AMAT Educational Series

Cultural Conversations – Understanding Filipino Nurse History and Working with Filipino Families

Hosted by the AMAT Asian Pacific Islander Committee

Chair: Sabrina Ho

Objectives

• Develop an understanding of Filipino nurse history from the Philippines to United States

• Explore Filipino nursing culture

• Overview of Filipino culture surrounding death/dying

• Best practices when working with Filipino families

A History of Filipino Nurses in the United States

Professor Catherine Ceniza ChoyUniversity of California, Berkeley

Department of Ethnic Studies

Presentation Objectives

• Give an historical overview of Filipino nurse migrations to the U.S.

• Identify some of the current developments of this phenomenon

• Reflect on Filipino nurse cultural beliefs surrounding medicine

Empire of Care: Nursing and Migration in Filipino American

History

• Co-published by Duke University Press and Ateneo de Manila University Press in 2003

• Documents the creation and development of a Philippine professional nurse labor force for international export

• Places a “human face” on the phenomenon of Filipino nurse migration

Why focus on Filipino nurses?

• Since the late 1960s, the Philippines has been the leading exporter of nurses to the United States

• By the late 1970s, the Philippines became the world’s leading exporter of nurses

• A 2005 study noted that Filipino nurses make up almost 40% of the internationally trained nurses in the US, with about 100,000 nurses or 3.7% of the total US nursing force.

Historical Overview of Filipino Nurse Migration to the United States

• Filipino nurse migration to the United States is not a 21st century phenomenon

• originated during the early U.S. colonial period in the Philippines

• U.S. colonial government created an Americanized training hospital system

“1915 Class and the Superintendent of the School of Nursing, Philippine General Hospital School of Nursing,” 1915-1916

“Senior Class Receiving Instruction in Operating-Room Techniques,” from Philippine General Hospital, 1915-1916

Maria Abastilla Beltran (left) prior to her departure to America in 1929

Historical Overview of Filipino Nurse Mass Migrations

• Recruitment of Filipino nurses to alleviate U.S. nursing shortages began in the 1950s and continued throughout the second half of the 20th century

• 1950s-1960s Exchange Visitor Program

• 1960s-1970s Occupational Immigrant Visas

• 1970s-present Temporary Work Visas (H-1)

• 1990s-present EB-3 immigrant visas

1965 Advertisement in Philippine Journal of Nursing: “Travel as a simple route to happiness”

1969 Advertisement in PJN Targets Exchange Nurses for Permanent U.S. Employment

Changing Attitudes About the Significance of Filipino Nurse Migration

• In the early 1900s, Philippine nursing was conceptualized as a form of nation-building

• In the 1960s, Philippine government criticizes exchange nurses who remain in the U.S. as national traitors

• Beginning in the 1970s, Filipino overseas nurses are conceptualized as national heroes

Past and Present Challenges Faced by Filipino Nurse Migrants

• Fraudulent recruitment practices

• Exploitive work conditions

• Resentment between “foreign” and “home-grown” nurses

• Language issues (testing; English-only)

Current Developments and Resources

• International export continues

• Reports of Philippine doctors enrolling in nursing degree programs to work overseas

• Ethical dilemmas continue

• Multiple generations of Filipino nurse migrants exist

• Philippine nursing organizations abroad are important resources (Philippine Nurses Associaton of America or PNAA)

Cultural Beliefs Surrounding Medicine

Filipino nurse training in and incorporation of Western medical practices is dynamic

•Persistence of traditional beliefs; for example, the significance of keeping the body intact for viewing and burial

•Fear of the unfamiliar and unknown

•The need for new narratives, educational resources, and community support

Catherine Ceniza ChoyContact information

Please feel free to contact me by email at

ceniza@berkeley.edu

The link to my faculty webpage can be found at

http://ethnicstudies.berkeley.edu/faculty/

Michael Munoz-Romero RN CCRN CPTCProcurement Transplant Coordinator

05/16/2013

How does Philippine law define “death”?

• j) “Death” - the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brain stem. A person shall be medically and legally dead if either:

(1) In the opinion of the attending physician, based on the acceptable standards of medical practice, there is an absence of national respiratory and cardiac functions and, attempts at resuscitation would not be successful in restoring those functions. In this case, death shall be deemed to have occurred at the time those functions ceased; or (2) In the opinion of the consulting physician, concurred in by the attending physician, that on the basis of acceptable standards of medical practice, there is an irreversible cessation of all brain functions, and considering the absence of such functions, further attempts at resuscitation or continued supportive maintenance would not be successful in restoring such natural functions. In this case, death shall be deemed to have occurred at the time when these conditions first appeared.The death of the person shall be determined in accordance with the acceptable medical practice and shall be diagnosed separately by the attending physician and another consulting physician, both of whom must be appropriately qualified and suitable experienced in the care of such patients. The death shall be recorded in the patient’s medical record.

Superstitious Beliefs

• Have grown in number throughout the various regions and provinces in the country.

• These beliefs have come from the different saying and superstitions of our ancestors that aim to prevent danger from happening or to make a person refrain from doing something in particular.

• These beliefs are part of our culture, for one derives their beliefs from the influences of what their customs, traditions and culture have dictated to explain certain phenomena or to put a scare in people.

• Some are practiced primarily because Filipinos believe that there is nothing to lose if they will comply with these beliefs.

Superstitious Beliefs about death

Superstitious beliefs

• When a member of the family has persistent fever, the spirit of a deceased relative is presumed to remind the family of an unfulfilled obligation to the departed soul.

• To scare the spirits away and to cure those afflicted by the evil spirits, the curative practices are: to flog the patient, put signs of the cross on his forehead or at every post of his house, and make all kinds of noises; sacrifice some live animals or offer some food, buyo and oil to appease the offended spirit; and wear amulets (anting.anting) to neutralize the machinations of the devil.

• When a sick person is seriously ill or is pronounced by reputable physicians as hopeless or incurable, he and his family have that instinctive urge to resort to the cure of the magicians, wizards, sorcerers, voodoos, mystics, conjurers, manghihilot (sprain curer), herbokirios, or faith-healer, be it of dubious value. Remorse comes if they do not resort to such a practice because as a result of breaking away from old beliefs and practices, someone in the family might keep saying ever afterward, If only we had done this, the patient might have pulled through.

Some more:

• After a person dies, his soul wanders around, for a time at least, before it goes to its final assignment. To keep this soul from molesting the bereaved family, relatives, and friends, and to coax it to go to its resting place, a novena should be recited for nine consecutive days.

• Friday the 13th is an unlucky day-doubly unlucky-for anyone who does any business, work, or operation.

ASSESS THE FAMILY

EXPLORE

Further explore

Organ Donation in the Philippines

Organ Donation

The Stolen-Kidney Myth

• The original story comes from a "friend of a friend/cousin/neighbor" who is supposed to have walked into a bar and met an extremely beautiful girl who allows herself to be seduced by the friend.  After a few drinks they go to a nearby hotel/motel.   The next thing he remembers is waking up in a bathtub, filled with ice and a fresh incision scar on his back.  Consulting his doctor he finds out that one of his kidneys had been removed and is warned that there is a syndicate specializing in stealing kidneys from healthy looking people, drugging them and performing the surgery in a hotel/motel room.  The kidneys are then sold to wealthy people who need the organ

Organ Donor Card

• In the Philippines, this is only INTENT to donate.

The Donation Conversation

The Donation Conversation

The Donation Conversation

Questions?

Next AMAT Educational Series Webinar

June 6, 2013, 2pm ET

Increasing Donor Designations through Partnerships in the African American Collegiate Community

2013 AMAT Annual Conference