Nurse? Nurse! Hello?

'IT'S ALL ABOUT THE MONEY'
• Fears rising over RP health care crisis

By MA. STELLA F. ARNALDO

LYLE R. Santos, 28, is a registered nurse who lives in Davao City. Nursing is actually his second degree, he told Business Mirror in an email. In 1999, he graduated from San Pedro College with a degree in Psychology but decided to study nursing at the Brokenshire College a few years after. He got his registered nursing license in 2005 but has yet to actually practice in a hospital.

Like many new graduates who have had difficulty finding a job that pays decent wages, Santos has joined the ranks of many young Filipinos who have seen nursing as a way to improving their economic situation. They see a bright future especially in the United States, which has opened its doors to foreign nurses and other medical practitioners to address a current shortage. The US Senate recently passed an immigration bill, which lifts the cap on the entry of foreign nurses to the US. Independent estimates by recruiters of nurses in the Philippines show a shortage of some 120,000 in the US this year.

Already, Philippine government officials and medical professionals have sounded the alarm of the impact of the continued outflow of Filipino nurses to the US and other countries like the United Kingdom, the Middle East, Singapore, Hong Kong, and the Pacific nations. According to data from the Philippine Overseas Employment Agency (POEA), at least 7,500 nursing personnel and professional nurses have been leaving the Philippines every year for greener pastures abroad. Thus, from 2000 to 2005, about 35,000 Filipino nurses have left the Philippines.

What is even more troubling is that even Filipino doctors have been retraining to become nurses abroad, according to an administrator of a well-known medical school in Manila who requested anonymity. She said over the years, a number of her school’s medicine graduates “have come back and are studying to be nurses instead.” And with enrollment in medical schools on the decline due to the excessive tuition fees and the number of years needed before a medical student graduates, there are also fears that there will not be enough doctors to sustain the Philippine health care system.

“[The future is] bleak if the trend continues,” admits Dr. Modesto Llamas, president of the Philippine Medical Association (PMA) in an interview. He estimated that “in the last five years, 3,000-4,000 doctors left as nurses [for work abroad].” He said most of them were doctors who were poorly paid in provincial hospitals.

Focus on this troubling phenomenon captured the attention of the public when Dr. Elmer Reyes, who had topped the Medical Board Exams in 2004, announced that he was going to work in the US as nurse. Reyes hails from Lamitan town in war-torn Basilan in Mindanao, and worked in the same hospital where his co-workers were later kidnapped by members of the terrorist group Abu Sayyaf. "While it pains me to do so, I'm looking forward to going abroad and not to let the opportunity pass," said Jacinto in an interview in Feb. 28 that year, the same day the results of the medical board exams were announced.

The Philippines is currently trying to promote itself to Filipino-Americans and Pacific countries as a center for health and wellness. Residents of Guam, the Northern Marianas, and Palau, for example, have been coming to Manila regularly to get treated in its first-class hospitals like St. Luke’s Medical Center, Asian Hospital, Medical City, and Makati Medical Center.

Santos said he wanted to become a nurse because of the higher pay he would get when he would work abroad. “It's all about the money–to put it bluntly. Before I went to nursing school, I worked as operations assistant for SM Cinema Davao. I was earning a little over the minimum wage and felt that with the pay I was getting, I wouldn’t be able to support myself or a future family [if I was going to have one].” He currently has a girlfriend. He added that he knows of at least two graduates in his batch who have also gone to nursing school.

Santos said he wants to prepare for his upcoming exams. “Since becoming a registered nurse last December 2005, I have solely devoted my time for review…. I chose to take the exams first prior to gaining clinical experience because I believe that once I begin to work, I would not be able to find time to prepare for exams,” he said in his email.

A Web designer on the side, Santos has also put up a blogspot entitled Pinoy R.N., where nurses here and abroad discuss issues concerning their profession and where he also posts announcements of nursing licensure exams. In his blogspot, Santos rages against critics who have called this new trend of Filipino nurses’ migration as a “brain hemorrhage”, akin to the “brain drain” in the country in the 1970’s when many of the Philippines’ brightest left the country which had been put under martial law.

“Nurses in government hospitals are underpaid yet overworked. In some cases, the nurse-to-patient ratio is as bad as 1:50. That's one underpaid and overworked nurse tasked to care for 50 patients with varying needs. As if this is not enough, they are constantly at great risk of losing their hard-earned license and means of livelihood should they commit grave oversights,” he wrote.

In the Philippines, nurses earn at least $2,000 a year compared to the $36,000-starting salary in US hospitals. Santos said: “Filipino nurses working abroad earn more than your average overseas Filipino worker [OFW]. Thus, by simple math, it can be safely assumed that they are able to make more dollar remittances to their families in the Philippines. This means a stronger peso for the economy, lesser cost for social services for the government, families left behind get access to quality education, health care, and a generally better life. It is a well-established fact that OFWs are the lifeblood of our country's economy. This is why OFWs are called ‘modern day heroes.’ Then why discriminate against the OFW nurse?”

To stem the migration of Filipino nurses abroad, two lawmakers, also medical doctors, have filed separate bills in the House of Representatives. House Bill 2700 filed by Rep. Tranquilino B. Carmona (First District, Negros Occidental) forces nurses to render two years of service in local hospitals before they are able to secure a clearance to work abroad by the Philippine Department of Labor. HB 2926 of Rep. Janette L. Garin (First District, Iloilo) also requires registered nurses to work in local hospitals for a minimum of three years as a requirement prior to working abroad.

Santos calls these bills “unfair” and only penalize nurses who want a better life for themselves and their families. “Nursing in the Philippines is generally a thankless job. Nurses are subjected to constant stresses and are exposed to all sorts of diseases on a daily basis. All these endanger both their health and their primary source of income. The remuneration is comparable or near the minimum wage. Working conditions are inhumane especially in government hospitals. Nurses are overworked yet underpaid. To deprive them of an opportunity to improve their lot is utterly unfair.”

But at the rate nurses are leaving, Llamas acknowledged, “there could be a deterioration in health care [in the country].”

While Asian Hospital in Alabang, Muntinlupa said it is still not affected by the nursing migration, Dr. Joel Beltran, hospital administrator, foresees this as a “cause for concern” in the near future. At present, he said, the hospital “continues to hire nurses. There are still a lot of applicants.”

What worries Llamas and Beltran is the declining number of enrollees in medical schools and the rising vacancies in residencies among hospitals.

Beltran said many “teaching hospitals” in Metro Manila have less doctors applying for residencies. Asian Hospital is not one of them. Llamas said fortunately, Indonesian and Singaporean doctors training here are now filling these vacancies. At the Asian Eye Institute at Rockwell, Makati City, for example, this writer was attended to by an Indonesian resident doctor training under her ophthalmologist. “It’s cheaper for them to train here,” said Llamas.

But the problem could get worse as there is now a shortage of students in medical schools. “There are two board exams [for doctors] every year. In the last exam, 1,400 or more passed. So about 2,000-3,000 pass the exams every year. But they are those who took up pre-medicine [courses] from five to nine years ago. Now there are not too many studying pre-med. There is definitely a shortage [of students]. In fact some medical schools had to close shop because there are no enrollees,” added Llamas.

He cited AMA College which had planned to put up a medical school affiliated with the Harvard Medical School. “It only had one or three enrollees,” he said. AMA already has a nursing school.

While he had no overall statistics on the shortage of resident doctors in Metro Manila hospitals, Llamas said at Chinese General Hospital in Manila, where he has a clinic, there is a 10-12 percent shortage in resident doctors.

To help staunch the outflow of Filipino nurses to other countries and keep more doctors in the government hospitals, the 50,000-strong PMA is pushing for the full implementation of the Magna Carta for Public Health Workers. This was signed into law in 1999 and seeks to improve the wages of government health workers and offer them incentives to stay in public hospitals.

“The local governments are not implementing it fully. That’s why government physicians are not getting the benefits due them. Also, the procurement of medicines has been devolved to the local governments and is no longer under the Department of Health. Some doctors are getting demoralized because they are getting substandard medicines. They have complained that the local government usually buys the medicine on the basis of price. If you buy something that is cheap but ineffective, then you’re wasting your money,” said Llamas.

As for Santos, he said he was determined to go abroad and have a better future. “Nurses are human beings too, like any other Tom, Dick, or Harry. They have dreams, aspirations, wants, and needs. If they choose to leave the country to find greener pastures elsewhere, it should not be taken against them, as it is just human nature to satisfy one's need. Each one of us has a right to pursue our goals and dreams. Engineers work in the Middle East so they can earn their keep and realize their dreams; seamen go on long and arduous voyages so they can give their families a glimpse of the good life. Why can't nurses do the same?”

(Originally published in the Business Mirror, Perspective, Aug. 22, 2006. Click here for more on the Empire of Care by Catherine Ceniza Chow, a socio-historical perspective on the Filipino nursing migration to the US.)