IMMIGRATION

RESEARCH FOR A
NEW CENTURY
IMMIGRATION
RESEARCH FOR A
NEW CENTURY
MULTIDISCIPLINARY PERSPECTIVES

NANCY FONER
RUBEN G. RUMBAUT
STEVEN J. GOLD

EDITORS

RUSSELL SAGE FOUNDATION I NEW YORK

 The Russell Sage Foundation
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BOARD OF TRUSTEES
Ira Katznelson, Chair
Alan S. Blinder Jennifer 1. Hochschild Eugene Smolensky
Christine K. Cassel Timothy A. Hultquist Marta Tienda
Thomas D. Cook Ellen Condliffe Lagemann Eric Wanner
Robert E. Denham Cora B. Marrett
Phoebe C. Ellsworth Neil J. Smelser

SOCIAL SCIENCE RESEARCH COUNCIL COMMITIEE ON

INTERNATIONAL MIGRATION
T. Alexander Aleinikoff Demetrios G. Papademetriou Mary C. Waters
Robin Cohen Alejandro Portes Aristide Zolberg
Nancy Foner Ruben G. Rumbaut
James H. Johnson, Jr. George J. Sanchez
Charles Hirschman, Committee Chair
Josh DeWind, Program Director

Library of Congress Cataloging-in-Publication Data

Immigration research for a new century: multidisciplinary perspectives /
Nancy Foner, Ruben G. Rumbaut, and Steven J. Gold, editors.
p. cm.
Includes bibliographical references and index.
ISBN 0-87154-260-9 (cloth) ISBN 0-87154-261-7 (paper)
1. Emigration and immigration-Research. I. Foner, Nancy, 1945-
II. Rumbaut, Ruben G. III. Gold, Steven J. (Steven James)
JV60l3.5 .155 2000
304.8'2-dc21 00-036619

Copyright © 2000 by Russell Sage Foundation. First paper cover edition © 2003.
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The paper used in this publication meets the minimum requirements of Ameri-
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 5
"EXPORTED TO CARE":
A TRANSNATIONAL HISTORY OF
FILIPINO NURSE MIGRATION
TO THE UNITED STATES

Catherine Ceniza Choy

T HE INTERNATIONAL migration of Filipino nurses is often charac-

terized as a post-1965 phenomenon. Between 1966 and 1985, an
estimated twenty-five thousand Filipino nurses migrated to the
United States (Ong and Azores 1994, 164); by the late 1960s, the Philip-
pines had replaced Canada as the major country of origin of foreign-
trained nurses in the United States; and in 1979, a World Health Organi-
zation report observed that among nurse-sending countries, the largest
outflow of nurses by far was from the Philippines (Mejia, Pizorki, and
Royston 1979, 43-45). The Philippines had became the world's largest
exporter of nurses, with significant numbers of Filipino nurses working
in the Middle East, Germany, and Canada as well as the United States.
To understand this phenomenon, sociologists, immigration histo-
rians, and scholars of Asian American studies have generally turned to
contemporary government policies. The U.S. Immigration Act of 1965,
for example, encouraged the immigration of Filipino professionals
through its occupational preference categories, which favored the entry
of professionals with needed skills (Allen 1977). With the establishment
of the Marcos dictatorship in 1972, the Philippine government focused
on the development of an export-oriented economy, which included the
export of labor as well as goods (Abella 1979; Hawes 1989).
Contemporary government policies help to explain the high levels
of immigration among professionals-including doctors, accountants,
nutritionists, and physical therapists, as well as nurses-from the Phil-
ippines to the United States after 1965; however, they do not explain
why so many Filipinas have become nurses, nor why Filipino nurses

113
IMMIGRATION RESEARCH FOR A NEW CENTURY

constitute such a significant portion of that migration. What enables

and compels so many Filipino nurses to work abroad? This chapter ad-
dresses these questions historically by exploring connections between
early-twentieth-century colonialist attitudes, mid-twentieth-century
u.s. foreign policy, and post-1965 Filipino nurse migration.

Foundations: Americanized
Credentials, Work Cultures,
and Dreams
The contemporary international migration of Filipino nurses is inex-
tricably linked to the history of American imperialism and the early-
twentieth-century u.s. colonization of the Philippines. As a part of the
establishment of an Americanized training hospital system in the Phil-
ippines during the colonial period, new standards were instituted to im-
prove the professional skills and standing of the nursing labor force.
These changes included an Americanized nursing-school curriculum,
English language fluency, and professionalization of the nursing work
culture. Studies by Paul Ong and Tania Azores (1994) and Tomoji Ishi
(1987) have linked the Americanized nursing-school curriculum and the
study of English in the Philippines to the later migration, but questions
remain: What did this curriculum entail? How did it develop? Why did
it take root so successfully in the Philippines? As American nursing
leader and secretary of the International Council of Nurses, Lavinia
Dock, noted in her early-twentieth-century history of nursing educa-
tion, "nursing in the Philippines has a history on which we may look
back with satisfaction, for, while carried on almost entirely by Ameri-
cans in the early days of the occupation, its speedy adoption into the life
and education of the Filipinos themselves and its wonderfully rapid de-
velopment have probably not been surpassed elsewhere" (1912, 307-8).
The Americanized nursing curriculum was officially introduced
into Philippine nurse training in 1907, with the establishment of St.
Paul's Hospital, the Civil Hospital (which later merged with and became
known as Philippine General Hospital), and University Hospital (later
known as St. Luke's Hospital) in Manila. Dock reports that the course of
study in these hospital programs included, "besides all the usual sub-
jects, the nursing of tropical diseases, the sanitary work of the Bureau of
Health, public instruction in dispensary and school work, English gram-
mar and colloquial English, and industrial and living conditions in the
islands" (1912,316). The "usual subjects" included anatomy and physi-
ology, practical nursing, materia-medica, massage, and bacteriology. The
first Filipino nursing students also heard lectures on medicine, commu-

114
 EXPORTED TO CARE

nicable diseases, and operating room techniques. Throughout American

colonial rule, faculty and supervisors were predominantly American
nurses and doctors. The study of English as an integral part of the curric-
ulum was unique in colonial education in general and especially so in
medical training. By contrast, for example, British colonial authorities
originally trained Indian physicians in their native tongue and translated
Western medical texts for their instruction.!
Although the improved standards and English language study theo-
retically enabled Filipino nurses to practice in the United States, their
preparation in the Philippines was not a strictly academic affair. It also
required an understanding of the social, cultural, and gendered dimen-
sions of American nursing. The early training of Filipino nurses fol-
lowed trends in nurse training in the United States, which was itself
undergoing transformation in the early years of the twentieth century.
In the mid-nineteenth century United States, nursing was primarily
the work of white, native-born, poor, and older women who entered
nursing at the end of their working lives, often for lack of other options
(Reverby 1987). Hospital nurses were often former patients, because the
prevalence of cross-infection within hospitals made recruitment of
nurses difficult. Responding to increasing concerns over the minimal
requirements for career nursing, American professional nursing leaders
in the early years of the twentieth century lobbied to raise the standards
of nursing programs and professionalize the field in an effort to regulate
the oversupply of ill-trained practitioners and increase nurses' prestige
and autonomy (Reverby 1987). Professionalization involved measures
such as the reduction of the number of nursing schools and more strin-
gent entrance requirements.
Inspired by the work of Florence Nightingale, and in an effort to
recruit younger women into their ranks, American nursing leaders also
tried to recast the image of nursing as a profession that could provide
"suitable employment" for young "gentlewomen," one that embodied
the virtues and qualities of middle- and upper-class womanhood in Vic-
torian America. Hoping to create the hospital training program as a
"protected environment" managed by a "hospital family" (Reverby
1987,48), leaders in the profession sought to institute sanitary measures
as standard hospital procedure, and hospital nursing schools recruited
young women from rural areas by promoting the "safe haven" the
schools could provide in urban areas.
Like their American counterparts, the first Philippine nursing schools
recruited young, healthy, "moral" women from "respectable" Filipino
families. St. Paul's Hospital, Philippine General Hospital, and St. Luke's
Hospital selected nursing students with the following qualifications:
I{good and sound physical and mental health, good moral character, good

115
IMMIGRATION RESEARCH FOR A NEW CENTURY

family and social standing, and recommendations from three different

persons well known in the community" (Gir6n-Tupas 1952, 62). Stu-
dents were recruited from areas as far away as Cebu in the Visayan is-
lands (the middle region of the archipelago) to train in hospitals in Ma-
nila, on the island of Luzon (the northern region of the archipelago). The
first Filipino nursing students traveled far from their families to live
in American colonial government dormitories. In 1906, a dormitory
opened for Filipino female students enrolled in the Philippine Normal
School, whose program included training in "social graces" and methods
of "home management" (Gir6n-Tupas 1952, 39). American and Filipino
supporters acted as members of the hospital "family." Sofia de Veyra, a
Filipina supporter for nursing schools in the Philippines, recalled, "We
did a lot of mothering to the first girls and used a great deal of diplo-
macy and tact to keep them going and keeping up their interest in their
work" (Gir6n-Tupas 1952,34).
Philippine nursing schools followed the American example in edu-
cational standards as well as in recruitment practices. In 1907, the en-
trance requirements of the first government training school for Filipino
nurses included completion of the seventh grade and satisfactory perfor-
mance on a qualifying examination. In 1917, the largest hospital school
of nursing, Philippine General, raised its entrance requirements, adding
completion of the first year of secondary school, and in 1930, the com-
pletion of secondary school was made mandatory for entering students.
By 1933, Philippine General Hospital School of Nursing gave preference
for admission to applicants who had earned six units of credit in the
University of Philippines College of Liberal Arts. Other schools of nurs-
ing in the colony followed Philippine General's example, raising their
educational entrance requirements accordingly (Gir6n-Tupas 1952).
From the early twentieth century to the 1950s, the work culture of
Filipino nursing students was similar to that of American students,
combining academics, work, and daily living within and around the hos-
pital school. Until the 1950s, in both the United States and the Philip-
pines, virtually all nursing schools required that student nurses live in
the hospital's nursing residence, under the close supervision of hospital
superintendents and matrons. The strict discipline and hard physical
work of nursing training (inspired by Nightingale's vision of models of
order, duty, and discipline) bonded nursing students to one another. Pu-
rita Asperilla described her own training at the Philippine General Hos-
pital in the late 1930s in this way: "You tend to become close to your
friends, your classmates, because you live together. You sleep together.
Our matron was very strict .... Nursing as [aJ profession before the war,
World War II, was militaristic .... They inspect[edJ you every morning

116
 EXPORTED TO CARE

before you [went] to the hall" (Asperilla, interview with author, Novem-
ber 11, 1994, New York).
Throughout the first half of the twentieth century, both American
and Philippine hospital nursing schools depended on the labor of their
nursing students. The "study" of nursing was in many ways "work." In
the United States, hospital training schools used nursing students as an
inexpensive source of labor, providing them with board and lodging and
compensating their duties with small allowances, which in the first two
decades of the twentieth century averaged about ten dollars a month.
Nurses washed operating sheets and towels and scrubbed bathroom
floors (Reverby 1987). The duties of Filipino nursing students were simi-
lar, and their compensation even more minimal. Purita Asperilla con-
tinued,

You see at that time, our education was done in the morning, then we
[were] on duty in the afternoon. We [were] depended upon for service. We
were given a salary of eight pesos in the first year, ten pesos in the second
year, and twelve pesos in the third year. We have free board and lodg-
ing .... But you know the first part of the curriculum is no hospital work.
We were in the linen room. We were arranging linens, mending linens.
(Asperilla interview)

Furthermore, the gendered construction of American nursing was

deliberately reproduced in the Philippines. Although nursing changed,
in the United States, from an option of last resort for women in the mid-
nineteenth century into a respectable profession for women in the early
twentieth century, it was still considered "women's" work. Dock's his-
tory of nursing education in the Philippines reveals the deliberate exclu-
sion of men from the labor of nursing, accomplished by placing them
instead in a training school for hospital attendants:

When Miss McCalmont took charge of the nursing force in the Philip-
pines, a peculiar state of affairs existed. All male patients, even the Ameri-
cans, were cared for by male attendants only.... Baths, treatments, and
nearly all surgical dressings were done by the attendants, who were gener-
ally ex-army corps men, with even less than ordinary training .... It
seemed impossible to get the nurses back into the hospital habits of the
United States, and an attempt was made to solve the problem by [estab-
lishing] a training school for men. (Dock 1912, 315)

As early as 1903, Major Edward Carter, surgeon of the U.S. Army

and commissioner of health in the Philippines, had recommended the
establishment of a training school specifically for Filipino nurseSj but it

117
IMMIGRATION RESEARCH FOR A NEW CENTURY

was not until 1907, at the urging of the dean of women at the Philippine
Normal School, Mary Coleman (who was responding, in turn, to the
suggestion of Sofia de Veyra), that the u.s. colonial government estab-
lished its first nursing school in the Philippines! at St. Paul's Hospital.
In her history of Philippine nursing, Anastacia Giron-Tupas! chief nurse
and superintendent of the Philippines, attributes the establishment of
the school at St. Paul!s Hospital to lithe cooperation of American and
Filipino ladies" (Giron-Tupas 1952, 34).
The first Filipino nurse graduates continued the collaboration. In
1922, Giron-Tupas joined 150 Filipino graduate nurses in organizing the
Filipino Nurses Association (FNA). They elected Rosario M. Delgado, a
graduate of the Philippine General Hospital nursing class of 1912, to be
its first president. Alice Fitzgerald of the Rockefeller Foundation Inter-
national Health Board! nursing adviser to the governor general of the
Philippines, served as the organization's adviser.
The FNA took as its mission lito exalt the standard of the nursing
profession and other allied purposes" (Giron-Tupas 1952, 299). Toward
that end, the association created a special section! the League of Nursing
Education. Although the leagues membership was predominantly Fili-
pino! American nurses, including Alice Fitzgerald and Lillian Weiser
(chief nurse and superintendent of St. Luke's Hospital) participated as
honorary members. In 1924, the league published its first "Standard
Curriculum for Schools of Nursing." By 1946! the FNA drafted its first
resolution, a petition for the creation of a College of Nursing at the
University of the Philippines.
In addition to raising the standards of nursing education, the FNA
shared other similarities with professional nursing organizations around
the world. The FNA registered Filipino nurses, created a central direc-
tory for private-duty employment, advocated increased salaries for
nurses and a government nurses! pension, provided financial assistance
to elderly and sick nurses! and set up scholarship funds for nursing stu-
dents. Based on its shared aims and activities with those of professional
nursing organizations around the world, the Filipino Nurses Association
became a member of the International Council of Nurses in 1929.
In the early twentieth century an elite group of Filipino nurse grad-
uates was able to pursue postgraduate study in the United States! after
which they returned to the Philippines to introduce the latest trends in
American nursing practice. In the effort to "civilize" Filipinos and to
IIprepare" them for self-rule, the American colonial government in the
Philippines sponsored a unique educational system involving universal
primary and secondary education for the Filipino masses and higher edu-
cation for young Filipinos of the elite class. Through the pensionado
program! the American colonial government sponsored members of the

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 EXPORTED TO CARE

Filipino elite at universities and colleges in the United States to prepare

them to assume top positions in American-established institutions in
the Philippines. Philanthropic organizations and American individuals
also contributed to this educational mission by financially sponsoring a
few Filipinos to study in the United States. Although the vast majority
of U.S.-sponsored Filipino scholars abroad were young men who studied
politics, law, and medicine, this group also included a few Filipinas,
who, it was proudly reported, "invaded the sacred and hitherto exclu-
sively men's realm of business and politics" through their studies
abroad (Ambrosio 1926, 1-2).2 However, they remained a minority. For
the most part American educational "opportunities" perpetuated gen-
dered assumptions about women's work in the Philippines. While Fili-
pino male students studied medicine and law, the majority of Filipina
students who studied abroad took courses that would best prepare them
for work in the home or in "female"-designated occupations. The most
popular fields of study for Filipinas in the United States were home eco-
nomics, social and religious work, and nursing.
In 1911, the first three graduates of St. Luke's School of Nursing,
Quintana Beley, Veneranda Sulit, and Caridad Coco, completed their
postgraduate coursework at Protestant Hospital in Philadelphia with the
financial assistance of the wife of a former U.S. ambassador to England.
They returned to the Philippines and assumed faculty positions at St.
Luke's. In 1922, the Rockefeller Foundation sponsored another St. Luke's
graduate, Escolastica Agatep, to study at Columbia University's Teacher's
College. Agatep became the first Filipina nursing arts instructor at St.
Luke's. In 1939, the Daughters of the American Revolution provided
Imelda Tinawin with a scholarship that supported her studies for the
bachelor of science degree in nursing education from Columbia Univer-
sity; from 1943 to 1945, Tinawin served as principal of St. Luke's School
of Nursing. Study in the United States became a prerequisite for social
and occupational mobility in the nursing profession in the Philippines.
This historical link between study overseas (especially in the United
States) and professional advancement in the Philippines laid the social
and economic foundation for Filipino nurses' desire to go abroad.
The popularity of Americanized nursing in the Philippines needs to
be understood within the context of limited educational opportunities
for Filipinas under Spanish colonial rule. Before the American annexa-
tion of the Philippines in 1898, the colonial educational system under
Spain offered separate and unequal opportunities for Filipinos based on
gender as well as race and class. The Spanish university in the Philip-
pines, the University of Santo Tomas, excluded women from programs
of higher education. In the late nineteenth century, the Spanish colonial
government also discouraged Filipinas from studying abroad at European

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IMMIGRATION RESEARCH FOR A NEW CENTURY

universities, although it allowed elite Filipino men, known as "il-

ustrados," to do so; Filipinas were also excluded from the study and
practice of medicine in the Philippines; during the Spanish colonial pe-
riod, Spanish friars and priests cared for the sick.
By contrast, under U.S. colonial rule, all American-established insti-
tutions of learning, including the University of the Philippines, were
coeducational from their inception. Through the pensionado program,
the American colonial government enabled the first Filipinas to study
abroad at colleges and universities in the United States, and the newly
established Americanized training hospital system introduced young
Filipinas to the study of nursing.
Given this particular historical context, some of the first Filipino
nursing graduates interpreted the introduction of American nursing as
an opportunity to enter a new and prestigious profession. As Apolonia
Salvador Ladao, one of the first graduates of the Philippine General Hos-
pital School of Nursing, recalled, "When we took up nursing, we did not
know what it was all about; we were simply selected and recommended
by our American teachers. We were thankful of this opportunity to enter
a new profession and to serve our people" (Gir6n-Tupas 1952,41).
The first Filipino nursing students were also able to interact with
colonial government officials and to attend government functions. Fili-
pino nursing students interpreted these opportunities as a form of pres-
tige bestowed on them as a result of their study of nursing. Ramona
Cabrera, another member of the first nursing class from Philippine Gen-
eral Hospital, explained that "the [American] people must have had a
high regard for the work of nurses, as the high government officials were
very kind and courteous to us. We were usually invited to accompany
wives of the high government officials from Washington who were visit-
ing the Islands. We were invited to the Governor-General's receptions
and other important social functions" (Gir6n-Tupas, 42).
The opportunity to study abroad also inspired Filipino nurses and
marked the beginnings of their idealization of the United States. In the
second decade of this century, according to Filipino nurse Patrocinio
Montellano, "to see America and have the opportunity to further my
studies had been my dream." At first, "it seemed impossible ... to have
my dream come true." However, when one of her female friends was
granted a government scholarship to study in the United States, Mon-
tellano recalls, "my obsession to go abroad was rekindled. I was deter-
mined to follow her by all means" (1962, 235).
During American colonial rule, the United States was a "land of
promise" for Filipinos, like Patrocinio Montellano, who received Ameri-
can scholarships and professional opportunities unavailable to them
during Spanish colonial rule. However, this promise was still reserved

120
 EXPORTED TO CARE

for an elite group of Filipinos. In the 1920s, male Filipino migrant work-
ers constituted the overwhelming majority of Filipinos in the United
States. They labored in the sugar plantations of Hawaii, the agricultural
fields of California, and the canneries of Washington and Alaska, supply-
ing an important source of labor to American industries, yet they faced
considerable racism and prejudice in the form of segregation, poor work-
ing and living conditions, antimiscegenation laws, and racial violence. 3
This contradiction of American policies-privileging a few Filipinos, at
times, at the expense of the general Filipino population-is a theme that
would resonate in Philippine nursing, particularly in the mid-twentieth
century.

To The Point of No Return:

Filipino Exchange Nurses in the
United States
The establishment of an Americanized training hospital system in the
Philippines during the American colonial period created the professional
and social foundations that enabled a Filipino nursing labor force to
work and study in the United States. Furthermore, given the complex
histories of Spanish and U.S. colonization of the Philippines, Filipinas,
in general, and Filipino nurses, in particular, viewed work and study
overseas in the United States as a "dream," a sure path to professional
mobility upon their return to the Philippines. Transnational scholarship
programs sponsored by the U.S. colonial government, U.S. philanthropic
organizations, and American individuals allowed Filipino nurses to turn
that dream into a reality.
These factors provide important historical linkages between early-
twentieth-century colonization and the preponderance of Filipino nurses
in the United States after mid-century, but how did opportunities for a
few to study abroad develop into a mass migration of Filipino nurses in
the post-1965 period? Furthermore, if study and work in the United
States had become a path of professional mobility for Filipino nurses
upon their return to the Philippines, why did so many emigrate to the
United States through the occupational preference categories of the Im-
migration Act of 1965? Why did significant numbers of Filipino nurses
in the late twentieth century remain in the United States as a perma-
nent part of the American nursing labor force?
The socioeconomic and cultural significance of experience abroad
for Filipino nurses changed dramatically in the mid-twentieth century.
During this period, several exchange programs served as vehicles for the
transformation of nursing into an internationally recognized profession.

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IMMIGRATION RESEARCH FOR A NEW CENTURY

While new international work programs in Germany and Holland re-

cruited Filipino nurses to work outside of the Philippines, the U.S. Ex-
change Visitor Program (EVP) facilitated the first wave of mass migra-
tion of Filipino nurses abroad by providing several thousand Filipino
nurses with the opportunity to work and study in the United States.
Between 1956 and 1969, more than eleven thousand Filipino nurses par-
ticipated in the EVP (Asperilla 1971, 52). Under the EVP, the experience
of going abroad was transformed from an opportunity reserved for the
few into one available to any Filipino registered nurse.
In 1948, the Exchange Visitor program was established by the Amer-
ican government, through the U.S. Information and Educational Act.
The general objectives of the program were "to promote a better under-
standing of the United States in other countries and to increase mutual
understanding between the people of the United States and the people of
other countries." However, the motivations for establishing the program
were rooted in Cold War politics. According to Senate reports, "hostile
propaganda campaigns directed against democracy, human welfare, free-
dom, truth, and the United States, spearheaded by the Government of
the Soviet Union and the Communist Parties throughout the world,"
called for "dynamic measures to disseminate truth" (U.S. Senate 1948,
4). One of the "dynamic measures" the Senate proposed was an educa-
tional exchange service involving the interchange of persons, knowl-
edge, and skills.
Exchange Visitor Program participants from abroad engaged in both
work and study in their sponsoring American institutions, for which
they received a monthly stipend. Several thousand U.S. agencies and
institutions, including the American Nurses Association and individual
hospitals, served as sponsors. The American government issued EVP
visas for a maximum stay of two years. Upon completion of the pro-
gram, both the American and the sending-country governments ex-
pected the EVP participants to return to their countries of origin. In all,
between 1956 and 1969, nurses made up more than 50 percent (11,136)
of the total number (20,420) of exchange visitors from the Philippines
(Asperilla 1971, 5).
Filipino nurses may initially have perceived the Exchange Visitor
Program as "a dream come true," but exploitation in U.S. hospitals
complicated romanticized Philippine narratives about work and study in
America. Many sponsoring American hospitals actively recruited ex-
change nurses to alleviate growing nursing shortages in the post-World
War II period. Some American hospital administrators took advantage of
the exchange status of Filipino nurses by assigning them the work of
registered nurses and compensating them with a minimal stipend.
Other American hospital administrators abused the educational and pro-

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 EXPORTED TO CARE

fessional component of the EVP by assigning Filipino exchange nurses

the work of nurse's aides (Alinea and Senador 1973).
By the mid-1960s, the use of exchange nurses as employees ap-
peared to be more the rule than the exception. A Philippine Department
of Labor study committee characterized the EVP as a handy recruit-
/I

ment device" and "a loophole for the circumvention of United States
immigration laws" (cited by Asperilla 1971, 54). In 1966, the Philippine
congressman Epifanio Castillejos, visiting the United States to survey
the situation of Filipino exchange nurses, severely criticized the pro-
gram: "Almost every Filipino nurse I met had problems which ran the
gamut from discrimination in stipend, as well as in the nature and
amount of work they are made to do, to the lack of in-service or spe-
cialized training in the hospitals they work in" (Castillejos 1966, 306-
7). However, reports of discrimination and exploitation did not discour-
age further Filipino nurse migration to the United States through the
EVP. Between 1967 and 1970, more than three thousand Filipino nurses
participated in the program (Asperilla 1971, 52).
Why, despite reports of suboptimal living and working conditions,
did several thousand Filipino nurses continue to come to the United
States? The dissatisfaction of Filipino nurses with work schedules, op-
portunities, and salaries in the Philippines was a major factor. Several
former exchange nurses I interviewed had used their exchange place-
ments to leave unfavorable work conditions in the Philippines. Milagros
Rabara, for example, applied for an exchange placement to avoid an eve-
ning work shift (Rabara, interview with author, March 21, 1995, New
York). The limited number of days off at her hospital in the Philippines
was a motivating factor for Lourdes Velasco to apply to the exchange
program (Velasco, interview with author, February 6, 1995, New York).
Filipino nurses working in the Philippines also earned low wages
and little professional respect. At some government agencies, nurses
were paid lower wages than janitors, drivers, and messengers. In the
mid-1960s, Filipino nurses earned between two hundred and three hun-
dred pesos monthly for a six-day workweek, including holidays and
overtime if required (Quijano 1968, 8). In the United States, in the
mid-1960s, general-duty nurses earned twice as much, from four hun-
dred to five hundred dollars a month."
Filipino nurses were also attracted to the prestige attached to study-
ing and working in the United States, a prestige originally created by the
American colonial scholarship programs in the early twentieth century
and revived in the mid-twentieth century. The Filipino Nurses Associa-
tion contributed to the re-creation of this idealization through news sto-
ries in their official publication, the Philippine Journal of Nursing (PTN).
Simply participating in the EVP was newsworthy. In 1960, the journal

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IMMIGRATION RESEARCH FOR A NEW CENTURY

published the names and alma maters of the more than one hundred
Filipino exchange nurses leaving for the United States every two to
three months ("Local News: 104 Young Nurses Off to the United
States" 1960; "Local News: 122 Young Nurses Departed to United
States" 1960). The PTN also reported on the professional recognition that
Filipino nurses had gained in the United States. When Chicago's Ameri-
can Hospital honored Juanita Jimenez as "Best Nurse of the Year," the
PTN featured Jimenez as "a silver lining in our profession" (Bacala 1962,
192-93).
The ability of Filipino exchange nurses to improve their socioeco-
nomic status through their earnings in American dollars, the acquisition
of material goods unobtainable in the Philippines, and new forms of lei-
sure also contributed to the prestige of work and study in the United
States. Independent of wage differentials, which were considerable, the
devaluation of the Philippine peso further increased the earning power
of Filipino nurses working in America. The devaluation of the Philip-
pine peso began in 1946 with the Tydings Rehabilitation Act, and by
1971, one American dollar was equivalent to six and a quarter pesos. As
exchange nurse Ofelia Boado observed, "the pay [in the United States]
was good compared to what I was getting in the Philippines .... It be-
came so clear to me that many nurses come here not for advancement
but for pay, for really good pay" (Boado, interview with author, February
6, 1995, New York).
Some Filipino exchange nurses manipulated the exchange visitor
program to serve their own agendas, for example, by working sixteen-
hour shifts to earn more money. With their stipends in American dol-
lars, American credit cards, and layaway plans, the exchange nurses pur-
chased stereos, kitchen appliances, and cosmetics unobtainable for all
except the affluent elite in the Philippines. They enjoyed forms of lei-
sure completely unavailable in the Philippines: Broadway shows, perfor-
mances at Lincoln Center, travel within the United States and to Eu-
rope. They lived in their own apartments and stayed out late at night.
According to Ofelia Boado, "You're very independent. You have your
own apartment. In the Philippines, you live in the dorm where every-
thing closes at 9:00 P.M. Or even if you stay at home, you don't go home
late in the night or anything like that" (Boado interview).
Given these opportunities abroad, Filipino exchange nurses created
a folklore of an America filled with social and economic promise. In
their letters to Filipino nursing friends back in the Philippines, boasting
of high salaries and II good living" in the United States, Filipino ex-
change nurses encouraged other Filipino nurses to follow their example
(Asperilla 1971, 15-17, 72).
Going abroad became a trend among Filipino nurses. One study re-

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veals that between 1952 and 1965 an average of slightly more than 50
percent of the 377 graduates from the University of the Philippines Col-
lege of Nursing went abroad (Ignacio, Masaganda, and Sta. Maria 1967).
Filipino exchange nurses, directly or by example, encouraged not only
thousands of other Filipino nurses to go to the United States but also
other young Filipinas to enter nursing school. In 1962 there were more
student applicants for nursing studies than Philippine colleges and
schools of nursing were able to accommodate (de la Vaca 1962); and
going abroad after the study of nursing figured prominently in the plans
of most of them. In 1963, FNA president Luisa Alvarez asked prospec-
tive nursing students why they chose that field of study. She reported,
"This may surprise you but about 80 percent of those asked have an-
swered me that it is because they want to go to the United States and
other countries" (Alvarez 1963, 169).
By the early 1960s, many Filipino nurses hoped to remain indefi-
nitely in the United States, as well. In 1960, Alvarez reported that many
Filipino exchange nurses in Chicago complained about the length of
their visits, claiming that a two-year period was insufficient time to
"avail [themselves of] the benefits of the program" (1960, 133). They
asked if it were possible to extend their visit to a period of three to five
years. When extensions of the exchange visit did not materialize, some
Filipino exchange nurses returned to the Philippines after their two-year
stay. Others, however, attempted to bypass the two-year exchange limit
and their mandatory return to the Philippines altogether and to change
their" exchange" visa status while they were still in the United States.
According to the U.S. Mutual Educational and Cultural Exchange
Act of 1961, exchange visitors were unable to apply for permanent resi-
dence until they had returned to their countries of origin and lived there
for a period of at least two years after their departure from the United
States. Yet Filipino exchange nurses employed multiple strategies to
avoid returning to their homeland. Some married American citizens.
Others immigrated to Canada. Filipino exchange nurses also exited the
United States through Canada, Mexico, or St. Thomas and reentered on
student visas. Some utilized a combination of requests by American
universities, the Philippine Consul General, and American hospital em-
ployers to petition the Exchange Visitor Waiver Board of the Department
of Health, Education, and Welfare for a waiver of the foreign residence
requirement. When even these strategies failed and the Immigration and
Naturalization Service (INS) set their dates for departure, some Filipino
exchange nurses brought their cases to the U.S. Court of Appeals in an
attempt to overturn INS rulings.
The widespread desire of Filipino exchange nurses to remain in the
United States became a cause for alarm for Philippine government offi-

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IMMIGRATION RESEARCH FOR A NEW CENTURY

cials and nursing leaders. They interpreted nurses' duties as an integral

part of Philippine nation-building. Songs, such as "The Filipino Nurses'
Hymn," promoted this relationship between nursing and Philippine na-
tionalism: "We pledge ... to build a better nation that is healthy and
great" ("The Filipino Nurses' Hymn" 1962,34). The hymn conjures im-
ages of Filipino nurses "traveling on" to all regions of the Philippines:
"In towns and upland terraces/In plains, in hills and mountains."
Philippine government officials and nursing leaders took pride in
the professional achievements of Filipino nurses abroad and empathized
with their desire to go to the United States and to remain there, given
the potential social and economic opportunities. They also continued to
endorse participation in the EVP and to believe that Filipino nurses'
training abroad was necessary for the national development of the Phi-
lippines.
However, government health officials and nursing leaders also
harshly criticized the new lifestyles of Filipino exchange nurses abroad,
employing a rhetoric of spirituality and morality in their efforts to per-
suade Filipino nurses to return to or to remain in the Philippines. They
characterized the economic ambitions of some Filipino exchange nurses
to accumulate American dollars and to purchase American goods as a
dangerous obsession. Critics charged that some Filipino exchange nurses
had become financially as well as morally bankrupt-that they mis-
calculated their expenditures and, using credit and layaway plans, over-
spent their earnings. Others associated the nurses' new lifestyles in
America with licentiousness. They claimed that the women smoked,
drank, and talked behind each other's backs. The harshest criticism was
leveled against Filipino exchange nurses who used marriage to Ameri-
can citizens to remain in the United States. The editor of the Philippine
Tournal of Nursing likened those nurses who "marr[ied] any American
they could entice, if only to stay in the country of their husbands," to
prostitutes: "This is 'selling' themselves" (Bacala 1963, 136).
The national problem that Filipino exchange nurses had become
only worsened when it became clear that the vast majority of returning
Filipino exchange nurses planned to go back eventually to the United
States. 5 If they contributed at all to Philippines nation-building, it was
not for very long. They compared their salaries, nursing facilities, equip-
ment, and research opportunities in the United States with those of the
Philippines and found the latter sorely lacking.
By the early 1960s, the international migration of nurses, partic-
ularly Filipino nurses, seemed unstoppable. Hospitals in Holland, Ger-
many, the Netherlands, Brunei, Laos, Turkey, and Iran recruited Filipino
nurses to alleviate their nursing shortages. Although Filipino nurses had
to adjust to the different languages and foods as well as some new nurs-

126
 EXPORTED TO CARE

ing procedures, nursing practices in Europe, such as the emphasis on

bedside nursing, were generally similar to those in the Philippines.
When officers of the Filipino Nurses Association visited hospitals in the
Netherlands that had recruited Filipino nurses, they concluded that Fili-
pino nurses in those hospitals were safe and well taken care of, and
these reports-which also publicized favorable work conditions and bo-
nuses-inspired further migration abroad.

Producing Nurses,
Exporting Women
In 1965, the U.S. Congress passed the Immigration and Nationality Act,
which expedited a process that was already under way among Filipino
nurses. The new law created a more equitable system of immigration
involving worldwide ceilings and per country quotas. One major impact
of the new legislation was the increased migration of highly educated
and skilled persons into the United States through occupational prefer-
ence categories. These categories dramatically affected Filipino profes-
sional immigration. Between 1966 and 1970, 17,134 Filipino profes-
sionals emigrated to the United States, constituting almost one-third of
all Filipino immigrants (Carino 1987,309).
In the 1960s and 1970s, engineers, scientists, and physicians as well
as nurses made up the bulk of professional immigrants from the Philip-
pines. However, the demands for foreign-trained nurses to fill critical
U.S. nursing shortages (exacerbated by the creation of Medicare and
Medicaid programs in the mid-1960s), in combination with Filipino
nurses' professional skills and historically shaped desires to work
abroad, made the Philippines a dominant force in the international mi-
gration of nurses. By 1967, the Philippines became the world's top send-
ing country of nurses to the United States, ending decades of numerical
domination by European and North American countries. In 1967, Fili-
pino nurses received the highest number of U.S. nursing licenses among
foreign-trained nurses-l,521 licenses out of a total of 5,361 (Quraeshi,
Quraeshi, and Mangla 1992, 61).
New American legislation also facilitated the adjustment of ex-
change visitor's status to that of permanent resident. A new law, passed
in 1970, enabled exchange visitors to waive their two-year foreign resi-
dency requirement. Between 1966 and 1978, 7,495 Filipino exchange
visitors adjusted their status to become U.S. permanent residents (Tul-
lao 1982, 132-33). The growing exodus of Filipino nurses abroad
through new avenues of immigration created new problems for nursing
in the Philippines. As the demand for nursing education exceeded the
enrollment spaces available in Philippine colleges and schools of nurs-

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IMMIGRATION RESEARCH FOR A NEW CENTURY

ing, Filipino businessmen and health educators opened new schools of

nursing in the provinces as well as urban areas. Between 1950 and 1970
the number of nursing schools in the Philippines rose from 17 to 140
(Joyce and Hunt 1982).
As the number of nursing schools increased, so too did the demand
for nursing school faculty. At the same time, the socioeconomic rewards
of working abroad depleted the supply of Filipino nursing instructors.
Although the Philippine Board of Examiners for Nurses required a ratio
of one faculty member to ten to twelve students during clinical supervi-
sion, according to one nursing dean, Rosario S. Diamante, the ratio was
"not possible due to the rapid turnover of faculty. This was mainly due
to an exodus abroad either as immigrant or as participant of the Ex-
change Visitors Program or under a working visa" (Diamante 1972, 39).
A 1974 summary of problems encountered by the Council of Deans and
Principals of Philippine Colleges and Schools of Nursing included the
"sprouting of many schools of nursing posing problems of lack of quali-
fied faculty members." (Diamante 1975, 80). The council reported, "We
conduct seminars for them only to find out that they have left the coun-
try" (Diamante 1975, 80).
As new avenues of entry to the United States exacerbated the trend
of migration abroad, as the aggressive international recruitment of Fili-
pino nurses continued unabated, and as nurses' wages in the Philippines
lagged behind those of nurses abroad, Filipino nursing leaders, in collab-
oration with the Philippine government, employed new strategies to re-
tain Filipino nurse graduates, if only temporarily. In the early 1970s,
mandatory health service requirements for new nurse graduates replaced
emotional appeals to nurses' selflessness and humanitarianism. How-
ever, these service requirements were only temporary.6 Decrees by Phil-
ippine president Ferdinand Marcos mandating several months of health
service in rural areas were token gestures to alleviate the maldistribu-
tion of Filipino health personnel in the country. At the same time,
Marcos also committed the Philippines to an export-oriented economy,
which included the export of people and skills as well as goods. Govern-
ment officials thus promoted the export of laborers, including Filipino
nurses, when the shortage of Filipino nurses serving the general popula-
tion was most acute.
By the early 1970s the Marcos government was promoting "employ-
ment contracts" of Filipino laborers and a "dollar repatriation program"
as a way both to alleviate unemployment and to revitalize a failing Phil-
ippine economy. Marcos's address to the Philippine Nurses Association
at their 1973 convention in Manila revealed the government's new com-
mitment to exporting womanpower: "And so, in short, what is the pol-
icy of nursing? . . . It is our policy to promote the migration of

128
 EXPO/<-TED TO CARE

nurses .... We encourage this migration, I repeat, we will now encour-

age the training of all nurses because, as I repeat, this is a market that
we should take advantage of. Instead of stopping the nurses from going
abroad, why don't we produce more nurses? If they want one thousand
nurses we produce a thousand more?" (Marcos 1974, 21-22). Like the
revenues earned from agricultural exports, the earnings of Filipino
nurses working abroad, deposited in Philippine banks, would help to
build the Philippine national economy. Marcos encouraged Filipino
nurses abroad to "earn for the country" as well as for themselves.
Given the shift to an export-oriented economy, Filipino nurses
abroad were no longer seen as having abandoned their role in Philippine
nation-building; rather, they were now considered integral to the pro-
cess. Once criticized in the 1960s by the Philippine secretary of health
for "turning their backs on their own people when the almighty dollar
beckons," Filipino nurses abroad now became the new national heroes.
Their work as nurses abroad continued to be associated with prestige.
However, this time the prestige derived from indefinite working so-
journs abroad, during which they would return a portion of their "pre-
cious dollars" to their country of origin. In his 1973 address to visiting
Filipino nurses from abroad, a new Philippine health secretary, Cle-
mente S. Gatmaitan, proclaimed, "We in the Health Department are
happy that you have elected to stay and work abroad .... While in other
countries, you give prestige to the Philippines because you are all vir-
tually ambassadors of good will. ... Another benefit that accrues from
your work is the precious dollar you earn and send back to your folks at
home. In this manner, you help indirectly in the improvement of our
economic condition" (Gatmaitan 1973, 90).
These changes in the attitude of Philippine government officials'
toward the mass migration of Filipino workers abroad led to the imple-
mentation of an official overseas labor policy. In 1974, the government
created the Overseas Employment Development Board and the National
Seamen Board. These agencies publicized the availability of Filipino la-
bor in overseas labor markets, evaluated overseas employment con-
tracts, and recruited Filipino laborers for work abroad.

Conclusion
At the close of the century, the Philippines continued to export its peo-
ple as contract workers overseas through government agencies such as
the Philippine Overseas Employment Administration. Filipinas have
played a significant role in this phenomenon. In 1991, they constituted a
larger proportion of the Philippine's overseas workforce (41 percent)
than its domestic workforce (36 percent). Significant numbers of over-

129
IMMIGRATION RESEARCH FOR A NEW CENTURY

seas Filipino workers in domestic services (housecleaning), entertain-

ment, and the sex industry, in addition to the overseas working force,
form a worldwide diaspora of Filipinas working in Japan, Canada, the
Middle East, and several European countries, as well as the United
States (Chang 1997, 135-37). This diaspora is a late-twentieth-century
phenomenon, but a transnational history of Filipino nurse migration to
the United States reveals that the migration of Filipino nurses has its
roots in practices established earlier in the century. Although contempo-
rary U.S. and Philippine government policies have facilitated migration
in the tens of thousands since 1965, American educational policies dur-
ing the U.S. colonial period in the Philippines and the U.S. Exchange
Visitor Program of the 1950s and 1960s laid the social, economic, and
political foundations for the Philippine export of nurses in the late
twentieth century.

Notes
1. In British colonial India, a provincial medical board proposed the
creation of a Native Medical Institution in 1822 to train Indian doc-
tors in Western medicine. Regarding the language of instruction, the
strategy described here was changed in the 1830s; see Arnold (1993,
54-55).
2. The original group of "pensionados" in 1903 consisted of 103 Fili-
pino men and no women. In 1904, of thirty-nine pensionados, only
five were women. In 1905, the gender imbalance continued, with
three Filipinas and thirty-four Filipino men studying abroad under
the auspices of the program. For a description of the original pen-
sionado movement, see Sutherland (1953). For a comprehensive de-
scription of the pensionado program from 1903 to 1943, see Munden
(1943).
3. By the 1930s, more than forty thousand Filipinos had migrated to
the United States. Government-sponsored scholars constituted only
several hundred of this total. The vast majority of historical litera-
ture on Filipino Americans focuses on this early-twentieth-century
group of Filipino male workers. The classic account of these Filipino
male migrant workers' experiences is Carlos Bulosan's America Is in
the Heart (1943). For a history of Asian American laborers in the
Northwest canneries, see Friday (1994). For a history of Asian Amer-
ican laborers, including Filipino laborers, in Hawaiian plantations,
see Takaki (1983).
4. According to the Bureau of Labor Statistics in 1966, general-duty
nurses in the United States earned a weekly average of $100.50. In
1969, an study by the American Nurses Association found that staff

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nurses in the United States earned a weekly average of $133; see

ANA Nursing Information Bureau (1969, 124).
5. In Purita Asperilla's study of 411 Filipino nurse returnees, 97 per-
cent said that they would like to go back if possible, and 86 percent
said that they had already made plans to go back (1971, 151).
6. In 1972, the Philippine Exchange Visitor Program Committee re-
quired medical and nursing graduates to serve in the Philippines for
one year after the results of their board examinations before apply-
ing to the exchange program; see Luzon (1972, 65). In 1973, Presi-
dent Ferdinand Marcos issued a presidential decree requiring Fili-
pino nurse graduates to serve for four months in a rural area as a
condition for obtaining licensure; see "Rural Health Experience for
New Graduates: A Must" 1973, 244, 246).

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