Empire of Care: Nursing and Migration in Filipino-American History

Empire of Care: Nursing and Migration in Filipino-American History By Catherine Ceniza Choy (Durham, NC: Duke University Press, 2003) (257 pages; $59.95 cloth; $19.95 paper). For nearly six decades, the Philippines has led the world in sending nurses to the United States when American supply of nurses wanes and demand for nursing care is high. Catherine Ceniza Choy argues that the roots of this phenomenon lie in the colonial connection between the two countries, and that the imperialist impulse continues to influence this unilateral nurse migration stream. Under this thematic premise, Choy crafts a historical account of the Filipino nurse diaspora that is contextually rich and accurate while exploring related issues of nursing's gender, race, and class stratification from both the sending and receiving nations. Organizing the book into three parts, Choy uses a plethora of primary and secondary source materials, along with interviews of forty-three Filipino nurses, to analyze the "culture of migration" (p. 4) implicit in Filipino nurses' transnational movement. In Part I, she examines the early twentieth century relationship between the United States and the Philippines and how American and Filipino nurses worked together and separately to shape the nursing profession in the archipelago. Early nursing development in the Philippines was mired in racism and power differentials that were accentuated by American nursing's feminizing efforts. Although both Filipino men and women trained as nurses, in time, Filipino women came to view the nursing profession as an avenue for adopting American work and academic values. By 1916, thousands of young Filipino women applied to nurse training programs in the Philippines, and dozens studied abroad in the United States. That English was an integral part of the curriculum in nurse training programs in the Philippines only facilitated the Americanization of Filipino nursing. Indeed, as Choy aptly demonstrates, the imperialistic linkage between the United States and the Philippines continued long after the country's independence in 1946. Part II traces the post World-War II migration of Filipino nurses to the United States through the Exchange Visitor Program (EVP). The EVP became an acceptable avenue for young, often single Filipino women to elevate their personal and family status. Travel agencies worked with nurse exchangees in "Fly Now, Pay Later" plans to expedite their journeys, much in the same way that later recruitment agencies would operate. Nurses needed only to deposit 10% of the travel costs and pay the balance over the one-to-two-year training period, paying exorbitantly high interest rates while doing so. Thus, the roots of exploitation, harbored in earlier colonialist relations, were revisited in a program touted as preparing nurses as "ambassadors of good will." It also became common knowledge that exchangees were used as lower-paid hospital employees. Exploitative practices unearthed in the EVP eventually motivated Filipino nurses to organize to improve their work conditions. Indeed, soon after Civil Rights legislation passed, the first Philippines Nurses Association (PNA) was established in Galveston, Texas, in 1967. The establishment of local PNAs in the United States coincided with a marked increase in Filipino nurse migration. …