Empire of Care: Nursing and Migration in Filipino American History (review)

Although we know that medicine and nursing are transnational enterprises, few historians of twentieth-century health care have looked beyond the boundaries of one nation-state or another. Diseases do not respect political demarcations, physicians and nurses have been migratory—yet our historical studies rarely recognize the dynamic, cosmopolitan aspects of modern medicine. Catherine Choy, however, shows us what nursing and medical historians can learn from immigration history and "postnationalist" American studies. In Empire of Care she charts the development of an international Filipino nurse labor force, drawing together studies of U.S. imperialism, immigration policy, hospital management, and nursing. She also provides us with a model of how to combine, with sensitivity and insight, archival sources and contemporary interviews.

The Philippines has become the leading supplier of nurses to the United States: more than 25,000 Filipino nurses immigrated between 1966 and 1985; in New York City hospitals, almost one in five nurses is from the Philippines. The basic argument of Empire of Care is that this massive nurse migration is an outcome of early twentieth-century U.S. colonialism in the Philippines. Established in 1907, the first nursing school proved very popular with young, lower-middle-class women seeking to maintain or increase their status, and aspiring to a modern American career and way of life. From the beginning, nursing education in the Philippines prepared Filipinos to work in the United States. Choy insists that the attraction of the United States was not solely economic: nurses learned English, became acculturated to American practices, and modeled themselves on Yankee "originals." After the exchange visitor program was organized in 1948, Filipino nurses flocked to American hospitals. For a few, the pull was indeed largely economic; but some wanted travel and adventure, and others hoped to improve their cultural status. Some maintained a romantic view of life and career in the United States; most, however, found colonial inequalities and hierarchies reproduced across the Pacific. Choy conveys vividly the diversity of motivations and experiences among the expatriate nurses, and the multiple ways in which education and career can shape identity and attitude.

A combination of events amplified Filipino nurse migration in the late 1960s: the 1965 Immigration Act allowed foreign nurses to settle as permanent residents; the demand in the United States for nursing services increased; and the Marcos government developed nursing into a new export industry for the Philippines. Feeling disparagement and discrimination, the nurses banded together in their own professional organizations and tried to improve their conditions. Choy suggests that many older, colonial representations of Filipinos continued to exert an influence on contemporary attitudes toward immigrant nurses. Filipino nurses were sometimes the first suspects when things went wrong. The most notorious example occurred when Filipina Narciso and Leonora Perez were accused of poisoning patients in the Veterans Administration Hospital in Ann Arbor, Michigan, in 1975. They were eventually acquitted, but Choy argues that in the prosecution the nurses "emerged as dark, dangerous, and conspiratorial Filipino natives with the propensity to harm their American patients" (p. 122). This, she claims, was another legacy of American colonialism.

Choy might have told us more about the fashioning of the gender identity of male Filipino nurses; and she might have compared the experiences of Filipino nurses with those of other foreign and minority nurses in the United States. I was sorry that she missed the echo in the VA investigation of the 1916 poisoning allegations against nurses in the Philippines General Hospital—a precedent that would have strengthened her argument. But these are minor faults. Historians of medicine and nursing will learn much from Choy's innovative transnational study. It will surely inspire many of us to reframe our analysis of twentieth-century health care.