Importing nurses: a money-making venture
by Grace Chang Currently, there are 100,000 registered nurses in the Philippines, but almost none actually reside in the country. Similarly, 90 per cent of all Filipino medical school graduates do not live in their country. Since the 1970s, the United States has imported women from the Philippines to work as nurses, ostensibly in response to domestic shortages in trained nurses. This importation system became institutionalised in the H-1 nursing visa, which enables a hospital or nursing home to sponsor or bring a nurse with a professional licence from abroad to work in the USA for two years. Under the H-1 program, an applicant must take the US nurses' licensing exam. If she passes, she can gain permanent residency after two years. During those two years, she is nearly captive to her original sponsoring employer. If she fails the exam, she loses her sponsorship and technically must leave the country. More often, such women go underground until they can take the exam again. Sometimes, they work in nursing homes, where they are paid as little as US$5 an hour; others arrange green-card marriages. In 1988, the Filipino Nurses Organization fought for the Nursing Relief Act, which has provided some rights and stability to H-1 nurses in the last decade. The law grants nurses permanent residency after five years of living in the United States and working in the nursing profession. Mayee Crispin, a Filipino nurse, organises H-1 nurses at St Bernard's Hospital on the south side of Chicago. At St. Bernard's, 80 per cent of the nurses are single Filipino women on H-1 visas. The starting wage is US$14 an hour, in contrast to US$16 an hour at other hospitals, and the ratio of patients to nurses is high. But many of the nurses are reluctant to organise, fearful of losing their jobs, or their employer's immigration sponsorship, if they are identified as being pro- union. Many are sending remittances to their families at home and struggling to pay off their debts from migration. Crispin proposes that importing nurses from the Philippines is a moneymaking venture for hospitals and the nursing recruiters they contract. According to Crispin, a hospital typically gets workers from overseas by making an official certification that it cannot find US workers to fill its nursing positions. (This is usually because the hospital offers wages that few US workers are willing to accept.) The hospital is then free to contract a recruiter to go to the Philippines in search of nurses. A nurse must pay, on average, between $7,000 and $9,000 to the recruiter. Since most women cannot afford this fee, they agree to have it deducted from their wages. After paying off such fees and sending roughly 25-30 per cent of their wages to their families at home, their monthly wages disappear quickly. In essence, most of these women live in a situation much like indentured servitude or debt bondage for at least two years. Crispin says that hospitals, by hiring migrant nurses, not only get cheap labor, they also get a workforce that is extremely vulnerable, fearful, uninformed of its rights, and thus likely to resist unionisation. With few US citizens going in the field or willing to work for such low wages, many Jamaican and Filipino women migrated to the US to do this work. With the downsizing in health care, many of those same nurses who have been in the US for more than a decade are now finding themselves just as vulnerable as new immigrants.
* * *Grace Chang is a writer, activist, and mother of two. This article appeared in Dollars and Sense a bi-monthly publication of economic issues and opinion.