QUEZON CITY Philippines — Philippine government officials and medical professionals have sounded the alarm of the impact of the continued outflow of Filipino nurses to the U.S. and other regions like the U.K. the Middle East Singapore Hong Kong and Pacific nations. According to data from the Philippine Overseas Employment Agency 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.

Lyle R. Santos 28 is a registered nurse who lives in Davao City Mindanao in the southern Philippines. He is studying for the National Council Licensure Examination for registered nurses which he will take Aug. 15. Nursing is actually his second degree he told the Journal. 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 received his registered nursing license in 2005 but has yet to actually practice in a hospital.

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

What is even more troubling is that 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 cost of tuition 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 ” Dr. Modesto Llamas president of the Philippine Medical Association said in an exclusive interview. He estimated that “in the last five years 3 000 to 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 U.S. as a nurse. Reyes hails from Lamitan town in war-torn Basilan southern Mindanao and worked in the same hospital where members of the terrorist group Abu Sayyaf later kidnapped his co-workers. “While it pains me to do so I’m looking forward to going abroad and not to let the opportunity pass ” Jacinto said 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 on Guam the Northern Mariana Islands and Palau for example have been coming to Manila regularly to get treated in its hospitals like St. Luke’s Medical Center Asian Hospital Medical City and Makati Medical Center.

Santos told the Journal that 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 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 in December 2005 I have solely devoted my time to 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.

A web designer on the side Santos also put up a blog entitled “Pinoy R.N.” (filipinonurse.blogspot.com) where nurses here and abroad discuss issues concerning their profession and where he also posts announcements of nursing licensure exams. In his blog 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 1970s when many of the Philippines’ brightest left after martial law was instituted. “Nurses in government hospitals are underpaid yet overworked. In some cases the nurse-to-patient ratio is as bad as one to 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.”

Nurses earn at least $36 000 starting salary in U.S. 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) requires nurses to render two years of service in local hospitals before they are able to secure 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 said they 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 not affected yet 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 reporter was attended to by an Indonesian resident doctor training under her ophthalmologist. “It’s cheaper for them to train here ” Llamas said.

But the problem worse Beltran said 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 to 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.” He cited AMA College which already has a nursing school which planned to open a medical school affiliated with the Harvard Medical School. “It only had one or three enrollees ” he said.

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% to 12% shortage in resident doctors.

To help stop the outflow of Filipino nurses to other countries and keep more doctors in the government hospitals the 50 000-strong PMA is actively campaigning 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.

According to Llamas “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.”

As for Santos he said he was determined to go abroad and have a better future. “Nurses are human beings too. 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?” MBJ