Diana Laxamana broke into a sweat. Her heart raced. Her stomach knotted. Thoughts swirled through her head as she processed the information her coworker had just disclosed: Laxamana, the assistant director of nursing at a senior living community, had been in contact with a nurse who’d been exposed to a confirmed COVID-19 case at another facility.
Immediately, she called her husband and asked him to prepare their spare bedroom. Since she didn’t drive, he picked her up like he usually did after her shift, but this time, she climbed in wearing an N95 mask, goggles, and gloves, and didn’t kiss or hug their two-year-old daughter hello. The whole ride home, she tells me that she tried to breathe as little as possible.
As soon as they arrived at their Seattle home, she beelined to the spare bedroom, where she self-quarantined for 14 days, the amount of time it can take for COVID-19 symptoms to appear after exposure. Her husband left her meals outside the room and she locked the door, despite her daughter’s heartbreaking pleas to join her inside. Since she had only a secondary exposure to COVID-19, though, she still went to work.
Laxamana and I are both 33. We’re related by marriage, and our moms attended school together in the Philippines. My memories of her revolve around playing outside, sweaty and spent, in our families’ hometown of Quenabuan in Santa Ana, Pampanga when I visited as a kid. She immigrated to the U.S. in 2016, joining the droves of Filipino nurses in search of opportunity overseas.
Recently, reports have surfaced that the coronavirus pandemic has dealt a disproportionate blow to the Filipino community, whose members account for a large fraction of nurses in the US and elsewhere. Of course, that's not to say Filipino nurses or other healthcare workers are any more heroic than those of other ethnic backgrounds. But certain factors might make them more likely to put themselves at risk, E.J.R. David, a Filipino-American professor of psychology at the University of Alaska Anchorage, tells me. When most of us Filipinos work in healthcare, or have loved ones who do, this can have major implications for our physical and mental health, as well as the very fabric of our community.
The Philippines is a huge exporter of nurses. Out of the 26,000 licensed nurses it churned out between 2012 and 2016, around 18,500 relocated overseas every year within that time frame, Bloomberg reported, based on government data. According to STAT, Filipino nurses account for an estimated 4% of nurses in the U.S., although in some places — like my home state of California, where almost 20% of registered nurses are Filipino — they comprise a far larger proportion.
The story behind why so many Filipinos enter nursing is steeped in American colonialism. Shortly after Spain surrendered the Philippines to the U.S. in the late 19th century, Americans established their educational system on the islands, according to the Associated Press. To quell resistance to colonialism, they framed it as a benevolent act, and the US as “the land of opportunity,” David explains. Nursing schools became a training ground for U.S.-bound nurses, he says. In fact, most of the instruction was in English.
Filipino nurses first arrived en masse in the U.S. in the wake of World War II, under a program designed to expose people from other countries to American culture in order to resist Soviet propaganda, per the AP. The passage of a law that allowed residents to petition family members to live in the U.S., and hospitals to grant green cards to nurses they recruited from overseas, ushered in the second wave after 1965. Amid a shortage of nurses post-World War II, American hospitals ran ads specifically for Filipino nurses.
Over time, job opportunities in the Philippines dwindled, leading to a “brain drain” of highly trained people, including nurses, David explains. To this day, many Filipinos pursue nursing in hopes that it’ll allow them to move to the U.S. And, as Berkeley News points out, several U.S.-born Filipinos enter nursing, too. I've seen my FilAm friends' parents encourage it as a stable, secure career.
For a while, Laxamana accepted that she wouldn’t attend college — her family couldn’t afford it — until her uncle agreed to pay her way, as long as she studied nursing, back when nursing opportunities abounded in the Philippines. Later, her other uncles chipped in, too. But her funding situation remained shaky. Every semester, she said goodbye to her friends, unsure if her funding would run out and make it her last.
She finally received her nursing license in 2006 — but by then, the field had grown oversaturated in the Philippines. Hospitals required newly-minted nurses to work for free before promoting them to a position that offered minimal pay, which wouldn't happen until a full-time employee resigned. Laxamana tells me this was common practice at the time. Many, many Filipinos had trained as nurses, only to find that there were no jobs available for them.
So she volunteered at a government hospital in Pampanga for a year, without benefits. All she received after volunteering was a certificate of "employment." But employment agencies would required nurses to earn it in order to apply for positions abroad. "So we sacrificed and worked for that paper," Laxamana says.
Many of us Filipinos see our intense work ethic, our self-sacrificing nature, our cheer in the face of hardship, as sources of pride. And yes, these traits are noble — they're also exploitable.
Employment agencies also required them to have at least two years of working experience before they could apply for positions overseas, she explains. Some didn't count volunteering as working experience, but with no job openings in sight, she took a risk and volunteered anyway. "Everyone's goal then was to get out of the country."
She passed the NCLEX, the licensing exam that would allow her to practice in the U.S. Then, she began another volunteer position in Pampanga. A year later, she landed a paid position — although she worked for only around $180 a month and had to commute four hours a day. She later started a higher-paying job in Manila before finally immigrating to the U.S. when she was 29.
Laxamana says she’s noticed that in the U.S., Filipino nurses have a reputation for being especially resilient. “If you call them to work, they will come,” she tells me. “We will do our very best, even if we’re already bleeding.”
Many of us Filipinos see our intense work ethic, our self-sacrificing nature, our cheer in the face of hardship, as sources of pride. And yes, these traits are noble — they're also exploitable. I can't help but think, of course the powers that be want us to celebrate working ourselves to death without complaint.
I worry about the strong, selfless Filipina nurse archetype, especially in a pandemic. When I ask David what it could mean for Filipino healthcare workers, he notes that, without data, we can’t conclude whether they’re more likely than other health workers to risk their lives.
“If you call them to work, they will come,” she tells me. “We will do our very best, even if we’re already bleeding.”
That said, he thinks many feel added pressure to push onward because they’re on work visas, and/or supporting family members back home. In the Philippines, remittances sent by loved ones working abroad are a big help in covering food and other living expenses, CNN Philippines reports. Last year, they accounted for almost a tenth of the country’s economy.
Sending money home is a central aspect of the Filipino immigrant experience. My mom has helped support her family in the Philippines pretty much since she arrived here; it’s just what you do. Besides providing for her husband (who parents full-time) and their daughter, Laxamana sends money to her parents, and normally, so do her two siblings, who work in Japan and the United Arab Emirates.
But since COVID-19 has resulted in closures of some of the remittance centers where they live, she needs to pitch in extra. Even though her parents understand her situation, she still feels heightened pressure to provide, which makes sense — filial piety is a big deal in Filipino culture.
David thinks the cultural value of “Bahala na” might also make Filipino healthcare workers more vulnerable. The phrase means “come what may, almost like, ‘I don’t care what happens, I’m going to go out there and do what I need to do," he says.
I’ve noticed my mom adopt this attitude in hard times, reassuring me God would find a way. Kevin Nadal, a professor of psychology at John Jay College of Criminal Justice at City University of New York, told NPR it has roots in centuries of colonialism, which forced Filipinos to resign themselves to their circumstances as a way to cope. Perhaps Spanish colonizers exploited it, not unlike how some white Christians used the Bible to justify slavery. David, though, says it may be less an act of resignation as it is an act of resistance and courage in times of difficulty. And it may make Filipino healthcare workers more likely to endanger themselves.
Finally, if Filipino healthcare workers do have a higher threshold for risk, the belief that their experiences pale next to the conditions they endured in the Philippines might be another contributing factor, David explains. Laxamana says the challenges she deals with now, like acquiring enough PPE for her facility amid shortages, have intensified her stress. But they still don’t compare to what she went through as a nurse in the Philippines. She tells me of a time she worked unpaid for 24 hours straight. “Once you become a nurse in the Philippines, they treat you like a maid” — at patients’ beck and call, in other words, for very low wages.
Coverage of the Asian community amid COVID-19 has largely, and rightfully, focused on racism and xenophobia — but “that narrative doesn’t capture the Filipino experience with this pandemic,” David says. Only 5.5% of about 1,500 people who reported coronavirus-related racist incidents to Asian Pacific Policy & Planning Council and Chinese for Affirmative Action were Filipino.
On the other hand, many of us work in healthcare, David says, or know someone who does. Besides Laxamana, at least three of my friends or relatives work in healthcare, and I worry about them. I can’t imagine what others, who have multiple immediate family members on the front lines (I know one whose parents are both nurses) are going through.
“The Filipino diaspora is highly, highly concerned that they, or someone they deeply love and care about, might be infected by COVID-19,” David says. “There’s a lot of anxiety. There’s a lot of distress perhaps… There might be some trauma too in people who have lost loved ones.” At least 30 Filipino healthcare workers — and even more in their extended families — have died since late March just in the New York-New Jersey area, ProPublica reports.
On top of that, we’re more likely to have underlying health conditions that may increase our risk of serious COVID-19 illness, David says. A recent study of various Asian subgroups in California found that "Filipinos had the most disparities." They were more likely than white Americans to be in fair or poor health, and overweight or obese, as well as to have asthma and diabetes, a reality that remains obscured when looking at Asians as a single category.
As David points out, the impact of COVID-19 on Filipino health workers comes as no surprise to those of us in the diaspora. That it hasn’t received as much as attention as an Asian narrative in this pandemic reflects what he views as a larger problem of Filipino invisibilization. “If people care about justice and people care about inequities, if those truly are American values that they care about, then they will care about Filipino healthcare workers right now.”