|Dr Janet Hargreaves, University of Huddersfield||The UKAHN Bulletin|
|Volume 9 (1) 2021|
Reading this book has taken me back 5 decades: In my nurse training in 1970s England, it was usual to find a group of ‘Commonwealth’ students in one’s cohort [in our school they would be from Mauritius]. I do not remember any particular tensions, but equally I can recollect little curiosity amongst us English nurses as to their motivations or experience. This book has led me to reflect back and to reconsider the role that post- colonial Britain was playing in my own experience, as well as the ways in which migrant nurses are used, abused and portrayed over time.
In her book, Empire of Care, Choy explores the development of Filipino nursing in the 20th century. Choy charts the history of the Philippines, as a Spanish, then American colony prior to independence in 1946, and focusses particularly on the significance of American imperialism for the development of nursing in the Philippines, and the phenomena of Filipino nurses’ dominant role as migrant nurses in the US. Using extensive, rich oral history and interview material from the nurses themselves, Choy offers insightful analysis of Filipino nursing and migration.
War between the US and Spain led to colonial control of the Philippines transferring from Spain to the US at the turn of the last century. With what Choy describes as the ‘interrelated myths of US exceptionalism and benevolence’, health and hospital care was transformed, in part, by re-engineering nursing into a predominately female profession, trained in the American way.
Refreshing and important for being written by a person of Filipino heritage within the US, this book is able to critique the emerging history, capturing the nuances in what is never a simple victim versus victor story. Nursing was clearly used as an instrument of colonial control, inculcating western notions of health and hygiene into the indigenous population, but it also gave Filipino women professional, educational and travel opportunities hitherto unknown. Through a complex, double-edged interplay in the post- independence period, Filipino nurses became (uniquely?) suited to work in the US, which was in need of their cheap and compliant labour. Pay was significantly higher than at home, allowing for the acquisition of consumer goods and the transfer of US dollars back into the Philippine economy. Life was more relaxed, allowing for emancipation, travel and adventure. In addition, Choy asserts that nursing in the US was more equal/ egalitarian. She hints at a class system in the Philippines in which family status and patronage dictated success. Through either the ‘Education Visitor Program’, which allowed a 2-year period in the US, or through direct immigration, nursing in America offered equality and status to all who nursed there, on the basis of merit.
Thus, nurses were beckoned west. Hospitals, recruitment and travel agencies used manipulation and exploitation on a number of levels. Political changes in the US and the Philippines, including Independence, increased nurse migration to the point that by the 1960-70s Filipino nurses formed a significant sub-set of all nurses working in the US, and the largest single migrant group. This phenomenon was politically desirable in the newly independent Philippines, where the Marcos government encouraged the ‘export’ of nurses and other skilled workers, even though this caused shortages at home, as they sent valuable dollars back into the economy. Choy’s research shows the explicitly racialised position of Filipino nurses left them fully aware that they were being used, so they balanced this against the benefits whilst beginning to organise and fight for their rights. In the all too familiar tropes of economic migration US nurses tolerated, and even welcomed Filipino nurses at times, but also blamed them for undermining status, pushing professional boundaries and bringing salaries down.
As the century progressed and polarised views regarding immigration escalated, Choy uses a media analysis of two high profile events to highlight how the racially defined undercurrents affected the nurses’ experience: Firstly, mass murder of eight nurses, two of whom were Filipino. A ninth nurse, also Filipino, survived and was pivotal in the conviction of the killer. She was feted in the press where she was characterised as a typical Filipino nurse – modest and womanly whist being morally strong and steadfast. Secondly, the mass murder of hospitalised patients, where an aggressive, FBI investigation found two Filipino nurses guilty, who were subsequently acquitted , largely through the efforts of a Filipino – funded campaign. Media coverage was very negative, spreading ‘yellow peril’ fears and blighting the image of immigrant nurses. Choy asserts that the changing ways in which the Filipino nurses were perceived, demonstrates the problematic relationship immigrants have in their adopted country.
I found this a good read, well written and researched. The authority of the text is enhanced by Choy writing from within the Filipino community, rather than this being another gaze from without, looking in.
Written before Covid 19 was anything more than a theoretical possibility, but read by me as nurses worldwide, whether in their birth or adopted country, are simultaneously feted and abused, it is a salutary reminder of the importance of history. We need more insights into nursing history, particularly from the viewpoint of nurses themselves.