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It's All History by Jon Malek

Filipino nursing immigration to Canada

by Jon G. Malek

For decades, Filipinos have staffed medical facilities across Canada. In Canada, a career in nursing is often seen as a means to a stable job with good pay and benefits while in the Philippines it can provide a strategic opportunity to work abroad. Today, the plight of internationally trained nurses and their difficulty in having their credentials recognized in Manitoba is under the political spotlight as Manitoba’s healthcare facilities have faced a crisis in staffing throughout the COVID-19 pandemic. It hasn’t always been this difficult for nurses to have their foreign education recognized, however, and decades ago when Canada was facing a similar shortage of qualified medical professionals, Filipino nurses, doctors, and technicians were recruited to keep the healthcare system afloat. The history of Filipino nursing in Canada from the 1950s to the 1970s is wrapped up in the history of imperialism, racism, and an uneven flow of people between the global south to the global north.

As Catherine Choy has shown in her history of Filipino nursing migration, Empire of Care: Nursing and Migration in Filipino American History, the United States established several nursing colleges in the Philippines that taught the most up-to-date techniques in nursing, in part to improve healthcare in the tropical colony, but also to build a body of well-trained healthcare professionals who could work in the United States. Throughout the 1950s and 1960s, Filipino nurses, as well as doctors, looked to the United States as a place to work abroad. This was made possible through the American Exchange Visitor Program, known as the EVP, which allowed Filipinos entry into the U.S. for training and work experience in American hospitals. While the program was meant to give Filipino healthcare professionals experience in modern practices, which they were intended to bring back to the Philippines, many took the opportunity to apply for residency after their tenure in the EVP, leveraging their healthcare expertise to become permanent residents in the United States.

Policy changes within the U.S. in the 1960s attempted to limit these applications by requiring that Filipinos leave the country for two years before applying for landing status. The idea was that they would return to the Philippines, where they would work and become settled in their lives. However, Filipino healthcare workers, intent in their desires to immigrate to the U.S., began looking north of the border to Canada. They became increasingly aware that Canada needed healthcare workers as its medical schools were not able to produce the number of new nurses required. The Winnipeg Tribune in March 1969 noted, “If it was not for the nurses that come here from the Philippines, some of the country hospitals would face a disastrous staff shortage.”

This acute need for nurses was tied to fundamental changes in Canadian healthcare that shifted from a reactionary model to a preventative one. This led to a growth in hospitals, clinics, and privately-run medical homes, which required a growing body of health professionals. Furthermore, movements toward a universal healthcare insurance system for Canadians, starting with Saskatchewan in 1947, promised to surge the demand on the medical profession. So, instead of returning to the Philippines, Filipino healthcare professionals secured jobs in Canadian hospitals and worked for the two-year period that they were required to remain outside of the U.S. Afterwards, many indeed applied to the U.S., but significant numbers opted to remain in Canada. While small Filipino communities had existed in Canada since the second half of the nineteenth century, this was the beginning of the Filipino community in Canada.

This movement of Filipino healthcare professionals into Canada required special interventions from the government because Canadian immigration policy was overtly racist at this time and prevented Asian immigration to the country. Canadian politicians still viewed the country as “White” and restrictive immigration policies were in place to ensure that only racially preferred immigrants were permitted into Canada on a permanent basis. These exclusionary policies remained in effect until the 1960s when Canada’s immigration system was overhauled and one’s racial and geographic background were removed as qualifiers. Instead, a points system was established, brought into full force in 1967. It awarded applicants points in a variety of areas such as education, work experience, proficiency in English or French, which made it much easier for Filipinos to immigrate to Canada.

When Filipino healthcare workers began looking to Canada in the late 1950s, these policies were still in place. White Canadian officials and politicians were thus presented with a conundrum brought about by their deeply rooted anti-Asian racism. The applicants had the skills and education that were so badly needed in Canada’s healthcare system, but the mere fact that they were Filipino legally restricted them from entering Canada. The records make it clear that immigration policies were strictly applied to Filipinos in other contexts, but in the case of the healthcare workers there appeared to be a willingness to make exceptions. A major difference in the case of healthcare professionals appears to be the EVP, as well as the American-style nursing schools in the Philippines. By participating in the EVP, Filipino nurses, doctors, and other workers were deemed to have had appropriate education and work experience. Moreover, exposure to American society and culture ensured their transition to Canada would be easier and, compared to most other immigrants of Asian descent, educated Filipinos had strong English language skills.

The ad hoc system that was developed allowed Filipino nurses entry to Canada as permanent residents upon an offer of employment from a hospital. Each healthcare worker was approved on a case-by-case basis, but only in rare circumstances were their applications denied. Eventually, assessment teams were even sent to Manila to test applicants and speed up their processing. These Filipino professionals were very quickly welcomed by the hospitals in which they worked, with documents indicating how valuable they were in hospitals, especially in Toronto.

Part of this willingness to grant permanent residency, though, was also rooted in contemporary foreign affairs, particularly between Canada and the Philippines. In 1951, the Philippine government enacted what became known as the Reciprocity Act that essentially barred entry to foreign nationals whose countries did not permit Filipino immigrants. This Act specifically targeted Canada’s anti-Asian policies and was a hard blow because there were significant Canadian business interests in the Philippines. As part of smoothing things over with the Philippine government, Canadian officials gradually accepted small numbers of Filipinos, providing an additional context to the early history of Filipino nurses in Canada.

The presence of Filipinos in hospitals across Canada became more pronounced as nurses and doctors were steadily hired and placed in facilities. Part of this was due to government initiative, but the networking of Filipinos themselves also played an important role. Nurses in the EVP program often communicated their experiences with their friends once they arrived to work and live in Canada. Word-of-mouth was also a means for nurses in the Philippines to learn about opportunities in Canada. In 1959, when the first Filipino healthcare professionals were applying to Canada from the EVP program, many were coming from Chicago, and it was surmised that they were being coached by someone on their applications as there were many similar statements being made.

When applicants from the EVP began looking to Canadian hospitals, officials weighing the applications expressed multiple concerns. The first was the fact that Canada was in dire need of nurses and could benefit from these Filipino applicants. The second was that they were concerned about enflaming international relations with the Philippines by refusing the entry of Filipinos and risk renewed retaliation from the Philippine government. Third was the concern of the sincerity of the Filipino nurses to stay in Canada, although ultimately it turned out that many did want to stay. Finally, there was some concern that by accepting these Filipino applicants, Canada would be siphoning a talented labour force that was intended to return to the Philippines.

On this last point, W. R. Baskerville, director of immigration, expressed concern that Canada might be contributing to the failure of the EVP. In one of these communications, there was a hand-written note by an anonymous writer that stated “if they are not under objection to return to their own country and we are desperately in need of […] nurses why not take advantage of the situation[?]”

While the elected politicians in charge of immigration were clear that these approvals to Filipino healthcare workers were only made on an individual basis due to immediate hospital demand, the civil officials who dealt with this issue were intently focused on the immediate and long-term labour needs of Canada. This is not to say that racial bias was not present – it was – but that it was increasingly being subverted beneath a practical understanding of Canada’s situation. It was becoming clear to many in the department of citizenship and immigration that, if Canada’s economy and, in this case, healthcare system were to grow and prosper, foreign labour would need to be tapped in the form of immigration. I thus argue that this immigration of Filipino nurses and their service in Canada’s healthcare, along with intense pressure being applied by the Philippine government over reciprocity in immigration, helped convince many that a change in policy was needed, contributing to the push for the 1967 points system.

Shortly after this immigration reform, though, there was a sharp drop in the numbers of Filipino healthcare professionals admitted into Canada, controlled in part by an ability to reduce the number of points assigned to their profession. The acute labour shortage of the late 1950s and 1960s had largely been solved, and it was becoming so difficult to attain recognition of credentials that immigration officials actively discouraged nurses and doctors, warning they would not find work in their field. In 1973, fifty-nine doctors were admitted; this fell to thirteen by 1975. Thus ended a formative period of the Canadian Filipino community that saw a sharp rise in educated immigration who would go on to found community organizations across Canada. These healthcare professionals found work in their area of training with relative ease, something that many nurses trained in the Philippines wish for today.

As debates on credential recognition occur today, it is important to acknowledge this history and to remember that there was a time when both government and professional associations worked together to speed up the process and tap the skilled labour of newcomers to Canada.

Jon Malek received his PhD from Western University and currently teaches history at the University of Manitoba. He is working on a book manuscript on the history of the Winnipeg Filipino community.