Abstract
Caring for Strangers: Filipino Medical Workers in Asia tells a migration story that is both old and new in the current literature. Numerous studies have examined the experiences of Filipino medical workers, particularly that of nurses. Yet, most of these studies have been largely situated in destination countries located in the West, where foreign nurses come mainly as migrants who seek to settle permanently in their host countries. In this book focusing on Filipino nurses and nursing aides, Megha Amrith explores how these medical workers make meaning of their work, status and identities within Singapore, a wealthy, multiracial nation in Southeast Asia. Here, these Filipino migrants are often “in transit,” using Singapore as a steppingstone to better opportunities elsewhere. At the same time, they represent only one of the many types of jobs that Filipino migrants have taken on within Singapore. As such, they also face constant comparisons to domestic workers, who engage in forms of care work within Singaporean homes.
Amrith shows how these Filipino migrants negotiate conflicting images and stereotypes, reinforced at both the global and local levels. On the one hand, the Philippine labor-exporting state promotes Filipino medical workers as “ideal migrants,” skilled professionals who provide much-needed labor in destination countries across the world. On the other hand, Filipino migrants, in general, are also often portrayed as victims – exploited and downtrodden individuals forced to leave their families behind as they seek economic opportunities overseas. Amrith argues that Filipino medical workers in Singapore straddle between these two stereotypes, and such conflicting images play out as they go about their work and interact with patients of different ethnicities and nationalities. Her book provides a compelling example of how we must recognize broader contexts of race and nationality in order to investigate the politics and nuances of care work.
Amrith developed her arguments based on an ethnography in one government hospital and one nursing home in Singapore. She also followed her research participants in the many places they frequented in Singapore, such as Lucky Plaza (the “Filipino mall”) and their parish churches. In the latter part of the book, she writes about visiting the Philippines, where she spoke to nursing students, staff nurses and recruitment agencies in Manila. She then accompanied one of her research participants, a Filipino nurse, back to the latter’s home village in Iloilo, where she witnessed a family reunion.
Amrith’s book must be commended for taking pains to show how we must understand nurse migrants’ experiences and perspectives in terms of the work environments where they are embedded, their professional status in the Philippines, and comparisons to other groups of Filipino labor migrants such as domestic workers.
In terms of work contexts, Amrith discusses two very different “spaces of care.” The first is a public hospital that prides itself in being at the forefront of biomedical technology and medical innovation. It promotes a professional image, that Filipino migrants initially take pride in. In contrast, Amrith also visits a Buddhist nursing home, where work is less stressful, but also less prestigious. Here, Filipino migrants care for poor, elderly Singaporeans who often lack family support. In each of these contexts, the medical workers face different challenges. In talking about nurse migration, scholars tend to focus on the migrant experience of acculturating into a host country or city. Amrith’s work points out correctly that a lot is also about acculturating into a new work environment, with its own culture and norms as to what care work is and should be.
Amrith also provides rich insight into the intimacies and tensions that emerge as Filipino medical workers care for patients of different Asian ethnicities and nationalities. She shows how the tensions in providing care are rooted in racial and national identities and ideas of being “First World” or “Third World.” In the process, Amrith’s interviewees grapple with their multiple identities, and seek ways to differentiate themselves from medical workers of other nations, Singaporean “locals” and Filipino domestic workers.
Given the different comparisons the book sought to make, one that is less successful is Amrith’s exploration of the nursing profession and care work in the Philippines and Singapore. While her interviewees described the diminished status of nursing in Singapore, it seemed too simplistic to assume that nurses in the Philippines are held in high status. Based on her interviews, Amrith depicts nurses in the Philippines as a “respectable class,” accorded with much status. While true in some cases, often, the respect given to the nursing profession is highly dependent on the demand for nurses overseas. Studies on Philippine nurse migration show that when the “economic potential” (to use Amrith’s words) for overseas work fades away, so does the “prestige” associated with the profession (see Guevarra, 2010; Ortiga, 2014).
Given the strong link between migration and nursing education, the book needs more discussion of how the “economic decision” to pursue nursing is then linked with the act of caring. If the motivations behind the profession were mixed at the beginning, how do these varied motivations affect the way migrants define their care labor when they get to Singapore? Amrith’s text provides the beginning of this argument but does not seem to go all the way.
It is also important for Amrith to recognize that while Filipino nurses do travel to a wide range of destination countries, it was the news of the USA accepting nurses that sparked such widespread expansion of nursing programs in the Philippines. When retrogression and the financial crisis came into effect, the demand for such courses fell. In this sense, the ideal of working and living in Western destinations like the USA and UK still drives the mobility dreams of aspiring migrants.
Overall, Caring for Strangers: Filipino Medical Workers in Asia is a welcome addition to the growing number of books that look at migration within the region, instead of the usual routes from Asia to the West. Amrith provides a compelling view of the contestations that emerge from interactions between migrant medical workers and their diverse patients, highlighting how intimate relationships often reveal larger social and political inequalities as well.