Coronavirus pandemic

Philippines paying the steep price of being largest nurse exporter

Nurses and healthcare workers gesturing love in celebration of Nurse Week and International Nurses Day outside Mt Sinai Queens in the Queens borough of New York City last Tuesday. ProPublica reported that at least 30 Filipino health workers had died
Nurses and healthcare workers gesturing love in celebration of Nurse Week and International Nurses Day outside Mt Sinai Queens in the Queens borough of New York City last Tuesday. ProPublica reported that at least 30 Filipino health workers had died in the New York-New Jersey region since the end of March. PHOTO: AGENCE FRANCE-PRESSE

It had become so bad that at one point, all she was dreaming about was blood.

"It was just blood everywhere," Ms Romina, one of close to 20,000 registered Filipino nurses now living in Britain, told The Straits Times.

In March, when Britain was in the grip of the Covid-19 pandemic, over a dozen beds at her paediatrics unit were sequestered for patients with the coronavirus. By then, the disease had already killed more than 40,000 and infected close to a million as it raced from Wuhan, in China, where it was first detected, to every corner of the world.

By the end of last month, Britain had close to 30,000 deaths from the virus, at least 29 of them Filipino nurses.

Ms Romina, 50, who asked that she not be identified by her real name because her hospital had not authorised her to grant interviews to journalists, knew one of those nurses. That nurse was a few years older than she was, and was more an acquaintance than a close friend. Still, her death cut deep.

"It was 20 years ago. I remember her serving us food when we first reported for work at the hospital."

What really got to Ms Romina, though, were her patients. Every one of them was at death's door, and they were alone. Many died without touching or even seeing in person their spouses, children or siblings.

It fell to strangers like Ms Romina to hold their hands as they took their final breaths.

Once, a 54-year-old woman was rolled into her ward. "She was already very sick… She was insulin-dependent," said Ms Romina.

The woman was a Filipino who had been a maid in London for more than 20 years. She never married. Her only family was a niece she had helped put through school and who was working in Bahrain.

Ms Romina recalled holding a phone to the woman's face. On the other end was her niece.

"Her niece kept crying. She kept asking me to help her aunt. All I could tell her was, 'We're doing everything we can.' But her aunt was too far gone… She died moments later," she said.

Ms Romina later found a quiet corner and wept. "I thought I already had a heart of stone," she said.

Most of her Covid-19 patients were on ventilators, and in rooms that were hot; the air-conditioning has to be turned down low and a fan cannot be used to reduce the risk of the air inside flowing to other rooms and contaminating them.

"It's like being in hell," said Ms Romina.

It is not just the hot Covid-19 rooms. She also has to don a fitted mask, a hazmat suit, goggles, and head and feet covers. They wear these for three hours, three times a day. They get 45-minute breaks in between to eat and relieve themselves. One time, Ms Romina said, she was in protective gear for seven hours straight.

Still, she counts herself lucky. Her unit is well-provisioned for an outbreak. Many of the nurses who fell ill were likely infected by patients in general wards who exhibited very mild symptoms or none at all. Thus they did not have anything on but a mask.

Mr Donald Suelto, 51, was not wearing a mask or a plastic shield when a patient at the chemotherapy department at Hammersmith Hospital in west London coughed in his face on March 25.

He was sent home three days later after that patient tested positive for coronavirus. Four days into his isolation, he developed a fever and was coughing.

He called his mother and told her he probably had the virus, and that it "felt like being stabbed with a knife all over my body".

He was told to call a Covid-19 hotline, but he complained to a friend on April 5 that he could not get through, and feared that he might not make it. That was the last time anyone heard from him.

On April 7, police found his body inside his flat. He had died alone.

This is the story of many other Filipino nurses not just in London, but all across the globe, in places where the virus has hit the hardest and killed the most.

ProPublica reported that at least 30 Filipino health workers had died in the New York-New Jersey region - the "epicentre of the epicentre", said a community organiser - since the end of March.

One in four Filipinos in the New York-New Jersey region works in hospitals and other medical fields.

Over the past two weeks, two Filipino nurses in Dubai were reported to have died of the virus.

In many other hospitals - in Italy, Germany, Spain, Saudi Arabia, Japan and Singapore - Filipino nurses are on the front lines, often also among the first to get infected.

This is the price the Philippines is paying for a decades-old immigration policy that has turned the nation into the world's largest exporter of nurses.

The Americans built hundreds of nursing schools in the Philippines. The intention was to create a pool of Filipino auxiliary nurses to help the US deal with its own outbreaks of cholera and malaria.

That set off a wave of migration to the US. Nursing became a path to a better life for tens of thousands of poor and middle-class Filipinos, an escape route from political instability and crushing poverty back home. By 2017, immigrants from the Philippines accounted for 28 per cent of the 512,000 migrants working as registered nurses across the United States.

In time, Filipinos would also answer the call for nurses in Europe, the Middle East, Australia, New Zealand and elsewhere in Asia.

The Philippines produced about 26,000 licensed nurses each year from 2012 to 2016. About 18,500 moved abroad each year during the same period.

The incentive to leave is compelling. State and major private hospitals at home offer starting salaries of about 25,000 pesos (S$700) a month, but in the provinces, the pay can be as low as 3,000 to 6,000 pesos.

A nurse could earn about five times more than the top salary abroad, especially in the US and Saudi Arabia.

But many often end up working the least desirable jobs and shifts.

It was part of a historical pattern, Dr Kevin Nadal, a professor of psychology at John Jay College of Criminal Justice and The Graduate Centre of the City University of New York, told ProPublica, of "immigrants doing a lot of the dirty work that people don't want to do… being painted as heroes, when in reality they are put in these positions only because their lives are viewed as disposable".

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A version of this article appeared in the print edition of The Straits Times on May 19, 2020, with the headline Philippines paying the steep price of being largest nurse exporter. Subscribe