In a public hospital in Manila, an elderly couple walked into the emergency room. Tatay had been suffering from a cough and asked to consult a doctor. The nurse asked him about his other symptoms, and as she handed him the patient information form to fill out, her tone changed from professional and friendly to gentle. 

“Kaya po ba ni Tatay isulat ang pangangalan niya?” (Can Tatay write his name?) 

The subtext of the question was not lost on me. 

Tatay looked down and shook his head.  

“Nanay, kayo na lang po.” (Nanay, please be the one to fill out the form), the nurse said in the same gentle tone that bore no trace of judgement or condescension.  

As the couple went over to a bench to fill out the form and wait their turn, the nurse turned to me. “Sila ba ang kaya mong iwanan?” (Would you be able to leave them?) 

Trained to leave 

Our nurses have always been trained to leave. The conditioning often starts with the prodding of parents to study nursing to get on the express lane to working abroad. In nursing school, this is reinforced by courses like cross-cultural patient care meant to produce a “global Filipino nurse.” The mindset is cemented by review schools that are connected with recruitment agencies. Nurses are one in a long line of human manpower that we export. 

Coupled with a state-sanctioned policy of labor exportation, the Philippines has become the premiere supplier of the world’s nurses, plugging in healthcare holes in developed countries with growing aging populations but declining nursing graduates.  

The World Health Organization (WHO) estimates that the world needs about 6 million nurses to bolster the foundation of the healthcare system. 

Government data shows that an average of 19,000 nurses left the Philippines from 2012-2016 to fill that gap. During that same period, the country produced about 95,000 registered nurses. The mismatched supply and demand has resulted in an oversupply of nurses.

“The demands of the global market have dictated the nursing supply in the country,” said Yasmin Ortiga, a sociologist and expert on the nursing industry.

However, global demand is volatile and influenced by changing immigration policies, public pressure to hire domestically, and market recessions. 

When the demand for nurses in the US – the largest market for Filipino nurses – fell in 2007, nurses found themselves in what Oritga calls “the migration trap.” Nursing graduates traded in the prospect of wearing scrubs for desk jobs as call center agents, flight attendants, and other non-medical fields.  

The oversupply made for a local buyer’s market with hospitals dictating working conditions and compensation. Hospitals opened up volunteer positions with no pay and  “work-for-a-fee” schemes packaged as in-hospital training programs that came with as much as a P15,000 ($300) price tag. 

Some swallowed the bitter pill just to get the two-year hospital experience they needed to qualify for nursing jobs opening up in Asia and the Middle East.  

A nationwide survey conducted by advocacy group Association of Young Nurse Leaders and Advocates (AYNLA) across 747 members showed that 67% had paid a fee to work or worked for free. Respondents said that the experience left them feeling a sense of personal degradation.  

Lorena Rolando’s first job was as a nurse reliever. “I was on call and would only work if the hospital needed me.” For each 12-hour shift, she was paid about P350 or $7. 

Jean Seno’s decade of working as a nurse started with working as an unpaid trainee and was followed by a string of contractual work that meant she would only be employed for a few months.

Beyond the tally of salaries and benefits, both said that the low regard for nursing as a profession is something you cannot put a price on. I interviewed these women separately but their insights were very similar. 

“Nurses are treated as ‘only the assistant’ of the doctor. We were never recognized as vital,” said Seno.  

“Tingin nila taga-hugas lang kami ng puwet ng pasyente (They only think of us as someone who washes a patient’s behind),” said Rolando.

It is a sentiment mirrored by legislators. 

In a 2013 senatorial forum, former NEDA chief Winnie Monsod asked Cynthia Villar why she opposed the CHED recommendation to close nursing schools that did not meet minimum requirements.  

According to Monsod, the decision to keep them open resulted in the CHED nursing committee resigning en masse for CHED’s failure to uphold the integrity of the nursing profession.

Villar defended her siding with nursing school owners, saying, “Actually, hindi naman kailangan ng nurse na matapos ang BSN (BS Nursing). Kasi itong mga nurses, gusto lang nila maging room nurse sa Amerika o ibang country…’yung parang mag-aalaga lang sila. Hindi naman kailangan ganun sila kagaling.” 

(Actually, nurses don’t need to finish BS Nursing. Our nurses only want to be room nurses in America or other countries, where they just need to coddle the patients. They don’t need to be that competent.) 

No reason to stay

Nurses have fought long and hard for decent pay, better working conditions – and respect. The law that would have increased the monthly salary of a government nurse to P30,000 ($600) was blocked for decades and opposed by private hospitals who said that a salary increase would force them to pass on the additional cost to patients. The law was upheld by the Supreme Court last October but has yet to be implemented. Additionally, there is still a need to pass similar legislation to standardize salaries between private and public hospital nurses.  

COVID-19 exposed the appalling work conditions and abysmal pay of nurses – and our own shortage of healthcare workers. It was upsetting to see photos of nurses in head-to-toe level 4 PPE watching over patients in non-air conditioned tents and think about their P10,000 monthly salary (even lower in private hospitals) and 12-hour shifts. (READ: Low pay, high risk: The reality of nurses in the Philippines)

At one point, the Department of Health (DOH) offered P500 a day to “volunteer” as a COVID-19 Health Warrior. The price of two grande lattes + a pastry because it would be “an honor to die for your country.” The DOH has since adjusted their employment and salary offer after the intense public outrage but again, it was another reminder of how little we value our nurses. 

Marla Asis, Director for Research at the Scalabrini Migration Center in Manila predicts that there will be an increased demand for healthcare professionals as the pandemic continues to grip the world. “Unless the Philippines can offer decent pay and decent working conditions to our nursing professionals, we don’t stand a fighting chance in retaining them.” 

The government needs to hire 15,700 nurses to cope with the COVID-19 emergency, and after years of sending them away, is now struggling to find ways to make our nurses stay. The government has implemented a deployment ban on newly hired nurses, and nurses like Seno and Rolando who were set to leave for the United Kingdom and Germany, respectively, have been grounded indefinitely. (READ: ‘Underpaid, overworked, unappreciated’: PH deployment ban scars nurses during pandemic)

Nurses and the public look at the deployment ban with a spectrum of conflicting emotions.

People recognize that nurses – like everyone else – have a right to leave, but worry if there will be enough of them left to care for us if we fall sick from a virus that refuses to be controlled. 

Leah Primitiva Samaco-Paquiz of The Ang Nars Partylist slammed the deployment ban: “It is their choice to leave. Would you want to stay if you are overworked and underpaid?” 

But some of the nurses I’ve talked to do want to stay. They want to serve the country and see through this pandemic, but they can’t help but think about the waiting overseas jobs that may go to waste if they don’t grab it.  

Take the nurse that I interviewed that day in the public hospital. She had been working there for 12 years and was set to leave for the United Kingdom. “I think I’ve paid my dues. I have to think of my family. I have two kids now.” 

After she attended to the elderly couple, she turned to me and her tone again changed to one of anguish, “Those are the people I will leave. I know they need me – us. But what about me?”

I didn’t know what to say. I looked down and wrote in my notebook, saddened by the thought that the Philippines is the country whose nurses are taking care of the world, but don’t have enough to take care of its own people. – Rappler.com

Ana P. Santos writes about sexual health rights, sexuality and gender for Rappler. She is the 2014 Miel Fellow under the Pulitzer Center on Crisis Reporting and a 2018 Senior Atlantic Fellow for Health Equity in Southeast Asia. Follow her on Twitter at @iamAnaSantos and on Facebook at @SexandSensibilities.com