Empire of Care

Nursing and Migration in Filipino American History

Empire of Care

American Encounters/Global Interactions

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Book Pages: 272 Illustrations: 6 b&w photos Published: January 2003

Asian American Studies, History > U.S. History, Medicine and Health > Public Health and Health Policy

In western countries, including the United States, foreign-trained nurses constitute a crucial labor supply. Far and away the largest number of these nurses come from the Philippines. Why is it that a developing nation with a comparatively greater need for trained medical professionals sends so many of its nurses to work in wealthier countries? Catherine Ceniza Choy engages this question through an examination of the unique relationship between the professionalization of nursing and the twentieth-century migration of Filipinos to the United States. The first book-length study of the history of Filipino nurses in the United States, Empire of Care brings to the fore the complicated connections among nursing, American colonialism, and the racialization of Filipinos.

Choy conducted extensive interviews with Filipino nurses in New York City and spoke with leading Filipino nurses across the United States. She combines their perspectives with various others—including those of Philippine and American government and health officials—to demonstrate how the desire of Filipino nurses to migrate abroad cannot be reduced to economic logic, but must instead be understood as a fundamentally transnational process. She argues that the origins of Filipino nurse migrations do not lie in the Philippines' independence in 1946 or the relaxation of U.S. immigration rules in 1965, but rather in the creation of an Americanized hospital training system during the period of early-twentieth-century colonial rule. Choy challenges celebratory narratives regarding professional migrants’ mobility by analyzing the scapegoating of Filipino nurses during difficult political times, the absence of professional solidarity between Filipino and American nurses, and the exploitation of foreign-trained nurses through temporary work visas. She shows how the culture of American imperialism persists today, continuing to shape the reception of Filipino nurses in the United States.


“Choy presents a compelling view of the colonial history of the United States in the Philippines, the Filipino adoption of an Americanized nurse education system and the growing needs for a new source of nurses in the United States. . . . Empire of Care is an interesting book, and is helpful for developing a personal, ethical position on the recruitment of nurses from countries who have a greater need of their services than the United States. The issues Choy raises have strong relevance to the crisis of today’s health care labor market and must be considered in shaping current governmental and professional policies.” — Sheila P. Englebardt , Independent Weekly

"Empire of Care is a sweeping and important study of race, gender, and labor in a transnational context. Blending feminist, race-critical, and global frameworks, Catherine Ceniza Choy presents a fresh look at Asian Pacific women's activities as students, organizers, and professionals in the late nineteenth and twentieth centuries. This 'postnationalist' American Studies treatment offers a powerful interpretation of Filipino/Filipino American women's history, as well as an impressive research and writing model for transnational work." — Patricia A. Schechter , Pacific Historical Review

"Empire of Care is truly a transnational history, well researched in U.S. and Philippine government documents, newspapers, and nursing collections and richly informed by oral histories. By linking migration history to U.S. imperial history, and Asian Amerian history to Philippine history, it makes significant contributions to all these fields. Scholars looking to internationalize U.S. medical, labor, and women's history also should be sure to consult this clearly written and engaging book." — Kristin Hoganson, Journal of American History

"[A] model of how to combine, with sensitivity and insight, archival sources and contemporary interviews. . . . Historians of medicine and nursing will learn much from Choy's innovative transnational study. It will surely inspire many of us to reframe our analysis of twentieth-century health care." — Warwick Anderson, Bulletin of the History of Medicine

"[A]n absorbing account of the intertwined influences of imperialism, postcolonialism, migration, transnationalism, and gender on immigrants and the fractured state of multiculturalism today. . . . [Choy's] lively handling of the intersection of ideas clustered around the figure of the Filipina-American nurse renders this monograph indispensable reading for scholars of immigration, diaspora, American empire, and ethnicity." — Madeline Y. Hsu, American Historical Review

"[A]n important addition to the expanding body of scholarship on gender, race, and transnationalism, especially as it sheds light on a hitherto overlooked phenomenon, i.e., the professional female migrant labor force. Most critically, the book challenges the notions of U.S. 'exceptionalism' and 'benevolence' vis-a-vis the Philippines, and points to a clear continuity, rather than discontinuity, between imperial and transnational dynamics, with gender and women as the central foci of analysis. An interdisciplinary study with a focus on the Asia-U.S. relationship, the book can be effectively used in Women's Studies, Ethnic Studies, Asian American Studies, and Asian Studies." — Mire Koikari , Women's Studies International Forum

"[C]lear and engaging. . . . Choy's study effectively expands the theoretical and conceptual frameworks of American ethnic history, particularly the assumption that migration is a spontaneous response to socioeconomic inequalities in the world system. The transnational and historical context of United States imperialism facilitates a more complicated picture of institutions, structural factors, skills and desires that constitute a culture of Filipino nurse migration over the twentieth century." — Kimberly Alidio , Journal of American Ethnic History

"[Choy] is extending feminist research into new territory."

— Asa Wilson , Minnesota Women's Press Inc.

"[T]horoughly researched and well-written. . . . [This book] will be as enjoyable to the average reader as to the scholar of nursing history or international relations." — New York State Nurses Association

"Are an Americanized hospital training system and colonialism to blame for the huge migration of Filipino nurses to the United States in the latter half of the 20th century? The author explores that premise through extensive interviews and ethnographic and archival research." — Canadian Nurse

"Ceniza Choy effectively presents what is a classic example of cultural imperialism. . . . Empire of Care is worth reading." — Robert H. Jackson , History: Reviews of New Books

"Choy crafts an historical account of the Filipino nurse diaspora that is contextually rich and accurate while exploring related issues of nursing's gender, race and class stratification from both the sending and receiving nations. . . . Empire of Care is a well written, provocative and long overdue analysis that will appeal to a wide range of academic audiences." — Barbara L. Brush , Nursing History Review

"Choy's book focuses on the nurses' migration as part of Filipino American history, but it offers many insights to understand the current wave--some might call it a tsunami--of nursing brain drain." — Michael L. Tan, INQ7

"Choy's study brings a much-needed analysis of Filipino nursing to Filipino American studies. With its depth of archival and ethnographic research, transnational analytical framework, and feminist critique, Empire of Care substantially advances our understanding of the interrelated operations of U.S. imperialism, Americanization and transnational capitalism. . . . Choy's clearly written study engages the reader with the history of Filipino nurses as an ongoing social history that highlights the contradictions of the politics of globalization while sharing the victories, both small and large, of Filipino nurses." — Eric Estuar Reyes , Journal of Asian American Studies

"Linking immigration, colonialism, and imperialism, Choy brilliantly demonstrates how nursing in the United States, rather than simply as a gendered and racialized institution, has to be understood as "an international arena for the conflict and cooperation of predominately women workers worldwide" (p. 9). . . . [C]utting edge. . . ." — Shu-Ju Ada Cheng, Gender and Society

"This study offers rich, new insights into the workings and consequences of American empire. . . . [A]n important work." — Arleen de Vera , Journal of Colonialism & Colonial History

"This volume makes an important and original contribution to the field of transnational labor migration. . . . Accessibly written and empirically rich, this book is well suited for advanced undergraduates and graduate students seeking grounding in the field. Scholars of immigration, gender, and Asian American history will find this book to be an essential contribution to our understanding of these issues." — Rich Baldoz , Contemporary Sociology

"[An] absolute classic: chances are, if have ever been to a hospital of any kind, you’ve benefited from the care of a Filipinx nurse. . . . Catherine Ceniza Choy traces the long history of that labor back to, you guessed it, the American colonization of the Philippines, which makes this book a vital work of American history as much as it is a cornerstone of Filipinx history, labor history, and feminist history." — Elaine Castillo, Electric Lit

Empire of Care is an extremely important work, a milestone in Asian American and American studies, and a singular contribution to the emergent field of Filipino American studies.” — Vicente L. Rafael, author of White Love and Other Events in Filipino History

"Empire of Care provides an eloquent analysis and exciting transnational interpretive framework for understanding the political economy of American imperialism and the immigration of Filipino nurses. Catherine Ceniza Choy’s lively and vivid history of women who connected the professional and the home spheres to become architects of their own lives against the backdrop of race, gender, and class constructions is an impressive contribution. Students of nursing, immigration, and social history will benefit enormously from this theoretically insightful and absorbing volume." — Darlene Clark Hine, author of Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890–1950


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Open Access

Author/Editor Bios Back to Top

Catherine Ceniza Choy is Associate Professor of Ethnic Studies at the University of California, Berkeley.

Table of Contents Back to Top
Illustrations ix

Acknowledgments xi

Introduction: The Contours of a Filipino American History 1

Part I. Nurturing Empire

1. Nursing Matters: Women and U.S. Colonialism in the Philippines 17

2. “The Usual Subjects": The Preconditions of Professional Migration 41

Part II. Caring Unbound

3. “Your Cap Is a Passport": Filipino Nurses and the U.S. Exchange Visitor Program 61

4. To the Point of No Return: From Exchange Visitor to Permanent Resident
Part III. Still the Golden Door? 94

5. Trial and Error: Crime and Punishment in America's “Wound Culture"

6. Conflict and Caring: Filipino Nurses Organize in the United States 166

Epilogue 186

Appendix: On Sources 193

Notes 197

Bibliography 229

Index 245

Sales/Territorial Rights: World

Rights and licensing

Honorable Mention, Lora Romero First Book Prize

Winner, 2005 Association for Asian American Studies Book Award

Winner, AJN Book of the Year Award

Additional InformationBack to Top
Paper ISBN: 978-0-8223-3089-9 / Cloth ISBN: 978-0-8223-3052-3
Publicity material