at the time, Ferdinand Marcos, also saw this market. He believed that the money that could be sent from overseas workers back to their families would build back the economy. He created the Philippines Overseas Employment Administration (POEA) that could provide contract labor, which helped employ many Filipino healthcare workers. Unfortunately, political instability was also prevalent under Marcos, and many Filipinos used immigration resources to escape.


However, Filipino healthcare workers were not exempt from exploitation and are involved in the history of the U.S medical systems that left these workers to work at understaffed hospitals since the 1960's. For example, during the 1980’s HIV/AIDS epidemic, many American-born healthcare workers refused to treat AIDS patients leaving Filipino nurses again to fill this gap. Many American health care facilities also lured in Filipino workers by promising better pay, but instead, they were forced to work long hours in unsafe conditions with the threat of their boss revoking their visa. As recent as 2019, 200 Filipino nurses won a lawsuit where they testified that owners of New York nursing homes were not paying the wages that they were promised in their contract and worked in unsafe conditions with insufficient staffing. This is a reality for many foreign born nurses, as they are sent to frequently understaffed and under-resourced rural areas.


Ad in the 1969 issue of the Philippine Journal of Nursing

So why are Filipinos specifically so prevalent in the United States healthcare system? The answer can be seen in the beginnings of the country’s colonization under the United States. The Filipinos were taught English healthcare and instruction. They were already introduced to the American nursing curriculum and work culture. This use of Filipino nurses is an ongoing cycle that continues in the present day. In April 2021, 24% of nurses who died from COVID were Filipino but only 4% of nurses who are registered in the United States are Filipino and in 2019, 1 in 20 nurses in the U.S was trained in the Philippines.


As a Filipino-American, acknowledging the circumstances that lead to the rise of Filipino nurses in the United States helps me understand more about the complex history between the two countries. It reminds me that there is so much to stories than just what seems on the surface, context can be everything.





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About the Author: Rebecca is an editor and writer at the blog at the Bittermelon. She loves to play volleyball and listen to music.


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