Choy, Catherine Ceniza. 2003. Empire of Care: Nursing and Migration in Filipino American History. Quezon City: Ateneo de Manila University Press.
Undeniably, nursing is popularly known as a profession Filipinos take to work abroad and earn money for their needs and wants. Undoubtedly, Filipinos are not ignorant of the obstacles that come with securing livable nursing occupations. Despite the soaring nursing education costs, the competition for foreign employment, and the possibilities for a scam, they are willing to go through these just to achieve financial success. However, it’s often overlooked why this is the case — why, nursing, and why migrating abroad to the United States of America (USA) would be the pathway for economic mobility. Choy (2003), in their book Empire of Care: Nursing and Migration in Filipino American History, unpacks this phenomenon and historicizes why this pattern between nursing and migration in the Philippines exists.
The book details the development of nursing and migration in the American colonial history of the Philippines. Part I discusses how American colonial policy paved the way for pioneer Filipino nurses to take preference for learning, working, and eventually, living, in the USA. Chapter 1 provides how the institutionalization of American nursing as a gendered profession in the Philippines allowed Filipino women to take professional work outside of the household. The provided opportunities for training and experience in the USA also linked these Filipino women to higher-earning occupations in the country once they returned. Chapter 2 problematizes this that, as the development remains uneven between the Philippines and the USA, women started to see being in the USA not as means, but as an end.
Furthermore, Part II discusses the utilization of the United States (US) Exchange Visitor Program to permanently settle abroad, with Chapter 3 narrating its origin and development as a migration opportunity for Filipino nurses. Chapter 4 elaborates on the motivations held by nurses and on the pathways made available by different actors in the continuing movement of nurses. Moreover, Part III then problematizes the supposed economic mobility present in the migration, showing the costs incurred to Filipino nurses in these opportunities. Chapter 5 uses murder cases to detail their exploitation, while Chapter 6 details how nurses resist their exploitation. Finally, the book ends with exploring contemporary developments, arguing that the pattern has not abated and has only been strengthened in both US and Philippine public policy.
Throughout the book, Choy (2003) makes a relevant point in terms of other forms of migration in different countries. For them, migration choices are not individual calculi done in a vacuum, but institutions enable certain migration opportunities to be more attractive for individuals than others. US hospitals advertise to Filipino nurses through Philippine media outlets, attracting them in terms of wages, educational opportunities, and employment abroad. Travel agencies extensively refer to the travel opportunities available to nurses that would be working abroad through its destinations and stop-overs in between. Finally, both governments pursue policies that encourage migration, with US legislation making migration more accessible for nurses to fulfill the domestic demand for nursing and with Philippine policy encouraging nursing abroad to increase foreign currency remittances.
However, as not all nurses chose to migrate to the US, this invites further questions on the variance of migration choices, something that the book could have discussed sufficiently in making its theoretical argument. In other words, why do we still have Filipino domestic nurses despite the attractiveness of US employment? Are they made aware of the costs, or do institutions not reach them to encourage their migration from the Philippines abroad? Answers to these questions would not necessarily weaken the argument provided in the paper but make the pattern of migration more precise for individual choices. Furthermore, it would also serve to weed out explanations that may not hold looking at those who stayed, increasing the paper’s cognizance of nurses’ agency in the book.
Nonetheless, the book is extensively rich in its detail of the history of nursing and migration between the Philippines and the US, comprehensively contextualizing migration flows that capture its unique relationship in US colonialism and imperialism. While recognizing existing global structural incentives to migration, Choy (2003) asserts that the relationship occurs beyond these structures and is not just brought about by contemporary developments in labor and capital migration. This assertion alone justifies the importance of studying such a unique phenomenon. By providing historical evidence, nurse migration to the US is not simply reduced to brain drain but as a postcolonial remnant of US imperialism. This elevates the need to understand political decisions throughout history and not just remain within the contours of the global economy.
However, Choy (2003) could have selected better cases in highlighting the costs incurred by Filipino women as nurses in the US. They could have made use of the exploitative practices present during nurses’ transition to settle abroad, such as lower wages relative to domestic nurses, discrimination in terms of schedule and duty preference, and unreasonable cuts from travel agencies through statistical comparisons. Instead, they made use of murder cases to present narratives of racial discrimination. These cases are arguably infrequent occurrences that do not comprehensively cover all the exploitation that Filipino nurses experience in the US. Ironically, as Choy (2003) critiques the US public’s spectacle for violence, they have also participated in this spectacle by foregrounding murder, instead of other and plausibly more relevant cases.
Choy (2003) presents a picture that is relevant for scholars of different fields, as they weaved colonialism, imperialism, public policy, migration, and nursing together in a comprehensive historical narrative. Social scientists can appreciate the intersections between disciplines and deepen their analysis of migration not just as economic calculi, but also as political outcomes. Policymakers can make interventions to produce better labor conditions for Filipino nurses. Finally, the public can look at the popular acceptance for nursing abroad more critically. To sum, Empire of Care: Nursing and Migration in Filipino American History is both local to the Philippines and the US and yet transnational; it takes stock of Filipino nurses’ individual choices and yet embeds these choices with institutions and structures that continuously constrains these choices.
