the Philippines has a problem on top of fighting the spread of the corona virus hospitals are facing another crisis they are more than 20,000 nurses short but the thing is tens of thousands of nurses graduate every year in the Philippines this 2010 oath-taking ceremony included more than 35,000 graduating nurses and this is a graduating class from 2017 and this one is from 2019 so how can the Philippines have so many nurses and be dealing with a shortage at the same time [Music] this story starts in 1898 when the Philippines became a u.s. colony Filipinos fought back but were ultimately conquered by American troops more than 200,000 Filipinos diet as part of the colonization of the Philippines the u.s. created a policy called benevolent assimilation that claimed to protect Filipino rights and liberties they use this to justify the colonization of the Philippines by arguing that this was a different kind of colonialism and imperialism this was a good kind of colonialism that would bring education infrastructure and public health the u.s. started taking over institutions and education and began developing a medical labor force in the Philippines they built more than 10 nursing schools in less than a decade Filipino nursing students had to learn Western medical practices from American teachers and they were forced to learn in English year after year new classes of American trained English speaking Filipino nurses graduated from nursing schools what this did was that it inadvertently prepared Filipino nurses to work in the United States the nursing training system went on until the Philippines gained independence in 1946 but even though the Philippines broke free America soon found a way to bring Filipino nurses over starting in 1941 after the u.s. entered World War two millions of Americans joined the Armed Forces and thousands of nurses enlisted to treat injured soldiers in the field and American hospitals started emptying out so the government funded programs like the cadet Nurse Corps to fill the gaps they provided millions of dollars for a lifetime education for free and encouraged American women in particular to enlist in a proud profession as a result nearly 200,000 American women became nurses for the army and civilian hospitals with the same purpose to ease the pain of war to help save lives but that all changed in 1945 when the war came to an end once the fighting was over there was less support for nurses government funding dried up and many women quit nursing hospitals started seeing a rise in vacancies and that meant America needed to find nurses to fill the void again instead of improving pay and working conditions to encourage American nurses to return the u.s. looked beyond its borders to fill the jobs Americans wouldn't take and it turned to a new temporary visitors program as a solution US hospitals started to use the exchange reserve program in order to recruit Filipino nurses because they had Americanized nursing training already and it worked Filipino nurses dominated the program for about a decade more than 10,000 Filipino nurses came to the u.s. to work but the real reason so many left their homes has to do with what was happening in the Philippines at the time after centuries of oppressive colonial control and their own world war two battles the Philippines economy finally started to stabilize cities were flourishing and tourism was booming but wages particularly in rural areas were still low for nearly everyone and that included nurses who despite having formal training were often paid less than janitors or messengers and that pushed many to go abroad in search of better opportunities but when they came over to the u.s. many sponsoring hospitals just used them as an expensive labor they assigned them extensive nurse work and only paid them a minimal stipend after their temporary placements ended many Filipino nurses went back to the Philippines while many others managed to stay longer and build a life in the US were they formed strong Filipino communities but the exchange visitor program wasn't the end of America's hold on Filipino nurses it was just the beginning the 1960s brought big changes to America there are certain historical events new Great Society programs such as the establishment of Medicare and Medicaid there are civil rights and social movements American women have more opportunities to enter other kinds of occupations all of these things converge to increase the demand for nursing services but also to result in even more nursing shortages in the United States in just three years nurse vacancies nearly doubled nearly one in every four nursing jobs was vacant to fill the new shortage the u.s. turned to the Philippines once again but this time it was different immigration policy in America changed drastically in 1965 with the new Immigration and Nationality Act for the first time people from all over the world could apply for immigrant visas then on top of sponsoring hospitals labor recruiters and travel agencies started targeting Filipino nurses with ads that promised them bright futures in America one particular ad featured a basket that was decorated with the Philippine flag it's addressing the Filipino nurse saying dear nurse if you're not happy where you are right now contact us and we can't promise you happiness but we can help you chase it all over the place so Filipino nurses began filling the huge shortages all around the US but soon many experienced discrimination the American nurse Association added licensing requirements to limit their entry the nurses who did pass those requirements came to the US and ended up in underpaid lower positions still it's this phase of migration that lasted through today and transformed the u.s. healthcare industry the temporary pathway established 20 years earlier became a permanent migration route and the hospitals now had a way to learn nurses over whenever they wanted but focusing on what pulled so many nurses to America overlooks the forces that continued to push them out which brings us back to the Philippines this is Ferdinand Marcos who rule the Philippines with an iron fist in 1972 under martial law he began to rule as a dictator he was behind more than 3000 extrajudicial killings and tens of thousands of tortures and incarcerations as a result of the unrest the economy that was starting to stabilize fell into a recession and unemployment skyrocketed but instead of addressing the lack of jobs the Philippine government actively promoted and publicized labor export the export of Filipino workers to countries throughout the world and that's because Filipino overseas workers were starting to send hundreds of millions of dollars back home to their families and the Filipino government wanted to keep that money coming overtime that government push led to a global migration making the Philippines the largest exporter of nurses in the world nearly 20,000 nurses leave the Philippines every year they go to Saudi Arabia or Australia the UK Germany but many of them have ended up in the US where nearly one-third of all foreign-born nurses are Filipino with the u.s. recruiting nurses on one end and the Philippines pushing them to work abroad on the other both governments have benefited from Filipino labor over the decades a total of a hundred and fifty thousand Filipino nurses have come to work in US hospitals and after years of exploitation and discrimination Filipino and Filipino American nurses have organized in the u.s. they pushed back on exploitative practices and have fought for better working conditions but surveys show that a large number of Filipino nurses are still concentrated in bedside and critical care some of the most dangerous and strenuous nursing work it's the kind of work that puts them disproportionately on the front lines of the fight against the coronavirus the pandemic has taken an outsized toll on Filipino health care workers of the 318 healthcare workers lost to the corona virus as of May at least 30 are Filipino and still thousands remain on the frontlines in April 2020 as a corona virus spread through the Philippines and the shortage of nurses across hospitals became a problem the government temporarily banned healthcare workers from leaving to work abroad while it might seem like a appropriate idea for Filipino nurses to remain in the Philippines it's also important to remember that Filipino nurse oversees migration is a long-standing phenomenon that has been actively promoted by the Philippine government even though the ban was eventually lifted it points to the instability that Filipino nurses have to live with on both sides of the migration route pushed and pulled between countries Filipino nurses continue to get caught in the middle even as they strive to work on the front lines providing critical care like they always have [Music]