Empire of Care: Nursing and Migration in Filipino American History (review)

Abstract

Reviewed by: Empire of Care: Nursing and Migration in Filipino American History by Catherine Ceniza Choy Arleen Garcia de Vera Empire of Care: Nursing and Migration in Filipino American History. By Catherine Ceniza Choy. Durham and London: Duke University Press, 2003. In Empire of Care, Catherine Ceniza Choy delves into the historical factors behind the emergence of the post-1965 international labor migration of Filipino nurses to the United States. Critical of past approaches that enfolded this migration into a larger spontaneous “brain drain” of Asian professionals and that portrayed these immigrants as taking advantage of the better salaries offered by industrial nations beset by labor shortages, Choy also challenges these approaches’ assumptions about American exceptionalism and the benevolence of American empire in the Philippines. Her thesis rests on four elements. Rather than a recent phenomenon set in motion by the liberalization of immigration laws, the waves of nurses to the United States originate with early twentieth century American colonial rule in the Philippines. Hence, the willingness of these women to leave is due not only to economics but also to cultural desires fashioned by America’s history of empire. Furthermore, the racialized social hierarchies first established under imperial rule continue into the present. Finally, the migrations of these nurses are not one-time journeys but transnational processes. Together these phenomena constitute what Choy calls an “empire of care.” In its early manifestation, this empire of care describes the hierarchical relationships between American supervisors and administrators and Filipino nurses and the transnational ties that facilitated the movement of the latter back and forth between the two countries. After independence, these connections continued and expanded further with globalization, creating in their wake uneven and exploitive relationships between developing and industrialized countries in the access and provision of health care. The resulting imbalances can be severe. During the 1970s, for example, when shortages created a demand for foreign-trained nurses in Canada and the United States, the ratio of nurses to every 10,000 persons in those two countries was fifty-seven and fourty-nine, respectively. By comparison, the ratio in the Philippines was only eight for every 10,000 (113–114). This study offers rich, new insights into the workings and consequences of American empire. During the first few decades of the twentieth century, American administrators sought to institutionalize Western medicine by setting standards for the education, training, and licensing of professionals. Though improving public health and sanitation and recruiting Filipinos into the health fields appear benevolent, there were exclusionary and coercive aspects to this story of “progress.” As Choy demonstrates, undercutting the progressive nature of this enterprise were racialized assumptions about Filipino capacity and hygiene. This led to a hierarchy of American nurses as supervisors and Filipino nurses as subordinates, a hierarchy reflected in segregated dormitories to keep American nurses from Filipinos who were seen as carriers of disease. Despite their “inferior” status, Filipino women circumvented or remade policies, thus exerting control over their own lives and helping to shape the broad outlines of colonial society. Most significantly, Choy traces Filipino nurse migration back to American colonialism. The American system produced nurses whose training and English fluency better suited them for work in American hospitals and whose colonial outlook encouraged them to prize, if not seek out, opportunities in the United States. Especially valuable are the analyses of the larger implications of these migrations for both societies. It details step by step how transnationalism was institutionalized on a larger scale, from pensionados whose travels strengthened transnational ties between metropolitan society and the homeland, to United States-sponsored professional exchanges that cemented international relations in the face of concerns over the Cold War, and the active efforts of United States and Philippine hospitals and travel agencies to recruit Philippine professionals. On the United States side, Choy pays careful attention to the experiences of Exchange Visitor Program nurses and their attempts to cope with hospital abuses. She also shows the cultural effects of these transnational migrations. During the 1970s, amid the growing disillusionment over the Vietnam War and tensions over foreign nurse graduates, the welcome accorded Filipino nurses eroded, degenerating into battles between nursing organizations over licensure. Also examined are transnationalism’s...