This was the question posed to me by a curious TV news reporter on May 7, just three days after a stretch limousine, carrying nine Filipino nurses to a bridal party across the San Mateo Bridge, suddenly burst into flames killing five of the occupants, including the bride.
Ann Notarangelo, the reporter who is also the weekend anchor of CBS 5′s Eyewitness News, explained that she was only asking the question because it was on the minds of her viewers. She came to my office to interview me because she thought I might know the answer as I taught Filipino American History at San Francisco State University and I am the legal counsel of the Philippine Nurses Association of Northern California. Plus, I added, I am also married to a Filipino nurse.
She said that she was frankly surprised to learn that 20 percent of all the registered nurses in California are Filipinos, a considerably large percentage since Filipinos number only 2.3 million (officially 1.2 million) out of a state population of 38 million.
“I just never noticed it before,” Ann told me, “because I generally don’t see people in racial terms.” But, she said, in reflecting back on all the times she visited friends and relatives in hospitals all over California, she now recalls seeing Filipino nurses everywhere. Not just in California, I said.
Filipino nurses in the US may be invisible even when they are visible everywhere but not anymore.
Tragedy Sheds Light on Filipino Nurses
The video clip of the fire-engulfed limousine was the top story over the weekend. The fatalities included Neriza Fojas, 31, a newlywed bride who was planning to get married again in the Philippines in June; Michelle Estrera, 35, the bride’s Maid of Honor who worked with her at a Fresno medical facility; Jennifer Balon, 39, and Anna Alcantara, 46, of San Lorenzo, both of whom worked at the Fruitvale Healthcare Center; and Felomina Geronga, 43, who worked at the Kaiser Permanente Medical Center in Oakland.
Americans also learned about the nurses who escaped the fire and were treated for burns and smoke inhalation: Mary G. Guardiano, 42; Jasmine Desguia, 34; Nelia Arellano, 36; and Amalia Loyola, 48. In a TV interview, an anguished Nelia Arellano blamed the limo driver for failing to stop immediately and for selfishly refusing to help them get out of the burning limo.
As the San Francisco Chronicle described it, “They came from little towns scattered all over the Philippines, hungry for the good life in America. A nursing degree was each one’s solo ticket over, and once they found each other, they became the best of friends.”
As the TV camera started rolling, the TV news reporter posed the question to me:“Why are there so many Filipino nurses in the US?”
There are push and pull factors that are at play, I explained. The main push factor is the poor Philippine economy where an average Registered Nurse earns only about 5 percent of what an RN is paid in the United States. The main pull factor is the nursing shortage in this country.
But Americans should not to be too surprised at the large number of Filipinos here, I told her. After all, the Philippines was a U.S. colony from 1899 until the Japanese occupation in 1942 and, some would argue, a “neo-colony” for many decades after the Philippines was granted independence by the United States in 1946.
It certainly does not surprise the British to see many Indians and Pakistanis in England, nor does it surprise the French that there are many Algerians in France. They understand that people from the colonized countries generally tend to gravitate and immigrate to their “mother” countries, even after their native countries are granted independence.
Four Waves of Migration
Filipino nurses did not arrive in the United States overnight. They have been immigrating here for more than a century. In fact, there are four distinct waves of Filipino nurse immigration to the United States.
The first wave came after the United States began its colonization of the Philippines and needed local health care professionals to meet the health needs of the subject population which is why the U.S. Army recruited Filipinos to work as Volunteer Auxiliary and Contract Nurses.
Under the Pensionado Act of 1903, Filipino nursing students were among those sent to the United States as government-funded scholars (pensionados) including those pursuing a nursing education. Some of those who stayed for employment as nurses went on to form the Philippine Nurses Association of New York in 1928. The association’s first president was Marta Ubana, who completed her Bachelor of Science in Nursing degree at Teachers College, Columbia University.
Many other pensionado nurses returned back to the Philippines to help set up and manage the 17 nursing schools that were established in the Philippines from 1903 until 1940. Large numbers of the graduates from these nursing schools thereafter immigrated to the United States as, unlike with the Chinese and Japanese, there were no exclusion acts enacted against them since Filipinos were considered “U.S. nationals” and even traveled with U.S. passports.
One of the pioneer Filipino RNs was Isabel L. Mina, who graduated with a nursing degree from the University of the Philippines in 1919 before working at the Mary Chiles Hospital in Manila. Isabel and two other Filipino nurses, Josefa Cariaga and Petra Aguinaldo, boarded a ship in Manila 1921 bound for Hawaii where they worked in a hospital before moving on to California. They then boarded a train and traveled to New York where they worked in a local hospital for several years.
Information about Isabel Mina was obtained by her San Francisco-based granddaughter, Lissa Sobrepena, who learned about her grandmother when she logged on to Ancestry.com. For a fee, the website produced photos of her grandmother in 1921 and her documents including the ship’s passenger manifests and the two passport applications she filled out when she lost her U.S. passport while traveling in the United States.
What stunned Lissa was when she found out that her grandmother’s best friend, Petra Aguinaldo, coincidentally just happened to be the grandmother of her husband, Robert Sobrepena. Neither Lissa nor Robert knew that their grandmothers – who died before they were born – were close friends and that they had traveled together across the United States as RNs.
The second wave of nurses from the Philippines began in1948 when the U.S. State Department set up an Exchange Visitor Program to “combat Soviet propaganda." According to Catherine Ceniza Choy, associate professor of ethnic studies at the University of California, Berkeley, and author of Empire of Care: Nursing and Migration in Filipino American History (Duke University Press, 2003), owing to the “special relationship” between the mother country and its former colony, a large percentage of the exchange visitors came from the Philippines.
Among these nurses was Maria Guerrero Llapitan who came to the United States in 1948 to take post-graduate nursing courses at Baylor University in Texas. Maria had served as the supervisor of the operating room of a hospital in Bataan before it fell to the Japanese invaders in 1942. After completing her postgraduate studies at Baylor, Maria moved to Chicago to work at the Cook County General Hospital where she met her fiance. She then went to Hunter College for Women in New York to get her nursing degree while working at Sloane-Kettering Memorial Hospital in New York.
Maria married her fiancé in San Francisco where they set up a family in 1951. She later was among the Filipino nurses who formed the Philippine Nurses Association of Northern California in 1961.
The third wave of Filipino nurse immigration to the US came after 1965 when U.S. Immigration laws were liberalized to allow Filipino nurses and other professionals to immigrate to the United States. It also allowed Filipino nurses to come to the United States on tourist visas without prearranged employment and to then adjust their status in the country.
During this period, the number of nursing schools in the Philippines soared from 17 in 1940 to 170 in 1990 to more than 429 at the present time. Many of these nursing schools were diploma mills exploiting the desire of many Filipinos to enter the nursing profession.
Unfortunately, as a result of the inferior education offered by these subpar nursing schools, only 15-20 percent of the Filipino nurses who immigrated to the United States after 1965 could pass the state nursing board exams. This led to the establishment in 1977 of the Commission on Graduates of Foreign Nursing Schools (CGFNS) to help prevent the exploitation of graduates of foreign nursing schools who immigrate to the United States to work as nurses but who can’t pass the nursing board exams here.
The CGFNS developed a pre-immigration certification program that consisted of a credentials review; a test of nursing knowledge (CGFNS qualifying examination), and an English-language proficiency examination (TOEFL).
Since 1977, CGFNS has administered more than 350,000 tests to approximately 185,000 applicants in 43 test sites worldwide. From 1978 to 2000, the data showed that 73 percent of CGFNS test takers came from the Philippines, followed by the United Kingdom (4 percent), India(3 percent), Nigeria (3 percent), and Ireland (3 percent).
'Grow Your Own Nurses'
Menchu Sanchez is a 3rd wave nurse immigrant who has worked as an RN for more than 25 years, the last three years at the New York University Langone Medical Center. Menchu was in charge of 20 at-risk infants in the Intensive Care Unit of her hospital when Superstorm Sandy battered New York last October and knocked out the electric power to the hospital. Menchu organized the nurses and doctors to carry the babies in warming pads down 8 flights of stairs to safety. Menchu was invited to sit beside First Lady Michelle Obama at the State of the Union address of Pres. Barack Obama on February 12, 2013.
In his speech, Pres. Obama cited Menchu as a role model: “We should follow the example of a New York City nurse named Menchu Sanchez. When Hurricane Sandy plunged her hospital into darkness, she wasn’t thinking about how her own home was faring. Her mind was on the 20 precious newborns in her care and the rescue plan she devised that kept them all safe.”
Many Filipino nurses who entered the United States on H-1work visas after passing the CGFNS tests benefited from the passage of the Nursing Relief Act of 1989 which provided for their adjustment to permanent resident status if they had H-1 non-immigrant status as registered nurses and had been employed in that capacity for at least 3 years.
But the “sunsetting” of this law in 1995 effectively decreased Filipino nurse immigration to the United States. The passage of the Illegal Immigration Reform and Immigrant Responsibility Act of 1998 (IIRIIRA) further discouraged nurse immigration.
The passage of nativist legislation was fueled by fears of foreign nurses taking American jobs as former Washington DC Mayor Marion Barry complained : “it’s so bad, that if you go to the hospital now, you find a number of immigrants who are nurses, particularly from the Philippines,” Barry told the Examiner. “And no offense, but let’s grow our own teachers, let’s grow our own nurses — and so that we don’t have to be scrounging around in our community clinics and other kinds of places — having to hire people from somewhere else.”
Grow your own nurses, that’s what the United States did. According to the National Council of State Boards of Nursing, U.S. nursing schools produced close to a million nurses from 2006 to 2011.
While the demand for Filipino nurses may have waned in the United States, the demand for Filipino nurses in the rest of the world did not diminish. Filipino nurses working for the National Health System (NHS) in England drew international attention last February when Britain’s 91-year-old Prince Philip, while on a tour of a new cardiac centre in Bedfordshire, England, turned to a Filipino nurse and said: “The Philippines must be half-empty – you’re all here running the NHS.”
Not quite, not by a long shot, your majesty.
According to Reuben Seguritan, general counsel of the Philippine Nurses Association of America (PNAA), the Philippines is the world’s largest supplier of foreign-trained nurses with 429 nursing schools and 80,000 nursing students.
To place this number in context, City College of San Francisco, with 89,000 students, does not have the resources to accept more than 75 students into its nursing program. The nursing students are chosen by lottery from a list of about 500 students who otherwise qualify for acceptance, a selective system practiced by community colleges all over California.
Is there a fourth wave of Filipino nurse immigration to the US?
Yes, but it hasn’t arrived yet. According to recent CNN report, “Demand for health care services is expected to climb as more baby boomers retire and health care reform makes medical care accessible to more people. As older nurses start retiring, economists predict a massive nursing shortage will reemerge in the United States.”
The CNN report adds: “We’ve been really worried about the future workforce because we’ve got almost 900,000 nurses over the age of 50 who will probably retire this decade, and we’ll have to replace them,” [economist and nurse Peter] Buerhaus said.”
The fourth wave may come as early as 2014 when the U.S. Patient Protection and Affordable Care Act, otherwise known as Obamacare, comes into effect and about 30-40 million Americans without any health insurance will finally be covered by health care insurance.
LPG Marketer’s Association party-list Rep. Arnel Ty believes that Obamacare will “stimulate” the U.S. hiring of foreign nurses. “This will hopefully spur U.S. demand for new foreign nurses and other health practitioners such as pharmacists, physical therapists, medical technologists, radiologists, and speech pathologists,” Ty said.
To another question posed by TV reporter Ann Notarangelo, I answered that I do not know the exact number of Filipino nurses in the United States. All I know is that number, whatever it is, was significantly reduced by 5 on the evening of May 4, 2013.