how the world sees america

"House MD" Lures Filipino Nurses

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DAVAO CITY, Philippines - When Teri Hatcher’s character on “Desperate Housewives” said on the show she didn’t want a doctor from "some med school in the Philippines" examining her, it raised a furor here last month. Protests. A signing-campaign. Then an official apology from the show. Why so touchy?

“We’ve lost our best nurses and doctors to America…and got nothing in return,” says Brokenshire Hospital’s director Dr. Jack Estuart in a faded yellow operating room. His nurse manager led a team of 108 nurses for eight years before one day informing him she was going to Odessa, Texas.

“Odessa!” he says. “Where is that? Where? She’s gone from all this responsibility to nothing.”

To some extent, he understands the allure of the United States. Salaries there are ten times what he can offer. But he wants the U.S. to offer the Philippines something in return: assistance to the government for more high-tech equipment and training facilities. And he wants medical schools here to send students into rural Philippines to give them a sense of commitment to their own people.

But he’s up against a stiff challenge. He says over the past decade with more movies and TV shows coming from the United States, America’s medical image in the Philippines has grown all the more glorious. Of course, flexible immigration policies for medical personnel and higher pay have a lot to do with why Filipinos have moved to the U.S. in waves over the past two decades, but there’s more to it.

When Dr. Estaurt was in Ateneo de Davao Medical School in the 80s, social activists roused him, calling for the ousting of dictator Ferdinand Marcos, and urging him to devote his life to helping the poor and building a new Philippines. He stayed, he says, for this purpose.

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Dr. Jack Estuart.

Today the medical school says the same words, but they carry less weight. Persistent corruption and mismanagement in the Philippines has dulled young medical professionals' desire to help their home communities. Money dedicated to medicine gets siphoned away in the rural areas, leaving doctors frustrated that they can’t do the work they want to for their people.

So says head emergency room nurse, Ray Bleica.

Ray has been trying to get to the U.S. since 1997. Asked if he feels bad about leaving the Philippines, a country in need, for America, “the land of milk and honey” as he calls it, Ray says, "It’s frustrating, but here politics are bad, there is corruption and insurgency.” Fighting the system is too difficult. “I can only do so much,” he says.

At least in America he can be sure to earn a good living and send much of that money back to his cousins here, without government officials taking a cut. Ray makes US$400 per month now. In America he could make almost ten times that.

But more money has its price.

Currently he supervises a dozen nurses working underneath him. Like his peers, Ray will move from being a leader, a position it took him almost a decade to acquire, to becoming a low-ranking member of the staff again in a hospital in Ohio. He's not sure what city he's going to. (Many Filipino rural doctors are doing something similar, sacrificing their medical degrees to become nurses in the U.S.)

Ray worries about being under-appreciated, citing the Teri Hatcher remark. And he worries about being too overwhelmed in "the land of stress." He imagines action-packed hospitals with tech-savvy labs. Nothing like Brokenshire.

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High-tech doctor, TV's Gregory House.

Where does this vision of the U.S. come from, I ask. Ray's face lights up as he recounts his childhood days pouring over copies of Reader's Digest. Now he’s infatuated with the TV shows ER, Grey's Anatomy, and House MD.

"They really teach me a lot," he says, about how hard American doctors work, how dramatic their lives are, and about America's technological edge. "I was amazed America has diagnostic departments like [the ones featured] in House," he says.

The big difference between American and Filipino healthcare styles, he says, is in the U.S. doctors rely on fancy machines to diagnose and treat patients. In the Philippines, doctors and nurses are “more sensitive to patients” and can diagnose just as well with fewer resources. The pace is more relaxed. The quality of care is more personal.

Dr. Gregory House, known for insulting his patients and going to technological extremes to get the right diagnosis, is a far cry from what he’s familiar with.

So do you expect to meet or work with a doctor like Gregory House, I ask. Would you like to?

Ray nods his head yes. “I hope so."

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Comments (25)

Pamela:

I agree with you Claire -- you are indeed better doctors because of this. Doctors in PGH would just look at you and know what's wrong. It is due to the greater exposure to many diseases, more hands-on experiences, and lack of hi-tech gadgets that make you Filipino doctors much more resourceful.

I live in a suburban town here in the US where doctors leave all the diagnostics to their PAs (Physician's Assistants). So they ask you for symptoms, leave you for a while, and go online (some medical database, I believe) to search for the answers.

Many American doctors I know would give you prescriptions.

"My head hurts,"

"Okay, here's a painkiller."

"Now it's giving me side-effects. I have dry mouth."

"Here's another prescription."

"I think my liver is dying."

"Here's another... prescription."

"Hey, you just killed me."

"Here's another... ugh."

This is what they call "Primary Care".

Welcome to America.

PS: And yes, I know a couple of American students who are now looking into studying medicine in these Asian countries. It's much cheaper to do so over there, plus they get more exposure and hands-on experiences. Med school here is just too expensive!

CLAIRE:

Hello. I am a doctor from the Philippines who just finished my training as an internist in a large charity hospital here. While it is true that we do not have the advantage of having sophisticated diagnostics and the capability of giving ideal care for our very poor patients, the clinical acumen we gain from our training, learning how to diagnose through history and physical exam, and learning to prioritize our diagnostics is invaluable. I think we are better doctors for this.

Nonetheless, many of our colleagues seek work abroad not just for financial reasons(though it is a big part of it), but also to see what it is like to practice medicine in a system where we can order anything and see it done. Many of my friends who are now training over there have plans of coming home after completing their training.

I just hope that when they come home and see how different things are over here, they don't go flying back to the US.

Long time listener, First time caller:

Dufus said: {Nobody believes what she said is valid, they do believe that a twerp like the character she plays would say something like that though. That's good writing.}

I'd like to present a different opinion here. All media has a social responsibility, same as individuals. Media paints a picture that people accept as normal behavior without realizing it, even if just in a small part of their sub-conscious.

What if instead of a discriminatory comment it was racially charged violence? Or a sex crime? Would you be so quick to call it "good writing"? There are in fact people who commit racial hate crimes after all.

Did the writers make the "character" suffer some tangible, clearly connected consequence in the show, thereby confirming that society should not tolerate that kind of bigotry? If not, it's not only bad writing, it's irresponsible.

Long time listener, First time caller:

Dufus said: {Nobody believes what she said is valid, they do believe that a twerp like the character she plays would say something like that though. That's good writing.}

I'd like to present a different opinion here. All media has a social responsibility, same as individuals. Media paints a picture that people accept as normal behavior without realizing it, even if just in a small part of their sub-conscious.

What if instead of a discriminatory comment it was racially charged violence? Or a sex crime? Would you be so quick to call it "good writing"? There are in fact people who commit racial hate crimes after all.

Did the writers make the "character" in the show suffer some tangible, clearly connected consequence in the show, thereby confirming that society should not tolerate that kind of bigotry? If not, it's not only bad writing, it's irresponsible.

FILIPINA:

To reply to Niall's comment...
The Philippines has more English-speakers than in England. Almost the entire population is bilingual, and many are multi-lingual. (speaking 2 or more dialects as well as English, sometimes even Spanish and Chinese)

Niall:

The only problem I sometimes have is with people who were not born in English speaking countries whose English is not what it could be.

Roy:

My experience with both American and Mexican doctors is that American doctors treat the symptoms with prescriptions while Mexican doctors treat the cause.
It is rare for an American over 50 to not be on some sort of prescription drugs if not multiple prescription drugs.

It makes one wonder about the US having the highest prescription drug costs and medical costs in the world.

Sadly Facts:

Sadly, we American can't produce enough Nurses, Doctors from our own soil. We are depend on other to care for us. Double SADLY that Philipines' Nurses, and Doctors abandon their people by going to the America for bigger paycheck.

13571113:

What is true of the U.S. is also true of Canada. A lot of medical talent has emigrated here from Asia, and I'm sure it has nothing to do with Canadian television.

George of Alaska:

Coming from a family of 3 generations of doctors and being married to a Filipino, I must say that their system of care is much less high tech than ours, yet as effective. I had to see a doctor this past summer for a skin irritation/infection and he was not only EXTREMELY inexpensive, but very good in his diagnosis and what he prescribed was very effective. The care received there is not unlike that received here in bush - Alaska or rural Alaska. The only way into the village I live in is by plane or boat, the same as much of the Philippines. Given the remoteness, people tend to put much credence into whatever they see on TV. Having access to larger cities helps dispell many of the myths they tend to believe from TV, mostlty the stereotypes. NOT everybody still wears their bluejeans halfway down to their ankles, as many kids here in Alaska believe from the MTV videos they watch, etc.

What else do the people of the Philippines have to gauge what the US is really like, except some retired expats and some of us nearing it? If my Ivy League educated cousin can run up a HUGE law school tab all based on how exciting LA Law once was, then can we blame the people of the Philippines? For perspective, I earn more in one month than my sister-in-law does in one year as a teacher. Wouldn't you want to go abroad, earn and send home a ton of money, then go home maybe ten years later to a HUGE nest egg? That is precisely what many do.

Ule:

There is no hospital in this country where doctors have the time to stand around and speculate, gesticulate, posture and shoot the breeze the way House and his make-believe colleagues do on that show. Given the combined pressures of exploding technology and managed care's cost-cutting, doctors are like factory workers, pushed to the economic limit. My wife, who is a real doctor, occasionally has time to watch television and she has seen House a couple of times. She laughed all the way through it. "Five doctors standing around one patient listening to their story and free-associating? Don't they have to work?" Real American doctors are flat out all day long and into the night, totally buried in work and paperwork. They read the chart, examine the patient, make a decision, give orders and move on. They are never done. House is a vacation by comparison, and a complete fantasy. Becoming a doctor in America so you could be like House would be like going to work for a nuclear power plant so you could sleep on the job like Homer Simpson, or joining the Marines so you could have laughs all day like Gomer Pyle.

Cashaw:

Some of the best doctors I ever had were from Vietnam, India and other places where people of colour come from, and here is why I say this. I am a dark skinned Black American, and most experiences with doctors has been around skin issues, mumps, rashes, ect.. The doctors of colour had no problems diagnosing the issues, I would imagine because they are used to looking at skin of colour.

Dan:

US Boards of Medical Examiners changed the multiple-choice testing format to essay-format to ensure practitioners' proper medical knowledge, majority of foreign-trained MDs can't pass Board exams currently.

Practicing medicine is an evident-based science... without proper tools will end up with wrong diagnosis that results with incorrect prognosis that ending up costing the health care system a lot more...

We get what we pay for.

Computer User 10:

"...within the US, ... Most doctors do not spend the time to listen to or fully examine their patients, do not brainstorm non-stop with other specialists to reach a diagnosis, and do not even think outside their specialties."

I agree with NR Nelson's statement above. I swear my EX-physician prescribes antibiotics for any problem I describe. And they pocket $75 for a 5-minute appointment.

I've also heard some filipino bashing a few times in movies, television, and cartoons (eg, Simpson's, Family Guy). Writers testing the waters?

Anonymous:

I agree with the Schez's comment. My mother recently broke her arm, and then suffered complications while in the hospital after surgery to repair the break. The American doctors and nurses in the hospital cared very little about the allergic reactions she was having to drugs, the interactions, and her basic pain. Of the primary surgeon, a native of my hometown and the father of one of my high-school classmates, I have to say I am ashamed. He was callous in his treatment of my mother, and I will never recommend him to anyone. In the end, it was an internist originally from Nigeria (and trained there) and a nurse from Mexico who made my mother's hospital stay bearable, solved the mystery of what was happening, and helped fix all the problems that developed out of a relatively simple accident.

Lakshmy Parameswaran:

The shortage of health care professionals is the single most reason why America imports doctors and nurses from countries like Philippines and India. The trend, started in the late 60s, continues still. A case in point is that of my husband, a surgeon educated in India, who was offered a research position at a major medical center in the U.S., a job for which he didn’t even formally apply. However, he had to undergo four years of residency training in order to practice as a surgeon, a rigorous process he had already undergone in India. Those four years were tough and traumatic for both of us as new immigrants.

Now, after thirty years of practice as a fine surgeon in the U.S., my husband says he owes his success to the sound diagnostic skills (thorough physical examination of the patient and questioning) he learned in India. The technological tools of this country would only corroborate his conclusions. Like the Teri Hatcher character, most patients underestimate the strength of these ‘foreign’ doctors who have benefited from the solid theory-based, patient-centered education of the East and training in the state-of-the-art hospitals in the West.

After years of putting patients first, my husband has the time now to watch an occasional episode of Grey’s Anatomy. He only wishes he had as many attractive colleagues as well as the energy, time and freedom (from responsibilities) to entangle himself with their lives. The aspiring immigrants of today who, based on TV shows like ER, think that the medical profession in the United States is ‘glorious’ and ‘dramatic’ are in for a big shock.

Leah:

Amir,

The title and parts of this post are misleading. Filipino nurses, doctors and other professionals do not come to this country because of what they see on TV and the movies!!! Please! I wonder if your own questioning led to these answers. I wonder if the interviewees are trying to make you as an American and a guest feel good. This is a very Filipino trait, if you haven't absorbed this yet, stay a bit longer and you'll understand. Like any other immigrant group, these Filipinos come to the US for the economic opportunities. It's the economy, stupid! --- As Clinton (the first) used to say.

And in response to Random --- they already are. In Baltimore City alone, hundreds of Filipino teachers are already teaching American kids Filipino English!

Dufus:

Hey, that remark by teri hatcher's *character* was meant to show what kinds of things such a person would say.
Nobody believes what she said is valid, they do believe that a twerp like the character she plays would say something like that though. That's good writing.

Do you see the difference? Are you saying the show shouldn't be allowed to say something like that because it disturbs somebody's feelings?

It's called drama, comeday, entertainment, Fantasy. if you can't tell the difference, maybe you need to go back to school for a while longer.

Allison:

UGH- it pains me to think that people in other countries might believe everything they see on American TV. These are fantasy shows- they are fictional dramas! Many of the situations and behaviors portrayed, if not downright impossible, are at least improbable and certainly unacceptable.

NR Nelson:

It's unfortunate that anyone, outside or within the US, would think that medicine here is actually practiced as portrayed on House, MD. Most doctors do not spend the time to listen to or fully examine their patients, do not brainstorm non-stop with other specialists to reach a diagnosis, and do not even think outside their specialties. See Medical Mysteries article Nov. 13, 2007 for an extreme example, which unfortunately is not that uncommon.

M. Stratas:

The Philippines produces brilliant and dedicated physicians, nurses and other medical professionals. Quite an anachronism for a country known for some corrupt government officials. Desperate Housewives was simply uninformed and ignorant and was going by the stereotype of a developing country. Some Filipino teachers have been "pirated" too to teach Math and Science.

Mike:

Maybe it'd be better for Americans to go abroad for their medical degrees. My brother is into his second year of residency, and it'll be a long LONG time before he pays off his student loan (+$500,000).

Maritza:

T.V. shows aren't luring nurses here - special visas and fantastic paychecks are! We're facing a drastic nursing shortage, and hospitals can't bring over enough highly-trained Filipino nurses fast enough with the current visa limits. This has been going on for years, and isn't related to "House".

Unfortunately, those glossy and glam labs and diagnosticians won't be found in places like Odessa.

random:

Maybe they can send us some english teachers as well.

sChez:

I beleive that some of the US's most capable physicians, surgeons and sicentists have trained in medical schools in Europe, Pakistan, India, Phillipines and China.
What a diservie the media does in their portrayal of the tru situation in the US. Suprisingly all of the current medical school curriculum is geared towards fostering physicians who are closely invovled with their patients. Look around the US. The impoversished and the slums of this country are being taken care of international medical graduates.
I would suggest that Teri Hatcher should be ready for quiet a run around from her Harvard trained primary care physician who will give her 15 minuts of his/her time, order a battery of tests to come to a pretty nonsensical conclusion. She would be lucky to be under the treatment of physicains who actually have practiced medicine, not fulfiiled a formality in a US medical school

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