Lorna Sianen Pagaduan was en route to a new nursing job in Libya when she “got stuck in Hong Kong ” more than two decades ago.
But that misfortune turned out to be a blessing in disguise, as 22 years later she is now president of the city’s Filipino Nurses Association, and has used her earnings to put six siblings through school.
This is why she rejects the Philippine government’s decision late last month to cap the number of newly hired nurses and other health professionals it sends abroad annually at 5,000, starting from this year.
“It’s very discriminatory. We understand the Philippines needs nurses but our families also need something to put in their stomachs,” said Pagaduan, who is in her late 40s. “What if, like me, you have six siblings, your father is jobless and your mother is sick? You would choose your family even if you love your country.”
When announcing the cap imposed by the Inter-Agency Task Force on Covid-19, labour secretary Silvestre Bello said it was imposed to ensure the country had enough medical professionals to continue to fight the pandemic, adding that the cap might “increase eventually”.
The Philippines has recorded more than 435,000 cases of Covid-19 and close to 8,500 related deaths, the second highest in both categories in Southeast Asia.
However, Dr Anthony Leachon, a former special adviser to the Covid-19 task force, told This Week in Asia the cap was “unnecessary” even from the perspective of handling the pandemic. He said the country had a large untapped pool of nurses who worked in “odd jobs like call centres” because of the low pay nurses earned in the Philippines.
“They are just not being mobilised properly by the government,” he said. “If they are properly paid, I think they will step up and go to local hospitals.”
Thousands of medical practitioners leave the Philippines to work overseas every year, with an estimated 16,000 nurses going last year alone, according to Eleanor Nolasco, vice-president of Filipino Nurses United advocacy group, which is based in Manila.
But the numbers could even be higher because the Philippine government only tallies fulfilled “job orders” for nurses, Pagaduan said, leaving out those who depart as “caregivers” – a role she herself initially occupied in Hong Kong.
It is unclear how many nurses there are in the Philippines, as the government’s statistical authority does not correlate such data. Filipino Nurses United said there were 200,000 trained nurses who were either unemployed or working in jobs outside the health sector, while in 2017 the Tokyo-based Medical Research Information Center Global put the number of board-certified Filipino nurses at 500,000.
That same year, a study by the Philippine Nurses Association, the country’s professional body, found that fewer than 68,000 nurses were employed in the country’s hospitals and state-run community health centres.
“There are just not enough job opportunities even in government hospitals,” Filipino doctor Hans Jesper del Mundo wrote in an essay for the Japanese centre, published in 2018. “This is the main reason why most health professionals practise abroad or even consider changing careers.”
Dr Jean Franco, a professor of political science at the University of the Philippines, said she was “totally against the cap” on nurse deployment as “it violates the right of our nurses to work abroad”.
“We really don’t have a shortage of nurses,” she said. “There are 200,000 jobless nurses because they don’t want to be employed in hospitals where the pay is low.”
After shelling out as much as 500,000 pesos (U$10,400) for a four-year nursing course, many of these “standby nurses” look to recoup their investment by working better paid jobs such as “business process outsourcing … or in high-end beauty salons and clinics”, Franco said.
She blamed the government for “commodifying” the profession as part of its decades-long policy of exporting manpower, which has encouraged an oversupply of nurses. This, in turn, depressed wages and led many hospitals in the country to only hire nurses on temporary contracts for low pay, on the understanding that they would leave for jobs abroad once they had enough experience.
Some hospitals in the Philippines pay their nurses as little as 500 pesos (U$10.40) a day — less than what a shop assistant in a large grocery store chain could earn. In other words, Franco said, “nurses are disposable”.
This leads to a high turnover, with one medical director of a large private hospital in Metro Manila telling This Week In Asia that nurses in his hospital who join “in January leave by the end of the year” and those left behind are “not that good”.
“You can’t blame the nurses for leaving because their salaries are really low. They should be given the opportunity but of course, this affects our health care system,” he said, on condition of anonymity.
In October last year, the Philippine Supreme Court ruled that nurses working for public hospitals and health offices were entitled to higher basic pay. The ruling effectively increased their monthly starting salary to 30,531 pesos (US$636) from 20,754 pesos previously — but it did not cover private hospitals, where entry-level salaries can be as low as 15,000 pesos.
Leachon, the former Covid-19 task force special adviser, said to resolve the problem of the lower pay scale in private hospitals compared with state hospitals, all nurses — not just frontliners — should be paid the same wage, with the government partly subsidising pay in private hospitals during the pandemic. He added that the country’s Universal Health Care Law, which provides budgetary support for health care workers, should be tapped for this.
As well as being underpaid, Filipino nurses are also often overworked, with many hospitals in the country ignoring Department of Health guidelines that a nurse should only care for a maximum of 12 patients over an eight-hour period, according to Nolasco of Filipino Nurses United, who said it was more common for nurses to care for as many as 40 patients as part of 12 to 16 hour shifts.
The government’s response has been to encourage nurses at private hospitals to “go on strike”, as labour secretary Bello put it last week, so their employers can “learn the value of your profession”. Philippine President Rodrigo Duterte, for his part, told the country’s nurses in August: “Enter the police force. The salary is higher.”
On Friday, the All University of the Philippines Workers Union-Manila, which includes medical frontliners, staged a lunchtime protest to demand promised hazard pay and risk allowances that had gone unpaid since March. President Karen Mae Faurillo said the union had recently been told there was “no budget” to fulfill these promises, which had been made by the Duterte government.
There is one part of the Philippines where nurses can expect to earn a competitive salary, however – the conflict-ridden Bangsamoro Autonomous Region for Muslim Mindanao in the country’s far south.
An additional 1,415 nurses were recently contracted to work for a year in the region’s community health centres under a Department of Health deployment programme offering salaries of 41,000 pesos per month, according to Yasmin Bacarat, governor of the Philippine Nurses Association’s local branch.
A lack of infrastructure, poor transport links and frequent power outages make working in the region a challenge, however.
Bacarat, who had a stint in Saudi Arabia before embarking on her 20-year career as a community nurse in Bangsamoro, said Filipino nurses should be given the opportunity “to experience life outside the Philippines” if they wanted.
“From my personal experience, it is really difficult to walk to all the barangays (villages),” she said.
“At first I looked at the rice fields and wondered why am I here, I want to work in Manila, but I realised I was helping save lives. It’s very self-fulfilling, so I fell in love with what I’m doing.”
As for Pagaduan in Hong Kong, now that all her siblings have finished school, “I’m already getting ready to go back home,” she said.
This article was first published in Asia One . All contents and images are copyright to their respective owners and sources.