“If I were to be without you I wouldn’t die,” –Pablo Milanez
The archipelago of Philippines consists of 7107 islands with a population of close to a 100 million people lying within the Pacific Rim of Fire where 81% of the world’s largest earthquakes occur. In addition, the large tropical typhoons (locally known as bagyos) season lasts from June thru November. On October 15, 2013 an earthquake with a magnitude of 7.2 struck the Visayans Island of Bohol killing several hundred people, injuring thousands, and laying waste to thousands of homes. The next month on November 8, 2013, an even larger disaster struck the country when the largest known typhoon to ever hit landfall struck. Its path of destruction was heaviest in the Leyte city of Taliban where over 6000 people perished. Most of the people drowned in an ocean swell that some locals put at twenty feet high.
In January 2014, I met with a Registered Nurse (RN) friend in Sacramento, California. She is originally from Tacloban and her oldest brother drowned in the flood. She and her family were relieved they could retrieve the body, but most of the dead were lost to the Indian Ocean. My friend told me her family described a sound like a very loud “roar, like a train” to explain how it sounded when the swell hit.
After the November typhoon Yolanda hit the Philippines, many international aid organizations and governments sent material and human aid to help the victims. One of those organizations is the United States Registered Nurse Response Network (RNRN.) This group was founded by National Nurses United(NNU.) which is now the fastest growing American trade union with over 170,000 members. RNRN is a disaster relief non-profit that sends union RNs to disaster hit areas around the world.
Originally created after the 2004 Indian Ocean tidal wave that killed 250,000 people, RNRN set up five clinics in Sri Lanka in alliance with the Sri Lankan RN union. After the Haitian earthquake that killed tens of thousands in 2010, RNRN sent RN’s to help staff hospitals in that country. After Hurricane Katrina hit the area of New Orleans in 2005, RNRN sent over 200 RN’s to that city to help in the medical recovery process.
RNRN’s mission is to provide disaster relief aid to areas of disasters around the world. RNRN does this in the form of RN deployments and sending material medical aid to those areas. A big reason RNRN came to fruition is NNU members felt frustrated trying to volunteer thru well known large international aid organizations. They feel that these groups can be very slow, sometimes taking months to allow international volunteers to work with them in places like Philippines after the typhoon.
Since Yolanda hit Pinoy land, RNRN has sent five groups of RNs to the Philippines Island of Panay. I am a medical surgical RN myself and was a member of the fifth brigade that left on January 15, 2014 and worked on Panay for two weeks. My fellow brigade members were John, a RN Labor Representative from the Maine Nurses Association; Megan, an ER and Pediatric Intensive Care Unit RN from the Minnesota Nurses Association; Diane, a Post Anesthesia Recovery Room RN from the California Nurses Association (CNA); Rene, a RN radiological interventionist from the New York State Nurses Association; and Elena, a post postpartum RN from CNA in Los Angeles.
We arrived on Panay Island January 17, 2014. Our destination was Roxas City, which is known as the seafood capital of the Philippines. Yolanda tore through this western Visayans Island killing several hundred people and leaving thousands homeless. Roxas City is roughly 300 miles from Tacloban. The local language in Panay Island is Ilongo, which is one of 120-175 languages spoken throughout the country.
English is also widely spoken and is the language used in the public educational system. It was imposed by the Americans after they occupied and colonized the Philippines from 1898-1946. Some historians put the number of Philippine deaths directly related to this invasion and occupation at one million people. The hardship most Filipinos face today continues largely unabated. The average life expectancy is 68 years with about forty percent of the locals subsisting on two dollars a day. Less than one percent of the Philippine government spending is on health care. This translates to about seven or eight US dollars per person, a shockingly low amount.
The annual typhoons are becoming measurably larger. This is probably related in some way to global climate change and the resultant rise of ocean water. The large ocean swell that exceeded fifteen feet in height in areas like Tacloban seems to point to evidence of the rising waters resulting from a warming of the ocean.
During our two weeks on Panay Island, our brigade established mobile medical clinics, volunteered in the public health department, and met several community activists. The mobile medical clinics we set up were in the area of Estanica, San Pedro and San Felipe. In each medical clinic we worked side by side with Pinay RNs providing triage to hundreds of rural Filipinos (locally known as Pinoys.) Then the patients saw the volunteer MD’s and got free medicine if needed. Help-Panay—a social activist group, and the Alliance for Healthcare Workers were the primary movers on the ground setting up the clinics.
During my time in triage I saw mostly cases of hypertension, stress, diabetes and often symptoms of Tuberculosis. Some of the hypertension was extremely high. If a patient in an ER in the US had extremely high blood pressure readings chances are great he/she would be hospitalized until their blood pressure was under control. I wondered what would become of these people once they ran out of the weeks’ supply of anti-hypertension medication we gave them. The number of hospital beds in Pinoy rural areas is terribly lack. To compare, in 2011, Philippines had 1.0 bed per 1000 patients, Cuba had 5.1 and in 2010 the US had 3.0/1000.
I asked a local RN about underlying health conditions in rural Panay Island and one thing she mentioned was a lack of diversity in the diet. She also mentioned the stress of daily life in the countryside only intensified by the trauma of typhoon Yolanda. In many areas pork is eaten as a staple due to the loss of valuable fruits and vegetables. I also wondered about the effect of the large use of pesticides in the countryside had on the population. I saw several young peasant men toting along a backpack full of herbicides or pesticides along with the sprayer. I was told Monsanto is heavily invested in the Panay Island countryside with genetically modified organisms.
Many folks had persistent coughs and reported at night that they had bloody sputum, along with night sweats. A local MD pointed out TB can be prevalent in these communities. TB is especially vulnerable in populations that live in close quarters. Also the medication regimens are up to 18 months long. It takes a committed person with personal and public resources to finish all the medication. If he/she doesn’t finish up their meds the TB can become more virulent in that person.
In Estancia, a town situated on the ocean, an ugly oil spill occurred during the hurricane when an offshore rig owned by the government overturned. At least 300,000 liters of oil were spilled. Hundreds of families were forced to evacuate to nearby communities. We visited one temporary community made up of tents and latrines built by Doctors Without Borders.
According to local activists in Estanica, the government claimed it had cleaned up the oil spill sufficiently for the displaced people to return. But the activists insisted that the spill was not cleaned up well enough. We visited the spill site and our eyes burned immediately; it appeared to require greater effort to breath and the shoreline was inundated with the black tar of oil. We were all shocked that thousands of people lived so close to the shore. None of us were experts on oil spills but it seemed that the whole area should have been evacuated for at least one mile inland until the spill was more thoroughly cleaned up.
One aspect of the education I received in Panay Island came from visiting with health care activists, reading their literature, and talking with local RNs. I found out that the Philippines is the largest exporter of RN’s in the world. A total of eighty-five percent of Pinoy nurses work abroad! Part of these numbers include MD, engineers, lawyers and other professionals taking up second careers as RNs in order to work abroad.
Hospitals in the US are usually more than happy to employ Pinoy or other foreign nurses. The hospitals don’t expect these nurses to demand fair wages, benefits and fairness or contribute to union organizing drives because of an understandable fear in a foreign climate. The few nurses who stay and work in the Philippines make about $130/month in a private hospital and $260/month in a public one. This is well below the monthly cost of living of $565/month for a family of six. Sadly I met many RNs who have graduated and have yet to find a job after two and up to seven years. According to a Pinoy nurse I spoke with, on a typical medical surgical floor one nurse cares for thirty patients. This is unheard of in the US, where RNs will care for five to ten patients on a medical surgery floor depending on the greed of the hospital.
The Philippines government pushes the myth that there is an oversupply of RNs. The reality is the hospitals which are increasingly privatized can afford to hire from the pool of unemployed nurses but choose not to in favor of increasing their profit. I saw an almost complete lack of nurses and MD’s in the rural areas. It appears health care is mostly situated in Philippine’s urban areas. Because of the multitude of challenges in Pinoy healthcare, RNs there find it very difficult to organize for their rights.
These economic structures in the Pinoy healthcare system have led to a large exodus of RNs. However, as I pointed out earlier, many Pinoy nurses are then exploited when they go abroad. I personally know many Pinoy nurses who have been cheated out of large amounts of money from hospitals or clinics in the Middle East, Europe or North America where they most often obtain work thru a third party. These agencies or middlemen usually charge the RN a few thousand dollars for jobs in the US. In the Middle East often it’s a year’s salary or more to pay off the agency.
On a side note, when I worked at St. David’s Main Hospital in Austin, Texas for three years they hired many RN’s from India on two year contracts. If the RN quit before the two years was up they would have to repay the agency thousands of dollars. This indentured slavery/servitude occurred directly under the nose of St. David’s hospital. This is not surprising since St David’s is owned by the Hospital Corporation of America (HCA), whose ex-CEO is the current governor of Florida, Rick Scott. As CEO at HCA, Scott oversaw the largest fraud settlement ever ($600 million) with the US government. HCA was charged with fourteen felonies on several different counts including stealing from patients, the Medicare system, and contractors. Scott’s ascendency to his current office in Florida seems to show that certain types of crime does pay. In Canada, Filipino Nurses are often recruited to work as registered nurses via the Live-in Caregiver Program. This program forces them to work as 24-hour domestic workers who clean, cook and care for the children and elderly of middle and upper class Canadian families.
While in the Philippines our brigade members agreed with our Pinoy coworkers and fellow activists that one of the best ways we could help them was to continue working for new RN unions in the US and strengthening the ones that already exist. That way, when Pinoy RNs work in the US, they will find work in more just conditions. Building unions in the US also strengthens the union movement in the Philippines and elsewhere. One solid union usually leads to more unions, especially in the same trade. For example, Texas never had RN unions until 2007 when Cypress Fairbanks Medical Center became the first Texas hospital ever unionized. Since then, six other Texas hospitals have unionized.
Building RN unions here in the US does not go unnoticed in faraway places like the Philippines. Workers and labor activists read and hear the news and feel empowered to continue their progressive work. Our brigade was more than amazed and emboldened by the positive struggles we saw by local RN’s and activists to build a more just health care structure in the Philippines.
Working side by side with our sister Pinay RN’s it was an uplifting and moving experience. I was really pumped up by our work and I truly felt the meaning of the phrase “international solidarity.” There is a personal side to my appreciation of international solidarity, given that’s how my parents were saved from the destruction of war and bigotry. In the eighth decade of his life my father counts his blessings daily and thanks the international volunteers who, on their own accord without the lure of greed and profit, saved him from the Nazis and that war’s terrible aftermath.
I greatly encourage anyone interested in the struggle for justice in Panay Island to reach out to such organizations as Help-Panay or Alliance for HealthCare Workers in Philippines, and National Nurses United. One can also contact RNRN through NNU to contribute funds towards further disaster relief projects. In addition, Doctors Without Borders does great projects the world over. Locally we must work towards building a stronger union movement in the United States.
David Abeles is a father and a medical surgical nurse who participates in the local Austin National Nurses United chapter. Please contact him at firstname.lastname@example.org to inquire on any info pertaining to the work or organizations I mentioned.