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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