Thursday, February 08, 2007

Kasarinlan Review: Empire of Care

Catherine Ceniza Choy. 2003. Empire of Care: Nursing and Migration in Filipino American History. Quezon City: Ateneo de Manila University Press. 272 pp.

First published in Kasarinlan: Philippine Journal of Third World Studies 21, 1 (2006): 199-203.

Catherine Ceniza Choy is one of the few critical voices in the North American academia whose work on the connections between empire building in Asia and the Pacific and American history exposes not only the persistence of US imperialism but its invisibility in the American mass media and other postmodern (and persistent) developmentalist discourses in the academe. The racialization, feminization, and commodification of migrant nurses are discussed alongside their efforts to form organizations and support networks to struggle against the conditions that shape their profession.

Empire of Care is a comprehensive study of the history of Filipino nurse migration and its transnational dynamics. Its methodical approach includes ethnographic and archival research. Choy notes that the main objective of this “two-shores approach” is “to place a human face on [this] study through in-depth oral interviews with Filipino nurses working in New York City hospitals” and a “five-month research trip to the Philippines” that allowed her to talk with “nursing deans, faculty members, and students at several Philippine colleges and schools of nursing in Manila; directors of nursing and staff nurses at private and government hospitals in Manila; government employees working in overseas agencies; and workers in nongovernment organizations focusing on the welfare of migrant women workers” (193-94). The thorough data and analysis that the book offers on the topic is also a result of extensive library work and participant observation.

Choy departs from what she observes as a current tendency in studies on migrant work that represent various migrant professions as if there were no significant differences to be explored. She argues that “the lumping of Filipino nurse migrants with professional migrants from Asian sending countries and/or other professional migrants from the Philippines produces some troubling effects” (3). Her critique of the predominant research on migrant work that lumps nurse migrants together with other Asian professional migrants is summarized in three points. “First, it tends to foreground the uniqueness of the United States as a receiving nation of a diverse group of highly skilled migrants… Second, although some studies have emphasized the unique situations of Asian countries that send professional migrants, they continue to emphasize an economic logic to explain professional migration, often referred to as ‘brain drain.’ Third, the statistical nature of these studies renders Filipino nurse migrants impersonal, faceless objects of study, an objectification that prevents an understanding and appreciation of these migrants as multidimensional historical agents, and consequently hinders an identification with them as professionals, women and immigrants” (3). Choy’s valuable critique of her own field of study sets the conditions for a more reflexive and critical study of migrant work, which considers the categories class, gender, and race as significant horizons of interpretation. From this perspective, Empire of Care puts forward a way of reading the history of nursing migrants that challenges the “popular amnesia” about American colonialism—one that erases the violence of colonialism and neocolonialism in colonial narratives. As opposed to reading migration as spontaneous flows that occur on account of the migrants’ calculated choice—a discourse that validates the erroneous and commonsensical belief that the United States offers limitless opportunities to practice one’s profession in the most fulfilling ways possible—Empire of Care argues that the colonial and medical agenda of the United States and the role of the Philippine government in maintaining an export-oriented economy structure the field of migrant nursing and the experience of migrant nurses. Specific yet very significant questions arise in the process of interrogating the relationship between the two countries (i.e., the Philippines and the United States) within the context of neocolonialism. This includes the shift from the early twentieth-century arrival of Asian professionals whose “prestigious path to professional mobility” limited professional mobility to the elites of the sending country to the mass migration of Filipino nurses in the post-1965 period. This shift is analyzed by accounting for a host of factors that shape nurse migration to what it is today. Choy insists that “Filipino exchange nurse migration refashioned, yet also perpetuated, the social and racialized hierarchies created by US colonialism in the Philippines. Second, the transnational dynamics of Filipino exchange nurse migration, which took place in the context of U.S. attempts to maintain its global dominance during the Cold War, prefigured the post-1965 immigration of nurses to the United States that so many studies have attributed solely to the ‘liberalization’ of US immigration laws, and specifically the passage of the US Immigration Act of 1965” (63). In particular, Choy cites the “poor working conditions of the nurses in the Philippines in the mid-twentieth century added to the prestige and transformative potential attached to work and study in the United States” (67).

Interestingly, one of her interviewees pointed out the polarized character of class stratification in the Philippines which accounts for the production of fantasies about “transformative potential of work abroad” (73). “As Josephine Abalos explained, ‘See, in the Philippines, if you were rich, you were rich. If you were poor, you were poor. Here [in the United States], it equalizes everybody. The work and the salary equalizes. Your status becomes lost…So you were somebody in the Philippines? Too bad. You are somebody here, but everybody else is everybody too, see?” (73). Choy refuses to resort to positivist empiricism that valorizes the oppressed subject by affirming the testimony of the credit-baited female who unwittingly produces an alibi for globalization. The author brings home the point vividly by discussing the role of Philippine placement agencies and travel advertisements that refashioned nurse migration into a “very different kind of commodity” (92).
Furthermore, Choy devotes a whole chapter exposing the invisibility of violence in the production of migrant nurses’ narratives through the juxtaposition of two notorious crimes: the massacre of eight nurses in South Chicago Community Hospital in 1966 and in 1975, the respiratory arrest of thirty-five patients, some of whom died at the VA Hospital in Ann Arbor, Michigan. Choy’s analysis of these crimes that involved two Filipino nurses as victims (1966 massacre) and two Filipino nurses as alleged perpetrators (1975) emphasizes the notoriety not only of the investigation process but also of the way the US media portrayed the said crimes. The portrayals consist of the affirmation of American benevolence vis-à-vis the “enigma of the little Filipino” (149), the inscrutable Oriental or the savage native. The close attention to the details of both crimes and the consequent movements of various organizations vis-à-vis the discourse of transformative potential of work abroad highlight the subjectivity of Filipino nurses as a dislocated subject of class. Reminiscent of Marx’s metaphor for capital—no less than the Faustian monster—Choy’s subtle critique of class consciousness significantly problematizes the divided subject of global capitalism whose desire and interest do not coincide. The irony in the title Empire of Care speaks sharply of the irony of American imperialist desires and its consequences on migrant consciousness.

However, another compelling irony deserves attention in the work of Choy. Her description of the “empire of care” as the “transnational dynamics of Filipino nurse migration” (193) seems to insert the phenomenon in the discourse of transnationalism—a discourse that is based on the impression that a new world community is emerging from the old dispensation. The concept “transnational” is derived from the assumption that communities are now based on a new “cosmopolitanism of interests”—shared attitudes, preferences, tastes. The operative term in the discourse of transnationalism is lifestyle, which in turn is a code of consumption (Ebert 2000, 3). Choy’s objective to critique the “the creation of an international Filipino professional nurse labor force primarily in the historical context of US imperialism”(1) has been substantially fulfilled but the discourse to which she inserts her critique (i.e., transnatioanlism) is precisely aimed at displacing the analytics of labor (or the social relations of production) with the “social relations of shopping” (McRobbie in Ebert 2000, 3).

This discrepancy is further observed in the study’s lack of engagement with the competing discourses on the “post-socialist” condition that configure academic debates of late. Choy’s theoretical combat is more focused on the substantive consequences of competing theoretical frameworks on various analyses rather on the fundamental differences that frame competing analyses. This creates a vague impression that the terms “empire,” “imperialism,” and neocolonialism are interchangeable and do not actually carry within themselves the weight of political debates not only on globalization but on the conduct of revolutions. For instance, is the use of imperialism akin to the Leninist construction of monopoly capitalism? Or is “empire” in Choy’s context an agreement with the Foucauldian construction of the new world order by Hardt and Negri? The work seems to leave much on the question of theoretical reflexivity. In Bourdieusian sociology, theoretical reflexivity is an instrument of combat against the globalizing trends of the neoliberal order. In this context, the discourse of transnationalism is the consequence of fine-tuning a critique of globalization according to existing geopolitical constellations. As an academic discourse, transnationalism erases the violence of the current global constellation. While Choy provides an eloquent discussion of migrant labor, the kind that is tied to the global capitalist logic, her labor of theorizing becomes a symptom of the metastases of imperialist benevolence. The “transnational,” as a way of reading current global flows, extends the invisibility of violence from the actual structure and experience of migrant labor to the labor of theorizing this historical juncture as “merely transnational.”

Nonetheless, for its breadth and committed scholarship, the Empire of Care is decidedly an indispensable document of migrant labor and how it is lived in these “interesting times.”—Sarah Raymundo, Instructor, Department of Sociology, College of Social Sciences and Philosophy, University of the Philippines-Diliman.


Ebert, Teresa L. 2000. Globalization, class and cynical reason: A forum of contemporary theory and transnational critique. Pullman: Washington State University.

Click this link to download the review in PDF.

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