Joey Domdom, Mayie Pagalilauan and Judith Salamat share some of the findings from their research into the situation of migrant workers providing care for the aged in New Zealand.

Christine (not her real name), a nurse who worked in a hospital in the Philippines for nearly four years, found that what she earned would barely meet the family needs. She decided to migrate to nurse in another country and so provide better economic opportunities for her family. She applied through agencies and was advised to come to New Zealand as a visitor and, while here, to have her visa converted to a work visa. She had to take big loans to pay the agency and for “show money” — indicating she could support herself while in New Zealand. Leaving family behind she was convinced she had made the right decision for their future.

Soon after arrival Christine looked for healthcare employment. Through the assistance and referrals of friends an aged-care facility provided her with the possibility of being employed as a caregiver. She recalls: “The condition was to be in a week-long training as a volunteer caregiver plus three days of orientation. This was while I was waiting for the conversion of my visa and the formal job offer. I wanted work, so I accepted the condition. The week of training and a day of orientation were not paid. That’s how I became a caregiver.”

Although Christine has been a full-time caregiver for the last three years she needs to renew her work visa regularly. “My contract expires in June next year. We hope the contract would be renewed so Immigration can extend our visas. I just want to stay here. I don’t know for how long, but I want to raise my family here.” Even though Christine is a registered nurse in the Philippines, her role as a caregiver here is considered “low skilled”. New Zealand has no formal scheme for caregiver migration. She would not qualify and could not apply for long term residency.

The Demand

Christine’s situation is a product of the demand for healthcare workers across the world. The increase of populations of aged citizens in many developed countries is causing the increased reliance on overseas trained health workers like Christine. The ageing population refers to the imbalance in the unusual growth in the number of older people and the corresponding number of births per capita. In New Zealand, people aged over 65 years will double in the future. This demographic change has a significant impact on health services with the expected prevalence of chronic illness, disability and co-morbidity. The demand on funding for health services is said to be increasingly pressured and acute, and the domestic supply of health workers is unlikely to meet the demand. As care for the aged is considered to be a low skilled, low status vocation it is difficult to attract local workers, especially young people.

Migration of Health Workers

Developed countries recruit and attract workers from less developed countries, like the Philippines, to cope with the demand. This has resulted in an unprecedented migration of health workers across the world. At the forefront of this global phenomenon is the formal caregiver sector. But it is claimed that this sector currently is poorly understood, marginalised, unregulated and under researched. The lack of attention the caregiver sector receives makes it vulnerable to exploitation right from the initial processes migrant workers undertake in their countries of origin.

Oversupply

In the the 1990s and early 2000s, the Philippine government expanded nursing education and migration in response to the demand for health workers overseas. Nursing schools were established throughout the country and students enrolled with long term aspirations of landing an overseas job. The Philippines was considered one of the world’s largest suppliers of nurses.

However, the demand abruptly shifted during the recessions of the late 2000s. The number of new nurses grew faster than the available hospital positions in the Philippines. In one academic year there were more than 70,000 newly registered nurses, not to mention those unsuccessful in the licensure exams, and only around 30,000 hospital nursing positions. This over supply led to the situation where nurses wanting to work overseas worked without pay in hospitals in order to gain the required experience for nursing jobs overseas. And where nurses even paid the hospitals to work and gain experience. While over optimism to migrate encouraged many to become nurses, the result was a great number of inexperienced nurses unable to find nursing jobs and build careers. Many eventually became caregivers, and in some instances domestic helpers, in developed countries.

The Reality

After investing in her costly nursing education, Christine’s only option was migration even if it meant not fully practising her nursing profession. “I am okay now being a caregiver because I’m able to save and send some money back home,” Christine says.

She takes comfort in the support of the Filipino community and her Church. “Pinoys (Filipinos) help each other. We share stories. I am not alone. Though we are not really close, we feel connected.” Christine is very positive about her work. “I view the residents as my grandparents. I miss my family and the residents are a substitute to my family. When the residents are abusive, I look at it as a challenge. I think of caring for them as looking after my grandparents.”

But it can be difficult. Christine and most migrant caregivers are confronted with adversities including discrimination, verbal and physical abuse, and bullying from co-workers. On her first week at work Christine learned to be vigilant around facility residents. “A resident pulled my hair — I did not know yet I had to be on guard all the time. Physical and verbal attack occurs almost every day. An internal report is written if we really get hurt like having bruises.”

A study of the lack of clarity around boundaries and job descriptions reveals that the role of migrant caregivers could change depending on the situation on the floor. Migrant workers take on, or are asked to assume, responsibilities beyond the area of care provision. Employers find it convenient but it is an exploitative path of saving resources at the expense of vulnerable migrant workers. Christine explains: “I have always been rostered to 3-10 pm shift. It is very tiring to be in this shift because I have to do most of the cares in a 15-bed wing. On top of this, my duties include cleaning and doing the laundry that take an extra 2-3 hours. I requested my supervisor for one morning shift a week so I could rest a bit. I did not get a response.”

Another practice that feeds on the migrants’ vulnerability is allowing them to work for an extensive period of time. Christine confides: “My permanent shift is 36 hours. I take as many shifts as I can. If I can grab 84-85 hours per fortnight then that’s okay. I can save more. I can send more money back home.” While workers may be happy with extra money, over-long hours cause risks for both the residents and the caregivers.

It is important that we acknow-ledge, discuss and right these chall-enges and issues. It is too easy for exploitation and abuse to thrive when they are left.

Source of Strength

Despite these structural barriers, migrant caregivers strive to settle into New Zealand society through their resilience and hard work. Regardless of the economic and work challenges, they feel their future is here. Christine says: “I have a job and earn more here than in the Philippines. Though New Zealand is far, the possibility of being together here as a family strengthens me to work hard and face all difficulties.” Christine hopes and prays that things will be better: “If I need to pray, I just go to the staff room and pray. My family is also praying for me. Prayer is my source of strength. I also involve myself in the Church aside from going to Mass. It is a way of giving thanks to God for the blessings and the guidance I receive.” She intends to take courses to meet the required competencies to practise as a registered nurse here.

Vulnerable

Central to the phenomenon of the consumption and provision of care for the aged population is the vulnerability of both the aged residents of healthcare facilities and their migrant caregivers. Older people need intensive healthcare and with the pressure on funding and resources, they risk substandard care.

Alternatively, the lack of conversation and understanding about the situation of “low-skilled” migrant caregivers shields practices that exacerbate marginalisation of this essential but vulnerable group.

Church and communities can do much to spread a better understanding of immigration policy, employment and the working conditions of migrant caregivers among us.

Tui Motu Magazine. Issue 228, July 2018: 8-9.