On top of fighting the spread of coronavirus,

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?

This story starts in 1898, when the Philippines became a US colony.

Filipinos fought back but were ultimately conquered by American troops.

More than 200,000 Filipinos died.

As part of the colonization of the Philippines,

the US 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 US started taking over institutions and education.

And began developing a medical labor force in the Philippines.

They built more than ten 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.

The independence of the Philippines as a separate and self-governing nation.

But even though the Philippines broke free,

America soon found a way to bring Filipino nurses over.

Starting in 1941, after the US entered WWII, 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.

“All working with the same purpose. To ease the pain of war. To help save lives.”

But all that 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 US looked beyond its borders to fill the jobs Americans wouldn't take.

It turned to a new temporary visitors program as a solution.

U.S. hospitals started to use the Exchange Visitor 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 US 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 II 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 of them to go abroad in search of better opportunities.

But when they came over to the US, many sponsoring

hospitals just used them as inexpensive 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, where 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 women's 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 US.

In just three years, nurse vacancies nearly doubled.

Nearly one in every four nursing jobs was vacant.

To fill the new shortage the US turned to the Philippines again.

But this time it was different.

Immigration policy in America changed drastically

in 1965, with the 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 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 shortages around the US.

But soon many experienced discrimination.

The American Nurse Association added licensing requirements to limit their entry to the US.

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 US

healthcare industry.

The temporary pathway established 20 years earlier, became a permanent migration route.

And hospitals now had a way to draw nurses 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 ruled the Philippines with an iron fist.

In 1972, under martial law, he began to rule as a dictator.

He was behind more than 3,000 extrajudicial killings,

and tens of thousands of tortures and incarcerations.

As a result of the unrest, the economy that was starting to pick up 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.

That's because Filipino workers overseas were starting to send hundreds of millions

of dollars back home to their families.

And the Filipino government wanted to keep that money coming.

Over time, that government push led to 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 US 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 150,000 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 US.

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's put them disproportionately on the frontlines of the

fight against the coronavirus.

The pandemic has taken an outsize toll on

Filipino healthcare workers.

Of the 318 health care workers lost to the

coronavirus as of May, at least 30 are Filipino.

And still thousands remain on the frontlines.

In April 2020, as the coronavirus spread in the Philippines, and the shortage of nurses

across hospitals became a problem, the government temporarily banned healthcare workers from

leaving to work abroad.

And while it might seem like an appropriate

idea for Filipino nurses to remain in the Philippines,

It's also important to remember that Filipino nurse overseas migration is a longstanding

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

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 frontlines,

providing critical care...

like they always have.