Mary Joy Dizon’s laugh cuts through the low rumble of trucks driving to and from Manila’s North Harbour Port.
She’s joking around with a worker as she gives him a tetanus shot outside the port’s small medical clinic. It’s supposed to be her day off, but she’s 10 hours into a 24-hour shift. She’s tired, but she knows every hour worked is one step closer to her goal of moving to Canada.
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For me right now, if there is a chance to go there, I will, she said.
Dizon says she loves being a nurse in the Philippines but can barely pay for her monthly expenses. She worries about her 15-year-old son Raven’s future and wants him to attend university. But that dream is out of reach on her current salary.
I will work for the future career of my son, just to give a better life.
Dizon is one of thousands (new window) of Filipino nurses considering leaving the Philippines for other countries like Canada. The nurses who spoke to CBC News in June say their low salaries, working conditions, and limited career growth has forced them to think about leaving their families for better possibilities.
Many Canadian experts say Filipino nurses are essential to Canada’s health-care system, and make up a growing portion of regulated nurses in Canada. The best available data from the Canadian Institute of Health Information (CIHI) shows about four per cent of regulated nurses working in Canada in 2021 graduated from the Philippines.
But that’s an undercount, as it doesn’t represent Filipinos who are trained as nurses but working in other health-care roles such as caregivers (new window), said Ivy Bourgeault, a professor in University of Ottawa’s sociological and anthropological studies department. She’s also the lead of a group of health experts called the Canadian Health Workforce Network.
Recruiters, politicians, university staff and family members often encourage nurses to leave the Philippines for better opportunities.
But Canadian officials are also selling Canada to nurses. Several provincial politicians and health leaders have travelled to the Philippines in the last year in hopes of filling Canada’s nurse staffing shortages, which have resulted in ER closures (new window), delayed surgeries (new window) and long waits for patients in ERs (new window).
It’s an approach Canadian politicians have turned to consistently since the 1960s.
As Canadian politicians speak about the success (new window) of their recruitment efforts in the Philippines, very few details on how these nurses are recruited abroad have been made public. CBC News spent weeks in the Philippines in June to learn more about the people involved in recruiting Filipino nurses for Canada, how they’re doing it and to understand why nurses are compelled to leave.
Inside the recruitment pipeline
In the last year, Saskatchewan (new window), New Brunswick (new window) and Manitoba (new window) government and health leaders have taken trips to the Philippines to recruit nurses.
This mission is an important step to highlight all that we have to offer, to attract new talent and add capacity, and contribute to our health-care workforce of the future, said Manitoba Premier Heather Stefanson in a news release (new window) before its recruitment trip last winter.
B.C. (new window) and Nova Scotia (new window) also sent government and health officials to the island country in the last year to talk with nursing schools and Filipino politicians about nursing education and credentialing. And Albertainked a deal with the Philippines (new window) last year to encourage more nurses to come.
The recruitment process is intense. Provinces often rely on private recruitment agencies to find nurses. There are hundreds of recruiters (new window) operating in the Philippines.
And it’s big business. For example, the Saskatchewan Health Authority awarded Regina-based recruiting agency OnSpec Solutions more than $840,000 (new window) to find 150 nurses and other health-care workers in the Philippines starting last fall.
The company then worked with Philippines-based Omanfil International Manpower Development. Moses Ramos, a recruiter with Omanfil, told CBC News they deployed over 100 nurses just to Canada.
To get nurses and other health-care workers to Manitoba, the province’s Shared Health hired Philippines-based recruiters Staffhouse International Resources and Andrews Manpower Consulting for $900,000 each (new window).
At least a dozen other countries (new window) wanted nurses from the Philippines in the last year as many countries grapple with nursing shortages after the COVID-19 pandemic. Canada had more than 34,000 nursing vacancies (excluding nurse practitioners) at the end of 2021, according to the Canadian Federation of Nurses Union (new window).
Finding nurses wanting to go to Canada is always a competitive process, said Jhon Adora, general manager of Philippines-based recruitment agency Andrews Manpower Consulting. He says their teams of recruiters find interested nurses by sending Facebook messages, posting on social media or meeting nurses at job fairs.
Adora says they also recruit in a way he calls
outsourcing, where recruiters go into the hospitals to find nurses.
We do that discreetly. It’s a kind of poaching, he said. He adds that in-hospital recruitment was done more freely before the COVID-19 pandemic, but staff are
Hospital directors in the Philippines say recruitment approaches like these can be challenging as they struggle to retain their own nurses.
If we allow these things to happen, then we will have problems, said Dr. Charito Malong-Consolacion, medical director of Manila’s University of Santo Tomas Hospital.
The Canadian sales pitch
Politicians or health officials will often present to interested applicants in the Philippines as part of these recruitment efforts.
Jon Reyes, Manitoba’s minister of labour and immigration, was part of the team talking about working in Manitoba (new window) when the delegation visited the Philippines in February. He spoke to a Manila hotel conference room full of potential candidates about Manitoba’s history of depending on Filipino nurses.
Give and take. We are taking workers from the Republic of the Philippines, but we also want to give back, he said, speaking about the incentives for nurses wanting to go to the province, like paid travel to Canada and a housing allowance.
Hiring may have become more competitive, but why Canadian provinces and territories turn to the Philippines hasn’t changed. Newspaper clippings and CBC radio archives show a pattern of provincial leaders recruiting from the Philippines whenever they were short on nurses.
Experts say recruitment kicked off in the 1960s, around the same time provinces started to build publicly-funded health-care systems (new window) and federal money to build new health facilities (new window) started flowing.
We needed more nurses … and our schools here could not keep up with the demand so they started thinking about ‘where are we going to find the talent’, said Jon Malek, a history professor at the University of Manitoba specializing in Filipino immigration.
Lourdes Cultura was among the first wave of nurses recruited.
She was offered a job at the former Riverdale hospital in Toronto while working at a hospital in Manila. In 1967, Cultura boarded a plane bound for Canada, according to her niece Valerie Damasco, one of Canada’s top experts on Filipino nurse migration.
She was motivated by the fact that she saw others had left the country. If I could go back in time and see what that was like, I’d be very interested because it has a lot of similarities to the recruitment that happens today, said Damasco, an assistant professor in Trent University’s sociology department.
Providing for loved ones
For many Filipino nurses who spoke to CBC News, a huge reason they want to leave is to support their families.
Nurses in the Philippines earn the equivalent of $300 to $800 per month depending on their qualifications and where they work, according to Filipino Nurses United union staff.
So when provinces like New Brunswick present their sales pitch – which includes salary figuresat least 7.5 times higher (new window) than those in the Philippines – nurses say it can be hard to ignore.
Deen Wally Julkarnain de Jesus is hoping to come to Manitoba. He became a registered nurse at the height of the pandemic, and hasn’t been able to shake off the pull of working abroad. He’s done the long shifts at a private hospital, and is now working as a private duty nurse, taking shifts at random.
“I have a lot of jobs. Here in the Philippines, we call it raket.”
But the 24-year-old says he wants better work-life balance, and sees Canada as a good country for that. He’s still waiting for his immigration and employment documents to be processed, but says going to Canada would be a dream — one his family had hoped about for almost 20 years.
I thought maybe this is my calling. I’m not only helping myself but my family as well.
Data shared by the Philippines’ Commission on Higher Education department shows that in 2022, more than 51 per cent — or 316,405 nurses — of their total number of nurses licensed to practice are working overseas.
Vincent Castro’s mom pushed him to become a nurse so he could one day go abroad and support the family. She left the Philippines when he was 15 to do exactly that, working as a caregiver in the U.S. for 10 years.
He would never see his mother again. She died from colon cancer while working abroad.
Going abroad is a huge trauma for me. If I leave for abroad, will I be coming back in an urn or will I be coming back alive? he said.
But the promise he made to his mother remains top of mind.
Although I can provide what is needed for my sister and my dad, I want them to experience much better, he said.
‘Better opportunities abroad’
The pressure to leave the country comes at nurses from many angles, including encouragement from the Philippines government. The government also plays a substantial role in the recruitment of nurses.
The Philippines president calls overseas workers “modern-day heroes” (new window) for what they do for the country’s economy. Remittances from overseas workers are a substantial economic driver for the Philippines, accounting for about 10 per cent of their gross domestic product (new window).
Patricia Yvonne Caunan, undersecretary for policy and international co-operation within the Department of Migrant Workers, often meets with provincial leaders. She says in those meetings, provinces typically look for anywhere between 150 to 300 nurses.
But the Philippines government wants the provinces to be recruiting even more than that, although Caunan doesn’t say how many.
Instead, she says Canada’s lengthy credentialling system (new window) has largely stopped provinces from recruiting more nurses. Many of the provincial regulatory bodies (new window) have made changes to expedite the process, which previously could take years (new window)before internationally-trained nurses are working in Canada.
Unlike, for example, deployment in the Middle East, deployment in Canada would take more steps. And that would mean you cannot really deploy in thousands, she said.
She adds the Philippines government recognizes that nurses have better careers overseas.
We want to have a future wherein the Filipinos have the choice, whether to work here or abroad, she said.
But to be honest, the Filipino workers really see better opportunities abroad.
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A message nurses say they hear throughout their careers is that better opportunities exist abroad. Often, it starts early on in school.
At the University of Santo Tomas (UST), one of the country’s top nursing schools, students are told about international opportunities from year one.
They’re not saying that you should stay in the Philippines because we love our nation. We do, but in a realistic standpoint for an individual who also wants to earn, also wants to have better experience in the hospital, they of course recommend going abroad, said Charles Hezekiah Importante, a fourth-year nursing student and outgoing president of the UST College of Nursing Student Council.
Nursing schools in the Philippines are an essential part of understanding why international employers want to hire their graduates. Under U.S. colonial rule, nursing programs were set up (new window) similar to those in the States, which would later help in creating a pipeline of nurses from the Philippines that could work in the U.S.
Now, recruitment at nursing schools is becoming increasingly intense.
No one knows that better than Rowena Escolar-Chua, UST’s dean of nursing. She says she receives about 10 emails a week from recruiters, employers or government agencies asking to tour their campus and talk to students.
She does a lot of screening before entertaining any officials, as they did with Nova Scotia health officials in February (new window). B.C. officials also requested to meet with university staff in June.
Once we commit our students, and later on our nurses, they know that we endorse them properly to the right company, Escolar-Chua said.
Most of the time, recruiters or health leaders are encouraged to talk to future nurses about opportunities at their career fairs. But, she adds, they also encourage nurses to work in the Philippines for at least two years to get experience before going abroad.
Recent recruitment trips point to Canada’s dependency on these nurses leaving the Philippines, a dependency experts say shows no sign of slowing down.
I think that’s always going to be present because it is a quick fix, said Margaret Walton-Roberts, a professor in Wilfrid Laurier University’s geography and environmental studies department.
She adds this recruitment approach isn’t a long-term solution.
There’s an ethics behind all of this. There are only so many health-care workers around the world.
Ruby Buzia, CBC News ·
This report is also available on Tagalog
The reporting of this story was made possible by the R. James Travers Foreign Corresponding Fellowship. Jim Travers, who died in 2011, believed it was crucial for Canadian reporters to
bear witness because in our interconnected world, foreign news is local news.
Editor: Natalie Stechyson | Lead Digital Producer: Ruby Buiza | Philippines Chase Producer: Guill Ramos | Senior Digital Producer: Brandie Weikle | Senior Web Developer: Geoff Isaac | Tagalog Translation: Catherine Dona
Special thanks to: Jayson Pajarillo, Rodney Ramos, Geric Cruz, Jilson Tiu, Kate Zieman and John Skaife