Filipino-American historian traces the history of Philippine nurses in the US

To Filipino-American historian Ren Capucao, hospitals smell like home. Growing up in Virginia Beach, Capucao would often visit his mother at Chesapeake Regional Medical Centre, where she worked as a nurse for three decades. “People find it weird,” he said with a laugh. “For me, visiting the hospital was a fun thing. I would see all these Filipino health care workers at the hospital, and most of them were nurses.” It did not seem unusual – in the Filipino family in which he was raised, it was normal to be encouraged to be a nurse. But as Capucao grew older and entered the field himself, he started to wonder why. So he decided to find out. But what began as a curiosity soon branched into a dissertation for a PhD in nursing at the University of Virginia, where he has for the past few years researched the history of Filipino nurses in Virginia and beyond. His research won a grant from the state humanities council and has also blossomed into a “Hidden Nurses” initiative with the university’s Jefferson Trust. Capucao, 27, interviewed current and former nurses from around the commonwealth for the project, and delved into the limited literature available on the history of Filipino-American nurses. “I feel like a lot of times between generations, there’s a missing link, a missing understanding,” he said. The oral histories have helped him connect to the culture. Filipino nurses in demand to fill Brexit shortfall but English tests create obstacle It all began with American colonialism, Capucao said. At the end of the Spanish-American War in 1898, Spain ceded the Philippines, which had been its colony since the 1500s, to the United States. It would remain a US territory until its independence nearly five decades later. Soon after gaining control of the Philippines, the Americans started introducing their own models of education – including for nursing. “Health care in general at that time symbolised modernity. So the ‘American dream’ was instilled in the Filipino people, from the early 1900s,” Capucao said. “And it really lives on. They transform[ed] the Philippine culture at that moment.” Nursing was a tool used for social mobility. In the early days, both men and women went into the field, “but since it [was] an American model, they pushed out men from nursing”, Capucao said. Filipino nurses started going to the US as early as 1911, Capucao learned. He discovered the journey of one who landed in Cleveland, Ohio, in 1926. But the first wave of Filipino nurses began after World War II, when the US experienced a severe nursing shortage, while also building and modernising many more hospitals. An exchange visitor programme created in 1948 to combat Soviet Union propaganda by exposing foreigners to US society brought “the first mass migration of Filipino nurses”. A second wave followed after 1965, when federal officials passed a new immigration law that allowed residents to petition for family members to join them in the US, and also introduced visas that let hospitals recruit nurses from abroad and give them green cards. “From there, it really opened up migration from the Eastern hemisphere,” Capucao said. “By the 70s, you start seeing the Philippines commercialise nursing. That becomes one of their biggest exports. “It’s like they were groomed to work here in the US.” Filipinos in Alaska are called Alaskeros – and they’ve been around since the 1700s Meanwhile, shortly after the Philippines’ independence in 1946, the Americans reached an agreement with the Southeast Asian nation that allowed them to recruit Filipino citizens directly into the US Navy. These recruits worked mainly as stewards, for which there was “an urgent need” during the Korean war, according to the Naval History and Heritage Command website. Soon the agreement was amended to specify that at least 2,000 Filipino men enter the US Navy each year, and the programme continued through the 1990s. Because of all that overlapping history, “throughout the 20th century, especially along the Eastern seaboard at large hospitals and naval bases, Filipino men and women would intersect”, Capucao said. “You start seeing Filipino nurses come to the Hampton Roads area because of Naval Station Norfolk.” The region’s naval base helped to give rise to the large Filipino population that continues to reside in Hampton Roads – nearly 30,000 in the seven cities as of 2010, according to Old Dominion University’s Filipino American Centre. More than 60 per cent of that population lives in Virginia Beach. Capucao’s mother, Jolly, got her nursing degree in 1976 and worked as a public health nurse in the Philippines for about a decade. Her brother was in the US Navy, and she and the rest of her family were waiting for his petition sponsoring their migration to be approved. It took years, but she came to the US in 1986. “Since I was in high school, I really wanted to be a nurse because I always see this picture or see the nurses with their white uniform, white caps,” said Jolly, now 65. “The white cap for many nurses was a status symbol of accomplishing your dreams,” Capucao said. “Going abroad [means] getting more money,” she said. “That’s why I did it. The compensation is much better as compared to the Philippines. Here the dollar is really worth what you’re doing.” Arriving in Hampton Roads can come with culture shock. Nurses first must pass a licencing exam, but for a long time, there was no place to turn for help. That’s why Araceli Marcial founded the Philippine Nurses Association of Virginia – then of Tidewater – in 1978. It was “designed to help the needs of the Filipino nurse”, said Marcial, now 84, who’s still passionate about nursing education and active in the region. She faced her own struggles when she first arrived in the US from the Philippines in her early 20s. “Everyone was talking about going to America,” she said. “It was a dream of my mother’s. All I heard was, ‘We’re going to America’.” Through the foreign exchange programme, Marcial landed at the Beth Israel Medical Center in New Jersey in 1960, working in the operating room. “But we were not used for what they said on the papers,” she said. “We were underpaid. We were placed wherever needed. It was an eye-opener.” She went to Philadelphia, met her husband who was in the army, and went back to the Philippines while he fought in Vietnam. Around 1970, she landed in Norfolk, where she started working with the Filipino Women’s Club and later started the nursing association. She said today it is more necessary than ever for the group to bring young nurses together. There’s still discrimination in the workplace – such as always being passed up for promotions. Capucao talked to nurses working in the South who remember being seen then as “in between”: considered white inside the hospital, but discouraged from using both white and “coloured” bathrooms elsewhere. “You had to work every day to be accepted,” Marcial said. Catherine Paler, the incoming president of the association who works in the oncology department at Sentara Princess Anne Hospital, said she thinks “a lot of hidden nurses have gone through this and not really spoken up”. “We’re more a culture of being humble. We don’t outright make our needs known.” Paler said a large part of her role with the nursing association is providing social support to young Filipino nurses arriving. And they are, consistently. Sentara recently recruited dozens of international nurses, a majority of them from the Philippines, as part of a recruitment effort that started late last year, said Arlene Sadoff, the health system’s director of talent acquisition. It’s always a struggle to find enough nurses, she said. Officials recruit nationally and internationally, but the islands specifically “tend to have candidates available that are interested in coming to the United States”, she said. “It’s not that we’re targeting the Philippines per se, that’s just where they’re a bit more available” and already have nursing degrees. This is the driving force behind Capucao’s oral history project: it’s vital to remember the past to make the best decisions for the future. “Filipino nurses are ‘hidden nurses’ – everyone knows they’re at almost every hospital, yet no one takes the time to listen to their stories or try to understand their history.” Growing up, he wanted to go into the medical field – but never as a nurse. After earning a history degree from the University of Virginia, he reconsidered. Capucao is passionate that the profession is undervalued and often misunderstood. And with an ageing population, the US is well on its way to a severe nursing shortage. “It brings to light how serious [the issue of] labour migration is. Do we need to focus more on training nurses in the US or are we going to recruit more nurses from abroad?” Paler said Capucao’s work is creating an appreciation of the struggles endured by the first waves of Filipino-American nurses. She hopes it inspires the new generations to advocate for themselves and others. “And, hopefully, be able to write their own story.”