"I should be thinking of the future of our kids"

February 3, 2005 -- Today National Public Radio's Morning Edition ran a very good report by Michael Sullivan, "Number of Philippine Nurses Emigrating Skyrockets." The balanced, comprehensive piece includes audio clips from a Manila hospital nursing executive, a senior nurse who is about to emigrate, the physician who directs the Philippines' National Institutes of Health, and government officials. The Philippines has long relied on remittances from workers abroad. But the fact that the nation is now exporting 15,000 nurses each year to developed nations like the United States, where they can make 20 times what they do in the Philippines, reportedly poses a serious long term threat to an already fragile and overburdened local health system.

The piece focuses on the prominent Philippines General Hospital in Manila. It describes the hospital as somewhat short of resources, but a provider of "first rate" care that used to have no trouble recruiting and retaining nurses the report describes as the "best" and the "brightest"--very unusual terms for the U.S. media to apply to nurses, and ones that all by themselves earn NPR and Sullivan a gold star. But now, in distressed economic times, the hospital is having just those problems. The piece includes an audio comment from the hospital's deputy director of nursing, who confirms that some of her best qualified nurses are leaving units like the ICU and the OR in order to support their families, and it "really affects the quality of care that we give to our patients." Later, Sullivan finds one of these senior nurses at the Philippines Overseas Employment Administration, where emigrants pick up required forms. This nurse, who has two young children, explains that her gold star life in the Philippines is not too bad, more or less average, and she is reluctant to leave. But she feels she has no choice but to go to the United States because economic conditions are getting worse at home, and "I should not be thinking of myself only, I should be thinking of the future of our kids." Of course, this is very sad, given what the loss of this senior nurse--completely understandable from her perspective--may mean for other kids in the Philippines.

For broader context, Sullivan consults the physician who directs the Philippines' National Institutes of Health. He warns that the insatiable appetite for Filipina nurses abroad and government indifference to the scale of the migration presents a health care crisis, which he says is moving from a "brain drain" to something more like a "brain embolism" (once again, a commendable emphasis on nurses' little-recognized intellectual qualities). He also notes that the situation is especially dire in rural areas, where some hospitals may have no nurses at all. The piece notes that Filipino physicians are also recognizing that they can make more money as nurses in the United States, and enrolling in nursing school--this last yet another critical point, since those who wrongly assume that nursing is merely a subset of medicine may believe that physicians can automatically be nurses. The piece also includes comments from officials of the Philippines government. In response to the concerns of health care leaders, these officials stress that the Philippines depends on the billions of dollars in foreign remittances to (as Sullivan puts it) "prop up its anemic economy," and they also contend rather vaguely that the nation actually does have enough nurses. They also argue that in the age of globalization, this kind of emigration is inevitable.

The piece might have explored the arguments some have made, especially in Europe, as to whether nurse-importing nations should impose restrictions on how nurses are recruited from nations like the Philippines. It might also have explained just how a lack of nurses affects care, i.e., what is it that nurses do that can mean the difference between life and death, between recovery and backsliding, between a good life and mere survival. This kind of information is critical to improving public understanding of nursing, which in turn is an essential part of helping the profession gain the strength it needs to overcome the global shortage. But given its more limited focus, the piece does a fine job, and we commend NPR and Sullivan for their work.

Listen to the February 3, 2005 story "Number of Philippine Nurses Emigrating Skyrockets." by Michael Sullivan on NPR.

Send your comments and notes of thanks to Michael Sullivan via the Ombudsman at ombudsman@npr.org

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