Filipino doc picks life as nurse in U.S.

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By ADAM GELLER, AP National Writer

The hospital lobby is a blur of surgical scrubs as a shift-change approaches. But when Elmer Jacinto slips in early in pressed whites and sneakers, he draws barely a glance from the guard behind the security desk.

It's 2:15 p.m. and soon he'll begin preparing IV drips and checking temperatures, tasks assigned to an entry-level nurse. "So much to learn," says the self-deprecating bachelor with the lilting accent. Except for the fact that he's one of only two male nurses on the floor at St. Vincent's Midtown Hospital, he's just one of the girls, co-workers say.

Well, here anyway.

But a world away, in his native Philippines, Jacinto remains at the center of a roiling controversy — a sellout to his critics, a paragon of hard work and admirable ambition to his supporters.

Once upon a time, Elmer Jacinto was his nation's most promising young doctor. But doctors in the Philippines are not well paid, and so he boarded a plane to America.

To make more money. To become ... a nurse.

It hasn't worked out exactly as he had expected. Life in New York has proved exhausting and full of unforeseen pitfalls. And back home, many of his countrymen still find his choice a difficult one to accept, because the parable of Elmer Jacinto raises grim doubts about their future.

"Jacinto encapsulates perfectly the country's fundamental question today," one Filipino newspaper columnist opined. "Namely, why should anyone want to stay in it?"

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When Elmer Jacinto graduated high school, the island of Basilan offered limited choices.

On Basilan, where dusty farming towns press up against thick tropical jungle, electricity is a sometimes event. Telephone lines deposit calls at dead-ends. Both problems are blamed on the Abu Sayyaf, a Muslim extremist group with an outsized reputation for violence.

So when Jacinto sat down with his father, a school teacher, on a spring night eight years ago to parse his prospects in the glow of kerosene, they set aside talk of dreams to examine reality.

"There is money in nursing," the older man counseled.

Jacinto finished at the top of a nursing school class of 250, and found work at the local hospital before leaving for a better-paying job in the city. In hindsight, the move seemed fated. Not long after, Abu Sayyaf guerrillas stormed the hospital, taking nurses as hostages. One of Jacinto's former co-workers was killed during a shootout with Filipino soldiers.

But in Manila, Jacinto pushed ahead, soon enrolling in medical school. For the second time, he rose to the top of his class, then joined 1,800 other aspiring doctors from around the country to take the national medical exam.

When the scores were released, Our Lady of Fatima University proudly hung a banner over its doorway to herald the results. Its valedictorian, Elmer Jacinto, was the No. 1 young doctor in the nation.

Jacinto, though, was already making other plans. His parents deserved more than even a doctor could give them. In a world where jobs and workers are shifted back and forth across borders like game pieces, he would play his hand — setting aside the goal of becoming a neurologist to work as a nurse in America for far greater pay.

His choice should not have been a surprise. Nearly a million Filipinos take jobs abroad each year, making them some of the world's most mobile workers. Some of the most successful are nurses, drawn to the U.S. and other wealthy nations with a ravenous demand for health care and not enough skilled labor to meet it.

But now the Philippines was bleeding doctors.

"Before, we just branded it as a brain drain. But I label it now as a brain hemorrhage," says Dr. Jaime Galvez Tan, a former minister of health.

He estimates that in the last five years, 9,000 Filipino doctors — out of about 56,000 — have retrained as nurses, and 5,000 have since gone abroad. The result? Some rural hospitals have few, if any, doctors and nurses. And care suffers.

Doctors leave because of political unrest and economic malaise, but money is a major factor. A nurse in the Philippines makes $150 to $250 a month; doctors make $300 to $800. But the average registered nurse in the U.S. earns $4,000 a month. Is it any wonder a doctor might leave?

The decision, though, remains intensely personal and sometimes embarrassing, and as an issue, it had generated limited attention — that is, until Jacinto made his choice and set out to explain himself to a nation of 84 million people.

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In early 2004, Jacinto quietly began telling others of his plans.

"Even before he announced his decision, we already felt it was coming," says Reynaldo Olazo, dean of medicine at Fatima. "It was I who brought it up because I could see his embarrassed smile."

But Jacinto's decision drew little notice until a friend suggested he talk with a reporter at one of the country's largest newspapers.

Jacinto, now 31, seems an unlikely candidate to stir controversy. With a toothy grin and somewhat large head, he has a boyish air. In conversation, he is reluctant to tout himself.

"Mister is fine," asked how he prefers to be addressed. "Here I am not a doctor."

Jacinto says the newspaper made him the face of an issue — the "doctor-topnotcher" who ignored the nation's interests for his own.

But he acknowledges wanting to draw attention to the shaky economic status of health care workers as an issue policymakers had too long ignored.

"Patriotism is a two-way process," he recalls thinking. "It's not only you as a citizen. It's also about the government that should also give you work, or something for yourself, to be able to live a dignified life."

His decision struck a nerve — and it was raw.

Jacinto's story "was like a slap in the face," Tan says. "Even ordinary people that I would meet, it was like, 'Hey, what has happened to our country?'"

The front-page story in the Philippine Daily Inquirer drew a torrent of letters. On the radio — the main source of news for many rural Filipinos — talk-show hosts picked over his decision.

"Deplorable ambition," one newspaper proclaimed.

"Is our government partly to blame for this exodus?" the Philippine Journal of Internal Medicine asked.

By the time Jacinto stepped to a podium two weeks later to take the doctor's oath, his private decision was public property.

"We cannot begrudge you, but only appeal to you to stay," a leading politician, Sen. Aquilino Pimentel Jr. said in a speech to Jacinto and nearly 950 other new doctors.

A fellow doctor, Willie Ong, got to thinking. Ong had been studying a story from the Old Testament. "To your descendants I have given this land," the passage read, recounting the promise made between God and the Israelites.

Ong was inspired. He wrote a "doctor's covenant," then convinced 1,800 physicians at a national convention to sign it, pledging to remain in the country for three years.

But another 2,200 turned him down.

So last year, Ong started the Movement of Idealistic and Nationalistic Doctors, or MIND, campaigning at medical schools to convince doctors to stay even before they became doctors.

Filipino lawmakers, too, found their way to the issue.

"There are dark consequences if we do not do something to mitigate a crisis," the president of the Philippine Nurses Association told lawmakers who called a hearing on health worker migration in the fall of 2004.

Lawmakers proposed requiring all new nurses to serve in the Philippines for two to three years before being allowed to work overseas. But critics say it will penalize poor families counting on money their children could earn as nurses abroad.

The question now is whether changes embraced by U.S. lawmakers will speed the exodus.

When the Senate approved an immigration overhaul last summer, it included a measure allowing an unlimited number of foreign nurses to enter the country. If that change becomes law, "the Philippine health care system will bleed to death," Tan says.

Either way, the debate comes too late to sway Jacinto. By the time U.S. lawmakers took up the issue, he'd already arrived.

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On a Friday night in November 2005, a China Airlines jet touched down at New York's John F. Kennedy International Airport after an 18-hour journey. Twenty newly minted nurses — including one Elmer Reyes Jacinto — walked down the gangway, and a recruiter from a chain of nursing homes stepped forward to meet them.

Jacinto and seven others were sent to Avalon Gardens, a facility in Smithtown, N.Y., a leafy Long Island suburb about 50 miles from Manhattan.

"Nursing is a Team Effort," cheers a sign hanging outside that pictures stick figures hand-in-hand atop a globe.

For Jacinto, this new world was exciting, but alien.

The air was sharp, the ground was brittle. He and his roommates were the only people who seemed to walk anywhere in a land where most everyone moved by car. The nurses felt drivers staring at them as they walked along Route 25 carrying groceries.

But the jarring adjustment was minor compared with problems that over time became increasingly troubling, he and other nurses allege. Their account is strongly disputed by the nursing home operator and its sister recruitment agency, which have accused the nurses of abandoning patients who require constant care.

The new employer, which had promised two months free housing, assigned eight nurses to a small, dingy home — a tight fit with three bedrooms and a single bathroom that did not always work. Jacinto and another man slept on pullout couches in the living room.

The home — a one-story bungalow large enough for a small family — still houses newly arrived nurses and their families.

On a recent visit by a reporter, it was home to eight people, including three children, after two nurses had moved out. The kitchen sink was clogged shut and was draining out the window. Lights in the kitchen did not work. A rat scurried across the driveway.

After a few weeks of doing clerical work, Jacinto and the other nurses say they were assigned to nursing duties but paid less than promised. Some say they were shortchanged in other ways, including not being paid for night work or given promised insurance.

By early spring, the nurses had had enough. Their employer, who contends they were always treated fairly, says many nurses walked out without giving notice, endangering patients.

What's clear is that on April 7, Jacinto and 10 others together tendered resignation letters. In all, 26 nurses quit, including five trained as doctors.

Not even five months had passed since Jacinto, briefly the most famous doctor in the Philippines, had arrived in the United States. Now he was anonymous — and out of a job.

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This fall, Jacinto's face returned to front pages at home, the central character in a revised morality tale about a trap set by naive expectations.

"The grass outside the Philippines is not always greener," the Inquirer reported, detailing charges and countercharges between the nurses and the nursing home recruiter.

Jacinto and the other nurses are out of work and running out of money, Filipino newspaper readers were told. Worse, they are living in abandoned, leaking houses, at the end of dark city alleys, stories said.

"They have found out for themselves that the honeyed words they had relied upon were laced with large doses of bitter circumstances when they disembarked on the shores of the promised land," Pimentel told fellow lawmakers in a speech on the floor of the Filipino Senate.

But Jacinto, himself, is missing from the discussion. He has grown weary of explaining himself.

On a recent afternoon, he leads the way through the streets of New York's Elmhurst neighborhood to a table at the Fay Dah Chinese bakery, where one counter serves bubble tea and another advertises international money transfers in Mandarin, Malay and Tagalog.

"I feel I belong here," he says, gesturing to sidewalks filled with people pulling laundry carts and talking on cell phones. "Look, Asians. Lots of Asians."

It took just weeks for the rebellious nurses to find work, he says, thanks to an insatiable health care labor market. He and three others nurses have settled into a spare, but spotless walk-up apartment a few blocks away, a plastic American flag planted next to the bushes out front. The nurses share meals under a print of "The Last Supper" and watch Filipino news on a big-screen TV.

And once a month, Jacinto walks to the bakery and wires $500 to his parents back in Basilan.

Jacinto does not pretend everything has gone smoothly.

He is uneasy that his hospital treats people with AIDS; in the Philippines, they would be quarantined to a few hospitals, he says. He finds it jarring that after months of taking the subway to work in Manhattan — "a jungle of buildings" — he never sees anyone but strangers.

And, after the struggles of the past year, he is so tired that he now thinks he may remain a nurse rather than pursue his dream of becoming a doctor in the United States. He may soon be looking for a job again — New York's drive to cut health care costs has targeted his hospital for closing.

Still, Jacinto says he is finding a place for himself — and a sense of peace.

Back home, the expectation is "that you should become the model Filipino, doing it for your country. I want something for myself," Jacinto says. "I want to move on."

He knows some in his homeland still judge him.

Well, he says, let them talk.

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AP Staff Writer Oliver Teves in Manila contributed to this report.