I was always taught to show respect to older relatives through the mano po gesture. If I were meeting a new family member, I would say “Ang pangalan ko Joaquim” to introduce myself. However, since immigrating to the United States from the Philippines, there are fewer and fewer people who call me by my actual name.
My family immigrated to the United States in 2002 after my mother accepted an opportunity to continue her career as a nurse and seek permanent residency in the United States. At the time, there were heightened demands for health care workers due to the implementation of Medicare and Medicaid under the Social Security Amendments of 1965. However, the Filipino nurse migration started as early as 1898, when the United States acquired the Philippines through the Treaty of Paris and started “benevolent assimilation,” which taught Filipinos how to speak English fluently, adopt United States culture, and aspire to the American Dream. Today, 1 out of 20 registered nurses in the United States is trained in the Philippines and maintains their status as the largest group of foreign-trained nurses to date.
During the COVID-19 pandemic, Filipinos comprised 4 percent of all registered nurses in the U.S. but constituted 31.5 percent of all COVID-19-related fatalities. Filipino nurses are more likely to work on the front lines of health care in acute or long-term care facilities. In these settings, they faced a heavy influx of patient admissions, a lack of personal protective equipment, emotional burnout, xenophobic hate, and financial responsibility to relatives back in the Philippines. As a night shift nurse on the congestive heart failure floor, my mother encountered all of these obstacles and feared spreading the virus to our family’s multigenerational household. During the pandemic, Filipino nurses displayed ingrained perseverance, resilience, and “hardiness,” which has been attributed to Filipino cultural characteristics. However, the pandemic has also exacerbated existing issues of extreme burnout as mass resignations have increased in the post-pandemic world. To this end, emotional, financial, and physical support should be provided to health care workers, especially those from marginalized communities, to increase retention and promote recruitment in fields that are vastly understaffed.
Stress related to occupation, lack of English skills, economic status, and immigrant status also applies to Filipino immigrants in general. These difficulties can be associated with increased chronic illness among Filipino immigrants. The Filipino American Paradox sees Filipinos as the major providers of health care to the U.S. population but are burdened by significant chronic health inequities themselves. For example, Filipino American adults have a higher risk of developing type 2 diabetes mellitus due to being more likely to smoke, consume alcohol, or be overweight/obese, especially in second- and third-generation Filipino immigrants. Another contributing factor could be avoidance of medical care in the first place. In Filipino culture, especially among the elderly, the concept of “bahala na” is a mindset where hospitals are avoided until it is absolutely necessary, and possibly when it is too late. Many cultures share similar sentiments of evasion and distrust towards health care, which hinders preventative care. In my personal life, I accompany my grandmother to visits with her primary care provider and try to explain why certain tests are ordered, how to apply her health insurance benefits, and answer questions about treatment plans. As the generation with more knowledge about American health care, it’s up to us to break generational mindsets and bridge the gap between the medical system and the patients it’s meant to serve.
Moreover, the voices of those who identify as Filipino are vastly underrepresented in those practicing medicine. As a second-year medical student at Geisinger Commonwealth School of Medicine, I am the only Filipino immigrant in my class. Filipino nurses have only recently been acknowledged as the backbone of U.S. health care as seen in HBO Max’s The Pitt. Despite the increasing rate of Filipinos entering the medical field, we are still grouped under the overall “Asian” umbrella. The assumption that homogeneity exists between Asian populations that are culturally and behaviorally distinct from one another can lead to fatal consequences. Information about the health of Filipinos is severely lacking in clinical research, specifically when statistical data is not disaggregated into Asian subgroups. Heart disease and stroke are the leading causes of mortality in the Filipino community, but there is not enough data to create efficient treatment and prevention strategies. The voices of Filipinos are muffled among the hundreds of Asian populations that some in the medical community consider to be the same. In order to address the impact of chronic illness and burnout amongst Filipino American immigrants, quantitative and qualitative studies on Filipino American immigrant health, well-being, and experiences should incorporate historical perspectives and public health outcomes.
All things considered, models of care and treatment that promote belonging, community, and celebration of all cultures should be established in clinical settings. I have discussed several strategies to achieve this goal to benefit the Filipino community in the United States. However, these approaches can be applied to all people in the health care setting. By tapping into the lived experiences of those around us, we can create a healthcare framework that helps everyone thrive and succeed. As an aspiring Filipino physician, I am excited to begin my career as Dr. Joaquim Diego Santos.
Joaquim Diego Santos is a medical student.
