Filipino nurses’ exodus

By Carlos H. Conde
International herald Tribune
TUESDAY, OCTOBER 19, 2004

PIKIT, the Philippines — For the past eight years, Mary Jane Maximo has ministered to the people of this small town as head nurse at its only private clinic. She has seen the violence and felt the pain visited upon Pikit’s residents; last year she watched as a government campaign against Muslim insurgents devastated the town and worsened its already extreme poverty.

Before the year ends, however, Maximo, a 29-year-old mother of one child, will be gone. She will leave the Cruzado Community Hospital and head for Saudi Arabia, where she will earn five times what she is making now.

Maximo is among the thousands of Filipino nurses and doctors who seek jobs abroad every year, leaving behind poorly staffed hospitals and clinics, particularly in rural areas, where the shortfall in medical personnel is worst.

“It can get to you sometimes,” Maximo said of her job. “But I have tried for years to resist the temptation to quit. I became a nurse because I thought I could be of help. I still think I can be of help, but there are days now when I am convinced that my life could get better.”

Health experts warn that the country’s fragile health care system could collapse if this brain drain continues and if the government fails to develop measures to compensate for the lack of local nurses and doctors.

Every year, as many as 8,000 nurses leave for the United States, Continental Europe, Britain and Saudi Arabia and other Middle East countries. The United States and Saudi Arabia are the most common destinations, according to Philippine labor officials.

An additional worry is that, of these nurses, about 2,000 are trained as physicians but are paid so poorly that they decided to study nursing so they could find work abroad, thus seriously depleting the ranks of Philippine doctors.

Medical schools here produce only about a thousand doctors a year, while enrollment is declining fast – by 20 percent last year – forcing some medical schools to close down. The ratio of doctors to the population is 1 to 26,000, compared with an ideal ratio of 1 doctor for every 6,000 citizens.

The enrollment for nursing courses, meanwhile, has shot up from about 20,000 in 1999 to more than 40,000 last year, according to the Philippine Nurses Association. The demand for places has been such that even computer schools have started offering nursing courses.

“It’s a national crisis,” said Doctor Bu Castro, president of the Philippine Medical Association. He said the country’s health care system would “certainly collapse” if the trend continues.

In a recent paper, Jaime Galvez-Tan, a former health secretary, described the crisis not as a brain drain but a “brain hemorrhage.” He warned of a “worsening of the health crisis already plaguing our country.” Very soon, he said, “the Philippines will be bled dry of nurses.”

Manuel Dayrit, the present health secretary, called the migration a cancer, “not terminal but certainly serious.”

It has come to the point where some 6,000 doctors signed a covenant last week in which they pledged to stay and practice in the Philippines before they considered emigrating. A congressman earlier filed a bill requiring nurses and doctors to practice in the Philippines for two years before they are allowed to work abroad.

Two years ago, the World Health Organization issued a warning: “If the world’s public health community does not correct this trend,” said Doctor Gro Harlem Brundtland, the UN organization’s director general, “the ability of many health systems to function will be seriously jeopardized.”

Castro said the most vulnerable to the effects of the trend are rural areas, where most of the country’s poor live and where health care is, in many instances, nonexistent. He added that 80 percent of doctors in community hospitals in the rural areas are studying to become nurses.

Across the country, particularly in the countryside, most government clinics have only midwives, who act both as doctors and nurses. In clinics and hospitals in towns and small cities, the turnover of doctors and nurses is so rapid that administrators are complaining not only about the cost of training new nurses but also about the poor quality of service that such turnover creates.

New nurses often stay here for just three up to six months to gain enough experience and the credentials they need to apply for work abroad; consequently, hospitals and clinics are perennially staffed by trainees and interns, said Doctor Jojo Carabeo, president of Health Alliance for Democracy, a group of health workers.

“The mass production of nurses this year is massive, so many hospitals end up with no nurses,” said Doctor Edwin Cruzado, owner the hospital in Pikit, a town in central Mindanao, in the southern Philippines.

The next three months are crucial for Cruzado’s 10-bed facility: In addition to Maximo, its two other nurses also have pending job applications abroad. “I don’t know where to find their replacements,” Cruzado said. Ironically, he is also studying to be nurse.

The average salary of a nurse in the provinces is about $120 a month. In contrast, a Filipino nurse in the United States could earn $3,000 to $4,000 a month. The average salary of a government doctor in the Philippines is $300 to $800 a month.

“How can you not think of leaving?” asked Maximo, who earns about $110 a month. “I have to think about my family.”

There is, in sheer numbers, no shortage of nurses in the Philippines. About half of the 40,000 nurses who graduate each year pass the licensing exam, and fewer still are hired abroad. The problem, according to Ruth Padilla, president of the Philippine Nurses Association, is that they are not inclined to seek employment in hospitals and clinics here because of the low pay.

“What we have is a shortage of skilled nurses and doctors, and those who are committed enough to go to the rural areas,” Padilla said.

About Carlos H. Conde

Researcher at Human Rights Watch (@condeHRW @hrw_ph). Former journalist (NYT, IHT, among others).
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