COVER STORY : Take a Close Look at the Wards of Any Hospital in the City and You Will Likely Find Many Filipino Nurses--Drawn Here by Opportunity and Climate. But With the Nursing Shortage Long Over, Some Notice Heightened Tensions Along Racial and Cultural Lines. : The Healing Touch
When asked if Los Angeles is considered a haven for Filipino health care professionals, Lorna Agdeppa simply smiles and leads the way across the cardiac surgical ward at St. Vincent Medical Center in Westlake.
In one room, a Filipino nurse is wheeling a patient to bed. Next door, another is monitoring a patient’s heartbeat, while yet another is rolling in a food cart.
Agdeppa said when she came to St. Vincent in 1976, only a few other Filipinos worked at the 386-bed hospital. Today, 70 of the 87 registered nurses in the ward that she co-supervises are Filipino.
Along with working at a medical center where an estimated 80% of the nurses are Filipino, Agdeppa has a brother who works as a doctor at St. Thomas Medical Clinic in Hollywood, a sister who is a medical technician at County-USC Medical Center and an aunt who works as a nurse in Whittier. Her mother is a retired nurse’s aide.
“It’s the easiest way to get out of the Philippines,” Agdeppa said of health care careers. “And it’s considered honorable work. Most of the Filipino nurses who came from the Philippines are from the middle class and tend to be advocates for people in need.”
Agdeppa’s family and work situation are considered more typical than extraordinary in Los Angeles’ burgeoning Filipino community. There were 18,625 Filipinos living in Los Angeles in 1970. That figure grew to 88,889 in 1990, making Filipinos the city’s largest Asian group, according to U.S. Census figures.
Although there are no exact figures, officials at several Los Angeles hospitals say Filipinos make up a large percentage, if not the majority, of their work force. The highest concentration of Filipino health care professionals appear to be employed as nurses.
About 60% of the 400 employees at Temple Community Hospital are Filipino, while about 58% of the registered nurses at the Hospital of the Good Samaritan are Asian--most of whom are Filipino, according to officials at the two Mid-City hospitals.
Filipinos also comprise an estimated 38% of the registered nursing positions at Queen of Angels-Hollywood Presbyterian Medical Center and about 45% of the nursing staff at Kaiser Permanente Medical Center on Sunset Boulevard.
“A lot of Filipinos come here because they like the warm climate and they like living in an area with a large Filipino population,” said physician Romeo Abella, who is also one of the owners of Temple Community Hospital. “When it comes to health care, many Filipinos come here to take advantage of the job opportunities.”
Filipino nurses, doctors and other professionals first started coming to Los Angeles and other U.S. cities after the Immigration Act of 1965 raised the annual immigrant quota for every non-Western country from 100 to 20,000.
At least 25,000 Filipino nurses immigrated to the United States between 1966 and 1985--comprising the largest group of foreign nurses to come to this country, according to a 1991 report on Filipino nurses by UCLA Profs. Paul Ong and Tania Azores.
This exodus, referred to as the “brain drain” by Filipinos, was welcomed by American hospitals in dire need of nurses during much of the ‘70s and ‘80s. The shortage was caused by a rapid growth in the demand for health care, which outpaced the supply of nurses. The fact that Filipinos spoke English and attended nursing programs modeled after schools in the United States made them even more attractive to American recruiters.
“When I went to nursing school, I didn’t envision myself coming to the United States,” said Thelma Ordonez, a Filipino administrator at Kaiser Permanente who immigrated in 1975. “I thought I would stay in the Philippines, get married and have children. But a lot of people were applying for visas, so I went to the embassy, applied, and lo and behold--I had a visa.”
Joseph Wm. Hummel, hospital administrator at Kaiser Permanente Los Angeles on Sunset Boulevard, said most large Southern California hospitals turned to the Philippines when they ran short of nurses, particularly to meet the needs in the growing critical-care units.
“Filipino nurses are well-trained, and since we have a significant number of Asian patients, they have fit in well to our cultural diversity,” Hummel said. “Filipino nurses in general have made tremendous contributions to the quality of care.”
But as Filipino health care professionals continue to flock to the United States and competition for jobs grows more fierce, some believe the relationship between Filipino and non-Filipino employees is worsening. Sometimes the problems stem from cultural differences. Other times, the high visibility of Filipinos at local hospitals creates resentment.
“Because a lot of Filipinos are coming here, there is hostility from those who believe they’re taking jobs away,” said Mariquita Davison, a Filipino graduate student at UCLA who is writing her master’s thesis on Filipino nurses. “There’s definitely tension in the workplace.”
Although the nursing shortage in the United States ended a few years ago and the recession has forced many hospitals to make cuts in staff, nursing schools in the Philippines continue to graduate about 20,000 students a year.
As a result, there are now about 50,000 unemployed nurses in the Philippines, most of whom would like to go to the United States, the Middle East, Europe, Asia or another part of the world but can’t find jobs, said Remigia Nathanielsz, a nursing consultant at the Bureau of Higher Education in Manila. Most Filipino nurses come to the United States on work visas provided by hospitals. Entry-level nurses in Los Angeles generally earn $30,000 to $35,000 a year, while recent graduates in the Philippines draw an annual salary equivalent to about $1,800.
“The financial opportunities here are so much greater than in the Philippines, so many people have a great desire to come,” said Lolita Manigbas, a nurse at Kaiser Permanente on Sunset Boulevard. “Most of my classmates in the Philippines are now working in Los Angeles.”
As a young girl growing up in the Philippines, Ofelia Jacob decided on a nursing career, partially because she was fascinated by the idea of wearing a white uniform. Several other Filipino health care professionals expressed similar attraction toward the white uniform.
“I had an aunt who was a nurse and I saw her in her white shoes and cap,” said Jacob, who works at the Hospital of the Good Samaritan. “To me it looked very elegant, and I just wanted to be like that.”
Others say they got into health care professions because their parents told them at a young age that it would bring honor to the family. In the Philippines, health care professions are among the most highly regarded careers.
“My mom said to me, ‘You’re going to be a doctor,’ ” said Valor Ramos, a Filipino premedical student at UCLA. “I wanted to be a baseball player but I had no choice.”
Many Filipinos also say they got into health care professions because they enjoy helping the elderly and the sick.
“The Philippines is not like here where when you grow old you get dumped in a nursing home,” Abella said. “We have a strong family culture and respect for the elderly.”
A caring instinct is what prompted Joel Eriman to go into health care. Although Eriman, a medical technician at Kaiser, doesn’t deal directly with patients at work, he spends most of his spare time helping AIDS patients through volunteer groups.
“I grew up with compassion in my heart,” said Eriman, who came to Los Angeles from the Philippines in 1967. “I look at it as my chance to give back to a country that has given so much to me.”
While working as a volunteer with AIDS Project Los Angeles, Eriman met a couple from Alabama who came to visit their dying son. The couple, who lost their son shortly after they arrived, didn’t know anyone else in Los Angeles and had little money to pay for meals or lodging.
Without hesitation, Eriman invited the couple to his four-bedroom home in Glendale and helped them make funeral arrangements.
“They told me I was the first Asian they had ever come close to, but also the first angel they had ever met,” Eriman said. “When they were leaving, I stuck out my hand to the father so he could shake it, and he grabbed me and said, ‘You have so much love in you, I’d just like to give some of it back.’ ”
While nursing and other health care professions have provided many Filipinos with rewarding careers, the hours are long, the work is grueling and relations with other employees and patients sometimes are tense.
“Most of the other employees feel we are a threat and say we are taking away jobs,” said one Filipino nurse, who asked not to be identified. “I’ve been told, ‘Why don’t you go home to your own country?’ ”
A doctor also once told the nurse: “Get me an American nurse who speaks and understands English.”
“He got angry when I asked him to slow down,” said the nurse, who speaks English fluently with a slight accent. “He was talking so fast and I just wanted to make sure I was writing down the correct information.”
Filipino nurses also remember times when patients have lashed out at them.
“Sometimes a patient will say, ‘I don’t want any Orientals treating me,’ ” Agdeppa said. “But we can’t do anything because most of our nurses are Asian.”
Problems also arise when Filipinos speak to each other on the job in their native language.
In a 1989 case that received national attention, Aida Dimaranan, a former assistant head nurse at Pomona Valley Hospital, filed a lawsuit against the hospital, arguing that a policy prohibiting the use of Tagalog in the maternity ward violated her civil rights. Tagalog is the official language of the Philippines.
A federal judge ruled in October, 1991, that the hospital’s policy was not racially discriminatory because it was “little more than management’s response to the increasing tension that was dividing the staff nurses.”
But the judge also ruled that the hospital unfairly retaliated against Dimaranan by demoting her for refusing to obey the language ban.
“Other employees thought we were talking about them in our native language,” said Dimaranan, who recently left the hospital and is seeking another nursing job. “But that’s just how we like to talk to each other, and we should have a right to speak our own language.”
Felice Klein, a nurse recruiter at Kaiser Permanente Medical Center on Sunset Boulevard, said cultural misunderstandings often are at the root of the problems between Filipino and non-Filipino employees.
“There has not been enough tolerance on both sides,” she said. “Many Filipino nurses feel comfortable speaking their native language, while other people think it’s not courteous.
“I think what’s happening at hospitals is happening in California in general. Many Caucasians feel that in terms of numbers, they will become the minority and that’s a very sensitive subject.”
Royal Morales, a Filipino who teaches a class at UCLA on the Filipino-American experience, said officials at Cedars-Sinai Medical Center have asked him to conduct workshops to help them understand the “Pilipino psyche.” (Morales said some people prefer using Pilipino because the word Filipino was created by Spaniards during their colonial rule of the Philippines from Fernando Magellan’s arrival in 1521 to the end of the Spanish-American War in 1898.)
“They wanted me to talk about why Pilipinos are so cliquish and why they speak in their own dialects,” Morales said.
Filipinos also are frequently labeled as not assertive, which can hinder their career advancement.
Only 9% of the Filipino nurses in the United States have risen to positions as administrators, supervisors or head nurses, compared to 18% of employed nurses, according to Ong and Azores’ report.
“Certainly, the perception of Filipino nurses as being cliquish, reticent, ‘less professional,’ and lacking social skills works against their being seriously considered or being invited to apply for managerial positions,” the report said. “The other side of the issue is that there is a real hesitancy on the part of many Filipino nurses to seek higher positions. . . . For Filipino nurses, fulfilling family obligations comes before professional advancement.”
Although some Filipinos have difficulty overcoming the stereotypes, many Filipino nurses have risen to high positions, Agdeppa said. Of the 28 nurses in management positions at St. Vincent, 14 are Filipino, she said.
“I think it depends on the hospital,” Agdeppa said. “The reason why so many Filipinos stay at St. Vincent’s is because the hospital’s values are almost like the values at home. People here treat each other well and respect the medical profession.
“The Filipino nurses here have a reputation of always striving for more.”
