Filipino health care workers during COVID-19 and the importance of race-based analysis

Without the care work provided by Filipino migrant care workers, many countries would have a difficult time coping with high health care demands, particularly during a pandemic.

LEGAZPI CITY, Philippines (July 6, 2016) U.S. Navy Lt. Brian Dueñas, a native of Lake Mary, Florida, preps for surgery aboard hospital ship USNS Mercy (T-AH 19) during Pacific Partnership 2016. Members of the Armed Forces of the Philippines, partner nations and Mercy crew worked together to provide patient care during the surgery. Pacific Partnership is visiting the Philippines for the seventh time since its first visit in 2006. Partner nations are working side-by-side with local military and non-government organizations to conduct cooperative health engagements, community relation events and subject matter expert exchanges to better prepare for a natural disaster or crisis.
U.S. Navy photo by Mass Communication Specialist 1st Class Elizabeth Merriam/Released.

Filipino workers on the frontlines during COVID-19 globally and in Canada

Warlito Valdez. Amor Padilla Gatinao. Daisy Dorinilla. Debbie Accad. Leilani Medel. Christine Mandegarian. 

These are just a few of the names of Filipino nurses, personal support workers, and caregivers in Canada, the United States, and the United Kingdom, who have died after providing frontline support to clients and patients with COVID-19 in hospitals, long-term care facilities, and private residences. The need to fill in job vacancies for health care personnel in migrant-receiving countries like Canada, and the existence of a labour brokerage policy that make the ‘export’ of labour and transfer of payment to home countries a vital part of migrant-sending countries’ [like the Philippines] economic growth strategy, compel thousands of Filipinos to seek jobs as migrant workers. Because many Filipino migrant workers go abroad to become care workers, the Philippines has effectively created what author and historian Catherine Ceniza Choy describes as an “Empire of Care”.

Without the care work provided by Filipino migrant care workers, many countries would have a difficult time coping with high health care demands, particularly during a pandemic. According to The Guardian, in the UK, there are over 18,000 Filipinos that work in National Health Services (NHS). The article offered some insights on the impact the virus has had on the community in the UK. As of April 15, at least 23 workers are believed to have died from the virus according to a list provided to the newspaper outlet; and one community leader stated that COVID-19 is “wreaking havoc in the UK’s Filipino community.”  In Spain, Filipino migrant workers with nursing degrees but who were hired as babysitters and nannies were suddenly given permission to work as nurses because the medical system could not cope with high numbers of COVID-19 patients. In the United States, 16% of all nurses are immigrants, and of those, 30% are Filipinos. Reports have indicated that COVID19 is taking an “outsize toll” on Filipino care workers.

The same trends are true in Canada. In fact, my co-editors and I argue in our introduction to our book “Filipinos in Canada: Disturbing Invisibility,” that Filipinos have dominated Canada’s nursing and caregiving professions and have in fact had to cope with the stereotypes of all Filipinos as being caregivers. These stereotypes are born out of the Filipinos’ ubiquity in caring professions in the country. 34.4% of internationally-trained nurses are from the Philippines, with a study from 2008 showing that although Filipinos constitute 1.2% of the Canadian workforce, they constitute 5.6% of Canada’s total health care aide labour force. While there has yet to be a study updating these figures, it is reasonable to assume, given how the Philippines has become Canada’s third largest ‘source’ country for immigrants (after India and China), that the proportion of Filipino workers in Canada and thus, the proportion of these workers who are part of the healthcare industry, has grown bigger. 

Caregivers & personal support workers during COVID-19

Despite the importance of ‘essential’ labour during this crisis, it is striking to note that mainstream media coverage has mostly ignored the contributions provided by Filipino healthcare workers specifically and all migrant healthcare workers more generally. While much of the attention has been given to doctors and registered nurses, other care providers such as personal support workers, licensed practical nurses, and in-home caregivers have not merited much attention.

The absence of any consideration of the situations of migrant caregivers who provide in-home care under Canada’s Caregiver Program (CP) is surprising. Migrant caregivers, 90% of whom are Filipino, provide intimate care for Canadian families, including Canadian seniors. With mandatory stay-at-home policies for nearly all workers (except those providing essential services), migrant caregivers may not be getting any breaks from their work. They now have to stay at their employers’ households where they may be on-call for 24 hours; those working for over-demanding or abusive employers find that they do not get any respite from such abuse, leading to increased anxiety. Some may also find themselves suddenly terminated, thereby jeopardizing not just their ability to earn a living but also their opportunity to continue staying in Canada and applying for Canadian citizenship. (The terms of the CP require that caregivers work in Canada for two years before being able to apply for citizenship). A study of in-home care providers conducted by the National Domestic Workers Association in the United States highlights how COVID-19 has led in-home care providers to become economically vulnerable; it is reasonable to assume that caregivers in Canada face similar circumstances.

In contrast, while there is extensive news coverage of COVID-19 in long-term elderly care facilities, such coverage mostly ignores the risks that personal support workers face. In fact, PSWs were blamed for infecting their patients. Some of these reports asserted that PSWs’ supposed lack of training was to blame (e.g., PSWs do not know how to properly wear masks), conveniently omitting the reality that there are insufficient numbers of Personal Protective Equipment (PPEs) for care workers. Figures from British Columbia, for instance, in mid-April Illustrated that 70% of care workers were facing a “critical shortage of supplies”. (Many care workers in other countries lack access to PPEs.  Many have had to be creative by fashioning their own PPEs, as in the case of this widely circulated photo of Filipino nurses in the United Kingdom, who wore garbage bags to protect themselves).  

Other reports draw attention to how these workers assumed multiple contracts in different care homes, thereby facilitating the spread of COVID-19. While it is true that PSWs’ employment in different facilities make it harder to contain COVID-19, the contextual reasons for why PSWs do so is ignored. As Pat Armstrong rightly pointed out, such media coverage ignores how the marketization of health-care services has meant that “just under half of all long-term care facilities are private, for profit entities,” which has led to a “deterioration in labour conditions.” 

Simply put, PSWs’ absence of job security as a direct result of the growing privatization of long-term care facilities has led many to assume multiple, part-time work contracts in order to make ends meet. Recent attempts to stop the spread of the pandemic in nursing homes, such as policies prohibiting workers from being employed in multiple care facilities, are woefully insufficient when they are enforced without simultaneously requiring wage increases for them.  In Ontario, employers are only “encouraged” to give part-time workers full-time hours, with no additional incentives for employers to do so. In addition, these policies exempt temporary agency workers, who are employed not by care homes but by staffing agencies. Giving PSWs access to PPEs, to higher wages and to permanent work-contracts with benefits for themselves and their families is therefore crucial to ensuring that PSWs are protected. Recently, the Government of Ontario introduced “pandemic pay” as a way to top-up the salaries of PSWs; while BC has dutifully taken the step to bring the operation of long term care homes under government operation to provide decent work conditions such as increased pay and full-time hours. However, long-term structural changes are needed in these facilities to ensure that workers, residents and patients don’t continue to face ongoing risks.  

Race and COVID-19: blaming ‘Filipinos’ for COVID-19 neglects structural factors

Implicit in media coverage of COVID-19 and Filipino healthcare workers in the West is the belief that workers themselves are carriers of disease. Because of the spread of COVID-19 in industries populated by Filipinos, which include the healthcare industry and also industries that are part of the food supply chain (such as meat-processing plants in Alberta, where 70% of all workers are Filipino), there exists the perception that Filipino culture contributed to the spread. 

A New York Times article on the role of Filipino nurses in fighting COVID-19 in the United States, for example, states without qualification that “migration is woven into the Philippines’ culture”. These narratives ignore how structural adjustment programs (SAPs) that place developing economies like the Philippines in a dependent relationship with more affluent developed countries — and not essentialist ‘cultures’ of migration — pushed Filipino nationals seeking better economic opportunities to go abroad. Continued economic stagnation, in fact, makes labour migration the only option for many families in the Philippines. Hence, the ubiquity of Filipino migrants globally is not the direct result of Filipinos’ “culture” of migration but a result of economic necessity. 

Policy Recommendations

In closing, it is important for any analysis of COVID-19 to take race into account. It is crucial for policymakers to get race-based data to understand the risks that different communities face when it comes to COVID-19; as well as the ways in which migrant workers like those in the Fillipino community are impacted. Only through the acquisition of race-based data can policy solutions that are attentive to the needs of specific communities be passed. While some jurisdictions have opted to collect raced-based data, such as the City of Toronto, the picture will remain woefully incomplete without a national approach. With reports already showing the magnified health risks faced by Black people and Indigenous people during COVID19, one cannot emphasize enough why obtaining race-based data is so crucial for sound policymaking. 

It is also important to assess how labour and immigration policies combine to create greater precariousness for Filipino migrant healthcare workers during COVID-19. Enshrining stronger worker protections is important for the following reasons: this will ensure that workers can say no to employer requests to work during COVID19, that workers will not face reprisal if they demand PPEs and stronger adherence to occupational health and safety requirements, and  that workers, overall, have a safe and harassment-free working environment. Stronger labour protections also ensure that Canadians receive higher quality care. But it is important as well to ensure that immigration policies are amended to ensure that migrant workers are protected. For example, care workers under the CP should be allowed extensions on the time it will take to complete their two-year work requirements if they are laid off by their employers during COVID-19 so they can apply for Canadian citizenship. Workers under the TFWP should be given open work permits that do not tie them to employers and be given permanent residency. Undocumented workers, some of whom work as care workers, should be given the opportunity to regularize their status. 

Finally, while it is beyond the remit of this paper to discuss the structural issues involved with labor export and labor import regimes, it is crucial to start thinking of alternatives to unsustainable patterns of labour migration that place countries like the Philippines in situations of perpetual debt bondage.

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