Filipino Nurses in the United States

Kelly Therese Pollock  0:00  
This is Unsung History, the podcast where we discuss people and events in American history that haven't always received a lot of attention. I'm your host, Kelly Therese Pollock. I'll start each episode with a brief introduction to the topic, and then talk to someone who knows a lot more than I do. Be sure to subscribe to Unsung History on your favorite podcasting app, so you never miss an episode. And please, tell your friends, family, neighbors, colleagues, maybe even strangers to listen too.

Today we're discussing the history behind the prevalence of Filipino nurses in the United States healthcare system. The archipelagic Republic of the Philippines is located in Southeast Asia. After explorer, Ferdinand Magellan arrived in the Philippines in 1543, it was colonized by Spain, and named Las Islas Filipinas in honor of Philip the Second of Spain. More than 300 years of Spanish rule left a lasting legacy in the architecture, language and food of the Philippines. In 1896, a secret military society called the Katipunan launched the Philippine Revolution to break from Spanish rule. It  wasn't the only conflict Spain was involved in. In 1898, the United States declared war on Spain, spurred on by the Cuban Revolution, where the US was backing the revolutionaries. The Spanish American War ended with the December, 1898 Treaty of Paris, in which Spain ceded Puerto Rico, Guam, and the Philippine Islands to the US, along with temporary control of Cuba. On June 12, 1898, the Philippine revolutionaries had declared independence from Spain. And on January 21 ,1899, the first Philippine Republic was established. However, the United States did not recognize the republic, leading to the devastating Philippine American war. In 1902, the Philippine Organic Act established an American civil government in the Philippines. The United States saw itself as a benevolent colonizer, believing they were bringing Christianity, civilization and public health practices with them. To that end, the United States established educational programs in the Philippines soon after it became a US territory. In addition to elementary and secondary schools, the Americans set up nursing training programs, with instruction and even licensure exams, all conducted in English. In 1916, the US Congress passed the Jones Act, which said that the US would recognize Philippine independence "as soon as a stable government can be established, therein." But they didn't set a date for such recognition. Filipinos repeatedly called for concrete steps to be established. And in 1934, Congress passed the Tydings-McDuffie Law, which was then accepted by the Philippine Legislature and which set up a 10 year transition period, after which the Philippines would be an independent country. In that 10 year period, World War II broke out, and the Japanese occupied the Philippines from 1942 to 1945. After the Japanese surrender, the United States recognized Philippine independence on schedule, with President Truman issuing Proclamation 2695 on July 4, 1946, and then with the signing of the Treaty of Manila. Independence would have limited immigration of Filipinos to the United States, but in 1948, the US created the Exchange Visitor Program. The goal of the Smith Mundt act of 1948 was to, "promote a better understanding of the United States and other countries and to increase mutual understanding between Americans and citizens of other countries." Under this program, foreign professionals could visit the United States for two years.

The program was not specifically designed for Filipinos or for healthcare workers. But Filipino nurses, already trained in American nursing practices, and with English language skills, made heavy use of the program. In 1965, the United States enacted the Hart Celler Act, also known as the Immigration and Nationality Act of 1965. As we've discussed on this podcast before, the new immigration system reduced the previous barriers to immigration that had been in place for non European immigrants. One of the preferences for immigration in this act was skilled employment. At the same time, the establishment of the Medicare and Medicaid programs in 1965 increased the need for trained nurses in the United States. Filipino nurses were needed in the US, and they faced stresses in the Philippines, including high rates of unemployment, political instability, and the devaluation of the Philippine peso against the US dollar, all of which made  emigration, and specifically emigration to the United States, particularly attractive. As today's guest, Dr. Catherine Ceniza Choy has noted, "By the early 1970s, a Filipino nurse in the Philippines, needed to work 12 years to earn what she could make in the United States in one year."

Philippine President Ferdinand Marcos saw the opportunity to create a labor export economy and the Philippine government began to encourage this out migration. Filipino nurses were specifically recruited to the US to serve on the front lines of nursing. This has been driven home during the COVID pandemic. A February, 2021 report by National Nurses United found that while Filipinos make up about 4% of registered nurses in the United States, they counted for a stunning 26.4% of the registered nurses who had died of COVID-19 and related complications. This is not a new phenomenon. In the 1980s, and 1990s, Filipino nurses were often on the frontlines of the AIDS epidemic as well, filling the least desirable nursing jobs and shifts. Joining me now to help us learn more about Filipino nurses is Dr. Catherine Ceniza Choy, Professor of Asian American and Asian Diaspora Studies, and Comparative Ethnic Studies at the University of California, Berkeley, and the author of both the 2003 book, "Empire of Care: Nursing and Migration in Filipino American History," and the new book, "Asian American Histories of the United States." Welcome, Catherine, thanks so much for joining me today.

Dr. Catherine Ceniza Choy  9:17  
Thank you for having me. It's a pleasure to be here.

Kelly Therese Pollock  9:20  
So this is just a terrific book. I'm really excited to have gotten a chance to read it early. So I wonder if you could talk a little bit about the inspiration which I know is not all happy. But you know what, why, why did you write this book now? 

Dr. Catherine Ceniza Choy  9:37  
Well, honestly, I started writing the book before, a few years before 2020, and before COVID-19 was declared a pandemic. But it wasn't until 2020 and 2021 that I started to really focus on the why, why I was writing this book. And I wrote the book in this context of the surge of anti-Asian hate and violence, in the context of the disproportionate toll of the pandemic on Filipino American nurses. And in many ways, these things were not new. And yet so many Asian Americans were experiencing this hatred for the first time or at a level of intensity that they hadn't before. And so it really came out of that, that very difficult time in our recent history. And the second thing that was happening was in 2020, many journalists started contacting me about why there was the surge in anti-Asian violence, and why historical context was important. And they also started asking me about why so many Filipino nurses are here in the United States and dying from COVID-19. And some of their questions were very straightforward, but also very basic in introductory questions to try to explain to the American public this longer presence of Asian Americans in the United States. And I realized that despite the progress Asian American historians and other scholars had been making, there was still so much more we had to do in terms of presenting Asian American history to a broader audience.

Kelly Therese Pollock  11:51  
Yeah, so in the title of this book, you talk about Asian American histories. And so I thought that was so compelling. And it's it's interesting to sort of think about this interplay, I think, between there being so many different stories, so many different histories, and yet also value in thinking about Asian American as a category. So I wonder if you could unpack that a little bit and talk about this idea of histories?

Dr. Catherine Ceniza Choy  12:20  
Thank you so much for that question. Initially, when I was writing and thinking about this book, which also came out of over two decades of teaching Asian American history, Asian American history and course titles, and in my original book proposal was in the singular and not the plural. But from the beginning of my career, I think this is true for so many Asian American historians, we grapple with the incredible diversity and the size, the continuing growth and heterogeneity of who is Asian American, and what does Asian American include. And it is such a difficult issue to deal with as an Asian American historian. And even before US immigration laws changed in 1965, there was already this difficulty in terms of summarizing and integrating the histories of the largest Asian American groups before 1965, which were Chinese, Japanese, Filipino, Asian, and Indian, and Korean American. And then after 1965, when immigration laws changed, we saw this incredible exponential growth of the Asian American community. And it now includes over 23 million people from over 20 countries from East Asia, Southeast Asia and the Indian subcontinent. And then on top of that, there's so many other kinds of diversity in Asian American communities. And so, for me, I feel that it is just so difficult to say that there's a singular Asian American history that encompasses this group, and hence in the title, and throughout the book, I emphasize that there are multiple Asian American histories, and this is a living history that continues to be dynamic and continue to grow. And we need to be open to that multiplicity.

Kelly Therese Pollock  14:44  
Yeah. And so I want to talk to them then about the organization of the book, because you're looking at sort of different moments in history, in Asian American histories, and yet drawing connections from the past to the present and back and forth, and so I wonder if you could sort of talk us through how you decided to take this massive amount of story and information and put it into a book.

Dr. Catherine Ceniza Choy  15:12  
Yes, that's always the challenge, I think with historical work is this aspect of synthesis of previous scholarly conversations about your topic, and then new research that has been done, and your own original research, and integrating all of those insights to create a narrative for the audience. And so that was a major challenge in this book. And so one of the unique aspects of the book is, I take a nonlinear approach to the organization of the book. And we're often accustomed to history books starting from one origin point back in time and then moving forward in linear fashion, to a more contemporary period or the present day. And I thought about that kind of chronological organization for the book. But then because of my experience, and the broader Asian American communities' experience in 2020 and 2021, I thought to myself, "I want to structure this differently and have each substantive chapter feature one calendar year. And rather than begin in the second half of the 19th century, I'm going to have chapter one begin with the year 2020. And move back in time." And so the chapter one is 2020. Chapter Two is 1975. And then it goes back to future particular years: 1968, 1965, 1953, and concluding with 1869. And then each of the chapters is not solely about that, or strictly about that calendar year, but rather that year, and some of the major events that that are happening during that year, serve as a touchstone for a particular theme. And then each chapter goes back in time to show longer histories of that theme or that moment, and also to our present day to show how these histories and these particular years and events still resonate, still resonate for us in the present, and that history truly is relevant.

Kelly Therese Pollock  17:56  
Yeah. I really appreciated it. I think it's, you know, some of the individual things you were writing about were things you know, I had known about, especially from researching for this podcast. But seeing all these connections and how they resonate, I think was was really powerful. And so I hope people will get the book and will see that piece of it. I wanted to ask too, you had these themes in the book. So you talk about violence, erasure, and resistance. And I feel like those are kind of the themes writ large of this podcast, although I've never expressed them in that way. So I wonder if you could talk about those themes, why those were the ones that you pulled out and sort of saw as recurring throughout these histories.

Dr. Catherine Ceniza Choy  18:40  
Thanks so much for that question. Those are the three major themes of the book. And it was challenging to say, here are these three themes, because there's so many themes in this growing group of Americans in the 21st century. And, again, going back to the year 2020 and 2021, as formative years, and experiencing not solely what was happening in terms of the pandemic and the surge in anti-Asian violence, but also the kinds of questions I was fielding from the media. Certainly violence was a major theme that came up and we say violence, it's one word, but it's really an umbrella category that encompasses so many different experiences. And oftentimes, what we're familiar with and what the media will portray, or, or analyze are the most egregious forms of violence, and there's certainly that in Asian American history, but then there are all these other forms, whether it's shunning in public places, spitting, bullying, verbal harassment, as well as arson, massacre, lynching. And then the second theme of erasure or omission of Asian American experience from US History more broadly, is something that I've been grappling with throughout my academic career and with my research, but I really wanted to say it in a very straightforward way that even in 2022, Asian Americans, and their histories are not integrated well in our educational system. They're not well known by the general public. And so Asian American scholars get the same questions again, and again, and the same kind of reactions, such as, "I didn't know that," about our history. And to, to directly respond to that I wanted to emphasize throughout the book, that part of this is the historical outcome of erasure and omission. And sometimes it's a benign neglect or forgetfulness. But sometimes it's intentional to uphold certain myths about US history. And then finally, the third theme of the book, which is resistance, was to say that Asian Americans are historical actors. We are not solely here in US history and have things done to us, that there is this longer history of Asian Americans who have fought back, spoken out, stood up, in a range of ways against their omission, their denigration, and dismissal, in the American experience. And then this is the part that can be empowering. And it can also be difficult to, to confront. But there's also strength, and even aspects of joy in the Asian American experience. And that's very important to remember.

Kelly Therese Pollock  22:44  
Yeah, yeah. I love that. So I want to turn to the Filipino nurses, specifically, who, as you mentioned, you've been studying for a very long time. I think it brought me back to we did an episode in May on Thai restaurants with Mark Padoongpatt, and you know, it's a similar kind of thing. Like everyone thinks, "Oh, Thai people, restaurants," and never question, "Okay, but why?" And so it feels like there's a similar sort of understanding in America like, "Oh, yeah, there's lots of Filipino nurses," but no one is saying, "But why?" So I wonder if you could talk a little bit about how you got into this sort of "why" question and the drive of your initial research into the Filipino nurses?

Dr. Catherine Ceniza Choy  23:33  
Sure. Well, let me first say that I really enjoyed that episode of your podcast with Mark Padoongpatt, and I'm also a fan of his research. And I love the parallel that and connection you're making between his work and how Thai Americans are so often associated or conflated with food and Thai foods specifically, and how this is a parallel to the Filipino American experience, where, if you are Filipino American, if people know something about Filipino Americans in the United States, they will associate Filipino Americans with health care, and specifically, nursing. And this was a topic of my dissertation research, which which became my first book, "Empire of Care." And it's a topic that started from my childhood. I was born and raised in New York City. I'm the daughter of Filipino immigrants. And growing up in Lower East Side Manhattan, one of my first and strongest memories, is the observation that so many Filipinos in my community were nurses. Now no one in my immediate family was a nurse. But so many of our neighbors, who are Filipino women were nurses, and they worked in the many different hospitals surrounding my neighborhood. And like so many Americans, I grew up, K through 12 not learning anything about Asian American, let alone Filipino American history. And as I started to become more serious about history in college, I realized that I wanted to go into a PhD program in history. And I wanted to document and analyze Filipino American immigrant experience, women's experience. And I returned to my childhood observation and that question, "Why were there so many Filipino nurses in New York City when I was growing up?" And that led to a primarily sociological literature about how, since 1965, there have been over 150,000 Filipino nurses who have immigrated to the United States that by the late 20th century, the Philippines had become the world's leading exporter of nurses to highly developed countries and that the United States was a leading destination. And so you have great concentrations of Filipino nurses in New York, but also in California, Texas, Florida, Massachusetts, Illinois, and and really through throughout the United States. So they're a highly visible presence. But even though they're more visible in the more contemporary period, late 20th, early 21st century, there's a much longer history of why it is US hospitals and other healthcare institutions have recruited and employed Filipino nurses. And it's a history that goes back over a century to US colonization of the Philippines. And that's surprising for a lot of people.

Kelly Therese Pollock  27:30  
So I want to dig into that sort of further-back history for a minute I and I want to sort of ask why your book is titled "Empire of Care" and talk a little bit about that empire. And then also this term that just sort of sends a shudder down my spine of "benevolent assimilation" that goes with that and sort of what what that means and how that leads to this sort of unintended consequence of the exportation of nurses.

Dr. Catherine Ceniza Choy  28:00  
Well, I titled the book "Empire of Care" to emphasize the major themes of why so many Filipino nurses are in the United States. And one of the major reasons is this theme of US empire and US imperialism, and how that larger history of us expansionism and empire across the continental, what we now know as the United States, but even across the Pacific Ocean, and into places like the Philippines was very much a part of this history of more contemporary migration. And then the care aspect is to refer to nursing as caregiving. And how part of US colonization in the Philippines, especially in the early 20th century, involved the establishment of Americanized hospital schools, which trained specifically Filipino young women to become nurses and caregivers, and train them in an Americanized nursing curriculum and compel them to learn the English language. And those specific aspects of an Americanized nursing curriculum and English language fluency would then become the preconditions for the mass migration of Filipino nurses that we see today. Care also refers to a kind of approach of the American colonizers who went into the Philippines and it relates to benevolent assimilation, which is a phrase that was historically used referring to a proclamation by US President William McKinley during that history, and this policy of benevolent assimilation, which signified that the United States was an exceptional colonizer. It was not a brutal or cruel imperial power, like other Western nations, but rather was coming as a friend to the Philippines and hence the the benevolent aspect of it. And so, "Empire of Care" is also referring to those themes of imperialism, caregiving, and, and benevolence. But there's a critique in the book that while this provided opportunities for young Filipino women in the Philippines, and provided opportunities for immigration and work in the United States, we have to remember that these Filipino nurses were often recruited and employed in the most difficult areas to recruit in the United States, and especially public inner city hospitals, in graveyard evening shifts in rural areas. And they were often restricted to work at the bedside, and at, you know, acute, acute, but also long term, but often that bedside care, which leads to their exposure and vulnerability to epidemics and pandemics like COVID-19.

Kelly Therese Pollock  31:56  
Yeah. And can you talk a little bit about the stereotype that Asian American stereotype and why that's harmful in general, but then specifically, in the case of these Filipino nurses, how this idea of being women and caregivers sort of plays into that stereotype, but then, you know, is ultimately kind of a dangerous way to envision people?

Dr. Catherine Ceniza Choy  32:21  
That's a great question. Because when we think about stereotypes for Asian Americans more broadly, things like the model minority will come up. And then when we think about stereotypes of Filipino Americans, specifically, the stereotype of the nurse or the caregiver will, will come up. And I imagine that some people might think, "Well, what's what's wrong with that? Because aren't these positive stereotypes and isn't this great branding to be thought of as some kind of model minority or as someone who is who is caring?" And in the book, I argue that these stereotypes are very harmful, actually, because they're flat, they're one dimensional, and they can turn in an instant, and lead to the dehumanization of Asian Americans were which we are witnessing in this moment, in this age of COVID-19. And stereotypes flatten an incredible multi dimensional experience. Not every Filipino American is a nurse. Many are in health care, but not all, all Filipino Americans are concentrated in nursing. And it's important to understand that nuance. And then there are many Filipino Americans, including myself, who aren't health workers, and who do a range of things in a range of industries. So it's harmful to limit one group's experience to one occupation. And while I think it is important to recognize the tremendous contribution that Filipino Americans and Filipino nurses specifically, have made to care and to caregiving for the most vulnerable populations, especially here in the United States, it is absolutely important to to emphasize that. And yet what's detrimental about the stereotype is that it assumes that Filipinos have an innate or natural ability to be caring, and it does away with the incredibly hard work of training to become a professional nurse, and all the nuances and the challenges of being a caregiver. And so those are some of the the main reasons why stereotypes are are harmful, even the seemingly positive ones.

Kelly Therese Pollock  35:09  
So you've also written about adoption and about adoption by white Americans of, of Asian babies. So, you know, there's this, in the wake of the Dobbs decision from the Supreme Court, there's this sort of response from certain people of like, okay, well, you know, adoption, adoption, you know, we'll adopt your baby, those sorts of things. I wonder if you could talk some about your research on adoption, and why it's not a sort of answer to just say, Well, let's just have a bunch of adoption," you know, so I wonder if you could just reflect on that.

Dr. Catherine Ceniza Choy  35:42  
My second book, "Global Families," was about a history of Asian international adoption in the United States. And it focused on the post World War II period, and then the decades following it, to show how that period of history was foundational for the United States becoming an international adoption nation, because the United States leads the world in terms of adopting children from overseas. And so many of those children came from Asian countries after World War II, after the Korean War. And in "Global Families," I point out that this history is nuanced and complicated. And that, even though, at that time after the Korean War, as as one formative moment, even though at that time, adoption was presented, especially by the media, and especially by independent adoption activists and advocates, as a form of humanitarian rescue, and there was just this very singular belief that it was the right thing to do, that we had to get those children out of Korea, and place them here in the United States in white Christian families. And it should be done as quickly as possible. And what we've learned over time, from many different historians, family historians, adoption historians, is that this was never a simple thing to do, and that it was quite complicated, and that there were some harmful effects. And sometimes these Asian children were moved from one abusive situation in their Asian country of origin to another one here in the United States. And we couldn't make, we shouldn't be making these assumptions that it is the best solution for the child. And we have to research it carefully and make sure that the placement is done in the most in the most ethical kind of way.

Kelly Therese Pollock  38:26  
So I have one last question for you. And that is, at the end of the preface of "Asian American Histories," you say, "And so I write in the way I wish to live, without fear. I write with a desire to see our nation move forward with a sense of collective purpose that emphasizes compassion and care for all. From my research and teaching. I've learned that Asian American histories can illuminate the way forward." I think I speak for a lot of Americans right now, when I say, I would also like to see the nation move forward with a sense of collective purpose. And so I wonder if you could just talk a little bit about the way that you see learning about Asian American histories as a way to to help us sort of think through where we go from here.

Dr. Catherine Ceniza Choy  39:10  
Well, thanks so much for engaging with the book. I appreciate that so much. And I think, in regards to Asian American history as illuminating the way forward, one of the things that I'm so struck by in writing this book, is that as difficult as it was to confront violence and the erasure of Asian American experience, I was left in awe after researching and writing each chapter with the way in which Asian Americans over time have fought not just for their survival, visibility. and their ability to thrive. But also it tried to extend that to the broader community. And that can be in terms of, well, taking care of Filipino nurses is about taking care of all American nurses, and all the people who come in contact with these nurses and caregivers. So it's not solely about a specific, their specific ethnic group, but about the broader community experience; or how Japanese American activists after World War II, and their internment and unlawful incarceration, wanted to make sure that this never happened, again, not solely for themselves and their families, but for any American group. Any immigrant should not be incarcerated without due process, and should not be associated with being a convenient enemy. So this reminds me that we're all in this together. And we really need each other to fight this pandemic, and the other existential crises that we're facing as a nation and a world.

Kelly Therese Pollock  41:39  
Yeah, thank you for that. So tell everyone how they can get "Asian American Histories."

Dr. Catherine Ceniza Choy  41:45  
You can get "Asian American Histories of the United States," wherever books are sold, from online, like bookshop.org, as well as other online sellers, like Barnes and Noble, and others. And you can also get it, if they don't have it in your public library or university, college, or school library, ask them to get it.

Kelly Therese Pollock  42:12  
Excellent. I'll put a link in the show notes. And it is such a readable book, I think everyone should go. And I think I think whether people have essentially no background in Asian American history, or know lots of stuff about Asian American history, they're gonna get something really meaningful out of this book. So I hope everyone will go pick it up. 

Dr. Catherine Ceniza Choy  42:31  
Thank you. 

Kelly Therese Pollock  42:33  
All right. Well, Catherine, thank you so much for joining me. I know I first reached out to you like a year ago to get you on the podcast, and I'm thrilled we finally made it work.

Dr. Catherine Ceniza Choy  42:42  
Yes, I am, too. And you can imagine, really last year where I was really just in the final stages of writing it and now it was it was a pretty challenging time. So thank you for your continued interest. I really appreciate it.

Teddy  43:02  
Thanks for listening to Unsung History. You can find the sources used for this episode @UnsungHistorypodcast.com. To the best of our knowledge, all audio and images used by Unsung History are in the public domain or are used with permission. You can find us on Twitter, or Instagram @Unsung__History, or on Facebook @UnsungHistorypodcast. To contact us with questions or episode suggestions, please email Kelly@UnsungHistorypodcast.com. If you enjoyed this podcast, please rate and review and tell your friends.