Culture Trap?

by Juan L. Mercado

The Internet carried this week a riveting article titled “Trapped Between Cultures—Neither Filipino Nor American.” The author is Dr. Eugenio Amparo, who has lived in the United States since 1974 when he started  residency at the University of Texas Medical Branch.

Now Amparo is retired. “I find time to contemplate [issues ranging from] quantum mechanics to the history of the bra,” which has led him to an “uncomfortable conclusion.” Neither Filipino nor American, he is “trapped between cultures.”

A 2012 head count shows 14,785 Filipino physicians  in the United States—a distant second to Indians. And 2,952 Filipino nurses took US licensure exams from January to September 2013—up by nearly 11 percent.

Nurses have a recent face. In his 2013 State of the Union Address, US President Barack Obama said: “When Hurricane ‘Sandy’ plunged New York University Langone Medical Center into darkness, nurse Menchu Sanchez from the Philippines didn’t think of her own home… Her mind was on the 20 newborns in her care.” The “rescue plan” she organized—taking babies down eight flights of stairs—kept them all safe.

As a child in Iloilo City, Amparo recalls dreaming of America: cars, supermarkets, snow. “Now, I have a BMW and a Mercedes-Benz in a three-car garage; a refrigerator full of food; and obesity. Add loneliness. I miss the Philippines.”

When he visits, “I envy the close family and friendship ties.” His first cousins are scattered in Metro Manila. Sundays, they lunch together in Quezon City. “By contrast, I can count on the fingers of one hand the times I met, in the past 10 years, with my brother in Virginia and sister in Oregon.”

Amparo’s daughter lives in San Francisco—a two-hour drive from his home. They meet once every two months. “My son and grandchildren are a 20-minute drive away.” It’s a major feat to see them once a week.

“Americans are too busy.” The world’s greatest economic power also has the loneliest people with a very high prevalence of depression. “I am not American enough to resign myself to loneliness, as a consequence of a rugged individualism…”

The solution? Retire in the Philippines? But it takes almost two hours to drive 13 kilometers from the University of the Philippines in Quezon City to the Philippine General Hospital (PGH) in Manila. You can barrel 104 kilometers from Sacramento to San Francisco in the same time. “I’m no longer Filipino enough to be patient with Manila traffic.”

Dealing with the US Department of Motor Vehicles or Internal Revenue Service can be frustrating. But it is done without bribes. “Our medical school alumni association donated a cargo container of supplies for [PGH]. It was confiscated by Customs and released only after politicians intervened.”

“I am no longer Filipino enough to ignore the chasm between rich and poor. A few minutes from Manila Polo Club, street children beg for coins. In the provinces, an unnerving darkness swallows up the small villages. I’m now too American to ignore all this, although I barely noticed it when I lived in the Philippines.”

“As a child I was so dirty and had to be periodically dewormed… My stomach has become too American, but I still long for bamboo shoots, hearts of palm,  dinuguan,  lechon, and talaba.”

What gnaws is the emergency services gap. America lulls you into the feeling that police, firemen or paramedics are a 911 call away. “I don’t see how an ambulance can possibly make it through Manila traffic.” You bump into armed guards outside gated communities, even in a noodle restaurant. “It seems no one expects the police to be of any help against criminals.”

That’s a partial profile of the diaspora. Filipino doctors and nurses also serve in Asean countries, the Middle East, Europe. While touring a cardiac center in Bedfordshire, Britain’s 91-year-old Prince Philip turned to a Filipino nurse and cracked: “The Philippines must be half-empty. You’re all here running the National Health Service.”

Today, the Philippines licenses 89,000 nurses who graduate from 491 schools. Another 4,500 new doctors are turned out by 38 medical schools, not to mention 1,240 dentists. But some will join an average of 3,568 Filipinos who migrate daily today. Given half the chance, 19 out of every 100 would scram for good, Pulse Asia surveys found.

Medical services here remain skewed. Private health facilities, considered by clients as providing better services, were heavily used by patients from higher-income groups (about 15 percent) than from the penurious (about 5 percent), the Asian Development Bank notes.

The poor trek to  rural health units and village health stations. Despite heroic efforts like Doctors to the Barrio programs, they provide shabby service: “Diagnosis is poor, resulting in repeat visits. Medicines are inferior and rarely available. And politicians try to bore into contracts for supplies—and threaten doctors who balk. So, many altruistic qualified doctors quit.”

In a country where legislators gorge on pork barrel, the total health expenditure per capita stands at 3.9 percent of GDP. Contrast that with the Western Pacific regional average of 6.1 percent. There have been attempts at innovative reforms, such as health-sector public-private partnerships, among others.

Migration, however, seeks out talent across the board. Three of our five children have migrated: a pilot, a lawyer, and a United Nations official. That’s par for the course.

Health personnel who stay don’t begrudge those who scoot. Ever homesick migrants pay back in service to the poorest in their countries of adoption. Dr. Eugenio Amparo, we’re sure, is one of those who “bloom wherever they are planted.” That service remains to be documented more fully.


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