They Who Are Forced To Flee
By John Rey Amestoso
In a nation that pushes you away and deprives you of reasons to stay, what will you do when you find yourself at a crossroads of serving the people whom you dearly care for, on the one side, and pursuing your personal growth and dreams after years of setting them aside on the other?
Such was the predicament of Trina*, a nurse from Mindanao who had once envisioned making a significant difference in her community’s healthcare system. Driven by her passion for bettering people’s health, she wasted no time in pursuing her calling. The then-young Trina immediately embarked on and dedicated herself to this life mission in the provincial hospital after passing the licensure exam in 2005.
Like many other Filipino health workers, Trina also planned to migrate overseas to seek better opportunities. In fact, in 2007, she passed the National Council Licensure Examination and secured a license to practice nursing care in the United States (U.S.). However, seeing the dire condition of her patients and the dismal state of the hospital system she worked in, she made the difficult decision to temporarily set aside her U.S. dream and stay in the Philippines.
“I took the USRN and I passed. I was supposed to come here [U.S.], but then I saw the situation in the provincial hospital where I worked. I was saddened and I thought that I could be a big help. So, I stayed there for many years.”
Although overworked and underpaid, she was fueled by her desire to serve her people. Hence, she contently worked in the same institution for 16 years until 2021 — when Trina finally called it quits.
‘I have been failed by the government’
In almost two decades of working in the institution, she saw how local politicians come and go; but barely had changed in the hospital from when she first entered its wards. If, at all, the situation worsened as the number of patients doubled while its capacity remained the same. Still, determined as she was, Trina never gave up on initiating changes.
One time, she recalled, there was a huge clinical training that she wished to participate in as a core educator to keep the hospital up-to-date with the latest framework in nursing care. But the said training was way too expensive for her pockets. And so, armed with her years of experience in the practice and sheer tenacity for positive change, she brought the idea to the governor at the time. However, her hope and eagerness immediately fizzled when her proposal was outrightly turned down. The politician simply replied: “You don’t have to.”
She felt betrayed and frustrated. Trina then realized how health in the country was subject to political whims. From the start, her dream was to contribute to the improvement of the institution to which she had dedicated so many years of her professional life. However, achieving such a dream seemed out of reach when those in power were the ones obstructing its realization.
The PH nursing export tradition
As much as she wanted to continue the service in her community, the increasingly worsening working conditions in the country, particularly in the health sector, left her with no choice but to pivot, look back, and pick up the dream she once abandoned.
In an ideal scenario, Trina needed not to choose between service to the people and her ambitions in life; these should complement each other. Regrettably, the government seemed indifferent to Trina’s dedication to her patients and the system.
Hence, leaving became a rational decision.
Data from the Department of Health (DOH) show that about one-third or around 316,000 of registered nurses in the Philippines have already migrated abroad. But this is not a supply problem, said Jocelyn Andamo, secretary general of Filipino Nurses United (FNU) in an interview. “It’s just that the government has not been giving us reasons to stay,” Andamo asserted.
The tradition of nursing export in the Philippines is not a recent development. It has been around for almost a century, with its roots firmly established during Ferdinand Marcos Sr.’s reign of terror, particularly as part of his New Society policy. The dictator exploited Filipino nurses to prop up the country’s faltering economy, treating them as mere pawns while he and his allies enriched themselves from the nation’s coffer.
Such exploitation has contributed to the ongoing crisis induced by brain drain and the stagnation of Philippine healthcare — systemic issues that can only be resolved by tackling their underlying causes.
Sickening reality of PH healthcare
“I feel sorry for the Philippines.” Trina could only utter these words when asked about her experience finally working as a nurse in the U.S. She observed that even homeless patients received premium care from her current hospital.
“When I was in the Philippines, the allowance I would allot for my 16-hour shift was only P100. But after almost every end of the shift, I would spend around P300 to P500 because the watchers and the patients had no food,” she woefully recollected. More so, despite her meager salary, Trina would willingly dip into her own pocket to cover the costs when family members lacked the resources to afford ambulance services for transfers between hospitals.
Trina also compared the nurse-patient ratio between the Philippines and the U.S. From her experience, in the Philippines, she would have around 60 patients per shift, while in her assigned unit in the U.S., she only has to attend to three patients every shift. The FNU stressed that the ideal nurse-patient ratio is 1:12, but the current prevailing ratio in the Philippines is about 1:50 per shift.
And then there’s the enduring issue of undercompensation. According to the 2020 data from the Department of Labor and Employment, entry-level Philippine nurses typically earn between P8,000 and P13,500 per month. Even at the upper limit, this falls significantly short of the family living wage of P36,210 for a family of five, as calculated by the think tank IBON Foundation in March 2024.
Hence, it’s unsurprising that many are dissuaded from pursuing the nursing program, and many professionals opt to either emigrate or abandon the profession entirely. The DOH estimates it will take about 12 years before the country fills in the void of nurse shortage with the current rate of graduates.
Hope amidst despair
“I want to come back. I want to help.” Trina expressed longingly. While it pains her, returning to the country is not viable at the moment. Her life in the U.S. may not be luxurious, but she now owns a house, and a car, and has surplus funds for leisure travel — accomplishments that would have been unattainable had she remained in the Philippines.
Nonetheless, Trina holds onto hope that one day the Philippines will have a robust healthcare system. She fervently prays for a future where all Filipinos can access quality care, whether in a public or private hospital. Likewise, Trina challenges the government to have “the backbone to support you [healthcare workers]; to provide you with a good life.”
Trina’s narrative is not new; it mirrors the clichéd tale of countless migrant workers pursuing better opportunities abroad. Yet, contrary to the prevalent misconception, their decision is not rooted in selfishness or caprice. Like her, many endeavor to enact systemic change, only to be at odds with those in authority.
In the end, their decision to work abroad does not reflect their character, but rather the government’s failure to ensure livable and fair working conditions in the country.
*The respondent’s real name was not disclosed to protect her privacy
