P H I L I P P I N E S
Health System Suffers Brain Drain
by Marites Sison
MANILA — "When will we ever be a family again?" Nelfa's five-year-old son asked when she came home to the Philippines for a five-week vacation from Britain, where she has been working as a nurse for 14 months.
Fighting back tears, Nelfa struggled to explain that despite her absence, they were still a family and that she was working abroad only to save for the future.
"My son didn't think we were a family because I was constantly away," she says, arguing that society's definition of a family should have adapted by now to realities shaped by more than three decades of overseas work, which has split millions of families.
Yet she feels she had no choice when she packed her bags in mid-May.
Nelfa used to have a stable job as a nurse for a government hospital. But the lure of a huge salary in Britain was irresistible: She was earning 11,000 pesos (200 U.S. dollars) a month in the Philippines, compared to at least 1,287 pounds (about 1,800 dollars) there.
Some nurses earn as little as 5,000 (100 dollars) a month.
"We have to be practical," says Nelfa, whose husband is a community doctor. "Our children are growing and we can barely afford to raise them with the rising cost of living here."
Nelfa, a graduate of the state-run University of the Philippines, says she was among the fifth batch of Filipino nurses to arrive in Britain when the European Union opened its doors to foreign nurses last year.
The Philippines is already the largest exporter of registered nurses to foreign countries, says the World Health Organisation. Official statistics put their number at 250,000 , coming from a country where an average of 2,600 people leave daily for overseas work.
Filipino nurses, who are in demand because of caregiving skills and a facility in English, are found in Europe, Africa, South America and North America.
So far, about 20,000 work permits have been issued to Filipino nurses in Britain. Labour Secretary Patricia Sto. Tomas said British labour officials have said that more than 80,000 more health-related jobs will open up in the next five years.
"It's the new growth area for overseas employment," Sto. Tomas says in an interview. In fact, she adds, nurses now represent the new wave of Filipino migrant workers, a niche once occupied by domestic workers and seamen.
The growing exodus of nurses to Britain is reminiscent of the 1970s, when thousands of Filipino nurses and doctors left for the United States to escape poverty and a corrupt government or simply to find better work opportunities.
But while government officials like to cite the professional qualities of its nurses, this exodus has also sparked fears of a brain drain in a country, where health care among a population of 76 million remains inadequate.
Sto. Tomas says that the only downside she sees to this new development is the fact that "the country becomes just a training centre for nurses''.
Still, she disagrees that it constitutes a brain drain. "We will suffer if they all leave. But we won't lose nurses. The older ones, those in their mid-40s are not likely to leave," she says. "Besides, the student population reacts to markets quickly. Enrollment is high. We won't lose nurses."
But Dr Michael Tan, executive director of the Health Action Information Network (HAIN), says his NGO has already lost two of its best nurses to Britain, proof that migration does take away precious human resources.
"The tendency is for the best to leave since they are able to hurdle the tough requirements," says Tan. "I still think the departure of nurses is a brain drain."
While the Philippines is producing more nurses than ever - it already produces more nursing graduates than any other country on a per-capita basis -- some of the more experienced and trained ones are leaving the country.
The Philippines' nursing schools - 175 as of 1998 - churn out more than 9,000 students per year, of whom 5,000 to 7,000 eventually become licensed registered nurses.
"We are left with the novices," says Dr Annabelle Borromeo, vice president for patient care services of Asian Hospital. ''The problem is not a lack of nurses.''
Dr Darby Santiago, senior resident of the state-run Philippine General Hospital's department of opthalmology, says the departure of experienced nurses directly affects the quality of health care because ''we depend upon them to interact with patients and to be our troubleshooters''.
"It's frustrating because the ones you've trained already know what to do and they learn how to anticipate your needs which, in turn, makes your work efficient. And then they leave," he sighs.
Thirty-one year old Rodel, another nurse slated to leave for Britain, says he does not really want to go back to overseas work but has to ''because I now have two children. We can't afford (to support them) any more''.
The British government, careful about accusations that it is draining the developing world of its nurses, issues one to two-year contracts on nurses.
However, the lure of lucre is attracting even doctors - some of whom are now training as nurses to take advantage of the more liberal opportunities in Britain, Sto. Tomas points out.
Unlike in the United States where nurses need to take a qualifying examination and spend months as interns, local nursing degrees are accepted in Britain if they have at least two years' work experience and finish a paid "adaptation" period of three to six months. They also have the option to bring their families there after two years, an added attraction.
Sto. Tomas defends the Philippine government's labour export policy that harks back to the seventies: "It's a matter of choice. I don't think we should subject workers to a situation where we will control whether they can go or not.''
But while Filipinos work overseas, Nelfa says she wishes that host communities ''also have to treat us well''. Often, she adds, what makes matters worse aside from the low pay is the treatment of foreign nurses as second-class citizens in hospitals.
Others report being forced to take low pay or work longer hours in nursing homes. In January last year, the Philippine and British governments signed an accord to ensure fair and equitable employment of nurses.
