Balikbayan

CONVERSATIONS WITH PINAY NURSES

by Alyssa Bernadette Cahoy

foreword

After four centuries of Spanish colonial rule, the United States acquired the Philippine archipelago as part of the 1898 Treaty of Paris that ended the Spanish-American War. President William McKinley framed this military conquest as “benevolent assimilation” with the justification that Filipinos were an “uncivilized” people.[1] The U.S. would hold sovereignty over the Philippines for the next five decades. With the U.S. occupation of the Philippines came the development of a new healthcare system. While hospitals and nursing schools provided professional opportunities for Filipino women, it was contingent upon the enforcement of American social beliefs and practices regarding class and gender, i.e., the racial inferiority of Filipinos.[2] Filipino nursing students were taught the English language among other nursing competencies.

 

Even after the Philippines gained independence in 1946, state policies encouraged the immigration of nurses and others deemed skilled labor to the U.S. The first mass wave of Filipino nurse immigration to the U.S. took place in the 1960s under the Immigration and Nationality Act.[3] Hospital recruiters targeted the Philippines in particular because Filipino nurses were already familiarized with American culture. Dictator Ferdinand Marcos in particular was a key figure in the construction of the Philippine labor export economy.[4] Moving overseas as a Filipino nurse was touted as a heroic act of nationalism.[5] 

 

To this day, the U.S. and Philippines have an enmeshed political relationship, in which the U.S. has continually relied on Filipino nurses to fill their shortage of medical personnel, and the Philippines has become increasingly dependent on remittances from Filipino nurses abroad. There are not enough employment opportunities in the Philippines for its growing population, so Filipino nurses continue to immigrate to the U.S. seeking to support their families.[6] Approximately 16% of nurses in the United States are foreign-born, and nearly one-third of those are Filipinos.[7] Filipino nurses continue to face inequities in the form of lower wages compared to their white counterparts, less desirable working conditions, casual racism, and even a disproportionate number of COVID-related deaths.

 

Prior to entering undergrad, I had planned to study nursing. It was what was expected of me, it was what I was prepared for, and at the time, I had not been exposed to other options. It felt like the safest way to secure a future for myself and my family. It felt like a respectable vocation, and I did not think to show any resistance. Maybe it was divine intervention, and maybe it was luck, but I ended up at the one university I applied to without a pre-nursing program, and now here I am, working in a Medical Humanities lab. I am grateful to be able to formulate these inquiries, to dig into tensions that have been purposefully obscured from my people, to investigate my personal trajectory and its entanglement with the Philippine global economy at large. 

 

I did not have the privilege of learning about comprehensive Filipino history in primary or secondary school textbooks. Being aware of that gap in collective knowledge and entering into this project, I intended to shine a light on America’s imperial past and challenge generational amnesia, but this project has proliferated in ways I could not foresee. My work has become less a formally-postcolonial critique of U.S. modernity and more so documentation of the flourishing of diasporic pinay communities. This research brings back into the light submerged historical experiences manifesting in everyday life struggles. Communicating with an accent. Ethnic food cravings. Professional credibility.

 

This project has allowed me to grapple with what it means to be a Filipino abroad. In many ways, assimilation has not granted Filipino immigrants the space to make their cultural presence known, in the US and in other nations. Discourses of the traditional and the domestic have invalidated diasporic identities. Occupying the space within these attitudes of unwelcome, these interviews felt like a way of saying, “We are here. We will be acknowledged. We are still Filipino.”  

References

  1. Cachero, P. (2021). How Filipino Nurses Have Propped Up America’s Medical System. Time. https://time.com/6051754/history-filipino-nurses-us/

  2. Choy, C. C. (2003). Empire of care. In Empire of care. Duke University Press.

  3. Brush, B. L. (2010). The Potent Lever of Toil: Nursing Development and Exportation in the Postcolonial Philippines. American Journal of Public Health, 100(9), 1572–1581.

  4. Muir, C. (2020). BIMI-HIFIS Policy Brief Series. Essential Workers or Exports: Filipino Nurses in the Era of COVID-19. Berkeley, CA: Berkeley Interdisciplinary Migration Initiative.

  5. Nazareno, J., Yoshioka, E., Adia, A. C., Restar, A., Operario, D., & Choy, C. C. (2021). From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID-19 through an intersectional lens. Gender, Work & Organization, 28(4), 1426–1446. 

  6. Lorenzo, F. M. E., Galvez-Tan, J., Icamina, K., & Javier, L. (2007). Nurse Migration from a Source Country Perspective: Philippine Country Case Study. Health Services Research, 42(3), 1406–1418. 

  7. Almendral, A. (2020). On Pandemic’s Front Lines, Nurses From Half a World Away. The New York Times. https://www.nytimes.com/2020/04/20/world/asia/coronavirus-philippines-nurses.html

“I'm not an American. Not a doctor. I'm a female, and I'm a minority. The undercurrent of his tone and his body language...you can just sense that if they had a choice, they would rather be in another exam room with an American male doctor. The hardest thing is proving yourself. Even though I am these things, I know enough stuff to give you safe care."

"Being in this job, you have to be constantly studying. It's not like you learn a skill and you're good the rest of your life. There are new devices and medicines that need to be learned. You have to be up to date on the latest medical management for each. You need to have a snippet of knowledge for almost every disease imaginable."

"That's where our heart belongs. You just understand each other. You don't have to explain yourself, why you leave your slippers at the door, why you stay up so late after what's supposed to be a simple meeting. We just don't follow time. We're having fun, and we're going to keep going until somebody gives up. We feel bad that our kids haven't gotten to experience the full richness of Filipino culture, especially the Banayihan, helping each other. You develop these close friendships with your Filipino friends, and you just show them who you really are. In a way, by keeping touch with our community, you get a glimpse of that here and there."

—K. Barcelon

"outpatient world"

Ode to Fil-Am Gatherings

 

Post-church lunches—doorbell rings 

every few minutes, famished crowd 

of tsinelas in the entryway, tita brings 

her centerpiece sabaw, heads bowed 

around the dining table, quietly proud 

of the lives they have produced anew,

their paths paved on untended ground.

 

        Where one of us goes, the rest are there with                        you.

 

Birthday celebrations—friends breeze

in, Kohl’s giftcards ready, blessing a row

of adults, collecting keys to their SUVs,

dropping off comfort foods arroz caldo,

pancit, kawali, adobo rice, menudo,

knowing glances of “dalaga siya” to

her reddening face, shy smile to show.

 

                Where one of us goes, the rest are there with                you.

 

Videoke nights—drunken neighbors sway

on beats two and four, glad to dance

and sing until exhausted, planning to stay

past midnight, knowing that this chance

to unwind is brief, worrying about finances

during the work week, budgeting a few

checks for vacation to the motherland.

 

                      Where one of us goes, the rest are there with          you.

 

Mutual understanding in the workplace—

late meal breaks taken together at two

in the morning. Back-bending, joint-cracking

                               Where one of us goes, the rest are there with you.

"The biggest shock when I first arrived here in the US was the transportation. Back in the Philippines, you can easily access public transit at any time and any place. The same as when I was in Europe—the buses, train, and taxis are everywhere. In the US, especially in Texas, people own and drive their cars. Public transport here is not easily accessible to all. It's hard if you don't know how to drive; the highway is scary and confusing."

"Nurses in the Philippines are not encouraged to suggest or facilitate a plan for the patient. We rely entirely on what the doctors have to say. Here in the US, communication is open. We are involved in patient care planning."

"Personally, the most fulfilling part of nursing is when I am part of my patient's journey from their diagnosis, treatment, recovery to their healing. In oncology, it is more challenging as you see patients' pain and suffering as they go through the cancer diagnosis and treatment. I am blessed to have the opportunity to hold their hands when no family can be around after their surgery, calm their fears and comfort them when they are alone. I am my patient's advocate when they can't speak up for themselves. Nursing is a demanding profession, but if you ask me, there is no other thing I would love and decide to do other than be a nurse."

—J. Quintayo

And Their Others

Trained soldiers in pressed white dresses,

worn crusaders for the blistering economy,

seafaring daughters carry the flickering lamp

to the gold-plated refuge of the patriots 

and their others,

where you can fall in convenient domesticity

with white royalty and meet his smiling family,

deign to forget teaching him your dialects and cuisine,

count yourself as one of the lucky few 

brown women 

to have assimilated into a society that touts its philanthropy.

If the ring fits, you must wear it.

"I was a doctor already in the Philippines. When you are just starting, you get very excited about getting to practice and see patients. It's very fulfilling. But the environment here is different from the Philippines. You have different patient demographics; we are a poor country. Here, we have all the tools. It's more about defensive medicine here."

"It's a totally different ballgame. When you come to the States, the nurses working here think like doctors. As a Filipino, I was timid and softspoken. I was misinterpreted, and I got in trouble with that. I realized that if I am here, I have to change. I have to be vocal and assertive, behave like an American."

"As a foreign graduate, you have to get a higher score than the American graduate on the licensure exam in the US. My program only had eight slots. Six of those slots are for American graduates; only two are for international students. It's very competitive. Most of those who evaluate the applications will not treat the schools outside the US as equivalent to the US standards."

"The thing I don't like is you are bounded by insurance. Insurance has the last say. If you prescribe something that insurance doesn't cover, you have to go to the less ideal one. You want the best for your patient; you're advocating for them."

—K. Roques

Laban Lang

Lamenting our ongoing history of sacrifice—

 

Our country promises us a fair trade

of honest labor for a moderate paradise.

 

 

Tita’s movements are measured and precise. 

Her expression of practiced peace, unafraid

of overseas passage procured by sacrifice.

 

Never mind your reflections on our market prices!

Pursed lips pause. Furrow in brow, faltering charade,

followed by assurance it works out in paradise.

 

Never mind your reservations, heed her seasoned advice

that no matter the youth, sobs, sighs she has paid,

through monthly remittances, her family is in paradise.

 

 

Our people are joyous eating simple white rice.

Sanctify this food, O Lord, they fervently prayed.

Pride for the enduring spirit of our people: sacrifice.

 

Never trampled, tampered. Like our flag’s sun, they rise

and carry on. Compromising, they remained,

seizing a life built on bedrock of sacrifice,

suturing our wartorn community in paradise.

selected stories from cherry sloan

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"I studied for the board and passed it miraculously. Different hospitals in the US reached out to some employment agencies in Manila. My friends asked if I wanted to go and told me it wouldn't cost anything. Why not?"

"My passion is breaking cancer silence because I'm a cancer survivor. I founded the Filipino Cancer Network. I was challenged by a member of the Asian Cancer Council at the American Cancer Society since they have Indian, Korean, Chinese, and Vietnamese support groups, but none for Filipinos even though they occupy most of the medical center hospitals. I got together some nurses. We applied for a 501(c)(3) status. We now have a logo, bylaws, officers, and we've been going strong since."

"Before you come here, make sure you're resilient. Make sure your eyes are open. Don't forget where you come from. Don't forget who you are. There will be discrimination. They will make fun of you for your accent. They will act out of ignorance. But just keep your composure. If people are degrading you and your culture, don't be a doormat. Continue to be yourself. You didn't come from the basura, the garbage. You are a professional. Stand your ground, and they will respect you."

—C. Sloan

"cannibals"

"warm sheet"

filipinx community at rice university

Unsaid

Dearest daughter, 

 

Our eyes look to you

with regretful pride,

 

    s                              g                t

       m                      n                       e

           i                i                               a

                    l                                          r

                                                                 s.

 

I didn’t mean to place 

the weight of generations

on your narrow shoulders,         

but you are an example

of a future where 

 

we 

are not consigned to

teeth-gnashing, wailing.

Praise the Lord for

blessing you with a good 

head and a strong heart.

 

Your cousins want to

know how you did it.

(Really it’s your

aunt who’s asking.)

We’re sending them

your review books.

Unsent

Dear nanay,

I am the inheritor of

regretful pride,

    s                             g                 t

       m                      n                       e

            i                i                              a

                     l                                         r

                                                                 s.

I know you didn’t mean to place 

the weight of generations

on my narrow shoulders,         

but I turned out to be an example

of a future where

we

are consigned to 

adjacency, model minority. 

Praise the Lord for

blessing us with thick

skin and open hands.

I want to

know why I had to be the one to do it.

(Really it's my

inner child asking.)

I'm sending you

all my love.

dedication

To the pinoy immigrants who will come after me: know you have space to take up here.

To my Filipinx community members: thank you for helping me remember where we came from. 

To my collaborators for this project: your memory is what helps us construct a home on new land.