Map of Philippines
In the aftermath of the Spanish-American War of 1898, the Treaty of Paris officially made the Philippines a colony of the United States after 350 years of Spanish rule. And aside from the Japanese occupation of the islands during World War II, the Philippines remained a U.S. commonwealth country until the end of the war in 1946, when the country was granted independence. During this time, English was declared the official language, the education system was set up to mirror that of the U.S. and nurse-training programs with an English-language requirement were created.
The migration of Filipino nurses began in 1948, when the U.S. State Department developed an exchange program to improve international relations. The program allowed many Filipinos to visit the United States for the first time. By the mid-1950s, the Philippines had become the largest exporter of nurses worldwide.
Over the last three decades, Philippine nurses have been recruited in large numbers to fill the nursing shortage in the United States. For American nurses, the difficult work schedules and relative low pay have encouraged many to leave the profession. But what is considered low pay by American standards is at least 10 times as much as Filipinos can earn at home working as a nurse.
On average, government doctors in the Philippines earn $400 to $500 a month, whereas in the United States, nurses can pull in upward of $4,000 a month. American hospitals have also lured Filipino nurses with bonuses in the thousands of dollars. The fact that unemployment in the Philippines is more than 10 percent also contributes to the continued exodus.
Nurses and other Overseas Filipino Workers -- referred to as OFWs -- send $15 billion in remittances back to the Philippines each year, which amounts to a seventh of the country's Gross Domestic Product (GDP). Approximately 10 percent of the Philippines' 89 million citizens live and work abroad. Last year, 1 million Filipinos left the country, enough to fill six 747s everyday, according to The New York Times. Most of the 3.2 million who have migrated permanently live in the United States, although there are 1 million OFWs in Saudi Arabia. Approximately 1.3 million are estimated to be working abroad illegally.
In addition to the higher wages, the allure of living in the United States, an idea planted during colonial times, remains strong. And nurses who do go abroad to work are considered heroes because they can support entire families back home in the Philippines. Despite all this and dwindling resources in the medical profession, the Philippine government has done little to slow the trend of doctors and nurses moving overseas. Plus, labor officials refuse to admit that there is a nursing shortage. (They do acknowledge, however, that the country is losing its most skilled nurses.) Still, government officials are devising a master plan to deter nurses from leaving by requiring graduates of medical and nursing schools to work in Philippine hospitals for at least two years.
But the real cost to the country has been devastating -- the number of Filipinos dying without medical attention has been steadily increasing for the last decade. In 2003, 70 percent of deaths received no attention by a medical professional, a 10 percent increase from ten years prior. And the lack of experienced nurses remaining in the Philippines has left a large question mark over the quality of instruction given to the country's future nurses.
Sources: BBC, Health Services Research, MinorityNurse.com and The New York Times.
From Our Files
Philippines: 'Islands Under Siege'
FRONTLINE/World and PRI World correspondent Orlando de Guzman, a Filipino reporter from the country's north, traveled to Mindanao in 2003 to witness and speak with Muslim rebels fighting a guerrilla war against the Philippine government.
The Philippines: 'Stop the Killings'
Correspondent Carlos H. Conde writes a dispatch about the rise of political killings in the Philippines, where one human rights group estimated that nearly 800 political activists, human rights advocates, peasant leaders, farmers and church workers have been murdered execution-style since President Gloria Macapagal-Arroyo came to power in 2001.
Philippines: 'The Black Stain of Oil'
FRONTLINE/World reporter Jason Margolis goes to the Philippines to investigate what was called the worst environmental disaster in the country's history, the 2006 sinking of an oil tanker off the breathtakingly beautiful coast of the island of Guimaras -- a story that barely caused a ripple in U.S. mainstream media.
Ecuador: 'Country Doctors'
FRONTLINE/World correspondent Mike Seely follows Ecuadorian doctor Edgar Rodas, as he treks to the most remote places in the Andes and the Amazon to provide medical care to those who would not normally receive any.
World Health Organization's 2006 Report: 'Working Together for Health'
In this multilingual report, the World Health Organization proposes that developed nations assume responsibility when recruiting highly skilled professionals from developing countries. Along with more ethical recruitment standards, the WHO calls for developed countries to acknowledge the impact of the workers' absence on the home country.
Philippine Nurses Association of America
An organization founded in 1979 by Filipino nurses working in the United States, the Philippine Nurses Association of America formed under the following mission: "Uphold and foster the positive image and welfare of its constituent members. Promote professional excellence and contribute to significant outcomes to health care and society."
Migration of Health Workers: Country Case Study Philippines
This 2005 study on the migration of health care workers from the Philippines (published by the Institute of Health Policy and Development Studies, the National Institutes of Health and the University of the Philippines in Manila) outlines the causes of migration and the effects on migrants, their families and the health care system in the Philippines.
NurseWeek: 'A Proud Nursing Heritage'
This 2005 NurseWeek article profiles one Filipino nurse in Houston, Merlita Velasquez, who migrated between the United States and the Philippines three times since the 1960s in order to juggle economic and family obligations.
Daily Herald: 'Trying Hard to Help Heal'
An annual medical mission to the Philippines, led by Filipino health care providers living in the suburbs of Chicago, is chronicled in the Daily Herald's five-part series, "The Philippines: Arc of the Islanders." The story highlights the challenges of getting much-needed supplies past customs and the rewards of providing medical, pharmaceutical and dental treatment to the country's poorest.
MinorityNurse.com: 'Philippine Nurses in the U.S'
This article in MinorityNurse.com gives an overview of the history of Filipino nurses' migration, beginning with the 1948 Exchange Visitor Program.
MinorityNurse.com: 'PNAA Study Paints Portrait of Today's Filipino Nurses'
MinorityNurse.com presents the findings of a 2002 study by the Philippine Nurses Association of America that surveyed 347 Filipino nurses in the United States to collect national demographical data.
Voice of America: 'Philippine Medical Brain Drain Leaves Public Health System in Crisis'
This articles touches on some of the public policy proposals that could alleviate the burden of the brain drain from the Philippines. Dr. Alma Naraga, a former municipal health officer in the Philippines, said, "If the need to really stay [in the Philippines] is such that my service is needed, I would be willing to spend five years here, provided that we will be compensated for our work."
Health Affairs: 'Trends in International Nurse Migration'
In this 2004 study, Linda Aiken, director of policy research at the School of Nursing at the University of Pennsylvania, argues for more domestic training and investment in nursing training programs in developing countries as a two-pronged strategy to solve the international nursing shortage.
International Herald Tribune: 'Cheating on Exam Taints Standing of Philippine Nurses'
Carlos H. Conde reports on the 2006 nursing exam scandal in which Philippine Nurses Association president, George Cardero, allegedly leaked the exam questions to students who had taken his test preparation course.
-- Alison Satake