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Filipino Nurses ‘Are Literally Dying to Save Americans’

A lot of our friends did not make it,” Tita Myrna told me over the phone. “A lot of nurses, their spouses.”

This wasn’t the kind of chisme-filled phone call I normally might expect from an auntie. From her tight-knit community in New Jersey, Tita Myrna could count 8 to 10 Filipinos off the top of her head, community members and friends that she knew, who died due to the coronavirus pandemic.

My Tita Myrna is Myrna Bautista, an emergency room nurse at both the Robert Wood Johnson University Hospital and the Trinitas Regional Medical Center, who has worked as a nurse in the tri-state area since the 1980s. Her husband is my mother’s cousin, Tito Tony, who used to work in nursing homes before retiring. Their daughter, Andrea, is a physical therapist who also works in a hospital in Newark. On April 4, Tita Myrna tested positive for the coronavirus.

“It’s scary,” she described to me. “Before I got sick, I witnessed those people—we were filled up with people with COVID-19. And once they are incubated—you know, the ventilator—that’s the end of their life.”

Tita Myrna stayed quarantined alone in her room for about 5 weeks. She refused to go to a hospital.

“The thought of being by myself in a hospital room,” she said. “When I had difficulty breathing, I’d just walk around the room, exercise my lungs.”

The worst of her symptoms, including severe nausea, vomiting, diarrhea, breathing difficulties and a lack of sleep and appetite lasted about a week. Tito Tony would bring food to her room decked out in a mask, goggles and gloves. She eventually recovered, but continues to experience soreness in her throat and heart palpitations. Months later, Tita Myrna is back at work in the emergency rooms of both of her hospitals.

“One doctor said that the treatment for COVID is Tylenol and prayers,” she half-jokingly said to me.

Tita Myrna recalled hearing about other Filipinos, like the Tapiru family in Chicago–how both the husband, Luis, 59, and wife, Josephine, 56, contracted the virus and were rushed to the hospital within the same week. Jo, a nurse, died. Later, authorities found their 20-year-old son Luis Jr. dead of the coronavirus at home on their couch. Another Filipino family closer to home, the Pabataos of New Jersey, were similarly devastated when parents Susanna, 64, and Alfred, 68, both healthcare workers, succumbed to COVID-19 only four days apart.

The names go on and on: Maria “Mama Guia” Cabillon, 63. Tomas Pattugalan, 70. Nicanor “Nick” Baltazar, 60. Susan Sisgundo, 50. Hazel Mijares, 66. Cristino Evangelista Fabro, 70. Louis Torres, 47. Romeo Agtarap, 63. Irene Burgonio, 54. Eduardo Gancayco, 62.

The numbers, while sorely lacking and very likely underreported, only emphasize the tragedy unfolding in the Filipino-American community. According to one report from Business Insider, 31.5% of all COVID-19 nurse deaths are Filipino, despite Filipinos making up just 4% of the national nurse population. Of the 230 U.S. healthcare workers profiled in an ongoing investigation of COVID-19 deaths by The Guardian and Kaiser Health News, at least 36 of them were born in the Philippines or of Filipino descent. Other, more informal counts put the toll much higher. One scroll through a frontline health worker memorial looks disturbingly like a page out of a yearbook for a Filipino family reunion.

As a Filipino-American, the statistics aren’t just alarming–they feel deeply personal.

“Receiving countries like the U.K. and the U.S. need to do a better job of recognizing the contributions that Filipino nurses are making to their healthcare delivery systems, that they are literally dying to save Americans and Brits and other people,” Catherine Ceniza Choy, a professor of ethnic studies at UC Berkeley and the author of Empire of Care: Nursing and Migration in Filipino American History, told me.

Most Filipino nurses, especially those who are now at the edge of retirement, are immigrants who trained as nurses in the Philippines and often have had careers in the United States spanning decades. In the New York-New Jersey area alone, about one in four Filipino adults work in the healthcare industry, an analysis by ProPublica found. In California, almost one in five nurses is Filipino.

“Filipino nurses have dedicated a significant part of their lives for American healthcare delivery,” says Choy. “They are not new immigrants. They have settled here. They have contributed.”

Large families consisting of health care workers are not strange in the Fil-Am community–they almost feel like the norm. KP Mendoza is a registered nurse who recently graduated from NYU’s nursing program and now works at the surgical ICU and transplant ICU of the Mt. Sinai hospital on Manhattan’s Upper East Side. Mendoza is the product of two Filipino nurses from Chicago, or as he says, “the Philippines exporting people like commodities.” In his unit alone, at least a dozen of the 70 or so nurses are of Filipino descent.

“It was a painful sense of camaraderie,” Mendoza said, calling his fellow Filipino nurses “titos” and “titas,” terms of affection meaning uncles and aunts in Tagalog. The sheer number of Filipinos in his ward gave him a kind of “unspoken community,” a small comfort during an unspeakably dire time.

“There are certain ICUs that see more death—mine certainly does—but to see people die in this way, and in a way that was very helpless, made me feel helpless,” Mendoza said, adding there was no surgery to simply “fix” people, and no drugs to cure them.

For many, the mental and emotional exhaustion didn’t stop at home. Mendoza recounted how the fears surrounding the virus affected the home lives of many Filipino nurses, who were afraid to bring COVID-19 home to their loved ones–often in large, multigenerational households. One nurse “slept in the garage for the whole pandemic. Another one slept in a spare bedroom,” he said. A colleague close had to rent out an Airbnb for three months.

“This calling is a risk to your life and your family,” Mendoza said, “A lot of people were separated from their loved ones, especially the older ones. You spend all that money just to live away from home. It was really terrifying and sad.”

Like most labor roles Filipinos have come to dominate, the cultivation of Filipino nurses grew out of American training programs in the Philippines and a sudden demand to fill nursing shortages in the United States especially after World War II. This is a familiar pattern of labor recruitment, beginning with the “manongs” in the early 1900s, Filipino men recruited to work on plantations, agricultural farms and canneries all along the West Coast. (Remember the Delano Grape Strike? That was started by Filipinos.) When the need finally shifted to nursing, Filipinos were able and ready to fill the market demand. Today, Filipinos dominate the nursing field all around the world. But while the prevalence of Filipinos as healthcare providers may be a source of financial stability and cultural pride, the COVID-19 pandemic has also shown that there is immense and exponential risk to the community.

“There’s these different levels of the longer history of Filipinos going overseas, playing essential roles in agriculture, healthcare, hospitality, and service occupations, which place them in a space that makes them vulnerable to exposure,” Professor Choy says.

At the beginning of the first global coronavirus surge, a scandal ensued when Germany and other European countries recruited Filipino nurses, even as the Philippines itself was experiencing a surge in COVID-19 cases.

“What’s going on with the job itself that there’s so much burnout, and instead they’re bringing in Filipino-trained nurses to do the job? At what cost?” asks Jennifer Nazareno, an assistant professor at Brown University School of Public Health. “They’re willing to do those jobs because they’re supporting their families not just here but in the Philippines.”

The Philippine economy relies on remittances from these workers, who brought in as much as $33.5 billion USD in 2019. The institutionalized labor export economy, pushed by Ferdinand Marcos’ dictatorial regime (late husband of the notorious Imelda, and personal friend of the Reagans) in the 1970s was inspired by the United States. Now, it sees as many as 2.2 million overseas Filipino workers, known as OFWs, across the world, mostly as nurses, domestic workers, and seafarers in Asia, the Middle East, Europe, and the United States. “We need to be careful of that part of our culture being exploited,” Nazareno tells me–she has done extensive research on Filipino elder care workers, many of whom work well into their 70’s and 80’s, often never retiring and never getting the chance to return to their home country.

Elder care work is one of the fastest-growing occupations in the United States, due to the rapidly aging population, and, like other service occupations that exist in the intimacy of the home, is primarily done by immigrant women. They are domestic workers–a workforce that consists of housekeepers, nannies, and caregivers–and make up a large proportion of low-wage Filipino migrant workers in the United States. Many of them are undocumented and forced to take up laborious occupations that can be easily exploited, despite many of them being skilled, educated workers back in the Philippines.

The Pilipino Workers Center (PWC) in Los Angeles has a base of over 2,000 domestic workers in the Los Angeles area, most “living in the shadows.” Associate director Lolita Lledo estimated about 10% of the organization’s base became infected with COVID-19. Most are care workers who tend to senior patients in their homes or nursing home facilities. Of the base, at least four members died.

The pandemic hit these workers especially hard, due to the nature of their work with patients who were most at-risk to contract the virus. But the economic and immigration statuses of these low-wage workers made their situations exponentially more difficult. Being exposed to the virus led to a myriad of dilemmas–surviving financially while being out of work during a 14-day quarantine, finding a safe place to isolate away from shared apartments that potentially put other caregivers, and thus, patients at risk, and getting access to testing and proper healthcare with limited funds and no insurance. Some, faced with their mortality, wanted to go home to the Philippines, despite it being a global pandemic, afraid of the possibility of dying alone in a foreign nation.

Dangers of the virus also meant that some families required 24-hour live-in care to lessen the risk of exposure when caregivers traveled to and from their patients. This meant skirting newly passed overtime laws because caregivers were desperate to keep their incomes.

It’s painfully ironic that folks who provide the very healthcare we expect to live decent, comfortable lives, cannot access that same healthcare themselves, and because of their undocumented status, have no proper access to other forms of relief such as unemployment benefits or stimulus checks.

In California, domestic workers were even denied Occupational Safety and Health Administration protections, after a bill that would have required domestic workers to be properly trained in safety guidelines and provided necessary personal protection equipment was vetoed by California governor Gavin Newsom. Lledo recalled an instance where one elder care worker pitched a tent and slept outside his home when he was informed that he may have been exposed to the virus at his workplace–then tested negative, but only after waiting two weeks for the results to come back. Another caregiver contracted COVID-19 and spent three months in the hospital fighting for his life, only to receive a six-figure bill.

“They just agree to pay $50 a month,” says Lledo, explaining that many caregivers just take on the most discounted payment plans because they don’t have insurance to help foot their hospital debts. “That’s how screwed our healthcare is… it’ll take them a lifetime to pay that.”

Nazareno argues: “This emerging Filipino American health paradox is happening where they make up large proportions of the workforce but have some of the worst health outcomes… Now overlaid with COVID–they’re now on the front lines of a global deadly pandemic–it makes it even more necessary for us to really understand the structural systemic inequities around labor that are happening in our country.”

While organizations like PWC continue to fight for state-level legislation for essential workers, the nurses I spoke to expressed a deep frustration for the federal government’s role in fumbling the pandemic response.

“I hate Trump,” said Tita Myrna, vocalizing a very strong political opinion that I had not expected to hear from her. “He should have warned people,” she said, blaming Trump for worsening the pandemic because of his refusal to acknowledge the dangers of the coronavirus and thus failing to give people the chance to prepare and protect themselves.

Mendoza, meanwhile, called the federal government “trash” and the coronavirus task force “an absolute joke.”

“A lot of people in government just completely have their ass backwards and it’s so frustrating because at the end of the day they’re not the ones taking care of people,” says Mendoza.

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