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The Philippines has a problem.
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On top of fighting the spread of coronavirus,
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hospitals are facing another crisis. They are more than 20,000 nurses short.
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But the thing is tens of thousands of nurses graduate every year in the Philippines.
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This 2010 oath-taking ceremony included more than 35,000 graduating nurses.
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And this is a graduating class from 2017.
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And this one is from 2019.
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So how can the Philippines have so many nurses...
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And be dealing with a shortage at the same time?
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This story starts in 1898, when the Philippines became a US colony.
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Filipinos fought back but were ultimately conquered by American troops.
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More than 200,000 Filipinos died.
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As part of the colonization of the Philippines,
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the US created a policy called “Benevolent Assimilation” that claimed to protect Filipino
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rights and liberties.
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They use this to justify the colonization
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of the Philippines by arguing that this was a different kind of colonialism and imperialism.
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This was a good kind of colonialism that would bring education, infrastructure and public health.
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The US started taking over institutions and education.
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And began developing a medical labor force in the Philippines.
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They built more than ten nursing schools in less than a decade.
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Filipino nursing students had to learn western medical practices from American teachers.
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And they were forced to learn in English.
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Year after year new classes of American-trained, English-speaking Filipino nurses graduated
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from nursing schools.
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What this did was that it inadvertently prepared Filipino nurses to work in the United States.
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The nursing training system went on until the Philippines gained independence in 1946.
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The independence of the Philippines as a separate and self-governing nation.
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But even though the Philippines broke free,
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America soon found a way to bring Filipino nurses over.
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Starting in 1941, after the US entered WWII, millions of Americans joined the armed forces.
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And thousands of nurses enlisted to treat injured soldiers in the field.
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And American hospitals started emptying out.
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So the government funded programs like the Cadet Nurse Corps to fill the gaps.
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They provided millions of dollars for a “lifetime education for free” and encouraged American
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women in particular to “enlist in a proud profession”.
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As a result, nearly 200,000 American women became nurses for the army and civilian hospitals.
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“All working with the same purpose. To ease the pain of war. To help save lives.”
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But all that changed in 1945, when the war came to an end.
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Once the fighting was over, there was less support for nurses.
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Government funding dried up and many women quit nursing.
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Hospitals started seeing a rise in vacancies.
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And that meant America needed to find nurses to fill the void again.
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Instead of improving pay and working conditions to encourage American nurses to return
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the US looked beyond its borders to fill the jobs Americans wouldn't take.
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It turned to a new temporary visitors program as a solution.
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U.S. hospitals started to use the Exchange Visitor Program in order to recruit Filipino nurses
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because they had Americanized nursing training already.
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And it worked. Filipino nurses dominated the program.
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For about a decade, more than 10,000 Filipino nurses came to the US to work.
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But the real reason so many left their homes
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has to do with what was happening in the Philippines at the time.
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After centuries of oppressive colonial control and their own World War II battles, the Philippines
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economy finally started to stabilize.
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Cities were flourishing and tourism was booming, but wages, particularly in rural areas,
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were still low for nearly everyone. And that included nurses, who despite having
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formal training were often paid less than janitors or messengers.
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And that pushed many of them to go abroad in search of better opportunities.
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But when they came over to the US, many sponsoring
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hospitals just used them as inexpensive labor.
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They assigned them extensive nurse work, and only paid them a minimal stipend.
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After their temporary placements ended, many Filipino nurses went back to the Philippines.
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While many others managed to stay longer and build a life in the US, where they formed
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strong Filipino communities.
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But the exchange visitor program wasn't the end of America's hold on Filipino nurses.
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It was just the beginning.
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The 1960s brought big changes to America.
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There are certain historical events. New Great Society programs such as the establishment
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of Medicare and Medicaid.
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There are civil rights and women's social movements.
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American women have more opportunities to enter other kinds of occupations.
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All of these things converge to increase
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the demand for nursing services, but also to result in even more nursing shortages in the US.
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In just three years, nurse vacancies nearly doubled.
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Nearly one in every four nursing jobs was vacant.
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To fill the new shortage the US turned to the Philippines again.
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But this time it was different.
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Immigration policy in America changed drastically
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in 1965, with the Immigration and Nationality Act.
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For the first time, people from all over the world could apply for immigrant visas.
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Then, on top of sponsoring hospitals -- labor recruiters and travel agencies started targeting
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Filipino nurses with ads that promised bright futures in America.
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One particular ad featured a basket that was decorated with the Philippine flag.
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It's addressing the Filipino nurse saying, Dear nurse, if you're not happy where you
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are right now, contact us. And we can't promise you happiness, but we can help you chase it
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all over the place.
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So Filipino nurses began filling the shortages around the US.
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But soon many experienced discrimination.
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The American Nurse Association added licensing requirements to limit their entry to the US.
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The nurses who did pass those requirements, came to the US and ended up in underpaid,
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lower positions.
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Still, it's this phase of migration that lasted through today and transformed the US
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healthcare industry.
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The temporary pathway established 20 years earlier, became a permanent migration route.
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And hospitals now had a way to draw nurses whenever they wanted.
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But focusing on what pulled so many nurses to America, overlooks the forces that continued
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to push them out.
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Which brings us back to the Philippines.
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This is Ferdinand Marcos who ruled the Philippines with an iron fist.
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In 1972, under martial law, he began to rule as a dictator.
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He was behind more than 3,000 extrajudicial killings,
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and tens of thousands of tortures and incarcerations.
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As a result of the unrest, the economy that was starting to pick up fell into a recession
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and unemployment skyrocketed. But instead of addressing the lack of jobs...
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The Philippine government actively promoted and publicized labor export the export of
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Filipino workers to countries throughout the world.
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That's because Filipino workers overseas were starting to send hundreds of millions
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of dollars back home to their families.
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And the Filipino government wanted to keep that money coming.
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Over time, that government push led to global
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migration, making the Philippines the largest exporter of nurses in the world.
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Nearly 20,000 nurses leave the Philippines every year.
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They go to Saudi Arabia or Australia. The UK. Germany.
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But many of them have ended up in the US.
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Where nearly one-third of all foreign-born nurses are Filipino.
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With the US recruiting nurses on one end
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and the Philippines pushing them to work abroad on the other,
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both governments have benefited from Filipino labor.
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Over the decades, a total of 150,000 Filipino nurses have come to work in US hospitals.
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And after years of exploitation and discrimination, Filipino and Filipino American nurses
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have organized in the US.
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They pushed back on exploitative practices
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and have fought for better working conditions.
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But surveys show that a large number of Filipino nurses are still concentrated in bedside and critical care.
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Some of the most dangerous and strenuous nursing work.
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It's the kind of work that's put them disproportionately on the frontlines of the
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fight against the coronavirus.
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The pandemic has taken an outsize toll on
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Filipino healthcare workers.
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Of the 318 health care workers lost to the
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coronavirus as of May, at least 30 are Filipino.
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And still thousands remain on the frontlines.
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In April 2020, as the coronavirus spread in the Philippines, and the shortage of nurses
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across hospitals became a problem, the government temporarily banned healthcare workers from
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leaving to work abroad.
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And while it might seem like an appropriate
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idea for Filipino nurses to remain in the Philippines,
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It's also important to remember that Filipino nurse overseas migration is a longstanding
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phenomenon that has been actively promoted by the Philippine government.
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Even though the ban was eventually lifted, it points to the instability that Filipino nurses have
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have to live with on both sides of the migration route.
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Pushed and pulled between countries
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Filipino nurses continue to get caught in the middle --
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even as they strive to work on the frontlines,
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providing critical care...
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like they always have.