Nursing in the Philippines

Early beliefs of health and illness in the Philippines were in conjunction with beliefs of mysticism and superstitions.[2] The cause of a disease was believed to be either another person, who was an enemy, or a witch, or evil spirits. Filipinos were careful not to upset other people or the evil spirits for the good of their health. These evil spirits could be driven away by people with the power to banish demons: priests or herb doctors. Filipinos who became sick were usually cared for by their female family members or friends in the home.[3]

People thought health was directly related to many superstitions and legends. Back then, there were no medical professionals but men known to practice magic and the supernatural. These herb men were known as “herbicheros.” Victims who suffered from unidentified illnesses were thought to be cursed by witches and wizards known as “mangkukulam/mangagaway.” Dangerous birthing and “pamao” were thought to come from “nunos”. While in labor, the “mabuting hilot” (good midwife) was usually present. If the birth became too dangerous, bad omens and evil sorcerers were thought to be the cause. Exploding gunpowder from a bamboo cane near the head of the person going through the suffering would usually get rid of the bad omen.[4]

During Spain's colonial rule (1521-1898) the Philippine education system offered distinct and unequal opportunities for Filipinos based on gender. An example of this sexism was allowing only limited numbers of women to receive primary education in Spanish charitable institutions.[3] Without an education women were unable to gain much knowledge or power. The knowledge of caring for others came from family members and personal experience with the sick. Nursing other individuals was seen as a task, not a job or a profession. During the Spanish regime many specialized hospitals were established to care for the Spanish king's soldiers and civilians.[2] To many elite Filipinos, the Spanish colonial hospitals were places where those who were not so fortunate to have homes, spent their last days until death.[3]

At the time of the Philippine Revolution many women transformed their homes into quarters to nurse Filipino soldiers and revolutionaries.[2] One of these women was Melchora Aquino, also known as the "mother of the Philippine Revolution". In her old age of about 80, Aquino was a supporter of the revolution by providing food and shelter to the revolutionists. She provided care for those who became sick or wounded. However, a few days after the revolution began, she was arrested by the Spaniards for providing care to the rebels. Because she did not reveal any information to the Spanish about the location of the rebel leader, Aquino was deported to Guam in the Marianas. After six years of exile, she was able to return in 1903, when the Philippines finally gained independence from the Americans. Aquino's work caring for the ill and the wounded during the revolution has brought comparisons to the British Florence Nightingale. Both these women cared for soldiers during war and paved the way for nursing practice.[5]

Although the Philippines had gained independence from Spain, the United States began to instill their power upon the islands, and a conflict broke out between the Filipinos and the Americans. This was the start of the Philippine–American War. The presence of Americans played a vital role in influencing the development of nursing into a profession. Nurses and missionaries from the United States came to act as nurse mentors for the Filipina women. Nursing education, like teaching and missionary work in the Philippines, provided white American women with a sense of purpose in the colony.[3] This influence then continued with the building of many hospitals where American nurses took charge and Filipino women began to learn under careful eyes.

An example of this was the development of the Iloilo Mission Hospital.[6] In 1901, through the efforts of Dr. and Mrs. Joseph A. Hall, missionaries of the Presbyterian Foreign Mission Board from the United States, a temporary bamboo clinic was erected at Calle Amparo (now Ledesma Street), Iloilo City, to serve as a venue for the treatment of health care to the very poor. This was made possible because Joseph Hall was a doctor and his wife was a nurse. Like other professions, nursing in the Philippines evolved only from the apprenticeship system.

This system laid the foundation upon which the Union Mission Hospital Training School for Nurses (now Central Philippine University College of Nursing) was built in 1906. Between the time that this school was built and the time that the Philippines gained their independence from US colonial rule in 1946, the nursing profession continued to grow with the development of more nursing schools and more Filipina women seeking to become nurses.[2] While taking advantage of these learning opportunities Filipinos began to learn more about the United States and the opportunities that the country could hold for them, such as extending their education and increased pay. This began the migration of nurses to the US. As individuals began travelling to and from the US, the stories they brought home began to spark the interest of others to follow.[7]

After World War II, when Manuel Roxas assumed the presidency of the Republic of the Philippines on July 4, 1946, it officially marked the end of the colonialism between the US and the Philippines. Like much of the rest of the world, the Philippine islands were in ruins and Roxas was determined to rebuild his country. He made it clear to his constituents that the new government was still going to rely heavily on US financial support in order to rehabilitate its national economy. Roxas’ first attempts to balance the Philippines' budget included collecting unpaid taxes, reducing expenses and promoting foreign trade, which would include the exportation of Filipino nurses. Already trained by Americans, Filipino nurses were the perfect candidates to assist the US and other countries experiencing post-World War II shortages. At the time in the Philippines there were also rumors of a nursing shortage; however, this was questionable, due to the expanding health programs, inefficient use of nurses' time and skills, and loss of qualified nurses to other countries. By the mid-1960s, Filipino nurses were entering the US by the thousands.[8] The benefit to the travelling nurses was that they were able to make nearly 20 times as much as they had earned back home. Part of this money would be sent back to their families as remittance, which would boost the Philippine economy. A negative effect of the high exportation rate was that the nurses were adding to their own country's nursing shortage problem. The Philippines also faced losing one of its greatest sources of social capital: educated workers. The negative effects were also seen in the US, as American salaries decreased because Philippine nurses who newly arrive would work the same job at a lower wage.

Many US states passed reforms in licensure for nurses. Decreased training mandates were created, as well as stricter adequacies for getting into a nursing institution. For instance, one prerequisite was at least one year of high school education. The idea of having students work in a more active role prior to seeing patients was a new idea that was beginning to pay off.[9]

In the Philippines, it was also the early 1900s when the first school for nursing was established. The program of study was still shattered and unclear. Only a few students were enrolled informally in this kind of education. A legislation or law was needed at the time, contributing to the establishment of the "First True Nursing Law" in 1919.[10] The Filipino Nurses Association was founded on September 2, 1922, which was later renamed to Filipino Nurses Association in 1966.[11]

The Philippines is the leader in exporting nurses to meet the demands of the United States and other developed nations. It has been argued, however, that the Philippines' persistent production of nurses for the global market is a state strategy to develop an export industry for economic development. Things such as immigration services and nursing licensing authorities encourage the production of nurses for export.[8]