Cleovi C. Mosuela
“Care workers call Canada our home. We work hard to help kids and the elderly, and do all the work in the house. We ask the government to help us to meet our needs too. Many of us have lost our jobs, so we need support. No one should be left behind who is still in Canada.” Winnie, migrant care worker.
Winnie is speaking on behalf of Caregivers Action Centre, an alliance of care workers (domestic workers, caregivers, and nannies) based in Ontario. With the COVID-19 pandemic response placing increased demands on care provision, care workers are positioned in a strange context of life and work. Vulnerability is something we do not usually associate with care workers, but with the ones being cared for. However, care workers are increasingly becoming at risk and in need of care themselves.
As families observe stay-at-home measures, some caregivers are being asked to live with their employers. Considering that caregiving involves skin-to-skin contact, such as feeding and bathing, care workers face risks to virus exposure. The prescribed ‘social/physical distancing’ to avoid infection is extremely difficult to follow.
However, because some stay-at-home care employers can do more of their own care work, and sometimes out of fear of exposure, other households no longer allow care workers into their homes. In Hong Kong, for instance, at least 35 Filipino domestic workers were laid off. Reasons ranged from disputes over the time domestic workers could go outside the house during rest days, to employers themselves having lost their jobs or having to leave the city.
The carer, who was once part of the household, may now suddenly be seen as threat and get treated as a stranger. This ambivalence can be somehow a familiar feeling for migrants. Often on a daily basis, migrant care workers must deal with their own families left behind. Their care practices at a distance take the form of constant (online) communication and flow of remittances, which help meet needs in the origin country, such as access to good education and housing.
Coronavirus is a moment of rupture that creates new worlds of uncertainty – especially when talking about complex relations of care that connect individuals and families across societies. But with coronavirus spreading in different parts of the world, the dangers of caring at a distance become even more pronounced. There is a question now of what it means to care when family members living apart across national borders are all exposed to the virus. How are migrant workers to deal with the tension between their risk of exposure to coronavirus, their risk of redundancy and their responsibility for supporting families in their home country? How can migrant workers continue their support if they themselves are in need of care as well?
This brings us back to the struggle of Winnie and the Caregivers Action Centre. Their experience of various forms of alienation and precariousness – lack of access to health care and income support – is also a possible point of mobilization. As migrant caregivers voice their concerns, they also envision a different world – a world in which they are less alienated and isolated. One in which they are members of the host society. The world they invoke is one in which they re-define themselves as essential workers and as rights-bearing individuals.
Winnie’s struggle is not specific to Canada or Hong Kong, nor relevant only during the coronavirus pandemic. Her predicament is shared wherever migrant workers act as a cheap cushion for richer countries cutting back on public provision for long-term care, childcare, and care for the sick. The case of migrant care workers being abandoned when no longer needed speaks to a bigger problem associated with care or caregiving. Caring is often considered dirty and demeaning work. This is partly because it deals with body waste, which can arouse feelings of disgust. But it is also care work, though integral to society, is undervalued and made invisible by idealized goals of material success, and renouncing of death and decline. Care work tends to be done by women, people in the lower ranks of society, or migrants.
When migrants take on care work in the host country, the care gained there involves care drained from the origin country. Families, particularly children and elderly, pay the social costs of the absence of caregiving and emotional work. And in the case of nurses migrating, the health system in the source country is at stake as well.
The pandemic manifests what has been half a century of dispensability of care, the expendability of specialized nurses, in the Philippines. The country has represented itself as producing the ‘best quality’ care workers for the global labour market – a market in which Filipino nursing skills have become embedded and valued. The Philippine state has been relying on care export and has constituted overseas employment as a vital and stable source of economic growth. Household remittances comprised at least 10% of the country’s GDP in 2018, and by 2019 these cash flows reached USD 30.1 billion in 2019 (the highest recorded since 2010).
Nursing education in the country is financed privately, which means individuals rather than the state invest in education for foreign labour markets. Consequently, these market forces have become the country’s gauge for multiplying the production of nursing skills. Between 1998 and 2012, the Philippine health sector was unable to absorb the number of nurse graduates which led to unemployment of approximately 300,000 nurses. Nurses have become vulnerable to illegal working conditions widespread in both public and private health institutions. This can involve false or forced volunteerism or performing volunteer work in hospitals that entails taking on the same duties as an employed nurse. Or it may entail paying training fees so as to gain work experience for overseas employment.
The current entry salary of nurses in the public sector is PHP 20,179/month (approx. USD 400), which is well below the family living wage of PHP 35,130 (approx. USD 700). It is further compounded by insufficient or non-implementation of benefits as mandated by the Philippine Magna Carta of Public Health Workers, such as overtime pay, night shift differential, on-call pay, and hazard pay.
Lack of decent employment and poor working conditions in the sector help to legitimate the Philippine state’s practice of facilitating nurses’ emigration. Consequently, the health sector has suffered from a depleted workforce. The nurse to patient ratio ranges from 1:50 to 1:80, compared to 1:12 set by the Department of Health. Due to the absence of more experienced nurses, 7 out of 10 Filipinos die without treatment from a health professional.
As of 17 April, the Philippine Department of Health reports 5,878 COVID-19 cases, 487 recoveries, and 387 deaths. Some 252 health care workers have been infected by the disease, of whom 11 have died. Due to a lack of capacity, some private hospitals in Metro Manila have turned down COVID-19 patients for confinement. With some 592 of their health care workers now on quarantine St. Luke’s Medical Center, for example, has announced it can no longer accept further patients.
In a recent attempt to augment health workforce capacity, the Philippine Department of Health is hiring 857 health workers to work in three designated COVID-19 referral hospitals in Metro Manila. Meanwhile, the Philippine Overseas Employment Agency, the office responsible for facilitating emigration of workers, has temporarily suspended bilateral negotiations of exporting Filipino health care workers. Recognizing that the uprooting of health personnel can directly undermine the country’s capacity to provide adequate care in these trying times, the Philippines realizes that it needs to take care of its own health system first in order to safeguard the right to health of patients. Although several questions remain concerning short- and long-term measures to protect these front-liners.
In this instance, it might be worth revisiting the World Health Organization Global Code of Practice on the International Recruitment of Health Personnel. It was set up on 21 May 2010 to guide states, both origin and host, in negotiating recruitment of health human resources while protecting the health systems in the poorest parts of the world. And to make sure that health care workers are not disposed of cheaply by upholding their rights to decent work.
The pandemic response prompts us to make care work a visible collective concern. This entails strengthening support for the social and economic relations through which care work, in private and intimate realms of life, is arranged. Migrant care work is essential in keeping societies functioning. It should not have taken a catastrophe to reveal the everyday tensions and problems of migrant care work.
Cleovi C. Mosuela is a postdoctoral researcher at the Faculty of Sociology, Bielefeld University, Germany and a visiting fellow at Lancaster Environment Centre, Lancaster University, UK.