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LABOUR-PHILIPPINES: Nurses' Exodus Making Health System Sick
By Patricia Adversario
MANILA, May 15 (IPS) - Philippine President Gloria Macapagal Arroyo brimmed
with pride when the leaders of Singapore and China said at the recent SARS
summit that Filipino nurses were performing admirably during the health
crisis, but that praise also draws attention to one of the country's
biggest illnesses - the exodus of its best nurses.
Many Filipino nurses, Arroyo was told, had cut short their vacations
because they said their host societies needed them given the rising cases
of people with the pneumonia-like Severe Acute Respiratory System (SARS).
That Filipino overseas workers or immigrants are appreciated in the more
than 100 countries where they work is a refrain often heard in the
Philippines, a country of 80 million people said to be the world's largest
organised exporter of human labour.
But the irony is particularly painful in the case of Filipino nurses -
of which nearly 14,000, or some say much more - leave each year for better
pay and opportunities.
The costs of this migration are being felt in this poor country that
needs its best health professionals but spends thousands of dollars
training each nurse - only to have them serve the needs of countries like
Britain, the United States, Saudi Arabia and Ireland.
"Sadly, this is no longer brain drain, but more appropriately, brain
haemorrhage of our nurses," said Dr Jaime Galvez Tan, vice chancellor for
research at the University of the Philippines in Manila, and executive
director of the National Institutes of Health Philippines. "Very soon, the
Philippines will be bled dry of nurses."
Rose Gonzalez is a nursing graduate turned public relations practitioner
for seven years, but who is now again a nurse, is leaving soon to work at
the Johns Hopkins University Hospital in Maryland in the United States.
She is among the Filipino nurses who find their profession the sure
ticket to a better-paying job abroad -and the shortest route to obtaining
immigrant status elsewhere.
Government figures report that 2,908 Filipino nurses left for 21
countries in the first quarter of 2002. In the previous year, 13,536 nurses
left for 31 countries.
The Philippine Overseas Employment Administration (POEA), which
processes the departure of migrant workers, said only 304 nurses left for
the United States in 2001. This figure, however, is said to be grossly
underreported. The agency also does not handle nurses who leave on
immigrant visas.
The Philippines is such a rich recruitment ground for nurses - and
increasingly, caregivers too - that U.S.-based hospitals hold nursing job
fairs in the country. The International Union of Nurses says close to
10,000 nurses were directly hired in this manner in 2001.
Tan says the annual outflow of Filipino nurses is now three times
greater than the annual production of licensed nurses of 6,500 to 7,000 year.
Because of the demand created by the ageing of populations in the
industrialised world in the next 10 to 15 years, Tan said: ''It will no
longer be the roller coaster demand for foreign graduate nurses seen in the
last 35 years. This time, it will be a persistent, chronic need."
The solution for these countries: hire foreign nurses to do the job. The
United States has said it would need around 10,000 nurses a year, while
Britain, Ireland, the Netherlands and other European countries would need
another 10,000 nurses a year.
Austria and Norway have announced their need for foreign nurses this
year and Japan, a new market, is expected to open its doors to foreign
nurses this year.
Concern is also rising about a shortage of nurses in the Philippines.
"In absolute terms, there is no shortage. There are enough warm bodies
here, but there is a shortage in terms of quality,'' said Dr Marilyn E.
Lorenzo, director of the Institute of Health Policy and Development Studies
and professor at the University of the Philippines College of Public Health.
The ones who have left are the skilled and experienced nurses. Most of
those still here are relatively unskilled and inexperienced, and go
overseas after a year or two of gaining experience. Tthis poses serious
implications for the quality of health care that they provide.
The government is the single biggest employer of nurses and pays better
than private hospitals, but it has not opened new positions and average
nurse-to-patient ratios are from ideal - 1:30 to 1:60.
Maria Linda Buhat, president of the Association of Nursing Service
Administrators of the Philippines, says nurses go overseas because of the
low salary at home, lack of professional opportunities, adventure, family
ties, citizenship and health reasons.
Overseas, the monthly pay ranges from 3,000 to 4,000 U.S. dollars a
month, compared to the 169 dollar average pay in most cities. In rural
areas, nurses receive from 75 to 95 dollars a month.
Lydia Vengzon, who worked as nursing director for years, recalls an exit
interview with one of her nurses, who was leaving for Britain to take on a
new job for 2,884 dollars a month. "In all my 31 years as nursing director,
my salary didn't even reach a third of that amount."
Virginia Alinsao, director of international nursing recruitment of the
Johns Hopkins Health System, recalls how one young nurse applicant she
interviewed in Manila in April said her mother had worked as a nursing
assistant in Saudi Arabia since she was five years old. "The applicant said
she wanted her mother to rest. Working as a nurse here won't allow her to
do that," related Alinsao.
Alinsao herself left the Philippines when she was 22 and has been in the
United States for 30 years. From her class batch of 50, only five have
worked as nurses in the Philippines. Most of them, like her, have since
become U.S. citizens.
She notes with amazement how even Filipino doctors have been studying to
become nurses, a reverse human resource development phenomenon that she
thinks is found only in this country.
Specialist doctors have also been enrolling in nursing schools to take
advantage of immigration visas offered to nurses who apply to work in the
United States. Doctors in the Philippines earn an average income of 300 to
800 dollars a month, a pittance compared to the salary of a nurse in the
United States or Europe. (END/2003)
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