Archive for January 2007
The Nurses Are Out
Filipino nurses are leaving the country in hordes, lured by higher salaries offered by Western countries.
Joanne (not her real name) has just submitted her resignation papers to the Office of the Director for Nursing of the Philippine General Hospital (PGH)
“I am leaving to work as a nurse in the United States,” said Joanne, who has been a nurse since 1996 and has a sister working also as a nurse in US.
Joanne is among the thousands of Filipino nurses who leave the country every year to seek for greener pastures in other countries.
In the state-run PGH, the country’s largest medical institution, about 15-20 nurses leave to work abroad every month, data from the nursing services office showed.
Joanne said that salaries in other countries are “more financially rewarding” and “tempting”.
“My sister earns as much as $34 (P1, 700) an hour in the States. Here, my monthly salary is just equivalent to a day’s salary of my sister,” said Joanne.
Exodus
Data from the Philippine Overseas Employment Agency (POEA) showed that 7,768 nurses went abroad in 2005. Saudi Arabia, the United Arab Emirates, Britain, Taiwan, Ireland and the United States are the main destinations of Filipino nurses who left in 2005.
“Our more experienced nurses are leaving the country so that leaves us with people who have only basic competencies to work in hospitals,” said Rita Tamse, deputy director or nursing services at PGH.
Tamse said of the estimated 300,000 Filipino nurses about 85 percent are working abroad and those nurses who chose to stay in the Philippines are overwhelmed by the number of patients they have to take care of.
“Ideally, the nurse-patient ratio should 1:5. Here in PGH and other hospitals under the government hospitals, the ratio is 1:15,” Tamse added.
The situation is more depressing at some hospitals in the rural areas where the ratio is one nurse for every 55 patients, according to a study by Jaime Galvez-Tan, a professor at the University of the Philippines. “Even the hospitals outside of Metro Manila are considered as partially closed because there are certain wards that do not have nurses anymore.
“There is inadequate manpower.” said Joanne. “Although you will learn a lot from working in government hospitals, it is difficult because you have so many patients to take care of that they do not receive the standard quality care.”
Global Demand
Experts say that the nursing diaspora is expected to persist as global demand for nurses escalate.
Tamse said that demand is expected to accelerate because of the Philippines’ trade agreement with Japan and the growing need from the United States.
“We have reached a new era where the demand for nurses is ten times more than during the 60s and 70s,”said former health secretary Jaime Galvez-Tan.
Tan said that the world needs about 20,000 – 50,000 nurses—ten times more than the demand during the 1960s and 1970s—because “people from rich countries started to have longer life span, therefore there is greater demand for health care.”
“It so happen that in their demand, they are wealthy and they could pay a higher price for their services for nurses that they need. There are also push factors like political instability, armed conflicts and malfunctioning o health care system in poor countries,” he added.
Competition
Tan said that the Filipino nurses will continue to benefit from this trend and rebuffed the claims that our nurses are facing threats from their counterparts in China and India.
“If you are a Chinese and you are the only child and you see China growing as a superpower, why will you migrate to the United States,” said Tan. “There is no way that the parent s will allow their son or daughter to leave.”
He added that the foreigners, particularly the Caucasians, prefer Filipino nurses over those from India and Sri Lanka.
“The Indians do not have the smiling face and the happy disposition,” he added.
Remittances
But aside from the growing demand, experts say that migration of health workers will continue because of the Philippine government’s dependence on remittances hamper the enactment of policies to control the diaspora.
World Health Organization’s representative to the Philippines Jean-Marc Olive, said, as quoted by Reuters : On one side you have a part of the government saying: ‘Let’s export as much as possible and let’s bring back money’. And on the other side, they are saying: ‘Hey come on, we are losing all our good guys.”
But aside from nurses, a tenth of the population in the Philippines is lured by high paying jobs in other countries and is driven by widespread poverty to work abroad. Remittances from these workers fuel local consumption, the main engine of the economy’s growth.
Remittances this year are ecxpected to reach $11.87 billion, the central bank said. From January to July of this year, remittances reached $7 billion,
Last year, the Philippine economy grew 5.1 percent from 2004, a figure which is at the top of the government’s forecast of 4.8-5.1 percent. Remittances reached $10.81 billion dollars and boosted consumption that makes up about 70 percent of the Philippines’s gross domestic product.
Nurse Joanne said it’s hard to leave the country but says she has to make the sacrifice to send her son to school.
“Life is difficult here because salary cannot make ends meet,” she said.
From MD to RN
That is according to Alliance of Health Workers (AHW), a group of medical workers in the Philippines, who cited the exodus of Filipino medical workers, particularly doctors and nurses as the main reason for the impending collapse of health care system.
The growing demand for medical workers abroad has caused the escalation of the exodus of nurses and doctors in the Philippines.
AHW said that from 2000-2003 alone about 51,850 nurses had left the country for greener pastures abroad. Meanwhile, the Philippine Medical Association (PMA) estimated that about 30 percent of the country’s 100,000 registered doctors have migrated to North America.
In the United States alone, there are 17, 297 documented Filipino medical doctors, a study by University of the Philippines professor Jaime Galvez Tan showed.
But what is surprising is the recent trend of doctors leaving the country to work as nurses abroad .Some 5,000 doctors had left the country to work as nurses from 2000 to 2004, according to AHW.
Serious
Former health secretary Galvez Tan said that this trend is very serious and will have severe implications to the already deficient Philippine health sector.
“Eight of out 10 doctors in the public sector is taking up nurses and most of them have already left abroad,” said Tan. “We have a small number of doctors working in the public sector and yet they are willing to work abroad as a nurse.”
Tan also said that even the private sector is affected because they are losing the specialists. A study by Tan showed that doctors studying nursing courses are surgeons, pediatricians, obstetricians, gynecologists, anesthesiologists and general practitioners who are between 25-60 years old.
“They do not see any career path in the country,” he added.
About 4,000 medical doctors are currently studying nursing.From June 2004-2005, 2,347 doctors took the nursing board examination, according to the Professional Regulations Commission.
Push and Pull Factors
Political instability, poor working conditions, threat of malpractice law and low salary and compensation are among the factors that trigger the exodus, according to a study, Brain Drain Phenomenon and Its Implication to Health.
“The push and pull factors are so strong enough to lure a 45-year old surgeon or a 35-year old obstetrician to still consider study nursing so that they can go the United States,” Tan added. “For many doctors, it is the easiest way out.”
Doctors in the Philippine public hospitals earn about 12, 500 pesos a month while those at private health institutions earn a monthly salary of 17,000. Meanwhile, according to the World Health Organization, a nurse in the United States or England would earn as much as $6,000 (300,000 pesos) a month.
The trend has forced some of the hospitals in the Philippines to shut down. According to the Private Hospitals Association of the Philippines, about 1000 private hospitals have closed down since 2000 due to lack of medical workers. That leaves the Philippines with only 700 private hospitals.
“Even the hospitals outside of Metro Manila are partially closed because there are certain wards that have no more doctors and nurses,” said Tan citing that three hospitals in Mindanao and two in Isabela province have no more doctors and nurses
The trend is expected to aggravate the already poor health sector in the Philippines. The World Health Organization estimates that there are 11 doctors for every 10,000 Filipinos. With the recent migration of doctors, the figure can become more alarming.
Government EffortsThe Philippine government, however, plans to enact a law that would control the exodus of Filipino doctors. One of these proposals, the National Health Service Act (NHSA),would ensure that the country will not run out of health professionals by controlling the departure of medical workers.
Moreover, the NHSA, would require the graduates of state colleges and universities to serve few years in the country before leaving.
“Because their tuition fees are subsidized, there should be a way that the government will be able to utilize the investment they had in the education of doctors and nurses coming from state colleges and universities,” Tan said.
Although some critics said that the NHSA would curtail the freedom of doctors, Tan said it should be pursued by the politicians.
“If human resources is indeed our main resources, then we should safeguard, nurture and protect it,” he said. “I hate to see the day that when a relative (of a goverment official) is brought to the hospital, the people there would say ‘sorry we cannot accept him, we do not have doctors and nurses.”
Everybody Wants To Be A Nurse
“I will definitely encourage my son to study nursing. It’s the best option, especially if he is able to go abroad.” said Joanne, who recently resigned from the Philippine General Hospital to work in the United States.
The Philippines, the primary source of nurses in the world, has sent an estimated 100,000 nurses abroad since 1994, according to a 2004 study “Brain Drain Phenomenon and Its Implications to Health” by professors from the University of The Philippines and every year, at least 20, 000 nursing positions are available in 32 countries
Joanne and her son, are among the thousands of Filipinos lured by the promises of the benefits of a nursing career—salaries as much as 300,000 pesos a month and even citizenship in other countries. And her son will have a number of nursing schools to choose from.
Mushrooming
Former Commission on Higher Education (CHED) consultant on nursing education Rita Tamse said that the hype over the nursing profession has caused the mushrooming of educational institutions offering nursing courses.
“In 2002, there are only 180 nursing schools. Now, we have 470 schools all over the country,” said Tamse who added that in there are more than ten nursing schools in some areas like Davao City.
“This is not a bottomless well. Some of the schools do not look at it that way. They just ride on the demand. We will never know if the demand will still be same ten years from now,” she added.
Tamse said that every year nursing schools in the Philippines churns out at least 15,000 graduates.
“Before the Nursing Law was amended, there was a ruling that the top 40 percent of the graduating high school class can pursue nursing study,” she said. “But it was scrapped
and now everybody can study nursing.”
The demand for nursing education has forced some schools to open many sections to accommodate more students.
“You will never believe it but there are schools that even have 100 sections of nursing students,” said Tamse who refused to identify the school.
The phenomenon has resulted to the dearth of nursing instructors and administrators that forced some of them to juggle teaching positions in various schools. According to former health secretary Jaime Galvez-Tan, there have been reports of “flying deans” or those who serve as deans in more than one school to fill up the position.
This scenario has alarmed the World Health Organization representative to the Philippines Jean Marc Olive who warned that it would compromise the quality of education.
While nursing schools benefit from the high demand, the medical schools, however, are not. Enrolment in medical schools has decreased and the number of students taking the National Medical Admissions Test dropped by 33 percent in 2004, according to Tan.
StandardsExperts, however, warned that with the mushrooming of educational institutions, the Philippine government should ensure that these schools meet the standards and produce competent graduates.
“Now the government is looking at the performance of its school in the examination,” said Tamse. “But many schools fall short of the expectation. There are schools that have a zero percent passing rate.”
Galvez-Tan said that from 1994 to 2004 there was a 22 percent drop in the number of students who pass the nursing board examinations.
Tan also said that despite CHED’s effort to close down nursing schools with poor performance, there are still schools that are still operating.
ASEAN Quotes
“Now the ball is in front of the goal. We just have to kick the ball in to have a goal.”
—India’s Minister of Commerce Kamal Nath, as quoted by Reuters, on the ASEAN-India Free Trade Agreement espected to be agreed upon in July
““All our leaders are very courageous. They are politicians in Southeast Asia, so they all must be brave. So they are all going to come.”
—ASEAN Secretary General Ong Keng Yong, as quoted by Agence France Presse, on the attendance of the delegates of the ASEAN Summit after bombings occured in the summit host Philippines the night before the regional meeting started.
“We have full confidence in our hosts.
—Singaporean Foreign Minister George Yeo, as quoted by The Daily Tribune, on the security measures on the ASEAN Summit in Cebu, Philippines.
Kids’ Top Ten Resolutions For their Parents
A survey commissioned by UK-based the Childline charity of the National Society of the Prevention of Cruelty to Children revealed the top resolutions for their parents:
10. To not shout
9. Consult about decisions
8. Give more responsibility
7. Work fewer hours
6. Listen more
5. Hand-out fewer chores
4. Buy presents
3. Treat children like a grown-up
2. Allow kids to stay up late
1. STOP SMOKING
For more information, click here
Million Thanks….
Apart from this long list of personas involved in this undertaking, I also like to thank some people who showed their unwavering faith in me to embark on this study. Their words of encouragement lessen the burden of writing this thesis.
2006 in Photos
With Mark, Apple Misada and Angeli
sister Joy and cousin Jerome at Baywalk,
By the way, I am their guardian.
FINAL DAY
With the people I met on a month-long internship
Gatecrashers at Makati Shang
Japheth Sareno,Kristene Kintana, Rhea Teves and Robert Siy
I also had my internship last summer at Reuters where I met some interesting personas.
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