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Spaces of expertise and geographies of ethics : health worker recruitment and migration from the Philippines… Santiago, Mark Lawrence 2013

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SPACES OF EXPERTISE AND GEOGRAPHIES OF ETHICS:  HEALTH WORKER RECRUITMENT AND MIGRATION FROM THE PHILIPPINES TO CANADA  by MARK LAWRENCE SANTIAGO    B.A. Philosophy (Magna Cum Laude), Ateneo de Manila University, 2003 M.A. Philosophy, National University of Singapore, 2007   A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in The Faculty of Graduate and Postdoctoral Studies (Geography) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) December 2013 ? Mark Lawrence Santiago, 2013  ii Abstract         Spaces of Expertise and Geographies of Ethics: Health Worker Recruitment and Migration from the Philippines to Canada is my contribution to the contemporary academic and policy interest on the issue of international recruitment and migration of health workers. Through the discipline of human geography and using global ethnographic methodology, my thesis fulfils four overlapping aims and objectives: (1) I explain the role of state institutions in the recruitment and migration of registered nurses from a major sending country context, the Philippines; (2) I illustrate how private recruitment agencies? strategic partnership with Philippine state institutions facilitate the migration of Philippine nurses to Canada and other migrant workers globally; (3) I describe the work of Canadian state institutions that sustain and support the current dependence of a receiving country like Canada on immigrant health workers through one province?s ?ethical recruitment? drive and the daily work of one provincial recruitment firm and finally; (4) I analyse how bilateral agreements, international instruments and ethical institutional design facilitate international health worker recruitment and migration. Through historically informed, ethically orientated and empirically grounded socio-cultural and political geographic analyses, I narrate stories of local, transnational and global policies circulating and flowing through the knowledge, action and expertise of individuals across multiple institutions and state border that affect and frame the issue of health worker recruitment and migration.  iii Preface    The Behavioural Research Ethics Board of the University of British Columbia reviewed and approved the fieldwork conducted that informed this dissertation in September 10, 2009 (H09-02288).    Production of this dissertation has been made possible through financial assistance from the Cordula and Gunter Paetzold Fellowship, the Mathematics of Information Technology and Advanced Complex Systems (MITACS) Fellowship, Metropolis British Columbia Centre of Excellence for Research on Immigration and Diversity (MBC), Health Match British Columbia (HMBC) of the Health Employers Association of British Columbia (HEABC) and the Trudeau Foundation Doctoral Scholarship.    The analyses presented here are strictly the opinions of the author and does not represent the views of those who funded this study.         iv Table of Contents  Abstract .......................................................................................................................... ii Preface ........................................................................................................................... iii Table of Contents.......................................................................................................... iv List of Tables ................................................................................................................vii List of Acronyms .........................................................................................................viii Acknowledgments ....................................................................................................... xii Dedication .................................................................................................................xviii  INTRODUCTION  Spaces of Expertise ........................................................................... 1  Global Dreams, Local Lives ....................................................................................... 1 Which ?Ethics? and Why ?Expertise??...................................................................... 4 Mesogeographies of Global Migration.................................................................... 11 Understanding the Social Lives of Institutions and Policies.................................. 15 A Note on Anonymity .............................................................................................. 22 Outline of the Thesis................................................................................................ 22  PART I   HISTORIES ................................................................................................... 27  CHAPTER ONE  Points of Departure............................................................................ 28  Between Academic and Policy Worlds ................................................................... 28 The 'Natural' Place to Recruit Health Workers....................................................... 31 Philippine-Canadian Transnational Migration Studies......................................... 37 Female Migrants and the Live-in-Caregiver Program............................................ 42 Gateway Cities.......................................................................................................... 46 The Gifts of Human Geography .............................................................................. 48  CHAPTER TWO   Fluid Geographies............................................................................ 52  Negotiating Global Ethnography ............................................................................ 52 Pinoy Big Brother, Saskatoon Edition...................................................................... 61 The Ethics of Researching Temporary Foreign Workers ...................................... 63 The Fulcrum............................................................................................................. 70 Navigating Centers of Power ................................................................................... 75 In the Mecca of Recruitment & Migration .............................................................. 77 Embedded Research ................................................................................................ 83 At the Centre of Global Health Diplomacy ............................................................ 84 Living and Creating Geographic Knowledge.......................................................... 85  PART II   GEOGRAPHIES........................................................................................... 90  CHAPTER THREE   Creating Global Nurses ................................................................ 91   v From My Field Journal ............................................................................................ 91 Introduction ............................................................................................................. 97 The Best for the Filipino, The Choice of the World ............................................... 98 The Power of Numbers .......................................................................................... 101 Branding Philippine Nurses through Globalizing Higher Education ................. 109 Geographies of the Philippine State?s Migration Apparatus ............................... 122 Industry Regulation ............................................................................................... 131 Employment Facilitation ....................................................................................... 132 Marketing Development and Promotion.............................................................. 138 A Look Into Market Updates and Market Advisories........................................... 140 Conclusion ............................................................................................................. 145  CHAPTER FOUR   The Business of Migration ............................................................ 147  Introduction ........................................................................................................... 147 The Entrepreneurial State?s Strategic Partner...................................................... 152 Recruitment Agency A........................................................................................... 159 Recruitment Agency B ........................................................................................... 167 Recruitment Agency C........................................................................................... 173 Recruitment Agency D .......................................................................................... 180 Improvising Policies through ?The Creative State? ............................................. 186 Conclusion ............................................................................................................. 198  PART III  ETHICS...................................................................................................... 199  CHAPTER FIVE   Policy Moves .................................................................................. 200  Introduction ........................................................................................................... 200 Transnational Migration Policy Regimes ............................................................. 202 Manitoba ................................................................................................................ 208 British Columbia .................................................................................................... 211 Alberta .................................................................................................................... 214 Saskatchewan ......................................................................................................... 216 Envisioning Ethical Recruitment .......................................................................... 220 Evolving Policy Outcomes ..................................................................................... 221 Provincial Health Worker Immigration................................................................ 236 Policy Approach to Transnational Labor Migration ............................................ 238 Moving Global Policy Frameworks ....................................................................... 240 The Road to A WHO Global Code of Practice .......................................................... 241 A Voluntary Code with A Multisectoral Audience .............................................. 247 ?Ethical Recruitment? and the Special Case of Developing Countries ............... 249 Balancing Individual Rights and the Public Good ............................................... 252 Fairness, Recognition and Self-Sustainability ...................................................... 253 Circulating People, Circulating Knowledge ......................................................... 254 The Upstream Challenge of Implementation ...................................................... 256 Conclusion ............................................................................................................. 258  vi  CHAPTER SIX  Placing Migrants ............................................................................... 259  From my Field Journal........................................................................................... 259 Introduction ........................................................................................................... 264 The Spatial Organization of an Institutional Ethnography ................................. 267 Ethical by Institutional Design.............................................................................. 274 Doing Ethical Recruitment.................................................................................... 280 Marketing 'The Best Place on Earth' ..................................................................... 283 Recruiters as Policy Translators ............................................................................ 285 Academics as Knowledge Brokers......................................................................... 287 Conclusion ............................................................................................................. 290  CONCLUSION   Geographies of Ethics ....................................................................... 293  Local Dreams, Global Lives ................................................................................... 293 The Political is Personal, The Intellectual is Spatial ............................................ 300 The Power of Embodied Knowledge .................................................................... 305 The Heart of the Matter ......................................................................................... 308  REFERENCES............................................................................................................... 312 APPENDIX A ................................................................................................................. 320 APPENDIX B .................................................................................................................. 327 APPENDIX C.................................................................................................................. 333   vii List of Tables  Table 1 Top 5 Destination Countries of Temporary Nurse Migrants?????.102 Table 2  Top 5 Destination Countries of Permanent Nurse Migrants??.???.102 Table 3 Market Updates????????????????????????????140 Table 4 Market Advisories???????????????????????????.141         viii List of Acronyms  AIT: Apprenticeship and Industry Training ADPCN: Association of Deans of Philippine Colleges of Nursing ALMD: Ministry of Advanced Education and Labor Market Development BLA: Bilateral Agreement BCNU: British Columbia Nurses Union BON: Board of Nursing CAD: Canadian Dollars CHED: Commission on Higher Education CIC: Citizenship and Immigration Canada CIHI: Canadian Institute for Health Information CIIP: Canadian Immigrant Integration Program CEO: Chief Executive Officer CFO: Commission on Filipinos Overseas COA: Canadian Orientation Abroad CNA: Canadian Nurses Association CRFA: Canadian Restaurant and Foodservices Association CRNBC: College of Registered Nurses of British Columbia CRNE: Canadian Registered Nurse Exam CV: Curriculum Vitae DFA: Department of Foreign Affairs DOH: Department of Health DOJ: Department of Justice  ix DOLE: Department of Labor and Employment DOT: Department of Tourism DTF: Difficult to Fill EO: Executive Order FCRO: Foreign Credential Referral Office FCRP: Foreign Credential Recognition Program GDP: Gross Domestic Product GPB: Government Placement Branch HHR: Health Human Resources HHRB: Health Human Resources Bureau HMBC: Health Match British Columbia HR: Human Resources HRSDC: Human Resources and Skills Development Canada ICAT: International Council Against Trafficking  ICN: International Council of Nurses IEN: Internationally Educated Nurse ILO: International Labor Organization INTARMED: Integrated Liberal Arts and Medicine IOM: International Organization on Migration IPC: International Pearson Center JPEPA: Japan-Philippines Economic Partnership Agreement KSA: Kingdom of Saudi Arabia LCP: Live-in-Caregiver Program LMO: Labor Market Opinion  x MOH: Ministry of Health MOA: Memorandum of Agreement MBC: Metropolis British Columbia MOU: Memorandum of Understanding NARS: Nurses Assigned to Rural Services NCLEX: National Council Licensure Examination NCSBN: National Council of State Boards of Nursing NIH: National Institutes of Health NLE: Nursing Licensure Examination NPA: New People?s Army OECD: Organization of Economic Cooperation and Development OFW: Overseas Filipino Worker PCBC: Philippines-Canada Business Council PCC: Philippine Chamber of Commerce PDOS: Pre-Departure Orientation Seminar PEOS: Pre-Employment Orientation Seminar PHP: Philippine Peso POEA: Philippine Overseas Employment Administration POLO: Philippine Overseas Labor Office PNA: Philippine Nurses Association PNP: Provincial Nominee Program PR: Permanent Resident PRC: Professional Regulatory Commission  RA: Republic Act  xi RN: Registered Nurse RSA: Return of Service Agreement SEC: Substantially Equivalent Competency SINP: Saskatchewan Immigrant Nominee Program TLC: Tender Loving Care TFW: Temporary Foreign Worker UBC: University of British Columbia  UP: University of the Philippines UPCAT: University of the Philippines College Assessment Test UP M: University of the Philippines-Manila US: United States (of America) USD: United States Dollars WHO: World Health Organization  xii Acknowledgments     Finishing this thesis is one of the most difficult marathon courses I?ve ever run but it is also one of the most rewarding. I could have not survived the process of researching and writing it without the help and support of so many individuals who I met through the course of my graduate studies at the University of British Columbia.    First, I want to thank my doctoral supervisory committee. Merje Kuus opened the doors to the Department of Geography for me. She shepherded me through the initial steps of becoming a knowledge professional. David Ley, always wise and kind, taught me to map not just the course of my career but also what goes outside of it. His attention towards my intellectual and emotional wellbeing goes unsurpassed by any teacher I?ve ever had. Dan Hiebert directed me to follow through this research project after I wrote a paper on the topic for his course on International Migration. His professional advice became key to my own career path. Jim Glassman, through his comments on my work during Geography 520 motivated me to use my philosophical background for the human geographical discipline. Jerry Spiegel introduced me to health policy and to key players in health human resources in British Columbia and in Ottawa. I could have not asked for a combination of these five outstanding intellectuals to work with me on this project.     Staff of the UBC Geography Department Junnie, Suzanne, Jeanne and Vicky deserves special mention for making the administrative issues related to graduate school and this thesis lighter. Staff at Green College, Lyn and Simone and its Principal Mark Vessey gave me home (a beautiful one at that) when I first arrived here in Vancouver. Staff at St. John?s College Alice, Stacy and its Principal Henry Yu  xiii provided me yet another home as I conclude this work. Because of my experiences at these Colleges and if only I could, I would love to remain at home there.   International Migration, Global Health and Philippine Studies scholars around the world served as inspiration and mentors: Geraldine Pratt, Henry Yu, Philip Kelly, Brenda Yeoh, Shirlena Huang, Bea Lorente, Margaret Walton Roberts, Alison Mountz, Robyn Rodriguez, Vince Rafael, Catherine Ceniza-Choy, Erlinda Palaganas, Aurora De Dios and Filomeno ?Jun? Aguilar. Their groundwork allowed for the intellectual shape of this dissertation.    In the Philippines and Singapore, Jun made me rethink my intellectual interests over lunches in Ateneo.  Bea pointed out that Geography might be a better discipline for me to study my intellectual concerns. Her hunch was true and that?s how I met Brenda and Shirlena and started my journey into the social sciences. Ma?am Oyie was an amazing interlocutor on Philippine migration issues. Tita Caster, Filipina nursing leader and scholar par excellence, provided me direction and contacts that made navigating the dizzying Philippine nursing circuits easier.   Here in North America, Robyn is a fabulous example for us early career Philippine academics. Vince?s wisdom and knowledge about the Philippines and its place in the world is an example of brilliant and enduring scholarship. I treasure his encouragement to cultivate my own work. Philip gave me an office at York University?s York Centre for Asian Research (YCAR) and was my intellectual refuge at the very early stages of writing this thesis. Indeed, YCAR was the place where this thesis was born. Gerry was the graduate studies program advisor when I started my PhD in the Department. She welcomed me to Geography and her decades long work on the Filipino Canadian community is an exemplar of committed scholarship.  xiv   Margaret and Alison were a pleasure to work with on a three-city workshop on global migration and its intermediaries that brought us together in New York (at the AAG), Toronto (in Metropolis) and in Waterloo (at the CAG). I look forward to future years of collaboration with these two inspiring women geographers. Henry deserves a second mention, as he became my unofficial mentor as I transitioned from philosophy to geography and from the humanities to the social sciences at large. Through allowing me to partly lead the UBC-NUS summer course and giving me permission to create Asia Pacific Worlds in Motion, he taught me that it is possible to be a leader early on in my career and create innovative pedagogical spaces that benefit our students and colleagues. His work on the intellectual history of the sociological discipline in the United States became the initial spark for me to realize that I should not take my position as a Filipino intellectual in Canada for granted. Rather, I ought to embrace being a part of a long history of Asian scholars writing about Asians and the Asia Pacific.    The Pierre Elliott Trudeau Foundation gave me the best academic gift I ever received. Through its Scholarship Program, I was able to meet highly engaged Canadian and global scholars. Special thanks goes to my Trudeau Mentor, Honourable Judge Mary Ellen Turpel Lafond, who welcomed me to be part of her personal and professional life. I will do my best to follow her example and work. By fully embracing her identity as a First Nations woman, she showed me that there is indeed power in the margins and that rigorous knowledge production imbued with an ethical action plan is its fount. I wish to collaborate with her vision for children and youth in the future. Jos?e St. Martin always offered me her kindness, by not only facilitating all the research trips and materials that made this dissertation possible; but  xv also making sure I am OK.  John Mabbott of Health Match BC gave me keys (literally) to access the world of health worker recruitment. He took special interest on my work as a scholar and made me confident to write about the subject after I have spent more than three years in and out of the organization he leads. Eva Mendez challenged my presuppositions about the health worker recruitment industry and introduced me to the complex beauty of the nursing profession. She allowed me gain clarity when I was drowning in information. Yvonne Atwood kept my nutrition in check during the final dash of this marathon. My office colleagues were constantly puzzled as to why I was working at Health Match BC yet not doing what they do ? to Anna, Evelyn, Barry and other staff at HEABC, thanks for the lunches and afternoon breaks that made researching and writing around you fun and exciting.   The nurses who welcomed me into their home gave me both information and insight about their lives and the institutions I eventually researched in Canada, the Philippines and Geneva, Switzerland. They ought to be named. Boni and Raine, Malvin, Kuya Rey and Ate Anne, Paolo and Ate Kat became my very own Filipino family in Saskatoon. While this thesis was mainly written in Toronto and Vancouver, its intellectual driver was my experience of living with these outstanding Filipino nurses who shared with me their new lives in the Canadian Prairies. Tito Freddie provided me home in Geneva and made sure that I know the city beyond the halls of the United Nations and international organizations.     Before coming to Canada, a number of people shaped me intellectually in Manila and Singapore. Thanks to Tan Sor Hoon, my thesis supervisor at the Department of Philosophy in the National University of Singapore, who did not clip my wings to academic philosophy but inspired me to philosophize in other places.  xvi This thesis ? the way ethics come alive through politics and geography ? contains obvious traces of my training in political theory with her. I owe a lot from my philosophy teachers from Ateneo de Manila University such as Sir Ediboi Calasanz, Dr. Ramon Reyes and Fr. Roque Ferriols SJ who grounded my thinking (in being and becoming). Mike Mariano, Albert Lagliva, Jope Guevarra, Rowie Azada, Guss Rodriguez, Momok Barbaza, PJ Strebel, Jac Cleofas, Jomel Santos and Maan Villanueva tolerated me as the youngest member of the Department (back then) and made me enjoy teaching. The Jesuits and the folks from San Jose were all instrumental my early intellectual formation. My spiritual director Father Jojo Magadia, SJ, a Jesuit leader and political scientist, deserves special thanks for guiding my way through life?s ?non-negotiables? and served as a father figure and refuge when I needed it the most.   My ?family of choice? here in Canada is an amazing group of people whose love and attention I draw my energy from. Outside the walls of work and academia, they gave me ample space to breathe. After I finished my demanding fieldwork that made me go on 12 return flights a year for more than 3 years, I suffered from a chronic illness that slowed down and interrupted my professional life for a while. It was a very difficult year but I will look back on it not with regret, but with gratitude towards my closest friends who spent many walks, dinners and conversations that helped restore my health and reinvigorated my spirit: Noreen M, Charlene S, Charlene R, Yuan, Laura N, Laura M, Camille, May, Michelle, Rose, Yolanda, Kara, Jeline, Jia, Kristi, Ana, Caroline and Eva - a company of extraordinary women.    Jeline, Laura M, Jia, Kara, May, Christine and Charlene S also read and commented on various chapters and iterations of this thesis and it is through their discerning eyes that my voice found its clarity. While I did not explicitly engage with  xvii ?feminist post-colonial scholarship,? these women of colour who live and breathe that field influenced my work. It is because of the support of such a network that a scholar like me can actually exist.   The very few but outstanding men who I care for complement the women who run my life: Simon and Arnold (and Zoe) provided me home and tolerated my baking habits at 3 o?clock in the morning in Ottawa at the very last stretch of writing this thesis. Adam made sure I was safe during my fieldwork and was a constant presence and company for three years. Dan, now No.1 Councillor in the Northwest Territories was my best gym buddy and friend. My closest friends and fellow sojourners who I met back in Manila and Singapore who are now all over the world are a source of warmth, presence and strength: Aaron M, Diane, Jon, Paul, Venus, Weng, JV, Aaron S, Sigh, Sharon and William.   Finally, a special thank you to my family. The love that binds me to them also mysteriously, constantly, sets me free. My sister Elena listened to every disappointment I faced this past year. She always reminded me that I am always enough. She and her husband Hermie gave allowed me to finally be at home here in Canada. My mother Beth sacrificed a lot so that my sister and me get to where we are now. Nanay Beth is our best caregiver. Her prayers saw us through our toughest challenges and joyful triumphs. We could have not asked for a better Nanay.  xviii Dedication  This thesis is dedicated to the loving memory of my father, our Daddy, Lorenzo Gatdula Santiago (1956-2001) Father, Husband, OFW   He worked overseas as a construction worker most of his life to support my family. His spirit lives among the fathers, mothers, sons and daughters  crossing global borders for their loved ones.  The love he provided us inspired me  to do the research and finish writing this work.  We miss and love you, Daddy.         1 INTRODUCTION  Spaces of Expertise     ?Just as none of us is outside or beyond geography, none of us is     completely free from the struggle over geography. That      struggle is complex and interesting because it is not only about soldiers and    cannons but also about ideas, about forms, about images and imaginings.?       - Edward W. Said, Culture and Imperialism  Global Dreams, Local Lives    On September 30, 2010, in partnership and collaboration with the University of British Columbia?s (UBC) Department of Geography and School of Nursing, Health Match British Columbia (HMBC) and Metropolis British Columbia Centre of Excellence for Research on Immigration and Diversity (MBC), an academic-policy workshop called ?Health Worker Migration in Canada: Histories, Geographies, Ethics? took place at UBC?s St. John?s College. As the culminating project of my fieldwork for this thesis, I conceptualized and organized this workshop to gather leading academic and policy experts from British Columbia (BC) and beyond to discuss the issue of health worker recruitment and migration affecting Canada, the Philippines and the world. It was an event full of presentations and discussions ranging from doctoral students, government immigration officials, nursing leaders, public healthcare executives and tenured university professors who have published  2 extensively on the topic. 1 Towards the end of the workshop, one nurse migrant participant, Anita (not her real name) contended with the representatives of the College of Registered Nurses of British Columbia (CRNBC) regarding the issue of recognizing her nursing practice hours outside of Canada?a requirement to qualify as a Registered Nurse (RN) in BC. An elderly Filipina woman in her 50s, Anita had worked in the Middle East for almost 20 years before moving to Vancouver to take her nursing upgrading courses while working full-time as a live-in caregiver. In a soft-spoken manner, she asked how she could find the time to work in clinical practice settings in Canada (as required by the CRNBC) if she had to spend her time in the job that pays for her (and her children in the Philippines) current subsistence. She used Canada?s federal Live-in-Caregiver Program (LCP) path as a ticket to permanent residency, and also a point of departure to work in the health care and social services industry in Canada.2    Many years ago, while still in the Philippines, she had aspired to work as a nurse overseas and used working in the Middle East as a stepping stone towards a country that would be a more secure place for her profession as well as offer more educational opportunities for her children. Unfortunately, her experience of Canada so far turned bitter as her educational credentials and professional experience had gone unrecognized. The hours she clocked in as a live-in caregiver did not and would never count as nursing practice hours. The hours she toiled in the emergency and operating rooms in Manila and Riyadh would not count as substantial proof that she could practice nursing here because those were done in different practice                                                  1 See details of the workshop at:  2 See details about Canada?s federal Live-in-Caregiver program at:   3 environments. As Anita moved further and further away from clinical and bedside practice settings within nursing, her dream of becoming a Canadian Registered Nurse (RN) became even more impossible to achieve. She needed to prove that she could practice here before she can actually practice.  I deeply sensed that she felt her economic future and social status were severely compromised by choosing to become a Canadian immigrant and citizen.    There was a silent pause in the audience after Anita shared her dilemma. The same question that plagued me personally and as a scholar doing research on the issue of international health worker recruitment and migration rose powerfully within me: Shall I side with the grievance of migrant nurses like Anita or agree with the gatekeepers of her profession that she does not deserve to apply as a Registered Nurse just yet? As the person responsible for designing and organizing the workshop, I stood there, in the middle of the two parties, unsure how to appease her. This woman, who was the same age as my own mother, just wanted to practice the profession she signed up for in her 20s. I felt for her. But I immediately thought that I couldn?t just simply be on her side and rally against the College. And in this case, my empathy would not bring her any closer to holding a nurse registration number.   This internal intellectual and emotional conflict between my personal and scholarly opinion around the topic became the most consistent theme throughout the process of doing my research for this thesis, Spaces of Expertise and Geographies of Ethics: Health Worker Recruitment and Migration from the Philippines to Canada. I was often caught in the middle?in the shades of gray ethical issues that had puzzled me from the very beginning.  An intellectual war within me ensued. At times, this war froze and paralyzed my capacity to concretely spell out what I thought about the issues arising  4 from my thesis subject. The ethical issues plaguing the phenomenon of international nurse and health worker recruitment and migration are not easy to solve. The genealogy of thinking about the subject had certainly evolved?but the dilemmas that confront the individuals and the institutions that shape these individuals? continue to take place, inscrutable.   Which ?Ethics? and Why ?Expertise??      This thesis studies and narrates the stories of the lives of people, policies and institutions that define the issue of international health worker recruitment and migration through the discipline of human geography using global ethnographic methodology. Empirically, what holds it together is its focused attention and detailed examination of concrete case studies concerning the social institutions that shape the international recruitment and migration of nurses from the Philippines to Canada in the context of a shifting global consciousness on equity and ethics.    This thesis aims to describe how the meanings of ?ethics? travel from place to place. It clarifies its plasticity as a concept and demonstrates how it moves and mutates. What should countries like Canada and the Philippines do in light of the recruitment and migration of health workers? Both countries face institutional and ethical challenges as to how they can sustain and distribute health human resources in their respective jurisdictions. I argue that the answers to such challenges lie within the details of cases and not through framing the issue through a prescriptive ethical theory (i.e. utilitarianism, deontological ethics or virtue ethics). Therefor3e, my use of the word ?ethics? here is primarily descriptive rather than prescriptive. I deploy the  5 concept of ?ethics? within the context of what philosophers of value, moral philosophers and especially applied ethicists call ?casuistry? or ?case based reasoning? (Jonsen and Toulmin 1988). Casuistic ethical reasoning, a widely accepted methodology in bioethics (a field of applied ethics that deals with ethical questions arising out of medical, clinical and health care contexts) and the intellectual paradigm behind case law, begins the analysis of an ethical dilemma or a moral issue through a thorough and detailed description of the empirical context surrounding and undergirding the dilemma or issue. In casuist ethics, contextual details presuppose and eventually determine moral judgments (i.e. whether a decision or a course of individual or social collective action is right or wrong) (Arras 1991; Jonsen 1991; Wildes 1993; Iltis 2000; Braunack-Mayer 2001). Social scientific disciplines such as human geography, through its methods, can describe empirical details that normative disciplines such as philosophy adequately provide. And the empirical details produced through the research process are not scaffolding ? they are precisely where the answers to an ethical dilemma can be found.    In my view, what human beings or institutions ?ought to do? (a prescriptive normative stance) goes hand in hand and should be balanced with a reality check of what we/they ?can possibly do? (a descriptive applied stance). For example, is it right or wrong to disallow health workers to move within and across national borders so as to sustain the health system where she works? Before we can answer this ethical issue adequately, we would need to contextualize it and provide further details. We may, for example, recognize and answer a few questions such as: who gives institutions (i.e. employers) the moral authority to coerce and put sanctions around the health worker to stay within a health services system? Do institutions have the right to withhold the  6 basic freedom to move across borders? Why is she moving in the first place? Was she a publicly educated, funded and trained health worker or did she receive and pay for her health worker education primarily through private and family support? Is her employer a publicly funded or a privately owned health facility? What kind of health system is she coming from? Is it a struggling health services system with very few remaining qualified people that serve and sustain it? Or is it a health services system where there is an abundance of unemployed and underemployed health workers who can be trained and eventually replace her? What kind of health worker is she? Is she an entry-level worker or an expert in her field? Which health profession does she belong to?   Using the methodology and logic of casuistic ethics, ethical judgments on the case above would depend on where a person is located vis-?-vis these questions. There is a culture behind ethics and this culture, in the case of international migration, is often paradoxical. While it is an international legal norm that every human being has the right to move, movement is heavily enabled by soci0-cultural context and constrained by political economic circumstances that often lie outside the control of an individual human being.  In a liberal democratic and egalitarian international system, every human being who decides that her life course would improve through migration can move without any problems. However, while some individual countries and nations are constitutionally founded on such political philosophical principles, this norm cannot be further from how their political institutions are built. The fact is that these same countries and nations that often profess liberal, democratic and egalitarian ideals have constructed and instituted borders that only a fraction of humanity can freely cross albeit with high entrance fees. And entrance does not imply and  7 necessarily result in membership. A human being who is not native to a country enters that place without the political and economic privileges that go along with citizenship and the social and cultural benefits of belonging.    Between facts and norms, there is a liminal space where tough ethical decisions are made by individuals and institutions. In this thesis, I often found myself perplexed by the ambiguities that the cases herein present. This does not mean that I was often indecisive; it only meant that I suspended judgment until I have satisfied my epistemic doubts. It is crucial to suspend judgment until I have described and examined the details of the cases and arrive at judgments that create possibilities rather than deconstruct without any foundations. Grounded empirical analyses of cases prevent us from arriving at generalized moral condemnation (the ?blame game?) and allow us to have an incisive ethical critique that can sharpen individual and collective freedom and responsibilities around the given issue.  In other words, by describing the conditions that surround the issue, realistic and grounded possible courses of ethical action arise. This would inhibit ethical sophistry as we realize that ethical judgments pertinent to one case might not apply to another.    Social, economic and political issues (such as the questions I enumerated above) arising from the international recruitment and migration of individual health workers (such as we can see in Anita?s story above) has increasingly captured the attention of various public and private sector actors involved with labor, migration and health care organizations (such as those who were participated as academic and policy experts in the workshop). Such actors include those that derive their work and value from recruiting health workers and assisting them in their migratory process. From a global policy perspective, the phenomenon became a hot button topic when it was  8 actively deliberated among state actors through the passing of the World Health Organization Global Code of Practice on the International Recruitment of Health Personnel (WHO Global Code of Practice) on May 21, 2010 by 193 Member States of the Sixty-Third World Health Assembly in Geneva, Switzerland.3 The WHO Global Code of Practice marked a significant milestone in global health diplomacy, having been the second international instrument adopted by the World Health Organization (WHO) with its full constitutional authority in more than 30 years.4    The global health human resource shortage, projected by the last WHO statistical compendium to be at 4.3 million is the key source of many social, political, economic and ethical dilemmas (?WHO | The World Health Report 2006 - Working Together for Health? 2013). Outside the domestic production of more health workers to form self-sustaining health service systems, international recruitment and migration is one of the key policy levers through which public and private sector health service providers can solve their own respective shortage problems ? making the phenomenon an urgent and inevitable national and global health issue the international policy community ought to confront together. The WHO Global Code of Practice can be viewed as an international instrument to encourage jurisdictions can potentially respond to the practical and ethical dilemmas related to health human resources.    There are many scholarly gains in researching an issue that has multi-national, multi-sited, and multi-scalar aspects and potential. The topic is timely and                                                   3 For the full text of the WHO Global Code of Practice, see:  4 The only other code to be agreed upon was the International Code of Marketing of Breast-milk Substitutes in 1981.  9 timeless at the same time ? deserving deep and sustained academic focus. The contemporary significance of the issue, manifested through heightened global policy interest that culminated through the passing of the WHO Global Code of Practice, has opened doors for researchers like me to collect data and test theories on inter-related aspects of health human resources and global labor migration. For example, policy-oriented research in health human resources and global labor migration has informed and framed the macro-scalar contexts through which the issue has been brought to the table in meetings at the global scale in the World Health Assembly. The timeliness and the policy relevance of the issue give incentives for academic researchers interested in health human resources and labor migration to frame academic research as policy expertise. In addition, researchers contribute to the global flow of information on the issue of health worker recruitment and migration through academic conferences, the public media, and within policy circles.    Expertise of the issue might bring scholarly publications and academic prestige to academic researchers. For policymakers, bureaucrats, and business professionals situated in the public and private sectors, acquiring expertise of the issue offers even more straightforward incentives. Migration and health care worker recruitment professionals deal directly with the daily bureaucratic and business operations that sustain the pipelines of health workers crossing international borders. The careers of public civil servants and the bottom-line financial success of private firm owners largely depend on creating order and making profit out of a simultaneously chaotic and financially rewarding system.    In the literature addressing the role of the private sector as well as state and public international organizations dealing with contemporary international migration,  10 this has been astutely called ?managing migration,? bearing both bureaucratic governmental, business profit and organizational meanings (Martin, Martin, and Weil 2006). In the Philippine segment of this global ethnography, arguably one of the most important source countries for migrant workers globally (alongside Mexico, China, and India), the phrase ?managing migration? has become the key activity that most state actors and private business operators claim to be doing on a daily basis. ?Managing migration? has become an underlying bureaucratic mandate for most of the state and private sector institutions researched here. As the President and CEO of one of the most successful private recruitment agencies for health workers in the Philippines has pointed out, it is part of agencies? everyday challenge to find honest ways of making profit through their hard work with one of the dirtiest businesses around. In this case he is referring to the fact that the media and the public sector have painted the private recruitment agency sector negatively ? comparing what they do to the business of human trafficking.   Determining whether or not private recruitment agencies are dirty or honest enterprises is not this thesis? main intention. It is clear from the outset that the primary motive of private recruitment agencies is to make profit from deals with foreign employers, whom they call ?principals.? The business product of the transaction between recruiter and principals is the facilitation of the recruitment and mobility of workers (health workers included) within or across state borders. Just like their private sector components, public sector workers?in source countries like the Philippines, government bureaucracies of receiving countries like Canada, or in international organizations like the World Health Organization (WHO) and the International Organization for Migration (IOM) ? are involved in what I call ?the  11 business of migration.? They are able to sustain their jobs in a global era of deep cuts in the public employment sector, through the work of managing and utilizing knowledge expertise on international health worker recruitment and migration.    When the media, the state or international organizations call upon academic researchers to deliver expert policy advice on matters such as health human resource policy and labor migration, there are unspoken assumptions about the accumulated knowledge and the everyday work of such professionals. Are experts equally interesting as the expert opinion they circulate among themselves in the social spaces they inhabit? Why are certain academics called upon to communicate their research results directly to the public and to policymakers? As highlighted above, it is not just academic researchers making knowledge claims about the issue of health worker recruitment that require a closer look vis-?-vis their political uses of expert knowledge. Investigation into the knowledge and the daily work of other policy professionals?such as government bureaucrats and members of private sector organizations through which policy-oriented academics circulate and look for validation and funding for their work?offers a fertile ground in how cultures of expertise and the politics of global knowledge transfer take place and come alive.   Mesogeographies of Global Migration     The nation-state and its institutions have recently assumed a less central role in ethnographically informed migration studies. As such, when geographers and other social scientists studying migration write about the plight of economic migrants, they usually use information and data gleaned from the attitudes and narratives of  12 migrants themselves.  In global migration studies, the use of survey questionnaires and participatory action methods among migrant workers have become commonplace. One can argue that counting migrants and listening to their voices constitute the core of contemporary migration studies and is standard in this multi-disciplinary field of study. While I agree with this, I argue that it is crucial to also study spaces and processes of global migration using a different scale, that which I call ?mesogeographies of global migration.?    By mesogeographies, I refer to spaces and scales through which economic migrants as well as various social actors interact to make migration actually happen, in order for movement to take place. Mesogeographies of migration are all over the place. In any given nation-state, there are many agencies and organizations that constitute their borders. These organizations often include those who compose the formal apparatuses of the state. Indeed, significant amounts of government funding go to border security and border patrol. Then, there are those organizations that are in between the market and the state. They facilitate and in fact gain profit or political legitimacy from facilitating the flows of economic migrant workers.    Migration scholars typically call them middlemen, recruiters, agents, brokers and body shops (Guevarra 2009; Hussein, Manthorpe, and Stevens 2010; Lindquist 2010; Lindquist, Xiang, and Yeoh 2012; Xiang 2011; Xiang 2012). By deflecting the gaze from the economic migrants themselves, migration scholars writing about recruitment and brokerage are able to focus on the complex set and mix of institutions composing the political economy of migration?and the various spaces where the state and markets meet, coalesce, collide, and dance. That is why the ?migration institution? and policies that leak, flow, and circulate through their spaces are at the forefront of the analysis of  14 contemporary global migration. But instead of being paralyzed due to the multiple possibilities of representation and narration, I have chosen to highlight certain actors, events, and spaces that will allow the reader to understand that the organization of global migration and the recruitment of highly skilled workers is not random. These narratives provide a sliver and offer only my interpretation of these people, texts and events; I do not assume that I could render a completely unbiased picture.    Recruiting highly skilled migrants such as health workers is carefully deliberated, planned and executed by institutional actors. And it is informed by economics, politics, ethics and the professional regulatory standards surrounding the health care professions. In a way, what I will show through the substantial chapters of this thesis is the counter-intuitive point that the tale of global migration (in the case of recruiting highly skilled workers) is not just about the migrants. The tale is also about the movement of capital and its institutions across spaces in unequal trajectories. However, the tale does not end in forwarding this claim. This thesis shows that this movement of capital across space, which creates spaces of recruitment and migration is embodied and disembodied at the same time - they are best manifested through the competition for the best and most highly skilled workers from all over the world. Private recruitment firms, along with recruitment-oriented policies designed and supported by states serve, as one of the most interesting spaces is to observe this.    This global ethnography questions another conceptualization that informs debates about the recruitment of highly skilled workers such as health workers and nurses, one that posits that the global North is exploiting, looting, stealing workers from the global South. These are words often thrown around in the media and academic circles which raise the issue yet do not render justice to it.  This ethnography  15 shows precisely the opposite: the so-called ?global South? is actually cooperating, or as I would prefer to call it, dancing with the ?global North? in enabling the recruitment and migration of health workers. To show this, I will further differentiate and disaggregate the uneven geographies that compose individual countries through a thorough understanding of their individual histories, geographies and political economies.   Understanding the Social Lives of Institutions and Policies    Grounded in a variety of approaches such as ethnographic participant observation and interview work in the Philippines, Canada, and Geneva, this thesis offers an examination of the spaces where expertise is formed and the social conditions that enable the transfer of expert knowledge across institutions and international borders. It suggests that expert-formation and knowledge-transfer are mutually constituted through the exchange of work by academic researchers, government bureaucrats, and business professionals. They are as crucial to this study as the subjects that they themselves study and serve in their everyday jobs. These actors form crisscrossing networks of influence and power that form a knowledge base with the potential to give birth to future policies that have the potential to affect us all.    But how exactly has this study been done?   Temporally, the actual research timeframe spanned a period of 18 months from July 2009 to December 2010.  Prior to my formal fieldwork, I did preliminary fieldwork in Manila, Philippines from June to August 2008 and from June 2009, an additional period of 4 months. I did not do any interviews during this period but  16 initially introduced myself to some of the key informants who I eventually formally interviewed when I returned to Manila from January to May 2010. The multi-sited nature of my research makes the project extensive and some might argue, ?all over the place.? As will be clear throughout the thesis, there are particular localities, centers and cities (Vancouver, Manila, Saskatoon) where I spent more intensive periods doing participant observation and interviewing than others (Ottawa, Seattle, Geneva, Liverpool). 5   From the outset, I was persuaded that understanding the empirical concerns of this thesis required conducting field research and gathering primary and secondary data in a number of places. While also deeply informed by philosophical debates about methodology in human geography and migration studies, before my fieldwork I read the methodology the sociologist Michael Burawoy has articulated as ?global ethnography? and the ?extended case method? (Burawoy 2009; Burawoy 2000; Burawoy 1991) and was guided by its principles early on.6 I resonated with the methodology outlined by Burawoy and his students in their work because it was apparent to me that the research topic of this thesis has a peculiarly global scope. I understand global in the sense of having an all encompassing and almost universal impact on every possible space and time on our conceivable past, direct present and anticipated future. International health worker recruitment and migration is a global issue that requires a globally attuned methodology because every region, country,                                                   5 To systematically show how my fieldwork unfolded, in Appendix A, I put in table form the following information: (1) an overview of my fieldwork schedule and locations, (2) the list of events I attended and organized and (3) list of key informant interviews.   6 I thank Jim Glassman who introduced me to Michael Burawoy?s work through his presentation at the UBC Geography Department?s Methodology Seminar Series. Indeed, I brought Burawoy?s books and articles with me while I was doing fieldwork.  17 state, province, town, city and social unit relies on the provision of health services by health workers in these scales. Health workers are in constant motion as they get educated, trained and recruited into health systems. Global ethnography and the extended case method assume that contemporary social science research questions are already interconnected with global, transnational, and translocal actors and institutions across space and time. This assumption challenges researchers to do multi-sited fieldwork, and has consequently compelled me to frame my research questions and emerging sub-questions historically as well. Employing global ethnographic methodology allows me to analyze issues that have deep historical roots, are spatially dispersed in nature, and have multi-scalar implications. The multi-layered character of my research objectives have thus required multiple research techniques as spelled out more fully throughout this thesis.    The nature of the research questions I initially set up in my thesis proposal required this extensive multi-sited, transnational and global approach to research. In my view, only an up-close ethnography of migration and recruitment institutions can reveal how they shape political, economic and ethical landscapes. Apart from Burawoy's work, this thesis derives inspiration from the writings of sociologist of knowledge Mich?le Lamont (2009) in her examination of academic judgment among professors in academic review panels. It also follows the work of political sociologist Christina Boswell (Boswell 2012) in her analysis of the relationship between immigration researchers and state officials in the context of state-funded immigration research bureaucracies in Germany and the United Kingdom.   Within the discipline of human geography, creative tensions between the subfields of political and social-cultural geography made advancing this thesis  18 possible. I derive inspiration from the work of geographers in these fields. The specific methods used here is influenced by the current work of political geographer Merje Kuus (Kuus 2013; Kuus 2011a; Kuus 2011d; Kuus 2011b; Kuus 2011c) in her work on intellectuals of statecraft, bureaucracies and expertise in the making of European Union policies. Her work speaks to both the benefits of and limitations posed by choosing ethnographic methods in conducting research in complex bureaucracies such as the EU. She warns us about the inherent difficulty involved in understanding opaque institutions. Her analytical focus on the role of geographic knowledge and expertise complements her socio-cultural analysis of both the roles and functions of EU diplomats and bureaucrats in the making of EU neighborhood policies. Like Kuus? work, this investigated ? in a subtle and indirect manner ? how geography, geographical concepts and geographic knowledge are enfolded into and preclude epistemological frameworks of global health and international migration.   This thesis is also methodologically influenced by the ethnographic tradition in human geographic studies of migration and its bureaucratic organization. David Ley?s work presented a model for me on performing a multi-scalar analysis of international migration (Ley 2011). His work exemplified how a broadly conceived human geographic study of international migration can allow multiple voices of actors and institutions to emerge. The synthesis of Ley?s work culminates in the book Millionaire Migrants: Trans-Pacific Life Lines (2011) where he uses a socio-cultural interpretation of amorphous Canadian immigration policies, the urban landscapes of Vancouver, BC (the material footprint of the phenomena of Chinese immigration to Canada) as well as careful attention to the very lives (across generations of immigrant parents and children) of those who create them. This work inspired me to go back and  19 forth between various scales of analysis for this thesis as well as to be inclusive and fair in my choice of key informants (Ley 2003; Ley 2011).    Alison Mountz? work on the Canadian state?s (through researching within Citizenship and Immigration Canada) response to refugees seeking asylum in the coast of British Columbia also influenced my methodology. Mountz paved the way for human geographers through her ?ethnography of the state? as outlined in her book Seeking Asylum: Human Smuggling and Bureaucracy at the Border (Mountz 2003a; Mountz 2003b; Mountz 2004; Mountz 2010). Her work brought to the fore the embodied practices of bureaucrats through which the state becomes a practical and real (as opposed to just merely symbolic) entity that refugees inevitably confront. The ?border? through which refugees have to go through are not just physical geographical barriers between national and state lines ? but also their fellow human beings.    Kuus and Mountz? work can be viewed as part of an emerging literature in political geography that addresses how complex social institutions are formed through the intricate play of power and knowledge among those who constitute them. This intellectual agenda brings social and cultural analysis back to the forefront of political geographic analysis ? akin to how Ley brought social and cultural geography in conversation with the political economy of international migration. Following this trajectory and borrowing the methodological innovation in this body of work enhances our understanding of why certain institutions think a certain way and how the knowledge and action of those who shape them ultimately bear responsibility on the impact of such institutions. In other words, this will make us understand and explore how geography and geographical assumptions play a role in establishing cultures of expertise.  In my view, the ?socio-cultural? and ?the political economic? are  20 not discrete and clearly demarcated and my methodological inclination is located at the very edges and far from the centers of both fields.     This thesis? data sources are divided into four categories?and they will appear as the key sources in its six core chapters. Primary sources include interview transcripts and field notes taken during my fieldwork. Secondary sources include government reports, newspapers, brochures, and PowerPoint presentations. Tertiary sources are academic publications and unpublished academic reports and theses. The selective use of quantitative databases forms my fourth data source.  Canadian data come from Statistics Canada (StatsCan), the Canadian Institute for Health Information and (CIHI), and Citizenship and Immigration Canada (CIC). Philippine data come from the Philippine Overseas Employment Agency (POEA), Department of Health (DOH), and the Commission on Filipinos Overseas (CFO). Global data come from the World Health Organization (WHO), the International Organization on Migration (IOM), the International Labor Organization (ILO), and the Organization of Economic Cooperation and Development (OECD). Specific databases from these research organizations will be explored for specific purposes throughout the thesis.    While all interview respondents received a standardized questionnaire, the open-ended nature of the interview process frequently changed the direction and content of the interviews. They typically lasted from one to four hours. Most interviews were conducted in English. Since I am proficient in Filipino, my informants from the Philippines would sometimes insert Filipino phrases and answer my questions in Filipino. I transcribed the first few interviews but hired three research assistants to assist in the transcription process throughout my fieldwork. While I was in the Philippines, I briefly hired and paid my first research assistant, a male nurse  21 who was then unemployed and who lived in my condominium building, to transcribe two interviews. In the second month of my fieldwork, he eventually found a job as a call center agent in one of the many outsourced medical transcription companies located in Manila and his work and night shifts at the call center made it impossible for him to continue transcribing for me. When I returned to Canada, I hired and paid for the services of two research assistants to transcribe the rest of my interviews. All of my three research assistants understood, spoke, and wrote Filipino so they translated the Filipino phrases and sentences to English during transcription.    Two techniques were used to analyze my field notes and transcripts. First, upon compiling my field notes for the last 18 months and receiving the transcripts from the transcribers, I manually looked for themes and assigned sections of the field notes and interviews with relevant codes. After the manual reading, I then proceeded to the second step of assigning codes through putting them in a separate file. This allowed me to counter-check the interview data repetitively and build a database of sorted field notes and interviews. Each chapter?s empirical sections are thus based on my interpretation of the themes that emerged from my field notes and the interviews and not on a pre-set structure or hypothesis typically used in qualitative research. In turning my field notes and interview data into an ethnographic document, I benefited tremendously from the techniques described in Writing Ethnographic Field Notes (Emerson, Fretz, and Shaw 2011) and Improvising Theory: Process and Temporality in Ethnographic Fieldwork (Cerwonka and Malkki 2008).       22 A Note on Anonymity    The anonymity of all key informants is integral to the production of this thesis. I aim to protect the identity of my key informants. I reiterate the importance of anonymity and how this is key for this work in the body of this thesis?when I discuss the vulnerable position of most temporary migrants and the hyper-competitive nature endemic to the migrant recruitment industry. In any case, some descriptive details about the work of public officials and private sector actors I interviewed are inevitably discussed, as one of the aims of the thesis is to understand their roles in the phenomena. The intent of these discussions is to illuminate the case studies herein and not to judge these individuals? characters. Thus, I removed all impertinent details about the nature of their jobs that would lead to their unnecessary personal identification.  Outline of the Thesis     To unravel its core arguments, this thesis will unfold in six chapters.    CHAPTER ONE, Points of Departure, selectively examines academic literatures form a burgeoning field where this thesis finds its empirical points of departure. Having an intimate knowledge of these intersecting academic fields facilitated my conversations with academic researchers, government bureaucrats and business professionals throughout my fieldwork. More importantly, the gaps, contradictions, and promises of this field influenced the theoretical trajectory this thesis eventually took.   23   CHAPTER TWO, Fluid Geographies, exposes how my own theoretical and methodological assumptions on the international recruitment and migration of health workers ruptured in ways beyond my control during my fieldwork. This chapter shows how external socio-political forces and personal ethical dilemmas affected decisions on where and how to conduct the fieldwork, and subsequently how to report the work to a broader audience. Through a reflexive approach, it discusses why and how my curiosity towards the central case study of this thesis was steered towards the direction of examining the political uses of expertise among transnational institutions through the lens of what emerged as a transnational socio-political geography of institutions, inspired by the methodology of social scientists and human geographers mentioned above. In other words, this chapter uncovers how the intellectual and socio-political landscapes I accessed as a human geographer throughout my research were formed through the creative friction of my knowledge of Philippine-Canadian transnational migration issues, and an ongoing attempt to understand the value of ethnography (participant observation and interviewing) in the fields of social and political geography in the discipline of human geography.    Overall, this thesis aims to further our understanding of migration institutional actors? roles beyond mere brokers and intermediaries in the international recruitment and migration of health workers. It constitutes a unified theme: that is, an attempt to understand the links between states, institutions, and actors in the international recruitment and migration of health workers from various scales in two countries, namely the Philippines and Canada. It shows how inter-linked the education, labor and health services sectors are, and how institutions in these sectors play a significant role in creating and sustaining the markets through which health  24 professionals participate.    CHAPTERS THREE, FOUR, FIVE and SIX are individual, self-standing case studies that will focus on four (4) aims and move the broader objective of this thesis:   CHAPTER THREE, Creating Global Nurses aims to understand the role of state migration institutions as framed and understood by key actors in the recruitment and migration of health workers. I focus particularly on registered nurses in a major sending country context, the Philippines. Informed by my ethnography along with institutional archives and academic literature, it zooms into the perspectives of health human resource and labor migration policy actors and nursing leaders.   CHAPTER FOUR, The Business of Migration aims to explain the role of private sector recruiters, a major ally of migrant sending states such as the Philippines in creating pipelines of recruitment and migration of nurses and other migrant workers. Here, we also inquire how such an alliance can be recast in terms of public-private partnership that does not only produce profit for the state and the private sector but also to give birth to new programs that can creatively and directly address domestic health human resource problems that plague the Philippines.   CHAPTER FIVE, Policy Moves delves into interstitial policy landscapes and spaces between sending and receiving countries by explaining in detail recent bilateral agreements the Philippines and Canada in the area of international labor migration. It will also zoom out into an international instrument produced by the member states of the World Health Organization that serves to promote ethical recruitment of heath workers and through a Canadian province?s ?ethical recruitment? drive in the Philippines.  25   CHAPTER SIX, Placing Migrants will explain the conduct of health worker migration institutions in light of shifting immigration and integration policies that sustain and support the current dependence of a receiving country like Canada on immigrant health workers through the work of a provincial recruitment firm based in Vancouver, British Columbia, Health Match BC. While the ample time I dedicated to doing fieldwork allowed me to see how the phenomenon of the international recruitment and migration of health workers can be studied from a myriad of perspectives, using different cases and methods, I deliberately chose these aims and corresponding research questions that propel them to understand the empirical case studies examined here for two reasons: a) they present a reasonable degree of internal coherence that can be explained using case study methods within a broader ethnographic methodology, and b) each have the capacity to shed light on each other. Developing a clear understanding of one specific case will make us understand the other specific cases more clearly, and vice versa. Having grasp of multiple cases also allowed me to enter into conversation with various stakeholders on the more ambiguous issues surrounding health worker recruitment and migration - particularly on the competing values (for example, protection and rights of individual migrant nurses vs. systemic efficiency) that underline the phenomenon. Narrative storytelling interspersed with various textual analyses will be the technique used throughout these chapters. This will further highlight my use of the ethnographic approach within human geographic studies of migration?and I will elaborate on this methodological intervention within these chapters. These chapters are designed to expand on theories of the migrant institution and the production, uses, and circulation of expert knowledge within those institutions by way of case studies.   26   CONCLUSION, Geographies of Ethics, delves into the broader global context of the issue of international health worker recruitment and migration. As this thesis? final chapter, it also reviews the personal insights gathered through the theoretical, methodological, and empirical chapters of the thesis. It concludes with some thoughts on how I view the issues I studied in relation to my personal journey as a human geographer and human being.   27 PART I   HISTORIES  28 CHAPTER ONE  Points of Departure     ?It was six men of Indostan      To learning much inclined,   Who went to see the Elephant   (Though all of them were blind),   That each by observation   Might satisfy his mind.?    -  John Godfrey Saxe/The Blind Men and the Elephant    Between Academic and Policy Worlds    As a subject of academic inquiry, the international recruitment and migration of health workers has been studied through various theoretical perspectives and methodological approaches. Indeed, because of the layers upon layers of complexity involved in understanding the issue and the contemporary relevance of its political, economic and societal implications, various academic researchers from different disciplines have tackled it and are currently producing studies, articles, and books on the issue. This burgeoning literature is at the crossroads of both academic research and policy interest on the subject. As such, this literature is not as clearly delineated in terms of disciplinary boundaries. Instead, this body of work is often organized around particular debates emerging from particular issues around the  29 broader theme of international recruitment and migration of health workers. Ultimately, this thesis hopes to contribute to honing a human geographical perspective to the broader literature on the international recruitment and migration of health workers.    As the study of global migration has been at the front and center of contemporary academic human geography in at least the last two decades, scholars from the human geographical discipline have had significant contribution to this literature (Connell 2007; Connell 2008; Connell 2010; Dyer, McDowell, and Batnitzky 2008; England and Henry 2013; Raghuram 2009; Walton-Roberts 2012). Indeed, a human geographical perspective has informed how the issue of health worker recruitment and migration was tackled in the academic literature. The comprehensive work of John Connell (and his more specific regional emphasis on the phenomenon as it affects the Pacific islands, Australia and New Zealand) is a touchstone for most academics inside and outside human geography researching the issue (Connell 2010; Connell 2008; Connell 2007). The contribution of Margaret Walton Roberts, whose writings about international health worker education, recruitment and migration are deeply informed by her engagement with the South Asian communities in Canada and her fieldwork in India complements my perspective here (Walton-Roberts 2012). Walton Roberts forwards the work of Nicola Yeates? on global care chains, influenced by feminist geographies, which have framed debates in the literature on the role of the state and other social institutions in the production of care workers(Yeates 2004a; Yeates 2004b; Yeates 2009a; Yeates 2009b).     Outside human geography but within the humanities and social sciences, historians (Choy 2003; Choy 2010) and sociologists (Guevarra 2009) have written about  30 it from a feminist postcolonial and post-constructivist perspective. Philosophers have recently been paying attention to the issue as well, mostly as a subject of applied ethics, bioethics and political philosophy (Benatar 2007; Dwyer 2007; Eyal and Hurst 2008; Gostin LO 2008; L. A. Eckenwiler 2009; Snyder 2009; Shah 2010; L. Eckenwiler, Straehle, and Chung 2012).   Outside the humanities and social sciences (and in relation to the empirical scope of this thesis) nursing scholars have led some of the most interesting global conversations on the topic. Globally, nursing is the largest regulated health profession in terms of sheer volume, and as a result of this, scholars working within and on the nursing profession have paid attention to the topic consistently (Hardill and Macdonald 2000; Armstrong 2003; Spetz and Given 2003; Aiken et al. 2004; Alexis and Vydelingum 2004; Alexis and Vydelingum 2005; Kingma 2005; Ross, Polsky, and Sochalski 2005; Likupe 2006; Oulton 2006; Alexis, Vydelingum, and Robbins 2007; Bach 2007; Dovlo 2007; Kingma 2007; Smith and Mackintosh 2007; Brush and Sochalski 2007; Alexis 2012; Huston 2013).    The Philippines (and Philippine nurses overseas) as the largest source of internationally educated nurses is one of the most classic case studies for this phenomenon (Daniel, Chamberlain, and Gordon 2001; Choy 2003; Withers and Snowball 2003; Brush and Sochalski 2007; Lorenzo et al. 2007; Brush 2010; Choy 2010; Masselink and Lee 2010; Vapor and Xu 2011; Tejero and Fowler 2012; Valiani 2012; Masselink and Lee 2013; Lin 2013). Scholarship that focuses on Canada that complement this work is also deeply informative for this thesis (Calliste 1993; Blythe et al. 2009; McGillis Hall et al. 2009; Little 2007; Labont?, Packer, and Klassen 2006).    31   Academic medicine has also produced a number of significant work on the issue of physician recruitment and migration (Ahmad 2005; Astor et al. 2005; Chen and Boufford 2005; Dauphinee 2005; Eyal and Hurst 2008). Looking at the cross section of various health professional disciplines, public health policy scholars have also interrogated the issue in relate to health services management and administration (Pe?aloza et al. 1996; Martineau, Decker, and Bundred 2004; Stilwell et al. 2004; Vujicic et al. 2004; ?Global Shortage of Health Workers, Brain Drain Stress Developing Countries? 2007; Chen 2010; Pe?aloza et al. 2011; Frenk et al. 4; Kanchanachitra et al.; Finch 2013).    In the next four sections, we will examine specific intertwining empirical fields of study that buttress this work so as to eventually cement its arguments to the speak to the human geographic and broader academic and policy literature on the international recruitment and migration of health workers I selectively reviewed above. This literature spans the study of global, Philippine and Canadian health worker recruitment and migration as well as Philippine migration to Canada produced inside and outside the discipline of human geography.  The 'Natural' Place to Recruit Health Workers    The current global reputation of the Philippines as the primary source of internationally educated nurses in Canada and the world did not happen overnight. It was the result of a confluence of historical, structural and institutional factors that formed and informed various transnational socio-cultural and politico-economic geographies that will be explored in this thesis. As a former Spanish and United States  32 colony, the Philippines and many Filipinos have already been connected to the translocal, transnational and global flows of people, product and ideas for a few centuries.    Historian Catherine Ceniza-Choy, in her book Empire of Care: Nursing and Migration in Filipino American History shows the history of nurse migration from the Philippines to the United States as a result of colonial and neo-colonial socio-cultural relationships and politico-economic structures. In her work, Ceniza-Choy used archival materials from the United States and the Philippines as well as oral histories of Philippine nurse migrants in the United States to illuminate this century-long history (Choy 2003; Choy 2010). Through her research strategy of using Philippine nurses? oral histories, Ceniza-Choy was able to counter-balance the prevailing economic explanations of the out-migration of Philippine nurses to the United States.  Such economic explanations persist as the bases for ?policy recommendations,? usually relying on analysis of quantitative data gathered through various statistical agencies and research infrastructures and circulated among policy and government circles.    Ceniza-Choy renders a micro-historical approach of Philippine nurse migration read against the context of a post-colonial reading of Philippine-American history. Her argument is that the Philippines became the primary source of nurses for the United States and globally not because Filipinos were ?naturally? preconditioned to become nurses overseas, but partly because of the establishment of Philippine institutions designed in the fashion of American institutions. After arriving in the Philippines in 1898, the Americans introduced nursing practices and built nursing and public health institutions, eventually producing American-educated Philippine nurses well prepared to work in a U.S. setting. These institutions, such as the Philippine  33 General Hospital and the University of the Philippines College of Nursing, organized during the colonial period from 1898-1946, still exist in the Philippines? neo-colonial present. Out of this initial colonial encounter came a long transnational history facilitating the exchange of nurses, nursing objects, images, and ideas making the Philippines the ?natural place? to recruit foreign nurses for the global market (Choy 2003). Ceniza-Choy shows the interdependency among various economic and political elite in the Philippines (state and non-state actors) with Americans who were based in the Philippines (i.e. nurses, doctors and public health professionals) in the American colonial period.    These various individuals helped produce nurses who were easily available to work in the United States because such nurses were, in a way, already prepared through the colonial encounter in the Philippines. She also highlights the crucial role of educational exchange partnerships such as the US pensionado scholarship program, which gave nursing scholarships to native Filipinos and facilitated their migration to the United States. In Ceniza-Choy?s account, the US pensionado scholarship program became an accessible pathway for nursing students who did not necessarily return to the Philippines, but extended their stay in US, or in some cases, sought job opportunities and went to neighboring Canada instead.7    Ceniza-Choy?s historical account provides various points of departure for examining the contemporary flows of Philippine nurses and other health workers to various destinations around the world, including countries that did not have colonial relationships with the Philippines where we find a lot of Philippine nurses and health                                                   7 The role of scholarship programs in providing access to US permanent migration was also documented in Fujita-Rony, D. (2002) American Workers, Colonial Power: Philippine Seattle and the Transpacific West. Berkeley: University of California Press.  34 workers, such as Canada and the United Kingdom. The crucial institutions in Choy?s narrative were the nursing schools, and eventually, the migration institutions that were set up as temporary state mechanisms to solve underemployment and unemployment. This insight was echoed to me in an interview with a Senior Administrator of the Philippine Department of Health  (DOH) who heads the country?s Health Human Resources Bureau, which oversees the entire country?s health workforce planning: ?It was never the intention of the Philippines to provide health workers for abroad, but you see from the time of Ferdinand Marcos? rule in the sixties, or even just after Philippine Independence from the US and World War II, there was this exchange program between the Philippines and the US. The objective of that program was actually to train Filipino health workers in the US, give them access to American style education and health care, and come back here in the Philippines and serve. So we send Filipinos, Filipinos have become nurses, doctors, and other health workers in the US. Most of them came back here but few did not. Why? Because they liked to be in the US and the other thing is that there was some, sort of, unemployment, difficult for them to come back here in the Philippines. Unemployment rate, as we all know, is gradually increasing.? (Interview by the author, February 24, 2010)   In Marketing Dreams, Manufacturing Heroes: The Transnational Labor Brokering of Filipino Workers, sociologist Anna Romina Guevarra reveals the contemporary relevance of Ceniza-Choy?s historical work.  By doing research among three crucial networks of social actors, namely Philippine state officials, Philippine private recruiters and Philippine nurses in the United States in Arizona and Texas,  35 Guevarra provides a transnational ethnographic account of the relationships between recruiters and the state, recruiters and nurse migrants, and nurse migrants and the state. (Guevarra 2009; Guevarra 2006)   Building on Ceniza Choy?s historical account, Guevarra uses her knowledge of Philippine history and political economy, and, combines this with extensive fieldwork, participant observation, and interviews with institutional actors in the Philippines and the United States. Guevarra?s goal is to show how ?labor-brokering practices of the state, working together with employment agencies, [provided] a unique form of labor control and a mechanism of neoliberal capitalist discipline that informs the country?s state-led transnationalism.? (Guevarra 2010) Drawing from Michel Foucault?s theories of governmentality, she critically and carefully interrogates the political power and institutional ideologies behind the practices of state actors and private recruiters that enabled the recruitment and migration of Philippine migrant workers. Her book uses interconnected case studies that provide readers with the perspectives of state actors, recruiters, and nurses. These case studies drive her analysis of how the Philippine state, as a major source of migrant labor, works hand-in-hand with the increasingly neo-liberal ideology of its state institutions. This neo-liberal ideology informs the practices of state actors, private recruiters, and the care workers themselves. Among Philippine migrant workers, Guevarra chooses ?care workers? and more specifically female domestic workers and nurses to show how the practices and perspectives of state officials and recruiters reinforce their gendered and racialized constructions as docile and flexible subjects, a labor force ready to leave the Philippines anytime. Guevarra?s work complements sociologist Robyn Rodriguez? book Migrants for Export: How the Philippine State Brokers Labor to the World (2010).  36 While Guevarra focuses on the tripartite-networked relationships between the state, recruiter, and migrant, Rodriguez takes stock of the relationship between the migration apparatus of the Philippine state and the migrant workers. Like Guevarra, Rodriguez arrives at the same conclusion about the nature of this relationship:  ?Labor brokerage is a neoliberal strategy that is comprised of institutional and discursive practices through which the Philippine state mobilizes its citizens and sends them abroad to work for employers throughout the world while generating a ?profit? from the remittances that migrants send back to their families and loved ones remaining in the Philippines. The Philippine state negotiates with labor-receiving states to formalize outflows of migrant workers and thereby enables employers around the globe to avail themselves of temporary workers who can be summoned to work for finite periods of time and then returned to their homeland at the conclusion of their employment contracts.? (Rodriguez 2010, x)   Like Guevarra, Rodriguez provides an ethnographic account of how labor brokerage emerges between the Philippine state and foreign employers. In particular, she spent time observing the premises and processes of the Philippine Overseas Employment Agency (POEA). The POEA is the Philippine state agency responsible for the regulation of private recruitment agencies, the processing of employment contracts between foreign employers and recruitment agencies, and the implementation of migration management programs, including pre-employment and pre-departure orientation sessions for migrant workers as well anti-illegal recruitment campaigns. Rodriguez combined her analysis of interviews and field notes with a closer inspection of government documents produced by migration institutions.   37    Albeit written from two different disciplines (history and sociology) and using different sources and research strategies, Ceniza-Choy, Guevarra, and Rodriguez?s books all illustrate the relationships between powerful Philippine institutions and the migrant workers they produce. Ceniza-Choy?s historical work prepared the ground for Guevarra and Rodriguez?s research. The latter two?s analyses benefited tremendously in fusing perspectives from individual actors and analyzing the role of structures, institutions and historical forces. While they all elaborate on the continuing influence of the United States? economic interests in framing Philippine state institutions, Guevarra and Rodriguez point to the more geographically diffused nature of recent Philippine migrations. Both also show the capacity of Philippine state institutions and the Philippine private recruitment enterprise to adapt to the needs of the current global economic landscape, where the United States is only one receiving country (albeit still the largest draw) attracting Philippine migrants. They label this complex form of institutional relationships as ?labor brokerage,? a useful way of conceptually condensing the practices for scholars looking at how the labor recruitment and migration process takes place.8   Philippine-Canadian Transnational Migration Studies     While I recognize the intellectual merits and follow the work of Ceniza-Choy, Guevarra, and Rodriguez, my thesis differs from their work in terms of its theoretical concerns, empirical scope, and the transnational lenses I use. While all of                                                   8 Choy recently pointed to this direction as well. See Choy, CC. Nurses Across Borders: Foregrounding International Migration in Nursing History in Nursing History Review, Volume 18, Number 1, 2010, pp. 12-28(17).  38 them examine the Philippines primarily from the perspective of its relationship with the United States, my transnational lens examines the relationship between the Philippines and Canada?two countries that have been rarely examined side by side in a sustained fashion in the literature on state and migrant transnationalism. While Ceniza-Choy uses post-colonial theory, and Guevarra and Rodriguez employ Foucauldian theories of governmentality to critique neoliberal ideologies as evident in the work of Philippine recruiters and the Philippine state, I draw from debates on the ethical uses of expert knowledge as a vehicle in achieving global health equity.  I reiterate that while this thesis departs from Ceniza-Choy, Guevarra and Rodriguez? research?theoretically, empirically, and in terms of academic disciplines?I likewise acknowledge that their work serves as a crucial foundation for my thinking about the subject. Their work has paved the way for me to focus closely on a Philippine-Canadian case study as well as divergent theoretical and empirical concerns not fully covered by their relentless focus on Philippine-US relations.    From the perspective of most Philippine studies scholars, the study of Philippine-Canadian relations is relatively less important than that which deals directly with Philippine-US relations. The history of United States? colonial presence in the Philippines stretches back to the 1900s, and today it continues to tremendously and deeply influence Philippine society, culture, and institutions. In contrast, Canadian presence in the Philippines is only a recent phenomenon, with a more shallow history and limited impact over about 60 years. Canada is seen by most Philippine studies scholars as a relatively ?marginal? Western country in a global system historically dominated by the United States and its socio-cultural, geopolitical, and economic interests. However, from the perspective of contemporary Canadian  39 scholarship, the Philippines and Filipinos present a fertile site and interesting group to study for the contemporary social sciences like human geography and migration studies. From a contemporary human geographic and Canadian migration studies perspective, the Philippines and Filipinos are significant subjects of inquiry because of the issues they bring and engage with presently here in Canada.    As of the 2006 Canadian census, there are currently around 410,695 Filipino-Canadians in Canada, making Filipinos the third largest group of Asian Canadians, after the South Asian and Chinese communities, and comprising 1.3% of the total Canadian population.  The top six provinces of Philippine immigration are: Ontario (203,220), British Columbia (88,975), Alberta (51, 090), Manitoba (37,785), Quebec (24,200), and Saskatchewan (3,770). The top six gateway census metropolitan areas for Philippine immigrants are: Toronto (171,980), Vancouver (78,890), Winnipeg (26,935), Calgary (25,565), Montreal (23,510), and Edmonton (19,625). Canada has the second largest population of overseas Filipinos after the United States, which has four million Filipino-Americans. Filipino workers in Canada sent home a record C$335 million in the first nine months of 2006. This is a more than triple increase from the C$102.8 million remitted in 2005. These figures indicate how Overseas Filipino Workers (OFW?s) from Canada help fuel the Philippine economy through household remittances. (Statistics Canada 2006)   Partly as a result of the bias towards studying American issues and the United States among Philippine studies scholars, little is known about the role of institutions and people in the recruitment and transnational migration of health workers such as nurses from the Philippines to Canada, especially on how these movements are restructuring the human and institutional landscapes of the Philippine  40 and Canadian healthcare systems. The social scientific literature on Filipino migrations to Canada has largely been about female domestic workers under the federal Live-in-Caregiver Program (LCP) and their labor market segmentation into the low-wage urban economy. (Pratt 1999, 2004) Most of the literature focuses on Filipino settlement to Canadian gateway cities, although some scholars have pointed out the significance of looking at non-gateway places (Bauder and Lusis 2008). Historical studies about nursing in Canada are often about Canadian-trained nurses who have practiced in Canada or overseas. (Grypma 2008, Toman 2007, Elliott et al 2008) These studies are usually framed as national histories barely reflecting Canada?s heavy reliance on migrant nurses today. The health disciplines scholarship on nurse migration to Canada is limited to studying its effects on the Canadian healthcare system, and rarely extends its analysis to how the recruitment of foreign nurses affects the healthcare systems of the sending countries.    Blouin (2005) and Little (2007) discuss the impacts of nurse migration to the Canadian health care system. Both acknowledge the Philippines as the number-one source of foreign-educated nurses in Canada. However, their studies are mostly overviews of the issue and do not tackle the specific transnational connections between Canada and the Philippines. Blouin (2005) explains the impacts of international trade agreements such as the North American Free Trade Agreement (NAFTA) in the cross-border mobility of Canadian nurses. Little (2007) synthesizes the information available on Canadian nurse migration, and explores policy options (such as retaining Canadian trained nurses and creating more spaces in Canadian nursing schools) on how to respond to Canada?s own nursing shortage. She highlights that Canada is both a destination and source of migrant nurses, with majority of Canadian- 41 trained nurses choosing to practice in the US.    Kelly and D?Addorio?s (2008) article in The International Migration of Health Care Workers, which relies on fieldwork done in Toronto, Canada and the Philippines, is the only Philippine-Canadian transnational case study on nurse migration. However, their article primarily focuses on the labor market segmentation of Filipinos into the Canadian health care sector. They do not tackle the recent recruitment efforts of Canada?s Western provinces (Saskatchewan, Alberta and Manitoba), which have used a framework of ethical guidelines for the migration of nurses from the Philippines, which informs this study.9   Before I delve into the empirical findings of this thesis, I will show how the academic studies reviewed below deal with the specificities of Philippine migrant experiences in Canada. At the same time they contain three major biases leading to certain inadequacies in understanding Philippine-Canadian transnationalism that my research aims to correct. These three biases are: (1) a population bias, (2) a spatial bias, and (3) a hermeneutic bias. The gaps in understanding Philippine-Canadian migrant experiences are made visible by who these studies often cover, where these studies are done, and what lenses used by social scientists to explain these studies.                                                      9 An initial review of databases in these agencies shows that it is difficult to track the precise numbers of Philippine-trained nurses migrating for overseas work and specifically, those who choose to practice in Canada. Most nurse migrants from the Philippines are privately recruited and some leave the Philippines to work in other occupations first. For example, professionally-trained nurses work as live-in-caregivers in the case of those migrating to Canada (Pratt 2004), or as domestic workers and nannies in the case of those migrating to Hong Kong and Singapore, making these migration inflows and outflows largely under-reported. I will talk about the complexity of counting Filipino nurse migrants more fully in Chapter Three.     42 Female Migrants and the Live-in-Caregiver Program    For the last 20 years, the academic literature on Philippine migrations to Canada has been defined through one particular federal immigration program heavily used by Filipinas: the LCP or the Live-in-Caregiver Program. About 90% of articles and books dealing with Philippine migrant experience in Canada explicitly engages with and mentions the LCP program as their main theme or topic. This shows a clear population bias in the literature right away: the literature on Philippine migration to Canada is mostly about Filipina women in the LCP. Because of the concentration of Filipinas in this program, ?Filipino labor? and ?Filipino identity? in the academic literature more generally have become synonymous with the experiences of immigrant Philippine women in Canada. As most Filipino-Canadian activists and academics writing about the issue put it, the LCP has become a ?Filipino issue.?    Since an overwhelming number (more than 98%) of Filipinos enlisted in the program have been women, it is not surprising that the literature about Filipinos under the LCP engages with wider discourses about gender and feminist theories and methodologies produced mostly by feminist activists and academics (Pratt 1998, 2004). In a way, this population bias is a fair representation of the gender distribution of the overall Filipino population in Canada, with 175, 640 male and 235,055 female Philippine migrants, or 65% female Philippine migrants making up the Filipino-Canadian community in Canada (Statistics Canada 2006). This rendered significant visibility to the Filipino Canadian community and the intellectual work around this issue deserves credit.   43   Many have justly criticized the program for a number of reasons including its negative effects on the stigmatization and racialization of Filipina labor in Canada (Pratt 2004; England and Stiell 1997; Bakan and Stasiulis 1997; McKay 2002). More importantly, activists and scholars claim that the program becomes a platform for what is known as a ?deskilling process.? The majority of Filipina women in the LCP usually arrive in Canada with professional backgrounds. These women include: registered nurses, teachers, accountants and clerks. They use the LCP as a stepping-stone to gain access to permanent settlement and citizenship in Canada, usually with a plan to reunite with their immediate families after finishing the program (McKay 2005, Pratt 1999, 2004).    Research about the LCP has led to a number of interesting innovations in feminist theory. Most notable among these significant contributions are the writings of geographer Geraldine Pratt. Pratt has been collaborating with the Philippine Women Center of BC for the last 15 years scrutinizing the effects of the program to the lives of Filipina migrant women. In Working Feminism (2004), she details the various experiences of Filipina women participating in the program through a feminist-inspired methodology, Participatory Action Research (PAR). PAR allows migrant women?s voices and stories to be heard by the researcher and by them. These stories were usually parlayed through non-traditional ways of narration and storytelling, including role-playing, singing and visual art and used as primary data in thinking through central concerns in feminist theory. Pratt?s research on live in caregivers has enabled her to produce research work on another subsection of the Philippine migrant population in Canada: the youth who were separated from their mothers who went through the Live-in-Caregiver Program. Her research indicated that the average years  44 of separation between mothers and their children are between 5 ? 7 years. Most children reportedly suffer from family separation, leading some of them to perform poorly in school or quit schooling upon arrival in Canada, contributing to the alarming dropout rate (of 75%) among Filipino students in Canadian high schools (Pratt 2003).   Deirdre McKay, also a geographer, has also published on the experiences of Filipinas working under the LCP. She has described instances where Filipina live-in caregivers become wives of their employers (McKay 2003). She studied how their citizenship rights are curtailed and how they get excluded from social and political spaces in Canada because of their position as domestics (McKay 2002). She detailed their routes of circulation, noting that most live-in caregivers consider Canada as the ?graduate school? for domestic work, since most of the Filipina women participating in the program have already worked in other Asian cities and countries, most notably, Singapore, Hong Kong, Saudi Arabia and the United Arab Emirates. According to McKay, Filipina domestics aspire to work in Canada because it is perceived to be the most liberal of all these places and it is the only receiving state that would allow them to gain permanent settlement and citizenship (McKay 2002, 2005). McKay?s work differs from Pratt?s research as her fieldwork was conducted on both sides of the Pacific. While Pratt frames her work around quite sophisticated theorizations crucial to feminist geographic circles, McKay captures the transnational aspects that Filipina domestics experience through the lens of her fieldwork in the Philippines.    McKay?s and Pratt?s work are complementary. Pratt has elevated the feminist discourse within human geography and has brought full attention to the specificities of how Filipina women and their families experience the consequences of the live-in-caregiver program. McKay offers fine-grained ethnographies of circulation  45 of Filipina domestics, captured through her interviews with pre-departure Filipinas in the Philippines, as well as those who are in transit in key cities of Philippine migrations such as Hong Kong and Singapore. In other writings (McKay 2005, 2006), she even describes the experiences of ?return? (balik-bayan) of these women and their reinsertion into their sending communities. She focuses on the various perceptions of those who are left-behind (families) by female domestic workers. According to McKay, domestic workers are usually perceived to be more cosmopolitan, having more social and cultural capital through their acquisition of new accents and new ways of clothing, and of course, through their fairer skin complexion compared to those who live currently in the Philippines (McKay 2006).    The emphasis on this migrant cohort leaves room for additional research to understand the experiences of other Philippine migrants in Canada who are (1) men and (2) do not enter through the Live-in-Caregiver Program. Male perspectives of Filipino migrants are often not visible in the literature because of the emphasis of the research agenda set around the LCP and Filipina domestic workers. Indeed, it is crucial to look into the lives of Filipino men (for example, Filipino male nurses or the husbands of Filipina domestic helpers, who fathered the left-behind children) to fully understand the impact of the LCP on the Filipino Canadian household. More research can look into the ways the migration process (where women come first) affected the notion of Filipino fatherhood and masculinity, as Filipino fathers become primary caretakers of their children, a clear reversal of perceived ?traditional? roles in Filipino families.    This can also be further explored by looking at another sub-section of the Philippine migrant population: other ?skilled? labor migrants, mostly composed of  46 Filipino men. For example, Filipino Chinese capitalists also moved from the Philippines to Canada from the 1990s. More recently, Philippine male migrants are landing through the temporary workers program and through the bilateral agreements signed between the Philippine government and Canada?s Western provinces. But they do not count in the studies so far. We can only anticipate future studies that can incorporate some of these other populations and can paint a more complex picture of the population diversity (and therefore, the range of experiences) among Philippine migrants to Canada.  Gateway Cities    A second feature of the literature on Philippine migration to Canada focuses on migration and settlement to the major Canadian gateway cities. The actual geography of Filipino settlement in Canada based on the Canadian Census widely supports this tendency.  This spatial bias towards migration to gateway cities precludes the range of experiences of Philippine migrants in other Canadian spaces?and whether the flows of Philippine migrants to these other places have outcomes similar or different from the outcomes they bring about in gateway cities. Geographer Philip Kelly claims that despite the volume of Filipinos in gateway cities, their patterns of settlement are very dispersed (Kelly 2006).    Bauder and Sharpe (2002) also point out that among all visible minority groups in Canada, Filipinos have the lowest level of residential segregation in urban centers. Kelly posits that this can in fact, be an ?indication of the spatial integration of Filipinos into the urban fabric? at least in Toronto  (Kelly 2006). Another possible  47 explanation for this geography of settlement includes the integration of Filipinos in the various job sectors they work in. As mentioned earlier, some migrants work as live in caregivers (therefore not needing their own houses while they work in Canada), while most may choose to live around their workplaces such as hospitals?both facilitating dispersal. Due to the cultural familiarity of Filipinos with North American culture and their linguistic familiarity with English, it is frequently unnecessary that they form ethnic neighborhood communities like other migrant communities.    Urban settlement mirrors the literatures about Filipinos in Canada, as most researchers are located in research institutions and universities in these urban centers as well. As a result, the various stories and experiences researchers capture about Filipino migration to Canada are centered on these gateway cities. However, with Canada trying to bring more migrants to second-tier cities and smaller towns, some researchers are pointing out and indeed are starting to do research on Filipino migration and settlement in non-gateway cities. For example, Lusis and Bauder (2008) interviewed Filipino migrants to ?second-tier cities? in Ontario, namely Guelph, Kitchener-Waterloo and Niagara Falls. This is exactly why I did my preliminary research in Saskatoon, Saskatchewan, with its growing Filipino population because of the active recruitment of nurses by the Saskatchewan health regions from the Philippines. Lusis and Bauder (2008) pointed out that Filipinos have generally positive experiences in these places.    In contrast, most of them have very negative impressions of large urban centers, in this case, neighboring Toronto. For most immigrants to second-tier cities, Toronto is too busy, crowded and impersonal. They also find the Filipino community there to be quite unfriendly compared to the closer relationships they build in the  48 smaller centers. Ironically, they find that smaller centers encourage them to be more multicultural and cosmopolitan. For example, they claim that in smaller centers, they are forced to learn about other ethnic communities? cultures and languages whereas the concentration of Filipinos in Toronto allows the formation of Filipino linguistic and cultural enclaves, thus limiting their immersion into ?Canadian multiculturalism.?    Lusis and Bauder (2008) encouraged Canadian policymakers to include smaller centers in the mental maps of pre-migrants in countries like the Philippines by improving their pre-departure programs in their embassies. When we look at the existing literature, we read Philippine migrant experiences against the grain of Vancouver and Toronto as spatial contexts. Migration to other places beyond these two cities as shown by Lusis and Bauder?s study can only give us a more varied picture of Philippine migrant experience to Canada. Studies beyond Vancouver and Toronto can also inform us of how migrants view different places of arrival. More straightforward comparative gateway city/non-gateway place-based studies would be promising to fully understand the precise meanings of other Canadian spaces for Philippine migrants.   The Gifts of Human Geography     The third bias underlying studies about Philippine migrant experiences to Canada is hermeneutic (or interpretive). By hermeneutic bias, I simply mean that studies are usually framed and interpreted through the debates of certain disciplines where the studies tend to get circulated, criticized and published. The conditions that allow research about Philippine migrants could not be dissociated from the research  49 results. In Canada, the leading discipline where these studies flourished and eventually got disseminated to a global audience is the discipline of human geography. The socio-geographical locations of scholars working on Philippine Canadian topics affect the framing of their studies. This brings us close to the inevitable reality that any scholar faces: one has to contain one?s work within a set of questions, theories and methodologies conditioned by the intellectual environment. A scholar?s social intellectual environment can sometimes bring light to his or her chosen topic of study but can also constrain further insights. Among studies about Philippine migrants to Canada, at least two approaches dominate the literature and both have contributed greatly to broader debates within human geography. They are namely: (a) feminist analysis and (b) labor market segmentation and class analysis.   The feminist approach is well articulated and developed by Pratt in Working Feminism and in her other articles. Theoretically speaking, Pratt engages with post-structuralist feminist thought. According to Pratt, post-structuralism is useful in interpreting the ?discursive construction? (Pratt 1997, 1998) of the racialized and ethnicized Filipina female body doing domestic work. More specifically, she tries to resuscitate the materialist implications of post-structuralist feminism, usually interpreted as not as useful in understanding the experiences and quest for liberation of women from the third world. For example, following Judith Butler, she claimed that the former?s theories can be put to work when read against the grain of the stories of various marginalized groups of women such as Filipina domestic workers in Canada. She insists on a ?vigorous materialist transnational feminism? bringing scholarly debates to bear on the lives of domestic workers, while at the same time spatializing post-structuralist feminist thought (Pratt 2004).   50   The second approach is the deeply related ?class and labor market segmentation analysis? articulated by Philip Kelly. Kelly?s work (2006, 2007) describes various dimensions of economic integration by looking into mainly numerical and statistical sources such as the LIDS (Landed Immigrant Data System) under the IMDB (the longitudinal Immigration Database) created by Citizenship and Immigration Canada as well as the 2001 Census of Statistics Canada. Kelly proposes that one way of looking at the economic integration of Filipinos is to see whether their ?skills and qualifications?are fully recognized in the host labor market.? His look at the evidence through the following databases above suggest otherwise. First, he found out that they face multiple obstacles in getting their credentials recognized, therefore making the process of deskilling or skill mismatch (as clearly seen in the case of live-in caregivers) an integral part of their migration into Canada (2006). For example, while LIDS data and other sources of evidence (including focus group discussions with Filipinos in Toronto) show that Filipinos are more educationally qualified, linguistically prepared (more fluent in English than any other immigrant group from Asia) and most culturally prepared to work in a North American setting (an indication of human capital), they still collectively receive the lowest salaries compared to other groups arriving during the same period in the Greater Toronto area (Kelly 2006).      Along with labor market segmentation, Kelly also sharpens the concept of class and how it has evolved through transnational migration, using a case study of Filipino migrants to Toronto as an empirical test case for his theorizations (2006). Indeed, Kelly is right to use Filipino transnational migration as a case study for the basic reason that ?class? is always at the crux of any analysis involving the Philippines and Filipinos. In short, class matters for Filipinos both in the Philippines and elsewhere;  51 and international migration is typically seen as one of the quickest ways for Filipinos to reconfigure their class positions within the Philippines and in the global political economy.   Seen from the perspective of the discipline of human geography, the insights produced by these studies about feminism, labor market segmentation and class are gifts to the discipline. However, this disciplinary bias in the existing literature sets out the conditions of other possibilities for research about Philippine migrant experiences in Canada. As the experiences of Philippine migrants get locked into the discourses and themes that preoccupy human geographers, we might run into the danger of under-acknowledging the complexities of what is being framed (the Philippine migration experience to Canada) to prioritize debates on our framing of these issues (the theories and methodologies we try to understand in human geography). To reiterate, the twin challenges for future scholars of Philippine migrations to Canada are as follows: (1) to take into account other aspects of Philippine migrant experience by looking at a variety of populations and conducting research in other places; and (2) to take up theories and methodologies that would untangle the disciplinary binding of Philippine Canadian migrant experiences with existing themes in Human Geography alone, while acknowledging and forwarding some of the insights that human geographers have already contributed in shedding light on the specificities of Philippine migrant experience in Canada.  52 CHAPTER TWO   Fluid Geographies  ?Indeed, Filipinos are a happy people but beneath their brown skin is lacerated flesh and a bleeding heart for their lives are truly melancholy and harsh ? these hapless, deracinated wanderers wrenched away from the sulky recesses of the provinces, from the slums of Manila and even the smug comfort of middle-class neighbourhoods. They are everywhere, I am now sure, even in the glacial isolation of the arctic, the pitiless deserts of the Middle East, the raging seas of the North Atlantic. Ah, my countrymen, dislodged from the warmth of their homes, to make a living no matter how perilous or demeaning, to strike out in alien geographies and eke from there with their sweat and their cunning what they can. I have seen them lambasted in foreign newspapers, ridiculed and debased by those who do not know how it is to be Filipino, how it is to travel everywhere and yet hold ever precious and lasting memory, stretching across mountains and oceans, of my unhappy country.?         - F. Sionil Jose, Viajero, A Novel  Negotiating Global Ethnography    On July 2009, I left Vancouver, British Columbia to trace the stories of how Philippine nurses were recruited to various health regions and eventually migrated and settled as new immigrants in Canadian cities. After reading extensively from the  53 available academic, policy, and popular literatures about Philippine migrant nurses in Canada, I wrote a thesis proposal to study the phenomenon in two Canadian Prairie cities, Saskatoon and Winnipeg. I chose these two cities because they are outside of the traditional gateway cities of immigration research in Canada (Toronto, Vancouver and Montreal). I justified this more fully in Chapter Two, where I discussed the intertwined epistemic biases of urban geography in the migration studies and human geographic literature about Filipino migrants in Canada.10 I also originally planned to trace back the processes that enabled the movements of Philippine nurses?in their sites of ?production?  (i.e. education, training, and initial work experience), the Philippines.     When I was preparing my proposal, I was confident that my research instruments and pre-existing personal and professional networks with the Philippine Canadian migrant community and my home country, the Philippines, would make the research process manageable. However, while I did possess a number of qualities that facilitated my transition from armchair graduate student to fieldworker, there was a number of ?surprises? that led me to rethink my prospectus and the trajectory of my research within the first few weeks in the field. I experienced confusion, desperation, and exhaustion as I tried to ?make sense? of what was going on in the ?field.?   While I was trained to debate academic concepts in human geography and migration studies, I quickly realized that I was a newcomer to the field of ?doing fieldwork.? Before doing a PhD in the social scientific field of human geography, I did both my BA and MA in Philosophy and specialized in political philosophy. This was                                                  10  I will deliberately refrain from citing academic references in the next few pages because I want to tell ?the story behind the story? (in other words, the thesis? ?empirical sources?) in as straightforward a manner as possible (with minimal self-censorship). Unlike the rest of the chapters in this thesis, this chapter is written very personally. This serves as a compass for the thesis and provides the skeleton for deeper theoretical reflection and further empirical exemplification throughout the remaining chapters of the thesis.  54 armchair work, reading philosophical texts and dissecting philosophical arguments. Being on the field, I was thrown into a different model of research altogether. While I knew how to read texts closely, I did not know exactly how to ?operationalize? an academic research project independently. While I read a number of ethnographic and qualitative works on transnational migration, I remained a neophyte in answering research questions through empirical data gathering and theory testing.   Another main concern for me at that point was my integration into the ?field?? and by this, I mean the household that was going to be the ?base of operations? for the very first phase of my research. I had to answer vulnerable questions about my current life status, in particular, whether I had a ?girlfriend? in Vancouver or whether I was looking for one in Saskatoon, constant questions posed to me by the Philippine nurses who are my housemates, who happened to be mostly men.   The first three months of my 18-month fieldwork (July-September 2009) were spent living in a household of four male Philippine and Canadian Registered Nurses in Saskatoon, Saskatchewan.11 In the same household lived the wife of one of the male nurses, also a Philippine Registered Nurse but in the process of preparing for her Canadian Registered Nurse exam at the time. We lived in a bungalow four streets away from the main thoroughfare, 8th Street, which one of my housemates called the ?Beverly Hills of Saskatoon.? I lived in a room adjacent to two of the male nurses, Kevin, and my childhood friend, Ronnie; and beside the room of another male nurse, Carlo. The couple lived in the basement of our bungalow. This is from the very first entry on my field diary:                                                   11 All of the names used in this thesis are pseudonyms.  55 ?When I stared through the window of my plane as we landed on the Saskatoon International Airport on July 16, 2009, the first impression I had was ?wow, this is a very, very flat and open place.? After a few minutes, I arrived at the airport lobby and was greeted by three Filipino male nurses, one of whom is a former high school classmate, neighbor, and childhood friend of mine back in the Philippines, Ronnie. My impression of the flatness and openness of the place turned quickly into a very textured encounter as they assisted me with my luggage and led me to my friend?s car. There were no awkward moments and there was a lot of bantering. Inside the car, they interrogated me right away. They asked why I chose Saskatoon as my field site, who is giving me money to do my study, and how long will I stay with them in their rented house while I?m conducting my fieldwork.? (July 20, 2009, Saskatoon)   As I landed in my first field site, Saskatoon, and was greeted by my childhood friend and his two other housemates, I immediately acknowledged how warm and accepting they were to me. In a lot of ways, I was not a foreigner to them. I was a fellow Philippine citizen living in Canada, albeit unlike them, I am not here to ?work? as a Philippine nurse, but to ?study? Philippine nurses. This caused some level of confusion to them?as they did not know why it was possible to work as a student. In their social and academic milieu, doing research meant doing nursing research?research of a clinical or scientific kind. In short, the idea that doing research?and in this case, ethnographic participant observation in a household of Philippine nurses in the middle of Canada, which provided me with a salary and subsistence?was a major surprise for them. Their questions were an indication of how simultaneously familiar and foreign I was to them, as I continued in my field note:  56 ?They were all asking and wondering why, of all other ?hipper? and ?bigger? cities in Canada, I chose to come to Saskatoon, and how it is possible for a Filipino student to not work and just be paid and study?My answers were simple. I chose to go to Saskatoon because I already know someone there (my friend) and I am studying full time because I competed and won a fully funded scholarship called the Trudeau Scholarship. Finally, that I might stay in their house for at least four months, and before the winter kicks in as I timed my research in the Philippines to begin by December. I also said that, unlike them, I am not brave enough to endure the infamous Prairie winter.? (July 20, 2009, Saskatoon)   My choice to go to Saskatoon and to ?study them? became a topic of conversation among the nurses in my first few days in the field. Ronnie, my long-time childhood friend, would often answer on my behalf?often with some braggadocio?that I came to ?study them? in Saskatoon primarily because of him. To his mind, his presence in Saskatoon became the main decision-making factor for my research project. His claim is true in the sense that I chose to stay and live with him and his housemates because of my familiarity with him and his story. After dropping off my luggage, they all went to ?Google? my name online right away. They wanted to see whether Ronnie?s claim?that I won the most competitive scholarship in Canada, and that I should be the ?pride of the motherland??was true. I was amused at the sight of four nurses cramming around a computer looking at the website of the Trudeau Foundation, my funding agency.12   In the website, they read the summary of my research, entitled Made for Canada, Product of the Philippines: Global Nurse Migrations and the Geopolitics of Global                                                  12  See:  57 Justice, which says: ?Nurses trained in developing countries are increasingly migrating to developed countries. This migration flow is a response to a global shortage of nurses, affecting global health security and population health in both developing and developed countries. Mark Lawrence Santiago's doctoral project will investigate this global phenomenon through a transnational study of Philippine-trained nurses recruited to work in Canada. Lawrence will look at how both the Philippine and Canadian states, nursing education sectors and labor recruiters become active brokers of this migration system.?   My ?Internet presence? became the topic of conversation for the first few hours inside the house as they also found a link to a radio interview with me about my research. They scrolled through the other recipients of the award and constantly mentioned the fact that I was ?the only Filipino? and ?non-Canadian? in the pack. I came there to study them?through participant observation in their daily activities as new immigrants in Saskatoon and as newly registered nurses in Canada. They were not blind to the fact that I was a researcher who aimed to know something that they had access to.    By Googling me in the first few hours of my arrival, they signaled to me that as much as I came there to know them, they also have the capacity to do research on me. This equality in ?access to information? between the researcher and the researched was not too surprising to me. I assumed that my research informants were highly skilled professionals in Canada, who shared, even exceeded, my own capacity to use communication technologies. Unlike ethnographers or anthropologists of the past putting up tents in so-called ?primitive societies,? my field site was urban and my  58 informants were global migrants and urbanites who constantly use communication technologies to communicate back with their families and friends back in the Philippines.  As much as I anticipated subjecting them to observation, I quickly learned that I, too, would be observed in the process. After they Googled me, I deposited my luggage in my new room, my home for the next few months. Then, we quickly picked up our lone female housemate, Ate Sarah, from the clinic where she had been confined.13 Before my housemates picked me up at the airport, she was rushed to the nearby clinic where a Filipino GP (general practitioner) serves as a doctor. They said that they go to this doctor because he is a Filipino ?pioneer immigrant? in Saskatoon (he has been there since the 1980?s) and one of the very few Filipino physicians practicing in Canada who received their degree from the Philippines. Ate Sarah?s husband, another nurse, was still in the Philippines to attend a sister?s wedding.    While waiting for her check-up to finish, we went to a nearby Burger King and started talking about their initial perceptions of Saskatchewan. Ronnie, my friend, exclaimed: ?maraming prat dito" (?there are so many fraternities here?). I did not understand what he meant by ?fraternities? but then he pointed out a group of six elderly white men and women with gray hair congregated at the next table. ?Mag-ingat ka dyan sa mga prat baka atakihin ka nila? (?be careful with those frat members, they might attack you!?). And then I understood it. He was referring to the fact that Saskatchewan has a lot of old people who would often congregate in public spaces like Burger King. He then said, ?makikita mo ?yan sa mga food courts? (?you?ll see them a lot in                                                   13 ?Ate? is a Filipino word that means ?older sister?; in ??traditional?? Filipino family and social relationships, it is typical for anybody younger to call older female friends ?Ate,? despite the absence of any blood relationship.  59 food courts?) and added: ?dahil sa mga prat kaya kami naririto? (?it?s because of those frat members that we are all here?). In this conversation, Ronnie pointed out that the reason why the Philippine educated nurses were in the province was because of the aging population, an accurate social scientific observation that has since been made into a popular joke shared among newly arrived Philippine nurses.    The following day, Ronnie brought me to the Saskatoon Food Fair along with Carlo, one of the male other nurses. They wanted to show me that a lot was happening in the city and that the park, where the Fair was held, was a ?cool place? to hang out since it was beside the Bessborough, considered the best hotel in town. The Bessborough was, incidentally, the nurses? first accommodation upon their arrival and orientation to the Saskatoon Health Region almost a year ago. They also toured me around the area of downtown Saskatoon and showed me the cineplex and mall, the largest in the province. They were quite eager to show me, a ?big city boy? from Vancouver and Toronto, that Saskatoon had everything to be found in any major Canadian city.    While I insinuated that I am still deep down a ?probinsyano? (from the province), they were convinced that my 8 years of living in big global cities outside the Philippines like Singapore, Vancouver and Toronto has turned me into a snob and that I would not appreciate the small city life that a place like Saskatoon offers. ?Nasurpresa ako na ito pala ang Canada.? (I was surprised that this was Canada), my friend quipped while we were looking at the South Saskatchewan River: ?Malamig masyado? (it?s too cold) ?at maraming bakanteng lupa? (there?s so much empty space). These impressions, built from their experiences of living for less than a year in Saskatchewan, are common. They found the Prairie winter weather too brutal. ?Halos matanggal ang  60 ilong mo sa lamig? (?your nose will almost fall off from the cold?)! ?Napakaraming lamok (?There?s too many mosquitoes?)! Then, they asked me how I found Vancouver?and how it compared to living there. These initial conversations reoccurred many times over in the duration of the first week among them?especially their complaints about the harsh winter in Saskatchewan and how ?Filipino bodies were not built? for the Prairie weather. A recurring theme was also how Saskatoon compared with other cities in Canada?in terms of scale, significance, and most of all, global connectedness.    After the Food Fair, we quickly went to their house so I could start settling in properly. While arranging my room, I realized that just to accommodate me, Ronnie had moved into Kevin?s room, just in front of my room. He pumped an airbed and set up a bed for himself on the floor. He reasoned that I deserved to have the comfortable bed because I am his close friend and I am also a special guest in the house. Despite his busy and backbreaking night shifts at the long-term care facility and the hospital where he was working, he took the time to clean his old room, bought new pillows as well as a duvet set and towels, and washed his old bed cover for me.  He knew that I was a neat freak and that I was very orderly in my things, so he made sure that my room would be good enough for me. He said that he wanted to please me because he did not want my Mom to complain to his Mom that he did not treat me well in Canada. As our mothers lived very near each other (just one block away on the same street in our hometown in the Philippines) and talk to each other in our barrio parish church all the time, he said that he wanted to be careful with accommodating me. But he also warned that he did not want me to ?report? to my Mom the things that he did in Canada, because she could easily spill the details to his Mom.    61   In any case, I settled in well. His claim that I was a clean freak was true: in less than an hour I?d cleaned the room further, rearranged the fixtures, and made sure that my sleeping space was distinct from my working space, where I planned to write my field notes throughout my stay with them. When Ronnie arrived from his shift, and saw that my room looked very clean and orderly, he exclaimed that he truly admired my space management skills, claiming that he knew who I was because we lived in the same preparatory high school dormitory (a Catholic seminary) in the Philippines for four years, from aged 12-16. He announced to our other housemates that I was the high school class valedictorian, always the ?first honor?, and that he was proud that I was making a study about the Philippine nurses in Saskatoon. I felt embarrassed and jokingly told him in front of his housemates that he should keep quiet about our common past, or I would spill the beans about his past as well.  Pinoy Big Brother, Saskatoon Edition    During my first few days in the household, I was slowly introduced to other nurses my friend and our housemates usually hung out with. I first met Ate Carmen and Elsa, who lived in a two-floor apartment about a 15-minute walk away from our house. I eventually realized that they formed an important part of the fabric of the social lives of my housemates. While I prepared some qualitative questionnaires for the nurses, intending to start interviewing right away, my daily life in the house took over. I had to adjust to the fact that I was living among five nurses, all Filipinos, and therefore had to watch my actions and myself carefully. Since Ate Sarah was recovering from her bleeding incident, we were quite attentive to her needs. Because  62 her husband had not yet returned from the Philippines to Canada, Kevin, Carlo, Ronnie, and I shared the common task of making sure we regularly cooked and brought her meals as she recovered in her basement room. The first few days became a sort of household orientation too. The housemates shared various expenses in the house, such as utilities and rent. They also shopped for groceries at the big discount stores together. They divided the house into four geographical zones of ?cleaning responsibilities.? In the main floor, Kevin was assigned to clean the kitchen, Carlo to the main reception area, and Ronnie to the common toilet and washroom. Ate Sarah and Kuya Jay were responsible for the basement, and everybody was responsible for their own room. When I arrived, they were puzzled over what particular space would be my ?cleaning responsibility.? I told them that I was open to cleaning any space, and I was informally assigned to clean the outdoor patio and the garage.    In a way, the household functioned like a Filipino family unit, albeit located outside the Philippines and constituted by non-traditional members of a typical family. In fact, living among the Philippine nurses seemed like the internationally syndicated television reality show Big Brother, except there were no cameras and there was really no Big Brother. Unless it was I, observing my life with them as events unfolded, writing field notes at Broadway Roastery, a coffee shop on the main street.  Indeed, for much of my stay inside the household, it felt like Bahay ni Kuya (Big Brother?s House)?complete with the melodrama and comedy of living among Filipinos, albeit in a Canadian Prairie ?global household.? Call it Pinoy Big Brother, Saskatoon Edition. The sense that the household was similarly structured as a Philippine family household reoccurred when Kuya Jay, Ate Sarah?s husband, arrived from the Philippines. Kuya Jay embodied the figure of our household head: not exactly  63 Big Brother, but rather someone who commanded respect and authority among the housemates, myself included. As soon as we met at the airport, I got the sense that he was revered among them.     There was a reason why everybody called him Kuya, ?older brother? in Filipino, used as a term of intimacy and respect for older males. Kuya Jay, as I heard from Ronnie and the other housemates, used to be a physician in the Philippines. He was one of thousands of Filipino doctors who retrained to become nurses to eventually get a chance to migrate abroad. In our first conversation, like the others, Kuya Jay asked me about my thesis and I had to explain to him why I was doing what I was doing. However, unlike the others, I knew that his perspective on my topic would be a bit more complex, less straightforward, than those of the nurses who went from nursing school, practiced nursing in the Philippines, and eventually migrated to Canada. His story was different from the rest of them because his professional trajectory is complicated by the fact that he used to practice as a doctor in the Philippines.   The Ethics of Researching Temporary Foreign Workers    While I knew I wanted to do research among Philippine nurses in Saskatoon, I had a lot of apprehensions about what to expect and what doing ethnographic research (participant observation and interviewing) actually entailed before I even physically moved there. This led me to think that it would help to diffuse my anxieties by contacting ?local academic experts? from the university, who might potentially lead me to ?sources? as well as contacts, especially among the nursing and  64 labor migration policy community in Saskatchewan. In my prospectus, I wrote that part of my intention to do this research was to understand the ?policy contexts? that allowed for the recruitment of nurses in the Philippines. As much as I am concerned with the Philippine nurse migrants, the methodological vision of my prospectus was to complement nurse-focused interviews and participant observation with interviews among Saskatchewan policymakers from a wide range of organizations, including nursing, but more importantly, the stakeholders who were involved in the recruitment of nurses from the Philippines.    My supervisors clearly communicated to me that I had to practice independent research?and that I could show a letter to potential interviewees from them if need be. I also asked my funding agency, the Trudeau Foundation, to provide a letter to show government employees my level of support. No doubt the acquisition of letters from these figures of authority provided defense mechanisms for my insecurities as a neophyte field researcher. So, even before my arrival, I contacted a senior university administrator, whom I thought could provide access to the network of stakeholders that recruited the Philippine nurses to Saskatchewan.  In an email to her, I introduced myself and my affiliations, and my interest in interviewing stakeholders. She replied quickly (within the same day) enthusiastically and positively, and agreed to meet with me on my arrival in Saskatoon.    The idea that the administrator was in a position of authority within the local university and the nursing and health community made me more confident about the prospects of interviewing policy stakeholders. She introduced me to a number of other nursing faculty, informing me of the fact that a number of nursing scholars from their own School of Nursing were also interested in doing research  65 about the newly recruited Philippine nurses. Unaware of the politics of research among academics, and especially between graduate students and tenured professors, my initial reaction was that of excitement about engaging the nursing scholars. I assumed they already held significant primary information from the perspectives of the stakeholders. This assumption rested on my belief at that time that I could not have access to government officials and senior policymakers in Canada unless mediated by others in equal or higher socio-political positions of power and authority than myself.    A week into my arrival, and while setting up my life in the household, I visited the office of the senior university administrator and one of the nursing scholars involved in the project. The receptionist in the office, a blonde white lady probably in her mid-twenties, mistook me for a computer technician and asked if I was there to fix the system. Unlike my arrival at the airport, where the greetings, familiar language, and jokes of three Filipino male nurses made me feel very much at ease right away, I felt really nervous before this interview. After all, this was the first time I would ?officially? speak with a person of authority about the topic of my research. Dressed in long sleeves and wearing my shiniest pair of leather shoes, I waited anxiously in the reception area. When the administrator?s meeting finished, she immediately went out, shook my hand, and introduced me to a nursing scholar who was already in the room.    While explaining what I aimed to accomplish in Saskatchewan, I also made an effort to be calm despite my nervousness. The nursing scholar asked me about my methodology. I told her I aimed to interview nurses in Saskatchewan, the stakeholders there (which was presumably why we were having that meeting), and stakeholders in the Philippines. She told me that my project was ambitious, and by the sound of it, highly qualitative. I agreed. I also informed them that my methodology was primarily  66 informed by ethnography?and that my interest was not in nursing per se but in the human geographical aspects of the nurses? recruitment and migration experiences. After my explanation, she informed me that they were doing a similar project, which was recently funded by the provincial government (100,000 CAD) involving the same set of issues. She also informed me that she expected ?me? to go through the ?ethics review process? of both the university and the Health Region, as my research subjects were part of these academic and health authorities? jurisdictions.    As any graduate student would do, I agreed to cooperate with them if that was what it took for my research to be recognized by the authorities?although my expectation was that the ethics clearance from my home university would have been enough. The scholar also added that two studies were ongoing among nursing scholars based there and that mine would be the third. We left with the agreement that I would report back on this exchange to my supervisors at the University of British Columbia and that we would revisit the topic later.     Of course, I reported back to my supervisors, and unavoidably, to my housemates. Ronnie brought me and picked me up at the university so he knew I was going to speak with the ?authorities.? Before I left the house, he was also very proud of the fact that I actually had the confidence to speak with ?white people? in positions of power. He said that while he dealt with white workmates all the time, he still felt very uncomfortable around them. He specifically pointed this out to our housemates?how I was able to communicate, banter, and argue in the same speed as ?white people.? So, when I went to tell him that I was interviewing a senior administrator and a nursing scholar, his reaction was that of pride about the fact that somebody like me, who is presumably somebody like him, could go and speak with them.   67   When I went to Ronnie?s car and recalled what just happened, his immediate reaction was negative. He said he could not believe why they wanted me to submit to the process of ethics review in multiple boards; and why they would not give me access to the nurses, as I was living with them already! I explained that this is university protocol, and that as an aspiring member of the academy, I needed to engage with the process. He then said that he would tell all the nurses to not cooperate with their research, a mail-in survey among the Philippine nurses who were recruited to Saskatoon and other health regions in Saskatchewan!   When we arrived home, despite my efforts to calm him down, he immediately and angrily spread this news among my housemates. They all agreed with him?that if the employers and university would not give me access to information, they would ?protest? against their research. After all, they did not feel comfortable about the fact that their employers would do research ?on them? at a stage where they were still not Canadian permanent residents. ?What if,? Ronnie asked, ??they? gather information that can be used against us? And what if they use that information to not give us the right to permanent residency in Canada?? When Carlo arrived, he immediately jumped into the conversation and told me that he was part of the advisory committee of the research that they are doing?and that he had a copy of the preliminary research agenda they intended to set. He offered to show the agenda to me, agreeing with Ronnie that it was unfair that they would not give me access to information. After all, their research process was still at a very early stage, and in fact, the nursing scholars (composed entirely of ?white women,? according to him) would benefit from a Filipino scholar?s knowledge, perspective, and cultural competency on the issue.    68   Ronnie?s strong opinions about his insecurities about ?them white people? and ?employers? doing research on Philippine nurses signaled two things to me. First, he assumed that ?only Filipinos? could study other Filipinos, a type of racial essentialism and an assumption that ?native informants? can only study and write about other ?natives,? which I do not necessarily agree with. After he made his statement about staging a protest against them, he quipped that they, or at least he, would not actually tell them the ?truth? about the nurses? situation and experiences in Saskatchewan. I interpret these statements as a way for him to empathize with me as his kababata (childhood friend) and kaklase (classmate), whom he assumed was in a privileged position to do a ?study about them,? since, unlike the university?s nursing scholars, I knew their language and had stock knowledge about the history and the political economy of the Philippines.    At this very early stage of my research (my first month in the field), I told Ronnie that I didn?t want to assume superiority above any scholar. I was willing to learn from these nursing scholars and gain access to the stakeholders, as they had a perspective on the issue that he and I did not have?that is, the perspective of Canadian employers and government officials who ?enabled? the migration and recruitment process to begin with. Ronnie then told me that whatever it is that they wanted to know, I could immediately know myself?and most of all, ?he knew? already?because he went through the recruitment and migration process himself. Obviously then, I could have access to his information because he consented that I live with him and I was with him all the time. Apart from this issue of ?privileged access? to information, Ronnie?s statement more importantly signaled the vulnerable position he and the rest of my housemates were in at the time of my fieldwork in 2009. All of them  69 were still at the mercy of their employers? nomination to the Saskatchewan Immigrant Nominee Program (SINP). Nobody among them was a permanent resident in Canada, and because of this, they did not think it was a good idea to ?tell the truth? to their employers (through the survey that the nursing scholars were designing).    There was more at stake than just my status as a graduate student researcher relative to tenured faculty, or my access to information among groups of people in positions of presumed power and authority. One of the more sensitive aspects of these encounters and exchanges is the fact that we academics are doing research ?on? temporary foreign workers to begin with.  It became clear to me that while the Philippine nurses I was living with may be described as ?Philippine nurse migrants recruited to work in Canada,? they do not fully share the same set of political rights and employment privileges as other internationally educated nurses who are here as permanent residents and Canadians. In many ways, apart from the shared language and knowledge of the Philippines, we were actually in the same visa status in Canada?as I am an international student under a temporary residence visa, and they were skilled workers under a temporary residence visa at that time. Our shared impermanence and visa status in Canada made me acutely aware of how they did not want to jeopardize their future as permanent residents and Canadian citizens in Canada. During this time, I was also preparing my own application to be a permanent resident, and so, I understood the physical and emotional anxieties they were undergoing to reach a state of permanency as Canadian citizens. While it took me a while to know with certainty that I wanted to live permanently in Canada and become a dual citizen of Canada and the Philippines, for most of them it was clearly one of the primary goals of their settlement after the first year of their arrival here.   70 The Fulcrum    After this series of events and upon reflection on the consequences of ?doing research? among temporary foreign workers in Canada, I began rethinking my research proposal and tinkered with the possibility of re-mapping my fieldwork plan. For four more months, I was still inside the Pinoy Big Brother household, still writing field notes, although I felt that a new direction might be worth pursuing. So, I consulted my housemates?the experts on my topic. I asked them what would be interesting to pursue or more precisely, which actors were worth interviewing to understand the phenomenon of health worker recruitment and migration from the Philippines.    One evening, we decided to head to a nearby Starbucks to talk about this. Three of the four men in the house gathered around me to construct a new research strategy after what they called the ?sabotage? by the research institutions in Saskatchewan. Kuya Jay, the most senior amongst us, suggested that I should focus on looking at the role of three sectors in the Philippines: the Philippine government sector, the nursing education sector, and the private recruitment agency sector. He said that they were the primary stakeholders of this global process, because they also ?earned? the most money in the process. Since they profited from the industry of training and sending Philippine nurses to Canada and elsewhere, they would likely be the most articulate and knowledgeable about these processes. They were also located in very different sites of power compared with the nurses.  Kevin, who was also very keen on giving me advice, said that those three sectors were doble-kara (?Janus-faced?). While they could be seen as the sectors that enabled their migration and recruitment  71 to Canada, he also had deeply painful experiences with them. He told us, for example, that he would desperately seek out newspaper ads every Sunday, feeling belittled and undermined by the recruitment agency staff every time he went to these agencies to give his resume.    Ronnie also commented that it would be interesting to hear their perspectives, because they were the sectors that disappointed most of the nurses, who simply don?t trust ?the Philippine system.? He asserted that there was a general culture of mistrust among Philippine nurses with the institutions that produced them, especially after the ?leakage? case in 2006, when members of the Philippine nursing regulatory body became accessories to the leakage of some questions for the national nursing regulatory exam. He said that during one event in Saskatchewan, the authorities from their health region brought some of the Philippine nursing educators and Philippine state actors to Saskatoon; he, along with other nurses, booed them in public. He said that he could not imagine how they had the ?gall? to show their faces to ?collect? money from the nurses through the Canadian government, after already benefitting from their payments in the Philippines.    While we were discussing my research, Kuya Jay asked me point-blank about the goals and objectives of my research. He said that while my research would be significant, it might also be very controversial. I told them that one of my aims (at that point) was to construct a robust argument that would compel Canada to ?compensate? the Philippines for their recruitment of health workers. He warned me to be extremely careful about constructing this argument. Kuya Jay said that while he saw my point, and in fact agreed with it, the Canadian government and Canadians could interpret it as ?too demanding.? He said that this kind of argument might lead Canadian  72 authorities to rethink their recruitment efforts in the Philippines, and they might channel their attention to other ?less demanding? source countries, like India and China. He said that this kind of argument might lead to the devastating result of Canada halting its interest in pursuing bilateral labor relations with the Philippines, thus preventing migrants like them from working in and migrating permanently to Canada. Kuya Jay also said that this might benefit the ?wrong people? because the channels through which any compensation might return are not corruption-proof (i.e. Philippine government officials).    These honest conversations with the nurses in Pinoy Big Brother house clearly showed that they know exactly what?s at stake in this kind of research?not only the ?contents? of the research, but also its consequences, or in the language of academics and bureaucrats, its ?policy implications.? After all, my housemates were the main ?products? of the nurse education, training, recruitment, and migration that I originally set out to study. During my remaining time at the house in Saskatoon, I went on several trips with the nurses to other nearby Prairie cities and towns to meet other Philippine nurses, in Wakaw, Prince Albert, Regina, Winnipeg, Edmonton, and Calgary. In those long-drive trips and through the daily kuwentuhan (conversations) I had with them, I gained considerable insight on how the nurse education, recruitment and migration bureaucracy, is currently organized in the Philippines. They gave me leads, names, and key actors in institutions that I should ?check out? once I returned to Manila to continue research. Moreover, they encouraged me to do the ?right thing.? For them, this meant exposing the inefficiencies and injustices produced and sustained by a ?corrupt? Philippine state and ruling elite, which drove people like them to migrate out of the country in the first place.   73   During a trip to Prince Albert, Saskatchewan with Ronnie and Kevin, they spent the entire drive telling me how to gain access to different private recruitment agencies, noting that the most crucial staff members there were often the secretaries of the CEO?s. They warned me whom not to talk to, whom to be close with, and most of all, whom to show respect for among Philippine nursing officials, government bureaucrats, and private recruiters. They also continuously and repeatedly told me that it was imperative for me to ?do something? since I was in a position to do so, a point which I contested. By ?doing something,? they meant serving Philippine labor migration interests by becoming part of the civil service and showing them how to manage nurse recruitment for the benefit of the Philippine public health system. While I found their encouragement flattering, I was also aware that I had little desire to become a part of the Philippine government bureaucracy as I had already worked in that bureaucracy before.    In October 2009, I returned to Vancouver, after more than three months of doing fieldwork among a household of Philippine migrant nurses in Saskatchewan. The entire Pinoy Big Brother household took me to the airport, and some of them were in tears, especially Ronnie, my childhood friend, and Ate Sarah. I have never felt more accepted by a group of expatriates, and the separation from them, whom I got to know as my latest set of friends and family in Canada, was not easy. But I had to move back to Vancouver to rethink my research plan and meet with my supervisors. At this point, I decided to shift my attention away from the nurse migrants and towards the actors and institutions that brokered their recruitment and migration from the Philippines to Canada. While I might?ve undertaken those stakeholder interviews in Saskatchewan, my gut feeling was that the actors there would impose their interests and authority on  74 me and I would find it difficult to work with them.    During this period, I was introduced to the Executive Director of Health Match British Columbia, or Health Match BC, a free not-for-profit placement and recruitment facility funded by the Government of British Columbia and attached to the Health Employers Association of BC (HEABC) and the Ministry of Health Services British Columbia. The Executive Director and I set up an interview. During the interview, I asked the Executive Director about the nature of their work at Health Match BC. As my thesis is empirically focused on the recruitment and migration of internationally educated nurses (IEN?s), he naturally directed me to their newly hired Senior Consultant in nursing and allied health. During the same month I interviewed the Executive Director, I interviewed the Senior Nursing Consultant. For the first time during my fieldwork, I felt that I reached a breakthrough?our conversation led to a discussion about a possible internship within the organization. This internship would later on allow me to see how the organization functioned on a daily basis as well as lead me to other actors within the health care and migration bureaucracy of British Columbia.    Through this chain of events, my ethnographic sensibility slowly steered my research away from documenting the lives of migrants to carefully understanding the roles of actors in institutions and bureaucracies that ?make and produce? them. I asked the Senior Nursing Consultant if I could observe their recruitment trips even before I began my internship with them. Upon the Executive Director?s approval, I joined Health Match BC and the BC Provincial Nominee Program of the BC Ministry of Advanced Labor Market and Development in two-day recruitment trips to Seattle, Washington State, USA and Ottawa, Ontario, Canada to observe how they recruited  75 nurses to work in various health regions of BC. I slowly shifted gears and decided to focus my thesis away from ?Philippine nurses in Canada? to studying the global networks of ?experts? on the international recruitment and migration of health workers?government bureaucrats, business professionals and academic researchers.14   Navigating Centers of Power    Ottawa, the seat of the Canadian federal government, became the first center I visited after I reworked my fieldwork plan.  Following a brief visit in early July 2009, from November to December 2009 I interviewed senior government bureaucrats from Citizenship and Immigration Canada (CIC), Health Canada, and the International Development Research Centre (IDRC). During both visits, I also sought interviews with academics based at the University of Ottawa doing health policy-oriented research on health worker migration. They subsequently invited me to become a Co-Investigator for a Canadian Institutes of Health Research (CIHR) multi-country project that would involve using the Philippines as a case study to understand the consequences of health worker migration in health human resource planning on source countries, a subject that is also a core empirical concern of this thesis. The other countries that are currently being ?examined? apart from the Philippines are India, South Africa, and Jamaica. Upon their request, I contributed to editing the draft of the proposal twice, once for the initial submission, and again for the revision of the second                                                   14 I thank Vicky Lawson for closely reading a shortened version of my proposal during workshop in San Juan Islands, and for providing crucial feedback during that workshop that helped reframe this thesis. After explaining what the internship might mean for my project and through a conversation in Ottawa, David Ley encouraged me to pursue the work at Health Match BC. Merje Kuus supported it by acting as academic supervisor for the project with them, and for guiding me through the sensitive research ethics surrounding research within state institutions.  76 draft, which was eventually funded with $1,353,177CAD by CIHR from 2010-2014.    After joining a teleconference to update them on the situation in the Philippines, they requested me to help rewrite the Philippine policy brief that was part of the CIHR proposal as I was supposedly the most ?knowledgeable? and ?on the ground? among the academic researchers in the network. I was doing fieldwork in the Philippines as the policy brief was being revised. During my visit in December, I was also asked by the Principal Investigator (PI) of the CIHR project to co-write a government report for Health Canada on promising bilateral and multilateral agreements on health worker migration, a supplement for the discussion on the pan-Canadian guidelines for recruitment of internationally educated health workers.15 I agreed to participate, both as part of the CIHR project and in the preparation of the government report, because I saw these as opportunities to directly communicate some of my preliminary research results to important bodies of Canadian policymakers and practitioners in the health human resources and health policy sector, including members of the Advisory Committee on Health Delivery and Human Resources, since they comprised the primary audience for the project and paper.    The CIHR project also gave me access to potential collaborators via the ?network? of academics researching international health worker recruitment and migration.16  Because of the report?s empirical focus on the Philippines, I introduced the PI to a leading Philippines-based policy expert on health worker recruitment and migration (the Head of the Health Human Resources Bureau of the Department of                                                   15 The findings that constituted this environmental scan were based on a series of information (See ?The Bilateral Agreements Matrix? in my appendices) I supplied the Principal Investigator (PI) and through the research assistance of another research associate.  16 About the Advisory Committee on Health Delivery and Human Resources :  77 Health), as well as the Ottawa-based Philippine Ambassador to Canada, both of whom I persuaded to become collaborators of the CIHR proposal as well. The PI subsequently invited them to be part of the research project and they wrote letters of endorsement for the project. During my time in Ottawa, the Ambassador of the Philippines to Canada invited me to join a diplomatic dinner in honor of the 60th Anniversary of Philippine-Canadian diplomatic relations. This event allowed me to co-mingle for the first time with the Philippine diplomatic community and observe how Philippine state officials in Canada interact with other foreign diplomats and consuls based in Ottawa. The Ambassador requested that I write a piece for the Philippine Department of Foreign Affairs on the issue of Philippine health worker recruitment and migration to Canada to use for a national consultation on migration among various Philippine government Departments. I subsequently gave the Philippine Department of Foreign Affairs a summarized version of my doctoral thesis proposal.   In the Mecca of Recruitment & Migration    In late January 2010, I travelled to Manila to seek crucial information, conduct key informant interviews, and do participant observation. During this visit, I was able to interview 20 key informants ranging from officials of the Canadian government in the Philippines, deans of nursing colleges, chiefs of nursing in Philippine hospitals, private recruitment agencies for labor migration to Canada, and policymakers from the government and the sectors of health, education, and nursing.  My conversations with policymakers and government bureaucrats centered on their roles in their organizations as well as potential policy implications of the recruitment  78 of Philippine nurses to Canada and other countries. While in the Philippines, I was able to do participant observation in a number of key institutions where some of my policymaker-respondents worked. I attended a labor market information session of the Canadian Immigrant Integration Program (CIIP) at the Manila office of the Human Resources and Skills Development Canada (HRSDC), the Association of Canadian Community Colleges (ACCC), and Citizenship and Immigration Canada (CIC), the Pre-Departure Orientation Session (PDOS) of the Commission on Filipinos Overseas (CFO), the Oathtaking Ceremony of newly registered nurses by the Philippine Nurses Association (PNA), and the Board of Nursing (BON). I also participated in a conference of the Philippine Nursing Research Society (PNRS) and attended an awards ceremony for the most competitive private recruitment agencies sponsored by the Philippine Overseas Employment Agency (POEA). I also contributed a research article on Philippine nurse migration to Canada to the Philippine Journal of Nursing as well as presented initial findings of my work at the Summer Institute in Migration Studies at Miriam College.     During the course of my fieldwork in Manila, the instantaneous and positive response to my letter of invitation among the key informants to participate in my research, showed how Canada is now seen as a crucial destination for new immigrants, where institutional actors can also play strategic roles for themselves and their respective organizations. I gradually became aware that state actors, nursing professionals and private entrepreneurs were willing to engage with a conversation about the Philippines? relationship with Canada because I was a source of structured knowledge about various Canadian institutions. In short, I was a ?vector of information? that they could potentially use to learn strategic information about  79 Canada and the Canadian nursing labor market.17 Unlike foreigners who do research in the Philippines on Philippine society and institutions, I was read through the lens of my Filipino-ness during my fieldwork there.18    My Filipino-ness proved to be both an obstacle and an entry point to my relationships with key informants. During a nursing conference at a leading nursing school in Manila, I interviewed an entrepreneur who operates a ?preparatory and bridging school? for nursing overseas. He told me that he expected a lot of the people I wanted to interview would refuse because they would think of me as potential competitor. I did not understand his point at first, so I asked him to explain further. He said that a lot of Filipinos and especially balik-bayan (return) Filipinos engaged with the ?nursing business? and that it was a fierce competitive field among nursing schools, private recruiting firms, and ?government people? involved in these sectors. He said that the fact that I knew how Canadian institutions were set up?especially in terms of the regulatory context of the nursing profession and immigration in Canada?made me a threat to their business and future ventures. He then said that it was imperative for me to inform everybody I was to interview that a) I am not a nurse and b) I am not planning to stay or return here in the Philippines permanently. What he basically meant was that I should assume unfamiliarity with the nursing profession and disinterest in                                                   17 I thank Gerry Pratt for introducing me to the term ??vector of information?? during a conversation over the ??logistics? ? (not the content) of doing research in Manila among state officials and private recruiters. I also thank her for allowing me to eventually own the term.  18 I thank Philip Kelly for telling me that foreign researchers (especially if they are ??white??) are read through their ??whiteness?? by key informants in a country like the Philippines. See Guevarra, A.R. ?The Balikbayan Researcher.? Journal of Contemporary Ethnography 35, no. 5 (2006): 526 for the politics of doing research as a Filipina-American return migrant in the Philippines. Guevarra expanded her analysis on this issue in the introductory chapter of her Marketing Dreams, Manufacturing Heroes: The Transnational Labor Brokering of Filipino Workers. Rutgers University Press, 2009. In addition, see the chapter ?Mapping an Ethnography of the State? of Rodriguez, RM. Migrants for Export: How the Philippine State Brokers Labor to the World. University Of Minnesota Press, 2010 for similar considerations of positionality among ethnic Filipino researchers from abroad doing research in the Philippines.  80 setting up a nursing-related business venture in the Philippines; only then would informants feel confident that I had no other interest in the issue except as a form of academic exercise.     Apart from my familiarity with Manila?s complicated transportation system, which allowed me to efficiently meet my key informants in person, the fact that I was not a nurse and not institutionally embedded in any of the institutions with which I did participant observation and interviews allowed me to navigate the various ways through which institutional actors think of the issue and of each other. While I carried knowledge about Canadian institutions and about Philippine institutions through my immersion among Philippine nurses in four Canadian Western and Prairie provinces (British Columbia, Alberta, Saskatchewan, and Manitoba), my lack of knowledge about the specifics of nursing education and the migration and recruitment sectors, put me in an advantageous position to ask questions and make the institutional actors and entrepreneurs articulate their views about their own institutions and businesses. Furthermore, unlike most researchers in health human resources and labor migration policy who take a so-called ?macro? approach to the issue and do not ?dwell? in the surroundings where the institutional actors meet and ?play? with one another, I made sure that my fieldwork in Manila lasted for more than a couple of days and was located in the densest node of the networks among the Philippine state actors, nursing leaders, and private recruiters I wanted to interview.    I lived in a loft-style condominium unit in front of a huge mall, strategically located near the Metro Rail Transportation (MRT) system and right at the heart of the city of Manila, in the district of Malate. I chose this condominium unit and area because of the security it provided me, as well as the comfortable access to most of my  81 potential informants. The Philippine General Hospital, the country?s most comprehensive public hospital, was located two blocks away; and the University of the Philippines, Manila (UP-M), the institutional home of the country?s premiere medical and nursing schools, was only one block away. The Malate district is also part of the famous ?University Belt,? the country?s spatial hub of universities, colleges, and polytechnics. Therefore, I had very easy walking access to numerous established and premier nursing schools, such as St. Paul?s University Manila, the University of Santo Tomas, the University of the East, and Far Eastern University, among many others. The head office of the Philippine Nursing Association and the headquarters of the World Health Organization Pacific Region were a few streets away. Most importantly, I was surrounded by literally hundreds of small and huge private recruitment agencies for all kinds of overseas jobs.     This area in Manila is a global hub of activities for those who are in the business of migration and for migrants themselves. Indeed, it can be imagined as an extension of the Philippines? Ninoy Aquino International Airport, a pre-departure area for the national airport?s pre-departure space for future migrants. Because of my strategic location in Manila, I also had everyday access to nursing students and nurses applying to work overseas in the recruitment agencies. In my condominium building, many tenants were either return migrants, or nursing and medical students from upper-class Filipino families who could pay the high rent. At a ?discounted rate,? I paid a total of 40,000PHP (1,000CAD) each month for four months. My landlady was a Filipina-Canadian nurse living in Toronto, who would rent out her space for ?balik-bayans? (return migrants) like me doing short-term visits to the Philippines. While Malate is a hub for migrants looking for contracts during the day, it turns into a thriving live  82 entertainment and prostitution district at night, attractive to tourists and foreigners of all types. The most crucial national event that coincided with my Manila fieldwork was the 2010 Philippine National Presidential Elections held on May 10, 2010. Apart from having the opportunity to vote in person for the first time since I left the Philippines to study overseas more than 10 years ago, I also witnessed how issues surrounding labor migration and access to public health services became some of the most crucially debated issues during the campaign period.19     I was considered by my informants as an outsider because of my ?disconnected status? with the nursing, private recruitment and public sector communities I set out to study in Manila. To them, my role was to ?understand the network? but I was not necessarily a part of it. To me, the greatest and most ironic chasm between myself and my informants in Manila was the fact that I did not share the socio-political and economic status they hold despite my ?elite,? ?global,? and ?Canadian? education. While I attended what is arguably the most elite private university in the Philippines (Ateneo de Manila University) as a full scholar, this did not really translate to any access to informants in the field because that university did not have any nursing school. While I had the opportunity to live in a secure, upper-class condominium because of the financial support of my funding agency, I was fully aware of my previous socio-economic background in the Philippines relative to my key informants. I come from a farming and working-class family from the second-class municipality of Balagtas in the province of Bulacan, and I am a son of a street food                                                   19 I noticed a similar pattern during the 2008 United States Presidential Elections, where immigration and universal health care became core topics of debate among politicians and candidates for office. Speaking of timing, it is also interesting to note that May 2010 is also the same month that the WHO Global Code of Practice on the International Recruitment of Health Personnel was passed at the 63rd World Health Assembly in Geneva, Switzerland.  83 vendor and a former migrant construction worker in Singapore and the Middle East. Indeed, I was aware that if the people I interviewed in the Philippines were to know this personal information, they would probably assume I was below and very far from the ?social? status and class positions they occupied, and were most likely take me for granted and not welcome my request for an interview.  Embedded Research      After my fieldwork in Manila, I returned to Vancouver to begin a funded internship with Health Match BC, an ?innovative and unique free physician, nurse and allied health professionals recruitment service funded by the Government of British Columbia?recruiting on behalf of over 100 health care facilities across the province.?20  As I mentioned above, I gained access to Health Match BC after an introduction by one of my doctoral committee members and through interviews with the Executive Director and Senior Nursing Consultant in September 2009. I interviewed them as experts on the recruitment of nurses from the Philippines to Canada. After transcribing and analyzing my interview transcripts with them, I was convinced that Health Match BC was a crucial site, indeed the place to conduct research on my topic, as the organization is deeply embedded among other organizations that deal directly with the recruitment and migration of internationally educated health workers, including nurses who were originally educated and trained in the Philippines.                                                     20 I have been granted explicit permission and consent by the Executive Director and the Senior Nursing Consultant to reveal the identity and the work of Health Match BC throughout this thesis. See:  84   After my internship, I also interviewed key informants from the government of BC, the Vancouver Coastal Health Authority (VCH), and the Provincial Health Services Authority (PHSA). My interviews covered the BC provincial nominee program, which nominated workers to the province; the integration programs of VCH for internationally educated nurses; and ?Nurse Vancouver,? a recruitment drive by three health authorities in the Lower Mainland (VCH, PHSA, & Fraser Health) from 2007-2009 to recruit internationally educated nurses from the UK. These interviews allowed me to move away from my key site in Health Match BC, and see how the institution was located within the larger complex of health care organizations and provincial immigration programs. My interviews with these key informants were about the relationship of Health Match BC?s recruitment efforts and their own institutional mandates.   At the Centre of Global Health Diplomacy      After these interviews in Vancouver, I visited Geneva, Switzerland, to attend and present at a workshop on health geography and health worker migration, organized by geographers from the United Kingdom and featuring academics and policy professionals.21 Before the workshop, I interviewed international civil servants about the WHO Global Code of Practice on the Recruitment of International Health Personnel, ratified unanimously in May 2010. A historic international instrument in contemporary global health diplomacy, the WHO Global Code of Practice constitutes                                                   21 See:   85 principles on how states and private recruitment firms ought to conduct their recruitment of health personnel from outside their jurisdictions, especially recruitment done by high-income countries from low- to middle-income countries. Formed after a lengthy process of international deliberation, the WHO Global Code of Practice considers the perspectives of a multitude of stakeholders, including international organizations, national governments and the private sector. While in Geneva, I also interviewed the Head of the Health Human Resources of the WHO; the WHO technical officer responsible for drafting the WHO Global Code of Practice from Health Human Resources Department; an official of the migration health section of the International Organization of Migration (IOM); and finally, the recently retired President of the International Council of Nurses (ICN), who also served as the President of the Canadian Nurses Association (CNA).  Living and Creating Geographic Knowledge    Every piece of scholarship is as much about the academic?s intellectual interest and the scholarly fields he belongs to as his own social and cultural presuppositions. One?s history informs a scholar?s sociology of knowledge. The challenge is to be aware that the ties between one?s scholarly work and one?s life are not as loose as we often want to depict as seekers of truth and objectivity. Our biographies shape our intellectual projects in more ways than we are willing to admit ? as the perception and admission of how they are enmeshed can potentially diminish our credibility as academic experts.    86   Since one of the concerns in this thesis is to slowly unfasten the locks of the black boxes of the health worker recruitment and migration industry in the Philippines and Canada, it will be clear to the reader that the topic I chose to investigate directly emanates from my biography; and unapologetically so. In this chapter, numerous themes emerged and they will be reinforced throughout the thesis? empirical chapters: my own background as a Filipino national and citizen who is also a Canadian permanent resident; my pre-existing long-term friendships with my key informants that drew me personally to my first field site (Saskatoon); the institutional barriers in the formation of social geographical knowledge; my advantageous role as a middle-man between the people who make policies and the very people affected by those policies through collaboration; and finally, the ways through which I argue we should listen closely, patiently and with care to our informants as field researchers.   The local, personal, and global realities I captured in my fieldwork all had an extremely non-linear character. I had to deal with surprises and twists that I only slowly understood after I moved away from the fieldwork process and began the process of analyzing the various data I gathered. The gap between the research stimuli (the people I met, the events I participated in, the kinds of information I accumulated through the process) and the analytic response formed in these chapters was very ambiguous in character most of the time. Because of the presence of this ambiguity, it took me a while to render a more definitive look at what exactly I was trying to understand.  I conceive of my role here less as a policy analyst (the typical role assumed by those who study policies) and more as an ethnographer, knowledge broker, and storyteller?as somebody trying to make sense and bring an interpretative order to global social realities in a mutually understandable manner, for myself as well  87 as for the readers of this thesis.                During my fieldwork in Vancouver, one of my key informants told me, after a series of meetings with other institutional actors and government informants, that she thought of me as the lead character played by Leonardo DiCaprio from the movie Catch Me If You Can, notwithstanding that character?s status as a con artist who misled people about his ?true identity.? She made this point because of the chameleon-like nature of the research I was doing as I was ?embedded? in the daily life of the very institutions I was observing and writing about. She also said that I was slowly becoming the ?avatar? of the government bureaucrats I was studying. What she meant by this was that I was able to enter their world, empathize with their personal circumstances, understand the meanings of their behavior, and perform their responsibilities with them?while shadowing them in a parallel universe of which they knew imperfectly: my field research and eventually, this thesis. She also said, in the context of meetings among other institutional actors, that I was becoming a walking, living, breathing embodiment of my research ? that I have become a research instrument myself.    By describing the twists and turns during my fieldwork, other researchers (especially junior academics such as graduate students) can probably learn something negotiating an extensive project and how to be ?open to surprise? during research. The sensitivity, openness, and curiosity to new vistas of research while doing fieldwork is as crucial as the careful formal design of the study itself. The subjects, contents, and products of social scientific research are constantly negotiated by the researcher through his social position among a field of institutions, groups, and actors influencing the shape of the academic and policy discourse in his field.   88   As the narratives and vignettes above show, I was transparent to my informants concerning my status, but the purpose, design, and substance of the research constantly shifted like a ?moving target.? These comments from my key informant and the constant reminders from my supervisors made me think hard about the ethics of doing research: whether I was crossing ethical boundaries by doing comparisons of institutions and countries, and whether I was deceiving people about my ?true interests? which inevitably and constantly changed, or whether I was compromising ?them? for the sake of gathering data and information useful for my research.    While I often assumed that researchers exploring other human subjects (and the institutions which they create and to which they belong) ought to be ethical and that research projects could be set in stone, the fieldwork process made me realize that there are a number of ethical conundrums that could only be recognizable as such after the fact, and that there are twists and turns that cannot possibly be manipulated and controlled prior to fieldwork. In short, a lot of careful compromise and meticulous negotiation must happen before, during, and after research. After all, ethnographic fieldwork is mostly done with people, who have their own vested interests, projects and goals. Moreover, I learned that while we solicit, build, and eventually gain trust among our key informants, in the end, our encounters with them inevitably become part of an ?archive of data? that can eventually be manipulated, controlled, and presented as academic texts. However, I do not look at this process as merely a situation where researchers carelessly and mercilessly misrepresent their informants according to their own pet theories, intellectual agendas, and academic schemas. Instead, I look at ?archives of data? as source and opportunity for us to be more intellectually honest,  89 humble, and open to different perspectives of how institutions and the world ought to look and be, so as to improve the way we think about and describe people, institutions, and the world.   In the concluding chapter, I will reprise my reflections on methodology by discussing how I used ethnography to position myself as a knowledge broker and use my research in pursuit of an integrated knowledge translation. Because of the ethnographic nature of this study, Chapters Four and Seven will be interspersed with extended ethnographic journal entries from my field notebooks from June 2009 to December 2010. I wish to reiterate that these entries ought not to be confused with the quotes I gathered from my primary interviews and the secondary academic literature, nor with the grey areas of information I gathered during the research process (brochures, websites, newspaper stories). Through the process of unraveling multiple perspectives, as well as dwelling upon my interaction with key actors in research sites (some of which already mentioned above), I hope to provide a clearer sense of how various stakeholders from diverse locales form a constellation of actors, an ?assemblage? of knowledgeable experts who shape local, national, and global policies around the recruitment and migration of health workers.  90 PART II   GEOGRAPHIES  91 CHAPTER THREE   Creating Global Nurses  From My Field Journal    It is sweltering hot outside, a typical Manila summer day. With a bottle of ice-cold water, I stand outside the largest mall in the Philippines, the Mall of Asia, along with thousands of Philippine student nurses wearing their white uniforms. Thousands of nurse graduates are being sworn in today and many of their relatives and friends are with them. Mothers and fathers put sampaguita garlands around their daughters? and sons? necks. Cameras flash everywhere. The nurses and their families take pictures of each other. Some of these family members have driven all the way from far-flung provinces. And I can tell they are all excited for today?s big event. I can?t emphasize this enough. Despite the heat and humidity, the sense of excitement ?and the exchange and flow of emotions?is palpable.    From where I stand, I see sea after sea after sea of men and women clad in white nursing uniforms.  Along with the crowd, I am patiently waiting for the cauldron to open. I finally enter the exhibition hall. On the escalator, there are separate lines for guests and inductees. I sit on the corner side of the area for parents and guests. I like observing events from the margins. We are watching the ceremonies through a projector. While sitting down with the parents, I hear a lot of random conversations?mostly complaints on the costs of tuition fees, how hard it  92 was to make their daughters and sons finish nursing school. And then, there?s the ultimate sigh?despite the fact that their children had gone through two major hurdles already, finishing school and passing the NLE (National Licensure Examination)?they would need to go through the worst hurdle: looking for a nursing job in a highly insecure job environment in the Philippines.    Like a running news commentary, these parents constantly talk while the ceremonies are taking place. They complain about the future prospects of their children. One says that apart from the job hurdle, there?s the NCLEX (National Council Licensure Examination) that the students would need to pass if they wanted to try to go to the United States. I can hear another parent gasp: another 135USD! Their lists of obligations to their children don?t seem to end. The parents are projecting their dreams to their children. One father is quite overpowering and says he will do everything just so his child can go abroad. He says that he has a cousin in Canada who can take care of his child?to work and train as an LCP (live-in-caregiver) first?because she doesn?t have experience and can?t get a proper nursing job in the Philippines or abroad. The children are becoming the channels of parents? unfulfilled dreams, of their unlived lives.   The ceremony is now beginning. A number of Philippine nursing leaders whom I already knew from my interviews are in the processional.  Honorific titles for these leaders are being thrown around.  In the duration of this entire event, each speaker (from the opening remarks to the keynote to the closing remarks) recognizes each nursing leader. This oath taking ceremony is not just for the new nurses. It is also for the nursing leaders to make the new nurses recognize who are leading them in their profession in this country.   93   The oath takers are not given much of a voice during the entire ceremony. Apart from leading the Florence Nightingale Pledge, no single new nurse is speaking. So is this pageantry for the nursing leaders to demonstrate who they are and what kind of power they have over the new nurses? The loudest claps in the entrance are for the Philippine Board of Nursing (BON) ? the examiners. The (ADPCN) Association of Deans of Philippine Colleges of Nursing and the Philippine Nursing Association (PNA) presidents also are receiving tremendous applause, as well as various leaders of nursing specialties and interest groups.    There is an opening prayer, an element of most Filipino ceremonies. In her opening remarks, the Chair of the BON highlights the number of examinees: 94,462, the highest in history. Of these, 37,527 passed; at 39.3%, this is the lowest passing rate in the history of the National Licensure Examinations for nurses.   The entire ceremony is filled with allusions to nurses serving the Philippines and serving the world. One key theme is echoing consistently: THE BEST FOR THE FILIPINO, THE CHOICE OF THE WORLD. This is the mission-vision being indoctrinated to the new nurses by all the speakers. It is the slogan of the Philippine nursing roadmap for 2030. The PNA President explains the meaning of this roadmap more explicitly. She also says that the PNA is not just in the Philippines. The organization also has presence abroad. In fact, it has many chapters in the Middle East, North America, Asia, and Europe, and each chapter is accessible to every PNA member overseas. Once a nursing student graduates from a Philippine nursing school, her career trajectory is not just limited to the local job market. The Philippine nurse is indeed a global brand.    One of the speakers highlights the importance of crafting this global  94 brand of Filipino nurses: they are globally competent but with a special added value: Filipino TLC (Tender Loving Care), separating them from the rest of nurses around the world.   One of the BON members is now presenting the inductees. She names each school with successful examinees, ranging from the highly regarded state school, the University of the Philippines, all the way to schools I have never heard of before. After a school named New England College was mentioned, commentaries from parents are running again:  wow, there are students all the way from England? They spent a lot of money just to attend the ceremony?   The ADPCN President is now delivering the Message of Commitment. She says that the kind and quality of nursing education they are receiving here in the Philippines is valued all over the country and all over the world. She instructs them to say out loud: ?I am a Filipino nurse forever.?    After her message, she appeals to the parents: as the new nurses have no money in their pockets, the parents should extend more financial help to them when they eventually seek jobs and transition to their early careers. This addresses the huge elephant in the room: the unemployment and underemployment of new nurses that goes all the way back to 2006. In her words, ?nothing is in their pockets, umutang kayo sa inyong mga magulang (borrow money from your parents), pay back when you are able to ? with no interest.?   She now says that the nurses should support their alma mater. She also repeats the same mantra: THE BEST FOR THE FILIPINO, THE CHOICE OF THE WORLD. She talks about producing humane and globally competent nurses who can deliver quality care. She wants the nurses to show the world the  95 brand of Philippine nursing: TATAK PINOY NA (Philippine Brand) nursing.   She introduces the keynote speaker?the first nurse to become Head Commissioner of the PRC (Professional Regulations Commission), the institution responsible for all the regulated professions within the country. She oversees 43 regulatory bodies.  The Commissioner highlights that she is a part of the team who helped make Manila?s International Pearson Center (IPC) a testing center for NCLEX, giving Philippine-based nurses the chance to take the US exam without the financial costs of going to the US. She calls the examinees MAGNIFICENT SURVIVORS as they just had a mind-boggling challenge?the volume and scale of the exam they took surpassed records in history. It had the highest number of examinees for what was, in her opinion, a very difficult exam. This exam also has the lowest passing rate for the national nursing board exam in a five-year period, but also has the highest passing mark for first-time examinees?more than 50%.    This batch is unique also because a different type of testing was utilized: instead of focusing on theoretical nursing knowledge, the exam?s focus was on critical thinking, an important element in nursing practice where nurses have to make swift decisions and actions in order to save lives. She says that this type of practice-based learning is the global trend, making this batch of nurses globally competent and equal to their counterparts abroad.  She says that the ceremony is a positive experience as it opens the door to their professional practice; and that they should be proud that the two letters R.N. could now be attached to their names.     While the commissioner is talking on stage, another parent at my back comments: R.N. nga, WALA NAMANG TRABAHO (Yes, they may be R.N.?s but they have no work).  96   The Commissioner also says that they should think of themselves as health care professionals in the health sciences. She is prompting them to have a sincere desire to serve. She keeps saying that we are at the cutting edge of new discoveries?and they should not be complacent. Instead, they ought to become lifelong students. The speech turns intensely emotional when the Commissioner requests the parents to stand up. Most of them are sobbing, crying?including the ones who made negative running commentaries. She asks the nurses to stand up as well, to look for their parents on the other side of the convention center, and say: Maraming salamat sa inyo, bukas may trabaho na ako. (Thanks to you, tomorrow, I will have a job).    She urges them to give back to the school, country, and parents whatever denomination they are earning, whether it?s ?peso, dollar, pound, or euro.?  The Commissioner tells them to love their calling with passion. And she urges them to be active in the PNA, and their alumni association. It becomes clearer to me that this is more than an oath taking ceremony; it is also indoctrination for the nurses to become members of their professional association. She then says that the nursing profession is not a joke, as they are dealing with people; and they should choose ethics over convenience, what is right, ethical and true, and have integrity. She ends by telling them to be like Mother Teresa of Calcutta, who was not only a saint but also a nurse.   Then, the PNA President starts to speak. Filipinos are obsessed with rankings?so she pays homage first to the top ranking examinees and schools.  She too says that this is the lowest passing rate in the history of Philippine nursing board exams?with an ironic tone. She highlights that PNA is the only admitted  97 member from the Philippines to the ICN (International Council of Nurses) and they are just a click away; and the new nurses are prioritized in their NARS (Nurses Assigned to Rural Services) Program. She tells them to love their work to make it less of a burden, and be proud: ?don?t say: NURSE LANG AKO (I?m just a nurse), but say I?M A PROFESSIONAL NURSE.?   The PNA wants the Philippines to be the top choice for employers around the world. The organization wants Filipinos to become world-class nurses and deliver the Filipino touch that can make a difference to the lives of the Filipinos here and foreigners abroad. The President says it?s ok to take new citizenships, as long as they retain their being deep ?warm-blooded Filipinos? intact?that they should continue to be inspired and struggle and be proud of what they can offer to the nation and the world.  - March 8, 2010, Manila, Philippines  Introduction     The excerpt above from my field journal covers the new Philippine nurses oath-taking ceremony for those who successfully passed the National Licensure Examination (NLE) in 2009. The narrative gives us a quick snapshot of how Philippine nurses are educated and branded through an assemblage of national nursing and migration institutions. In attending this event, I witnessed an elaborate display ? a pageantry that defines Philippine professional induction ceremonies. I also observed the often unseen and unheard reactions of people participating in such ceremonies. At its foreground, we see a coterie of actors who lead the Philippine nursing profession as  98 well as hear the public messages they send to those who are new to the profession. 22   Beyond the stage, there are other actors who were also crucial in shaping the new nurses? lives. They are the nurses? families and supportive relatives, often instrumental in shouldering the costs of their nursing education, yet just as often put on the sidelines of academic work on nurse migration. This cycle of inter-generational familial debt is normal among Filipino families.  Albeit supportive, families may also put significant amounts of pressure on the nurses to return these initial investments by pursuing financially rewarding nursing jobs?jobs that can never be found in the Philippines but only overseas. These are jobs that become the end goal of a pipeline of dreams that most students finishing nursing school in the Philippines have and will aspire for as they start their professional careers. As an academic ethnographer who also possesses insider knowledge regarding Philippine socio-cultural norms, I became equally sensitive to what can be dubbed as the ?official soundtrack? of the ceremony as well as its ?B side??the often unspoken assumptions and driving forces that give fuller meaning and texture to an event such as I describe above.   The Best for the Filipino, The Choice of the World    This chapter and the succeeding chapter will clarify how the brand mentioned above in the excerpt from my field journal, ?The Best for the Filipino, The Choice of the World? actually gets created on the ground and sustained as I answer three basic questions that informed my inquiry during the sending country leg of my global                                                  22 I am using the present tense for the excerpts from my field journal to capture the ??ethnographic present.??  I am deliberately choosing this writing style for my analysis as well. While the events I wrote about in my journal all happened in the past, I want to give the reader a sense of immediacy and tangibility often not captured through writing in the past tense.  99 ethnographic fieldwork in Manila: (1) Who are the major stakeholders in the recruitment and migration of health workers from major sending countries like the Philippines? (2) What kind of activities do they participate in and what can we ascertain about their interaction with one another? (3) How do they perceive themselves, their roles, and the future of the nurse migration industry in the Philippines and globally? By tackling these three basic questions, I aim to shed light on the concatenation of institutions, events and people that make up this brand.    While I did preliminary research on these questions during my research in Canada, and especially during the time I was living among the Philippine nurses recruited to work in Saskatoon, Saskatchewan, I was largely unaware of the dense, interconnected and web-like network of actors I would soon meet, interview and encounter in Manila.  As I mentioned in the previous chapter, my housemates in Saskatoon mapped out the very institutions that brought them there from the Philippines. As I quickly discovered as soon as I began my Philippine ethnographic fieldwork, there is a myriad of such institutions ? so what I will describe and discuss below is but a finely selected slice of what actually exists in the Philippines. While the actually existing networks that govern Philippine migration and drive the nursing industries are much more expansive than the fraction I interviewed, and the activities and events I had the opportunity to witness were also limited by my time in the field, we will still be able to have a sense of the dynamics between and among these actors as well as the intra-institutional interplays.    Here, I will answer the questions about the institutions in the Philippines through an exposition and analysis of my interviews with a strategically selected Dean of a Philippine nursing school, Philippine state officials in the health human resource  100 and labor migration policy sectors as well as nursing professionals. To strengthen our understanding of these interviews, we will also analyze the way some of their institutional materials and other researchers have framed an understanding of these migration institutions.    I discovered during my fieldwork that these groups of key stakeholders from the Philippines influence the shape of activities around the international recruitment and migration of health workers from the Philippines through their sustained involvement within migration institutions. I ask how actors in this field of power and influence within the area of health worker migration position their knowledge and use their organization?s work in order to produce and broker ?world class nurses? ready for Canadian and global export - ?The Best for Filipinos, the Choice of the World.?  This chapter will elaborate these actors? roles within a sending country context and in light of how the actors and institutions, as well as those external to them and their activities (academic researchers for example), frame themselves as experts. In other words, we will get to know who some of these actors are and through my narratives and interviews take part in their activities through the next three major subsections of this chapter. Branding Philippine Nurses through Global Higher Education looks into the role of actors in the Philippine nursing education system. Fluid Geographies of the Philippine State?s Migration Apparatus, focuses on the perspectives of Philippine state officials in the health human resources and labor migration policy sectors.      101 The Power of Numbers    Before I turn to a fuller analysis, I will first explain the place of quantitative data and statistical information in interpreting the phenomena under scrutiny in this ethnographic study. Here, I do not merely cite statistics relevant to this study, but also point out some of the undergirding knowledge production processes and politics that create these data. In my fieldwork, I learned that the quantification of information is one of the keystones for crafting expertise on the issue of Philippine nurse recruitment and migration.    Experts deploy various kinds of quantitative information in conferences, reports, and PowerPoint presentations to display mastery and authority over the issue ? and their expert claims based on such information circulate around feedback loops among domestic and increasingly, international policy circles.  These processes in turn influences the shape of both local and global policy formation and policy practice on Philippine nurse recruitment and migration.   First, the most obvious question: where do Philippine migrant nurses go? According to recent data from the POEA (Philippine Overseas Employment Agency) three countries dominate as key destinations: Saudi Arabia leads with 56%, the United States comes second at 10%, and the United Arab Emirates ranks third at 4% of key deployments. Note that this ranking considers both temporary migrant nurses as well as permanent nurse migrants. The POEA statistics below depict a fuller picture of where Philippine nurses have been deployed during the two years prior to the beginning of my research:   102 Top 5 Destination Countries of Temporary Nurse Migrants, 2005-2007 Country Total No. Of Temporary Nurse Migrants  Saudi Arabia 16, 533 United Arab Emirates 2, 052 Kuwait 835 United Kingdom 729 Ireland 672   Top 5 Destination Countries of Permanent Nurse Migrants, 2005-2007 Country Total No. Of Permanent Nurse Migrants United States of America 10, 553 Canada 322 Australia 85 New Zealand 21 United Kingdom 20  Source: POEA and CFO data from Lorenzo WHO Report 2008    These tables provide a broad picture of where Philippine nurse migrants have been deployed and give specific context to the place of Canada among the other national labor markets where nurses eventually gain employment. It is worth noting that these data come from two key sources, and are thus derived from different data-gathering mechanisms. On the one hand, the Philippine Department of Labor and Employment?s (DOLE) Philippine Overseas Employment Agency (POEA)  103 provides statistical data on Philippine migrants deployed on a temporary basis in receiving countries. As we will learn more in the next chapter, the POEA has a monitoring capacity to do this as it maintains a registry of Filipino migrant workers who secure temporary work contracts overseas.     On the other hand, the Philippine Department of Foreign Affairs? (DFA) Commission on Filipinos Overseas (CFO) provides statistical information on the number of Philippine citizens who gain employment overseas as permanent residents. This is because the CFO acts as the Philippine state agency responsible for overseeing the welfare and activities of Filipinos who are emigrants and permanent residents abroad, including those who reside in Canada. It facilitates the creation of Philippine immigrant associations. As a socio-cultural agency, it actively links second-generation Filipinos to the Philippines through the provision of a Philippines-based curriculum overseas and educational exchange programs in the Philippines.23 The CFO heavily monitors this information by requiring every Filipino who has or will become a permanent resident to attend a ?required? pre-departure orientation seminar (PDOS) and/or a peer-counseling seminar, in accordance with Philippine labor laws (specifically Article 19 of Presidential Decree No. 442, the Labor Code of the Philippines).24 Upon completion of these pre-departure orientation seminars, emigrants receive a CFO sticker, which need to be shown to Philippine airport immigration officials prior to departure. Failure to obtain the sticker (even with a permanent resident visa) would result in a refusal to exit the Philippines.25                                                    23 To understand the role and functions of the Commission on Filipinos Overseas, see:  24 Article 19 of Presidential Decree No. 442.   104   To be clear, while temporary workers are only issued temporary working visas in their destination countries, permanent residents are given permanent resident visas that also entitle them to employment. State institutions facilitating the migration and recruitment of Philippine migrant workers produce the quantitative data about Philippine migration realities that researchers often quote. The CFO and POEA serve different functions in terms of managing and regulating the flows of migrants (including nurses) from the Philippines. I discovered during my fieldwork that in terms of quantitative data specific to Philippine nurse migration and overseas recruitment, it is the POEA that collects, manages, and stores such information through the reporting mechanism called OFW (Overseas Contract Worker) Statistics. OFW Statistics has four (4) subsections: (1) Compendium of OFW Statistics, (2) Deployment Per Skill Per Sex, (3) Deployment Per Skill Per Country Per Sex, and (4) Deployment Per Skill Per Sex Per Country.26    Upon extracting information from these four databases, we can identify the number of Philippine nurses who have moved to work in Canada from 2000-2009.  Under POEA statistical classification, nurses belong to a major occupational group called ?Professional Technical and Related Workers.? In APPENDIX C (Deployment of Philippine medical professionals and social/health service workers to Canada, 2000-2009), I specifically focus by statistically presenting the occupations related to medical, health, and social services in what is broadly termed as ?carework.?                                                    25  26  To further understand how the POEA tabulates and classifies statistical information about Philippine migrants, see: ?  105   Apart from information collected and produced by the POEA and the CFO on Philippine migration, there are other sources of quantitative information relevant to understanding the broader context of Philippine nurse recruitment and migration, particularly in understanding and analyzing the distinct role of nursing education and regulatory institutions. Compendia of statistical and quantitative information on Philippine nursing called Nursing Competitiveness Indices were gathered annually through a series of two key conferences during my fieldwork in 2008 and 2009. They were presented and circulated at the First and the Second Nursing Competitiveness Conferences, which gathered key Philippine nursing leaders in the area of nursing education and regulation to address the issue of ?competitiveness? of Philippine nursing. As ?competitiveness? was conceived in local and global terms, another key sector represented were decision makers and practitioners in the area of overseas recruitment and migration. The majority of the keynote speakers for both conferences, all key Philippine state migration and nursing actors, was interviewed for this thesis.27    The theme for both conferences, ?Global Competitiveness in Nursing for National Development,? suited the local and global aspirations of Philippine nursing. It also reinforced the same theme of the Philippine Nursing Roadmap for 2030 that was the key message of the induction ceremonies I attended: ?Best for the Filipino, Choice of the World.? The specific vision of the Philippine Board of Nursing (the examining and regulatory body for Philippine nurses) speaks directly to these themes: ?By 2030, Philippine Nursing shall be a top provider of world class, EXCELLENT CARING,                                                   27 For a detailed report, see:,0,780  106 significantly contributing to the well being of Filipinos and people of the world.?28  These themes and vision statement are not mere wordplays. They point our attention towards the well-coordinated efforts and encompassing political economic vision by Philippine nursing institutions in marketing Philippine nurses to the world. The conference was hosted by the Presidential Task Force on the National Council Licensure Examination (NCLEX), which in turn was headed by the Commission on Filipinos Overseas (CFO) and the Institute of Health Policy and Development Studies of the National Institutes of Health (NIH).    It is crucial to briefly explain why the CFO hosted this effort. The Presidential Task Force on NCLEX was a special committee that was formed through Executive Order (EO) 550 to lobby for the possibility of instituting the US regulatory exam, to be administered by the National Council of State Boards of Nursing (NCSBN) in the Philippines.29 The reasons given by this Executive Order for instituting the NCLEX exam locally are: (1) the exams are already instituted in test centers outside the United States: Hong Kong, Korea, Australia, Canada, Germany, India, Mexico, and Taiwan; (2) Philippine nurses constitute the largest number of NCLEX examinees, and 83% of all foreign educated nurses in the United States; and (3) because instituting the exam in the Philippines would financially benefit Philippine nurses, sparing them the necessity of traveling to the United States just to take the exam. Upon the NCSBN?s agreement, the Philippine government would then logistically support the creation of such centers, as well as ensure the integrity of the examination process on Philippine soil.                                                    28,0,780  29 To view EO 550, see:  107   In other words, the Philippine government used the logics of precedence, quantity, and cost efficiency to persuade US authorities to bring the NCLEX to the Philippines. The Philippine government?s practical agenda for the localization of the NCLEX is deeply tied with its efforts to manage the recruitment and US-bound migration of Philippine nurses to the US, by making them qualified to practice there even before they secure job offers in US health care institutions. This is clearly manifested in the CFO?s role as the lead agency for the Task Force (as opposed to a health or nursing-related state institution) and key coordinator of conferences specifically addressing the issue of nursing competitiveness. In his keynote speech for the 2009 conference, the former CFO Commissioner gives us an overview of the concerns of the Philippine nursing/migration sector: ?Our involvement with the nursing profession started with the Presidential Task Force on NCLEX, which we were asked to head. We have carried out our primary goal of persuading US authorities to establish an NCLEX testing site in the Philippines. We could have stopped there, but we did not. Realizing that we could do more, we have taken the challenge of shaping and influencing the policy environment necessary to enhance and maintain our nurses? global competitiveness. Hence, we organized the 1st Philippine Nursing Competitiveness Conference in 2008? That conference provided an opportunity for the Task Force NCLEX and the other players in the nursing profession and industry to attain a consensus on issues such as nursing practice regulation and employment, nurse migration and ethical recruitment, qualification of Filipino nurses, competency development and technology transfer, and the identification of effective strategies  108 to address the competitiveness of Philippine nursing.? (CFO Commissioner)30              The five key areas of concern that were covered by the Philippine Nursing Competitiveness Conference in 2009 were: (1) regulation of Philippine nurses; (2) employment of Philippine nurses; (3) Education, training and development of Philippine nurses; (4) Nursing practice, leadership and governance; and?the most directly relevant?to this thesis; (5) Nurse migration management and recruitment. These were the very same issues I had identified as crucial to understanding the role of the Philippine state and Philippine recruitment and nursing sectors, issues that defined the course of my fieldwork.    During my research, I obtained copies of PowerPoint presentations given by the keynote speakers for both of the conferences as well as the Nursing Competitiveness Indices. These presentations and indices served as a repository of quantitative information that provided a general backdrop to the substantive issues under the core themes above. Throughout this chapter, I will heavily rely on these indices for secondary quantitative information.31  In addition, I will also refer to the presentations as a source of secondary qualitative information for the purpose of triangulation.                                                       30 The Commissioner?s speech can be found at:   31 See:  109 Branding Philippine Nurses through Globalizing Higher Education    In the event I narrated through the excerpt from my field journal, we see how a very distinctive message ??The Best for the Filipino, The Choice of the World? ? the particular brand of Philippine nursing that the Philippine nursing community wanted to project, was reinforced multiple times. This branding mechanism has helped create a sophisticated marketing strategy for the globalization of job opportunities for Philippine nurses. It provides a clear signal as to what the Philippine nursing profession is geared for. Philippine nurses may be locally trained, but they are globally attuned. The industry produces professionals who are not only meant to serve the domestic population?s needs, but also the human resource needs of the global health community.    This branding mechanism is far from new: it can be traced throughout the colonial history of Philippine public health institutions as well as nursing and medical education. As I discussed earlier, the Philippine brand of nursing was an initial product of a long history of local and global exchange that started with the colonization of the Philippines by the United States from 1898-1950s (Choy 2003). Prior to the arrival of the Americans in the Philippines, the public health infrastructure throughout the country was severely limited (Anderson 2006). Under Spanish rule, health professional institutions were particularly focused on medical education, and typically allowed access only to male members of elite Filipino families. Through the formation of nursing schools and the professionalization of nursing, the American authorities created and supported a public health system initially built with the key intention of dealing with white American bodies? exposure to tropical diseases  110 (Anderson 2006). The creation of a nursing education system subsequently opened the doors for Filipino women from both middle and upper class backgrounds, to gain entry into a health profession that was previously inaccessible to them owing to the male-dominated nature of Philippine medical education during that period (Choy 2003).   The legacy left by this complex and much contested colonial relationship is still very much present in the current institutions that drive Philippine nursing and nursing migration industries. So before turning to any contemporary review of such institutions and the actors that inhabit them, we have to first acknowledge from the outset that there will always exist traces of this colonial legacy?from curricula designed and delivered by nursing schools all the way to the orientation and primary preference of private recruitment agencies towards the US nursing labor market.  In other words, while attuned to the global and emerging new markets for Philippine nurses, the core outlook of these contemporary institutions in preparing new nurses both in the educational contexts as well as the recruitment process remains US-orientated. The focal receiving country that this thesis aims to understand, however, is not the US. It is Canada. This is because it became apparent to me that recent shrinking nursing labor demands in the US have provoked the Philippine state and private recruitment agencies to make their institutional structures even more fluid and flexible, primarily by systematically expanding their reach to Canada through the forging of bilateral agreements. This fluid and flexible nature of the Philippine public and private institutions can be viewed as a way for them to manage entrepreneurial risks in the context of the contemporary global financial crisis. The combination of these historical and socio-economic factors has driven the Philippine state to further  111 enhance its already-working migration management program through the coordination of its various institutions, as well as the clear marketing strategy which promotes the idea that the Philippines produces nurses not just for its own needs, but for the world as well.   Alongside recruiters and the Philippine state, the nursing education system is a key player in the production of professional nurses. While only indirectly responsible for the recruitment and migration of Philippine nurses to Canada, Philippine nursing schools have had a significant impact on shaping the attitudes and career opportunities of nurses educated in the Philippines. Outside their families that facilitate (through providing support for their tuition fees and living expenses) and influence (through social pressure or sheer expectation) Philippine nursing students? decision-making process to choose nursing as their career track, nursing schools are the first social institutions with which they come into contact, and thus are among the first to formalize their professional preparation. Nursing schools are also where they form initial bonds with other student nurses, learn directly from nursing professors, and start the process of ?dreaming? where they ultimately want to practice nursing. Nursing schools are spaces for social interaction, and inevitably, intense social comparison?as each student plots out his or her future.    Due to constraints posed by my research questions during my fieldwork in the Philippines, I did not focus a lot of my attention on the plethora of nursing schools currently existing in the Philippines. However, I had the opportunity to interview the Dean of the most reputable and competitive nursing school in the country, the University of the Philippines College of Nursing (UPCN) in Manila. The UPCN is the nursing school of the country?s premiere public university system, the University of  112 the Philippines (UP); and with only 70 freshmen slots (increased to 75 during the year of my research) available per intake, it is also the most selective of all the nursing schools in the country.    The positive scholastic and professional reputations of UPCN graduates are well known in the country. Graduating seniors from Philippine high schools compete to secure nationally coveted slots at the University of the Philippines system, through the University of the Philippines College Admission Test (UPCAT). Nursing, apart from the INTARMED, or Integrated Liberal Arts and Medicine program (an accelerated 7-year combined degree in pre-medical courses and medicine proper), is at the very top tier of UP?s quota courses. Therefore, only the best and brightest students who possess excellent UPCAT scores and weighted high school grade point average (GPA) eventually get in. In my interview with the Dean of UPCN, I inquired about the quality of UPCN and the concurrent demand and constraints for a public nursing school:    Lawrence: So what are UPCN?s admission rates?    Dean: We go by a quota system.  We only accept 70 slots, maximum of 75 and we increased it to 75 when there was a great demand just to accommodate politically, to show we are?I said, ?Good will!  Let?s increase by 5.?  The point is, what?s the reason for increasing?  The increase should be at the same time paralleled by an increase in resources and opportunities:  increase in the numbers of teachers who are equally as competent as the others, resources, and etcetera.  So if you?re not increasing that?and it?s difficult to increase because everybody was trying to become pilot teachers left and right.  Second, the regular nurses would experience?some are already moving and some are migrating so it was becoming  113 more and more difficult to get qualified faculty, right?  So if we can?t do that and we ourselves were affected by a shortage of teachers, what is my justification for increasing that number of students?  And that is the reason that we were giving to increase the slots. L: How many students apply? D: At the height, around, maybe, 2005-2006 we had as much as 14,000 applications.   L: Recorded through UPCAT, the University of the Philippines College Admissions Test? D: Recorded through UPCAT.  Through UPCAT, 14,000 students wrote Nursing as their First Choice.  And that means that the ones who finally get in are normally more academically adept ? cr?me de la cr?me.  And at that time the ones who would normally take medicine were opting for nursing as a pre-med so the effect was academically good but it didn?t necessarily translate to very good nurses because they had very different motivations.     Because of UPCN?s position among all the nursing schools in the country, its Dean and professors influence the changes within Philippine nursing education. They hold powerful positions not only in nursing academia, but also in the regulatory system that sets the standards for Philippine nursing at large. As it is one of the few publicly funded nursing schools in the country, the College?s thrust also includes a strong sense of social responsibility. In fact, during my fieldwork, the UPCN unveiled a new directive that would bond nursing students who graduate from the school to work in the Philippines for two years. This bonding scheme (a Return of Service Agreement)  114 has been in existence in the University of the Philippines? College of Medicine, but the nurse migration phenomenon made the university rethink its commitment to serving local needs. Bonding schemes are seen by some researchers in the health human resource field as one way to mitigate the negative consequences of migration, a practical solution especially for UPCN graduates and other health workers whose studies were highly subsidized by their governments (Eyal and Hurst 2008). The Dean explained:   L: Is there a return of service requirement for UP nursing graduates?     D: There really is none but it is something that we tell them?that you have a responsibility to the Philippines. But I changed my tune.  Since I became Dean maybe after one year?that?s where I had my own shift in thinking?I said I cannot stop them from going abroad but my request is that they stay and work first, gain experience to gain maturity before they leave.  In other words, I?m not saying, stay for the Filipino people and stay because of your nationalistic social responsibilities.  I say, stay for your own needs.  I changed my views and I?m sincere about it.  I?m not just putting it like that.  It?s actually for your own sake that you should work first before you go.  I even talk to the parents already.  In UP we don?t normally talk to the parents.  I can imagine that in Canada and the US, once you?re 18 the person is responsible, right?  But in UP, even if we?re not as clear as that in the Philippines, you?re very autonomous, the student.  We hardly talk to parents but now during the freshman orientation, I ask to meet the parents or whoever and then I said there?s a separate session with parents, and not just invite them to the orientation.  At first I was just inviting them and saying this and then I also had a session with the parents because the parents are the ones, or the family  115 abroad, who sponsors their education and usually are the ones pressuring the students to go abroad.  So I said, we need to partner in this because it?s what they need.  They themselves have to be convinced that it?s for the good of their daughter or son not to let them get out of the country right away? Although there?s nothing right now but that, we?ve started something new.  We?re starting a new policy, which will take effect next school year, not this school year because it?s too late. We will implement it in the following year, 2011-12.  We?re calling it an RSA (Return of Service Agreement).  That one is going to be mandatory.    L: For nursing or for medicine?   D: Medicine started it and we worked at it here in UP Manila.  Most of the health disciplines colleges will participate in it.  I was very supportive of it.  Nursing was very supportive of it.  It will be a requirement for admission, so they go through the process but they will have to continue in the process of the admission.  They will have to sign that they agree to that agreement.  So it?s not really mandatory but if you want to come in to nursing, it?s only those who would agree to it.  It?s an agreement.  And since nursing is four years, for us it will be two years mandatory return of service.   L: It actually makes sense with nursing.  I?m also interviewing the employers in Canada.  They wouldn?t really accept students who don?t have two years? experience from the Philippines anyway.     D: And some countries ask for three years, so anyway?  The one good thing I?ve realized is you need to tell them such information because it doesn?t register in most of their minds.  If you don?t start them right from the very beginning, people give so many different types of information and remember, we?re not only about  116 Canada.  Canada is a recent thing so sometimes?it?s the US and other countries.  In many cases they will really ask for experienced nurses.  Sometimes people tell them different things and then they waste their time and then they?re not applying because they?re waiting for an application, which will never happen so you have to prime them and not waste time.   L: I believe some of the recruitment agency will bend backwards just to give them false information because they will earn something in the process.     D: Or some, they let them apply to them and then while waiting for an opening?so they?ve already committed to a recruitment agency.  So I said, don?t do that to yourself.   In the excerpt below, the Dean explains her role? in the context of a national scandal that brought to the fore issues endemic to the massive expansion of the nursing profession in the Philippines, seen in the jump of the number of nursing schools within the period of only a decade:   D: My main role is that I?m the Dean of the UP College of Nursing and as a Dean of the College of Nursing you take on, unlike the other schools and universities, a very strong sense of social responsibility.  The other is we are a WHO collaborating center for nursing leadership and development in the country and being a collaborating center is a regional thing.  It means you have mandate over many other jurisdictions? in our case, we are the center in the Western Pacific region. We?re actually the first collaborating center of the WHO since 1987. And so then I personally feel as Dean, I?ve taken the role very seriously.  The other is when I became Dean it was the height of the different concerns in migration and the great demand for Philippine nurses and the explosion of the number of schools  117 for nursing in the Philippines and so we were faced with issues that previous Deans did not have to face.   L: That?s basically relating to the standards of education. D: Standards of education and then in relation to responsibilities of the school in terms of employment and what is the main reason, philosophy behind the school.  Are we just there to develop nurses for abroad or to even just develop nurses irrespective even if we know that students are just taking it for the sake of money and foreign employment and so forth?  Also in 2006 a very major issue popped up in the Philippines so that threw us right in the middle of a controversy or scandal where I personally felt was something that we needed to address immediately and properly, otherwise we?ll have permanent ramifications not only for going abroad but also in addressing the standard of nursing education in the country.  At the time, we were saying, ?anyway, we are only affecting those who will leave the country.? No, it will also affect the kind of nurses we have in the Philippines.  So it will be something that will affect all of us.  Even prior to that, I was already getting involved little by little in migration but mainly the nursing education side.  But because of the past trait of migration and demand, I already was starting to address that there is the responsibility of the school in also determining or influencing the kind of employment our students will get into, not necessarily for monetary interests of the school, because the others, they go into partnerships with other recruitment agencies, with other hospitals that recruit nurses and they earn something from it.  For me, it?s more of?we have a responsibility to our graduates.  We have to make sure they?re employed?and gainfully employed and properly employed?and that they fulfill the standards that we are developing nurses for,  118 so if I just think that our college is responsible only after graduation, I don?t think that is true.   In the quote above, the Dean alluded to several core issues in Philippine nursing which stem primarily from nursing education, and which pose direct consequences to the perception of future recruiters and employers at home and abroad. Two significant issues are worth noting here. The first is related to a massive cheating scandal, where the President and a few members of the Philippine Board of Nursing (the nursing regulatory body) leaked board exam answers to an owner of a business chain of review centers in exchange for monetary gain. The exam answers ended up in the hands of examinees reviewing in the owner?s review centers days before the exam date, and a group of students decided to report the incident to their schools and the media. I will describe this incident further in the final section of this chapter, as it has affected recruiters? perception of the particular batch of students (known as the 2006 exam takers) during the recruitment process.    The second issue points to the massive increase of Philippine nursing schools in the last decade, which, in the view of the Dean of the UPCN and other Philippine nursing leaders, has caused concerns about an overall dilution of nursing education standards. A key consequence of this dilution was, as mentioned above, the lowest-ever passing rate for the NLE, unprecedented in the history of Philippine nursing. Entrepreneurs who lacked the expertise and personnel required to run fully functioning nursing schools initiated the majority of these new nursing schools. These entrepreneurs saw a significant business opportunity in the nationwide increase of prospective Philippine university students seeking a nursing education, particularly in the 1990s and the 2000s. The following sections of my interview with the Dean  119 highlight these findings:    L: Did the mushrooming of these nursing schools negatively affect UP?  I?m sure it?s still the top choice among high school students?because you have a very strict set of standards to admit students to begin with.   D: I would think it did not affect us in the sense that it did not affect the number or the quality of people trying to get in.  By itself it did not affect it.  Let me think more.  It?s got to be affected somewhere but it?s not the number of schools but it?s the overall demand for nursing.  What got affected were the motivations of the students who applied to nursing.  So just like everybody else they had their own fair share of students who wanted to go into nursing for reasons other than serving people and helping people.  So that is what we are facing?a motivational crisis... On our side, and I still say, a big part of what happened in the dilution of the standards of nursing education in the country, had something to do with the failure of regulation of schools because we overproduce, we over-opened, over-supplied nurses.  And necessarily by increasing just through sheer numbers, obviously the quality will go down.  You have so many schools. Every school will need a Dean and a full faculty.  They started to get people, who, by virtue of just the minimum requirements, became Deans.  And then they started to need a lot more faculty who were not normally going to become faculty.  And then they started to recruit from nurses in the hospitals who moved to education and therefore depleted the hospitals and institutions of experienced nurses.   L: So they became clinical instructors.    D: So now you have the hospitals with very new nurses and our students go to these new? Our training of nurses is very different.  It?s highly dependent as well.   120 It?s highly influenced not only by the teachers in the school, but also by the clinical areas where they go.  You cannot say, ?Don?t look at it.  Close your eyes!  You look here.?  No matter how we do it, they will see and be influenced by the level of care and services that they?re exposed to.  So slowly, we?ve seen a decline also in the standards and the quality of services in the hospital.     L: It?s very co-dependent.   D: It?s co-dependent.  So when they start to blame education, they?re all interconnected.  They?re all interconnected so if we don?t deal with this in a more holistic, systematic approach we?re all going to go down the drain.   L: What do you think?  Should there be stricter regulations for nursing schools?  Where?s the enforcement going to come from? So CHED Commission on Higher Education should be able to ferret out all those nursing schools?   D: CHED should have more political will to really implement the standard, number one, in opening our schools, and number two, in monitoring, and finally, in closing schools.   L:   There are 472 nursing schools now.  So what do you think would we create an optimal balance?  If we just have, say, 100 or 150?   D: I wish I had the numbers showing the performance in the Board Exam.  Board Exam is the only objective indicator.  I?m not saying it?s the best indicator but it?s the only thing we have.  If you will gauge based on the numbers from the last time they published?they did not publish?because they should come out with data showing the average performance? Actually CHED comes up with it using the date of BON so they point to each other.  They point to each other.  I still say each of them have something to do with it.  Even if you?re just a  121 recommendatory institution, you should do your recommendation.  Did you recommend or endorse schools to be closed?  Did you follow through if you endorsed that it should not open?  Why did it open and why did you not call CHED and ask, ?We did not endorse things.  We would like a review of this because we did not endorse this.?  They keep pointing to each other and say, ?Oh, we have to change the law.?  I?m saying, whatever you have, the powers that you have and the mandate you have, there?s a way of enforcing that.     L: I?m just wondering what?s an optimal number.   D: I discussed these issues above so you have an idea where I?m basing it.  They came up with something a list of the outstanding schools, top performing schools, and then they have high performing schools, average performing schools.  That?s from the 80 and above, maybe.  Maybe average is from 60 to something.  So let?s make it from 60% and above.  I would think there are only about 50 to 70 schools.  Let?s make it 100.   L: Some schools accept so many students, right. D: They accept many students and they have an open admission policy.  So they don?t even screen.  As long as you want to be a nurse, you?ll be a nurse even if some people are not?it?s not only aptitude for nursing.  Some people don?t even have the aptitude for college.  And then some schools will kick out some students and then there?d be a school that would accept them.  They?re kicked out and some school will accept them.  It?s really hard to say but to give you an idea?in 1998 we only had about 168 schools.    The jump from 198 nursing schools to 472 at the time of my fieldwork had become a social and political concern among nursing educators and state legislators  122 who were keenly aware that this rise in number would only lead to the deterioration of Philippine nursing education?and, as a result, the global perception of the quality of Philippine nurses. It is worth noting how this trend slowly changed during the course of my fieldwork from 2008 to 2011. The majority of nursing graduates (whether or not they passed the Nursing Licensure Exam) could not find jobs in the public and private sectors in the Philippines; due to the visa retrogression issues and the global economic recession, they also failed in securing job opportunities in the US and in other countries. Because of this macro socio-economic context of nursing unemployment and underemployment, a new trend emerged, wherein nursing graduates started taking ?second courses? (usually in a related health care profession such as midwifery, physical therapy, occupational therapy, or pharmacy) to expand their job opportunities locally and overseas. While this was happening, attention towards the quality of nursing education also became heightened. The closures of nursing schools and the decline of interest among entrepreneurs to open new nursing schools were thus not the direct result of government regulatory standard, but of shrinking local and global job markets.   Geographies of the Philippine State?s Migration Apparatus    The mechanisms produced by the Philippine state through its migration institutions contribute to the perpetuation of a culture of migration informed by state entrepreneurialism, one where the state leads and develops strong partnerships with enterprise to sustain the delivery of social services (such as health care and employment assistance) while increasing profit. State entrepreneurialism goes hand in  123 hand with the neoliberal structures that have historically defined the Philippine state and its relationships with private enterprises. These structures were partly a result of the historical influence of American-style institutions, which were perpetuated by Philippine political and economic elites (in the public and private sectors) benefiting from the neoliberal state structures and ideology. Such conditions and ideology produce and permit the now-commonplace global idea that the Philippines is the ?source country? and ?natural place? to recruit internationally educated nurses.32   The main agency that leads the Philippine state in its entrepreneurial thrust of addressing employment issues for Filipinos within and outside the Philippines is the Department of Labor and Employment (DOLE). A stand-alone agency attached to DOLE is the Philippine Overseas Employment Agency (POEA). The POEA serves as the key ?overseer? of the migration of Filipino workers around the world, including nurses bound to Canada. Among all of the ?key institutions? in the Philippine state?s ?transnational migration apparatus? (Rodriguez 2010, xii) responsible for the recruitment and migration of Overseas Filipino Workers (OFW?s), the POEA is the most cited and deeply scrutinized by migration scholars. (Rodriguez 2010; Guevarra 2009)    Created through Executive Order (EO) 797 by former Philippine President Ferdinand Marcos on May 1, 1982, the POEA aims, as per its current vision, for ?excellence in governance for world class Filipino migrant workers? accompanied by a mission to ?connect to the world, in partnership with all stakeholders, facilitate(s) the generation and preservation of decent jobs for Filipino migrant workers, promote(s)                                                   32 However, I show that such idea is produced by these actors with the intent of profiting from both these activities.   124 their protection, and advocate(s) their smooth reintegration into Philippine society.? (POEA Annual Report 2010) The Head Administrator re-echoed this vision-mission to me during an interview:  ?Our task is specifically to oversee the migration of Filipino workers to countries. Now we have listed about 120 destinations, these are not countries of course, but destinations. And one of those destinations is of course Canada.? (Interview with POEA Head Administrator, March 2010)     Interestingly, the annual report quoted above celebrated 2010 as the ?Year of the Tiger, ?interspersing data with images of tigers. This imagery suggests the political economic projection and outlook of the current Philippine government, led by President Benigno Aquino, Jr., regarding the country?s imminent future as an ?Asian tiger economy.? This is a curious shift from celebrating Overseas Filipino Workers as ?national heroes,? the more traditional and common way of depicting OFW?s in Philippine government publications. Enthusiastically praising OFW?s for their role in fueling the domestic economy, the front cover of the report says: ?The tiger requires a vast habitat that supports its food requirements. It moves stealthily without bravado in a global jungle fraught with dangers. Until, suddenly, it makes an energetic leap for food that will nourish itself and a pride back home. Tigers have figured prominently in mythology and continue to be depicted in flags and heraldry. Through our cover?the mythical tiger head?POEA extols OFW?s and the tiger economy that they usher.? (POEA Annual Report 2010)   This discursive shift, read and found throughout the POEA?s annual report, reframes the OFW from a ?hero? to a ?tiger??surfacing the intent of the state in  125 creating and manufacturing an image of the OFW as an economic animal able to survive the stressful hardships presented by the current global economic recession. The tiger is a prominent Chinese and Asian mythological figure of economic prowess. Here it becomes a symbol of hope for a domestic economy largely depending on sending resilient migrant workers abroad. Casting migrant workers as ?tigers? allows the Philippine state to reconfigure their national heroic role in tandem with the re-imaging and re-imagination of the Philippines as a new tiger economy.  The symbolism aptly describes how Philippine migrant workers are sent out in an uncertain world (?the jungle?), expected to return to the homeland to send remittances or bring home remittances (?food?). After explaining the ?feng shui? meaning of the year of the tiger, the annual report further expounds the role of the migrant worker in keeping this ?tiger economy? afloat: ?During the 2008 global financial crisis, the Philippines was one of a few countries that managed to avoid recession. It may be partly due to minimal exposure to toxic securities but what kept the country afloat was the large amount of remittance from millions of Filipinos working overseas. GDP slowed down to 1.1 percent during the crisis, but rebounded to 7.3 percent in 2010, a 34-year high in the Philippine economic history.? (POEA Annual Report 2010)   Whether the Philippines did avoid the global recession is highly debatable, but this quote, which informs and frames the rest of the report, depicts a country that managed to sustain a positive economic outlook despite the presence of an economic global recession that continued until 2010. This optimistic outlook is even clearer in the opening section of the Administrator?s report, where it was stated that in the year 2010 alone, OFW?s remitted a total of $18.6 billion USD (820.4 billion PHP) which grew  126 by 7.3 percent from the previous year, representing 10 percent of the country?s GDP. In the same period, remittances from Canada (from both land-based and sea-based migrants) totaled $2,022,611 USD, a 6.4 increase from the 2009 total of $1,900,963. In an interview with a key staff member of the POEA, I was informed of the POEA?s role and scope of responsibility in the migration of Philippine trained nurses (and other workers) to Canada. The same interview allowed me to understand the POEA?s position in terms of how it affects and influences this migration: ?The POEA is the central government agency under the Department of Labor and Employment (DOLE), which regulates overseas employment. As such, we exercise primary and exclusive jurisdiction over overseas recruitment, employment, and recruitment-related activities. We make sure that all workers who intend to leave the Philippines for work abroad undergo POEA processing and documentation. The POEA as a regulatory body exercises quasi-judicial functions and imposes administrative sanctions against licensed agencies found violating POEA rules and regulations. The POEA is also mandated by Republic Act (RA) 8042 to provide legal assistance to victims of illegal recruitment, which is done through the Anti-Illegal Recruitment Branch. It is also a member of the International Council Against Trafficking headed by the Department of Justice (DOJ). Being the focal agency on overseas recruitment, the POEA influences the migration of Philippine-trained nurses and other workers through the formulation and implementation of rules and regulations and the propagation of information materials that will guide potential OFW?s in their chosen field. Information (especially on employment restrictions and in-demand jobs) coming from Philippine posts all over the world are processed by the POEA and disseminated to the public through advisories and  127 Memorandum Circulars. A potential OFW is assisted from decision-making (through the Pre-Employment Orientation Seminar or PEOS) to processing and until he returns to the country at the end of his contract.? (Interview with Senior Policy Officer, POEA, April 2010, Manila)   In terms of the POEA?s view on the current state of nursing education, training, retention, and migration in the Philippines to Canada, the officer states that: ?The nursing profession is an in-demand college and university course in the Philippines. There are more and more nurses who desire to leave the country for overseas employment as it offers higher salaries compared to a local job and opportunities for potential migration for the OFW?s and their families. This apparently triggered the upsurge of educational institutions in different parts of the country offering nursing programs. From only 170 schools in 1999, the number increased to 470 in 2005, and even more now in 2010. From the standpoint of overseas employment, there is an active migration of highly qualified nurses leaving for work abroad, hence the issue of brain drain. Given the ample supply of nurses domestically, it would seem, however, that the lack of nurses in our local health care system is not the direct result of labor migration but of many other factors such as unattractive working conditions and lack of benefits. The POEA, in coordination with the DOLE and DFA, is working towards the forging of bilateral agreements with destination countries of our health professionals that will promote ethical recruitment practices and bring about recruitment conditions to both sending and receiving countries. These bilateral agreements will develop implementing mechanisms for supply replenishment, reintegration through skills/technology transfer, which are brain gain schemes.? (Interview with Senior  128 Policy Officer, POEA, April 2010, Manila)   When I asked the officer his opinion about Canadian health regions recruiting Philippine trained nurses, he responded: ?The recruitment of Canadian health regions for Philippine-trained nurses is a positive development in the Philippine nursing profession because it promotes the Philippine nursing profession. The recruitment process is just and ethical because of the human resource development cooperation component in our bilateral relations with Saskatchewan, British Columbia, Manitoba, and Alberta to ensure sustainability of supply and human resources in the Philippines. The MOU with these Canadian provinces has good potential for migration to contribute to the human resource development needs of the country through education and training programs that will be implemented to compensate for the loss of skills resulting from the migration of workers to Canada.? (Interview with Senior Policy Officer, POEA, April 2010, Manila)   I then inquired about the POEA?s view as to what ethical and sustainable recruitment actually means for a developing country like the Philippines to a developed country such as Canada: ?Ethical and sustainable recruitment of nurses from developing economies like the Philippines by developed economies like Canada means that there is mutual recognition of rights and promotion of sound recruitment practices through mechanisms that support a healthy exchange of information and human resources. An unethical and unsustainable recruitment limits the opportunities for Filipino workers to develop their craft and does not recognize the inherent rights of migrant workers to just compensation and good working conditions.? (Interview  129 with Senior Policy Officer, POEA, April 2010, Manila)   The most controversial question I posed was regarding the idea of compensation, and whether Canada ought to compensate the Philippines because of its health human resource drain effect. The key official responded affirmatively: ?Yes. Our bilateral agreements with Canada mention exchange of cooperation and human resources through education and training programs. These programs are being implemented to compensate for the loss of skills resulting from the migration of Filipino workers to Canada. Continuing dialogues relative to concerns on the nursing profession, including the institutionalization and operationalization of ?giving back? programs and delivery mechanisms between the Philippines and Canada are encouraged.? (Interview with Senior Policy Officer, POEA, April 2010, Manila)   He further expounded on the advantages and disadvantages of recruiting Philippine-trained nurses to Canada, both to individual nurses and the Canadians who receive direct care from them: ?The advantages include increased remittances, acquisition of new skills, access to technology, facilitating continuous transfer of technology, improved standard of living, opportunity for permanent migration, and higher compensation compared to local jobs. Disadvantages include the fact the Philippines loses valuable human resources in the form of highly skilled workers (?brain drain?); the social repercussions (disruption of the family such as extramarital relationships); national government losses including inadequate funding for the development of health system infrastructure because available health resources are spent on the training of staff replacements; and finally, government income from taxation in  130 the provinces and the country as a whole is reduced because of the permanent migration of health professionals.? (Interview with Senior Policy Officer, POEA, April 2010, Manila)   The POEA official also highlighted the social, economic, and political benefits and costs of the migration of Philippine-trained nurses for the Philippine and Canadian health care system - in particular, the health regions where the nurses were deployed: ?The brain drain or phenomenon of well-educated professionals permanently migrating from developing to industrialized countries is a political and economic cost of migration, which on the other hand is compensated by the return of remittances. Health care professionals leave for overseas employment opportunities because of better opportunities. Perceived gains and losses to health worker migration? Migration is considered beneficial as it improves the quality of life of the migrant and secure the professional future of the health care migrants and their families. However, there are also considerable social losses incurred as a result of this situation. The healthcare system is more fragile as a result of rapid turnover and a permanent loss of skilled and experienced health workers, which affect the continuity of care and quality of services provided. Further, unmanaged migration mitigated the ability of healthcare professions to renew their ranks with the migrating educators and trainers. Social repercussions could also not be discounted such as disruption of the family and its possible consequences such as drug abuse among poorly supervised children as well as incest or extramarital relationships caused by the absence of a migrant spouse. Any economic gains are likely to be wiped out by social losses such as these. National government loses as  131 income from taxation in the provinces and the country as a whole is also reduced because of the permanent migration of health professionals.? (Interview with Senior Policy Officer, POEA, April 2010, Manila)   As we can ascertain from the knowledgeable responses of this senior staff official, and his intimate knowledge of the repercussions of the nurse recruitment and migration from the Philippines to Canada, the POEA is at the very center of the Philippine state?s migration apparatus. As one can quickly discern from the pages of its 2010 annual report, it is also one of the key drivers of the state?s success vis-?-vis brokering Philippine migrant workers to the world. This brokerage process, in turn, allowed the Philippine economy to keep afloat during the global economic recession. At this point, the reader might ask: but how does the POEA do this, exactly? This requires the further elucidation of the key functions of the POEA vis-?-vis the recruitment and migration of OFW?s, including health workers and nurses bound to Canada. As described below, the POEA performs five core functions under its broad role as an overseer that define the everyday work of the agency: (1) industry regulation; (2) employment facilitation; (3) marketing; (4) worker?s protection; and (5) general administration and support services. Since only the first three functions are relevant to our understanding regarding the brokering of Philippine nurses (and other Filipino migrant workers) to Canada, I will focus on them on this chapter.  Industry Regulation    One of the most well known functions of the POEA is the licensing and regulation of private recruitment agencies for the placement of overseas Filipino  132 workers.33 These regulatory and licensing functions are expounded even more clearly in the words of the POEA Head Administrator:  ?So since we are the overseas employment program administration?we are in charge of licensing agencies that are allowed to recruit and deploy Filipino workers because under our constitution? the deployment of Philippine workers through private recruitment agencies or in a limited basis by our government placement branch?And then, in our task of overseeing the overseas employment program of course we have a licensing function?so as I said, this is the function that oversees, or makes sure that agencies playing the industry are, well of course financially capable, of course they also have the marketing capability.?  (Interview with POEA Head Administrator, March 2010, Manila)    Employment Facilitation    As we can glean from the statement of the Head Administrator above, the second core role of the agency is employment facilitation. This is the responsibility of connecting Philippine-based workers with overseas employers. Also called ?government-to-government? hiring, in this role, the POEA acts on behalf of future overseas employees and takes on the task of being a publicly funded recruiter. The34                                                  33 As stated in the POEA?s website, the agency is responsible for the following in terms of this core responsibility: 1. Issues license to engage in overseas recruitment and manning to private recruitment agencies and ship manning companies; 2. Hears and arbitrates complaints and cases filed against recruitment and manning agencies, foreign principals and employers, and overseas workers for reported violation of POEA rules and regulations, except for money claims; 3. Implements a system of incentives and penalty for private sector participants; 4. Sets minimum labor standards; 5. Monitors overseas job advertisements on print, broadcast and television; 6. Supervises the government?s program on anti-illegal recruitment; 7. Imposes disciplinary actions on erring employers and workers and seafarers (  34 According to the POEA website, there are key responsibilities attached to this role: 1. Accredits/ registers foreign principals and employers hiring Filipino workers; 2. Approves manpower requests of foreign principals and  133 Head Administrator further explains the significance of this role: ?And then of course we also have, well, I think primary function of POEA would be the employment facilitation function?That means that we are here to serve?the needs and requirements?the needs of workers for documentation, and leaving the Philippines, and the requirement of employers abroad and in what they are seeking for workers from the Philippines. And of course by the agencies themselves, which are the partners of the employers abroad in getting Filipino workers from the Philippines.? (Interview with POEA Head Administrator, March 2010, Manila)   From one perspective, this particular role makes POEA a direct competitor of the very industry that it regulates, licenses and manages?an interesting feature of the agency. The unit responsible for these activities is called the Government Placement Branch (GPB).   Head Administrator: We have a government placement facility that is like a mini-recruitment agency servicing requirements of foreign governments only. And the fourth office is our adjudication office, which deals with adjudication of complaints of violations of recruitment agencies over their operations. Lawrence: I?m quite interested about that whole concept of mini-recruitment agency, because, is there a scenario where, say, I?m a government and I?m, for example, again, a regional health authority who wants a particular number of nurses with a particular kind of training and sort of competence?can the mini-recruitment agency in the POEA handle that? Or is it best, or optimal, for such                                                  employers; 3.Evaluates and processes employment contracts; 4. Assists departing workers at the ports of exit; 5. Develops and monitors markets and conducts market research; 6. Conducts marketing missions; 7. Enters into memorandum of understanding on the hiring of Filipino workers with labor?receiving countries; 8. Facilitates the deployment of workers hired through government-to-government arrangement; 9.Provides a system of worker?s registry. (   134 kinds of needs to go directly to a private recruitment agency?   HA: Well?   L: I?m just wondering. HA: As far as government employers are concerned, being serviced by the POEA is an option that they can consider. It?s an option. However, under a new law there is now a restriction on the government entities that can be serviced by the government placement branch in terms of the requirement of the new law for our government based? for the Philippines to have a bilateral agreement first with a country before our government placement service. It used to be that before, you know, Saudi Arabia can recruit them, they agree on the terms?fine. Now there?s this macro requirement of, is there first a bilateral agreement between Saudi and the Philippines? If there is none then they cannot service.   A bilateral agreement between the Philippines and the receiving country is required before a foreign country can use the services of the POEA?s employment facilitation branch. Rodriguez (2010) understands the role of the GPB in terms of extending the Philippines diplomatic relations with other governments and as a vehicle for the Philippines and labor receiving countries to further privatization and outsourcing. She posits: ?The state sees itself as being a more ideal provider of migrant labor to foreign governments than private recruitment agencies because the transfers of labor between governments become a diplomatic matter?. the fact that the GPB has a number of government clients suggest that with increasing privatization states are ?outsourcing? government workers, securing migrants from other countries rather than its own citizens and nationals.? (Rodriguez 2010, 71)  135   In the field of facilitating employment among health care workers and nurses in particular, the GPB has been responsible for sustaining employment facilitation relationships with four countries, namely: 1) South Korea, 2) Japan, 3) the Kingdom of Saudi Arabia, and 4) Taiwan. The 2010 annual report further explains the extent of these roles in terms of the deployment of nurses and health care workers, particularly to Japan through the Japan-Philippines Economic Partnership Agreement: ?[T]he Japan-Philippines Economic Partnership Agreement (JPEPA) includes trades in services, movement of natural persons, and technical assistance and cooperation, among others. JPEPA provides for the entry and temporary stay of certain groups of Filipino nationals in Japan, and vice-versa, for supplying a service. These groups include professionals and workers with specialized skills, such as lawyers, accountants, engineers, nurses, and caregivers? Finally, the Government-to-Government hiring agreement with the Kingdom of Saudi Arabia?s Ministry of Health (MOH-KSA) is long-standing and has been in place since the 1980s. The Ministry today stands as the GPB?s largest single employer of Filipino health care workers, hiring over 20,000 nurses, medical technicians, dentists and other health workers? (POEA Annual Report 2010)   However, while somewhat celebratory, the report was also quick to state that these government-to-government hires represent only a small fraction of the overall deployments during the year 2010, when 1,470,826 left the country, amounting to 4,030 departures on a daily basis. (POEA Annual Report 2010) In contrast, the Government Placement Program was only responsible for filling a total of: ?6,519 jobs: 1,892 through Korea?s EPS, 118 through JPEPA, and 4,156 through MOH-KSA, and 353 manufacturing workers for Taiwan?0.44 percent of total  136 deployments per year.? (POEA Annual Report 2010)  By stating the smaller fraction of deployments through the GPB, the POEA diminishes the popular perception that the deployment of OFW?s is primarily done through the direct facilitation of the Philippine state?and puts into perspective the somewhat limited role that the state has compared with the private sector recruitment agencies in the process of employment facilitation. Curiously enough, this is not what Robyn Rodriguez concludes regarding the relationship between the POEA and the private recruitment agency industry. For Rodriguez, the Philippine state has power over private recruiters. She states that: ?No privately owned labor recruitment agency has the capacity to map global labor market trends in the way the Philippine government can, equipped as it is with a global apparatus of embassy and consular offices?. Private recruitment agencies, therefore, cannot perform the same kinds of ?market promotions? for Philippine workers that the state is able to. Neither can most agencies negotiate with foreign states around the issue of migration policy. If anything, recruitment agencies depend on the state?s work in opening up markets for workers (even as the state itself profits from more and more migrants sending remittances home).?(Rodriguez 2010, 53)        To a certain extent, Rodriguez? statement has traction. There are indeed some countries that would be quite difficult for private recruitment agencies to reach in terms of their marketing efforts, because of political and linguistic barriers. Japan is an example of such an OFW-receiving country. It is important to note that among the four countries where health workers (particularly nurses) are sent, Japan, through the Japan-Philippines Economic Partnership Agreement had become a controversial  137 receiving country during the period of my research. Numerous nursing bodies, such as the Philippine Nurses Association (PNA), called for the removal of the clause vis-?-vis the recruitment of nurses (trade in health services) because of the use of the Japanese language in the regulatory examination (required for both domestic Japanese and internationally educated migrant nurses) to practice in Japan. The rationale of the PNA for this is that Philippine nurses might not be able to fully practice their profession and they might potentially end up in lower-tier nursing jobs (or in prostitution work). They cite that even Japanese-educated nurses have a low passing rate. To date, this effort to stop sending Philippine nurses to Japan has been largely ignored by the POEA?despite the fact that there has only been one successful examinee.35    In fact, as evidenced by the annual report as well as the statement above, the POEA continuously recruits and sends nurses to Japan. This was highlighted through a series of photographs in the annual report, which depicted the Head Administrator, along with the Japanese Ambassador to the Philippines, Japanese labor officials, and Philippine-educated nurses bound for Japan as part of the ?second batch? of JPEPA hires. The conflict between the professional nursing association PNA and the Philippine government vis-?-vis the case of recruiting and sending Philippine migrant nurses to Japan (despite their lack of readiness and preparedness in taking the Japanese nursing regulatory exam) shows one of the underlying values informing the work of the POEA: that their priority lies in creating pipelines (employment facilitation) without necessarily taking a higher level of precaution around the future of the workers they are sending overseas?in this case, the uncertain future of                                                  35 Philippine Nurses Association Nursing sector position statement on JPEPA. Available at JUNK-JPEPA-STATEMENT.  138 Philippine nurses who will be recruited to Japan with the disadvantage of not being Japanese language users.    Marketing Development and Promotion     Market development and marketing promotion are also key areas where the POEA keeps the Philippine state?s migration apparatus focused on delivering the goods (overseas jobs for Filipinos) they need to deliver. Overseas jobs do not appear from nowhere, and the overseas markets where the Philippines send its workers have to be tended over time. Under the ?employment facilitation? task, the POEA has a separate department overseeing marketing.     During my fieldwork in Manila, I had the opportunity to interview the head of the POEA Marketing Department, who spoke to me about the different functions that define the everyday work of her department. As I was curious about the impetus behind the demand for OFW?s, we had a discussion about what sector specifically triggers the process of creating markets?is it the Philippine state or the private sector (employers and private recruitment agencies)? As it turns out, and as expressed early on in this chapter, creating markets occurs through a public-private partnership (PPP), a complicated but highly strategic and calculated relationship between these two groups of actors that facilitate the creation of the overseas labor markets for OFWs: ?Well?the role of the marketing branch is?providing support to the marketing efforts of the private sector. Of course it?s not marketing which generates the job orders, it is? the large group of licensed agencies that looks for the employers and finds the jobs for our workers. But, the marketing department coordinates with  139 them. The function of marketing is basically the area of market promotions and research and employment standards for the nation. So in terms of research and standards, we basically gather the information from the host countries through our embassies and consulates on what the legal opportunities are, what are the job prospects there?We take a look at the laws and regulations that will govern employment, labor and immigration policies and to govern the entry of our workers there?And we pass it on, we process this information in some forms like our market updates, market advisories, we develop country profiles containing relevant labor market information that will guide the recruitment agencies on which markets, which countries to look for.? (Interview with POEA Director of Marketing, Manila, March 2010)   Clearly the Marketing department plays a crucial role in expanding the market base of potential employers for OFWs. They do this by directly supporting the private sector through their market research and market knowledge dissemination, a typical instance of how this public-private partnership works. The Marketing Department produces and circulates timely and authoritative expert knowledge about new migration laws and the latest labor market information in the form of market advisories and updates. These updates are fed directly into the labor brokerage system. Rodriguez (2010) supports this key insight into the work of the Marketing Department of the POEA in facilitating OFW?s to Canada as well. She captures this dance between the state, private recruiters and future employers: ?Labor market information generated through these market reports enables the Philippine state to proactively market Philippine workers to foreign employers. ?Market missions? have long been successful in facilitating outflows of Philippine  140 labor?the purpose of marketing missions is to generate interest in Philippine workers among prospective employers as well as to initiate discussions with foreign governments on the possibilities of formalizing inflows of Philippine workers.? (Rodriguez 2010, p. 59)  A Look Into Market Updates and Market Advisories    How do market updates and advisories work? To understand how these market updates and market advisories are crafted for specific overseas labor markets such as Canada, I did a thorough review over the period of 2007-2012, the timeframe of my research.  My review reveals the attention being paid by the POEA?s Marketing Branch towards Canada as seen in the table below:  Table 3  Market Updates No./Series Year Title No. 02 Year 2009 ONTARIO TO EXPAND PROTECTION FOR MIGRANT WORKERS No. 03 Year 2009 JOBS IN DEMAND IN ONTARIO No. 01 Year 2010 BILL ON EMPLOYMENT PROTECTION FOR FOREIGN NATIONALS INTRODUCED IN ONTARIO, CANADA No. 21 Year CANADA URGED TO CHOOSE SKILLED MIGRANTS TO  141 No./Series Year Title 2010 AVOID LABOR SHORTAGES No. 08 Year 2011 CANADA ISSUES NEW RULES TO STRENGTHEN THE TEMPORARY WORKER PROGRAM  Table 4  Market Advisories  No./Series Year Title No. 25 Year 2007 PROCESSING OF VISA FOR TEMPORARY WORKERS BOUND FOR CANADA No.01 Year 2008 EMPLOYMENT PROSPECTS FOR CANADA No. 07 Year2010 THE EMPLOYMENT PROTECTION FOREIGN NATIONALS ACT OF ONTARIO, CANADA    These market updates and advisories were released in order to inform private sector recruiters regarding various developments in Canada vis-?-vis two key issues: migration legislation and the immigrant labor market.  In the first table of ?market updates,? one can notice a pattern between two key issues: (1) migrant worker protection within Canada, and (2) job market demands and expansion of Canadian labor markets that can serve as opportunities for private recruiters and OFW?s.    142   Market updates No. 02 2009, No. 1 2010 and No. 8. 2011 follow the proposition and eventual passing of a bill in Ontario, as well as new legislation from Ottawa to protect migrant workers against unscrupulous recruiters and employers (mainly temporary foreign workers). By going back to the actual texts of the market updates, we will see the progress of how information found through these Market Updates builds the case that Canada has progressive legislation protecting migrant workers and has open new markets for future migrant workers. Market update No. 02 2009, ONTARIO TO EXPAND PROTECTION FOR MIGRANT WORKERS reads: ?Ontario is proposing to expand its labor law for protection of migrant workers. The Ministry of Labor raised issues on the charging of placement fees by recruitment agencies for workers who are looking for jobs and those changing their employment status from temporary to full- time worker, in a consultation paper. If the proposals on the protection of workers become part of the Employment Standards Act, it will cover temporary foreign workers from the food service industry to farm workers and nannies?. Ontario is presently consulting with Manitoba, which had passed a landmark legislation to protect temporary foreign workers through its Worker Recruitment and Protection Act. The Manitoba law, to be introduced in the first quarter of 2009, will keep track of employers who bring in foreigners on temporary work permits and will license only Canadian recruiters. Families who hire nannies will have to register as well. The new legislation will replace the Employment Services Act, which currently governs the activities of third-party placement agencies in Manitoba?. Under the Manitoba law, all employers will be required for the first time to initially register with the province before the recruitment of foreign workers begins?The registration will  143 ensure that employers are using a licensed recruiter and have a good history of compliance with labor legislation. In addition to employer registration, recruiters will be licensed and required to be members of the Canadian Society of Immigration Consultants or a law society. Recruiters will be prohibited from charging workers, directly or indirectly any fees whatsoever for recruitment. The law aims to ensure that foreign workers are treated the same as any other worker in Manitoba so that employers, not the workers, bear the cost of recruitment. The new regulation intends to protect around 700,000 people in the province with temporary jobs.? (Market update No. 02 2009)  The market update above keeps private recruiters and potential OFWs to Canada informed about imminent changes to the legal atmosphere in Canada around the protection of migrant workers. It also underscores how one Canadian province, Ontario, is learning from another Canadian province, Manitoba, in making progress around this crucial issue. As we will see even more clearly in the next section on another key function of the POEA (worker protection), the Philippine state constantly surveys new legislation overseas (not just in Canada) that would facilitate and support this key function.  The next Market Update, No.01 2010, BILL ON EMPLOYMENT PROTECTION FOR FOREIGN NATIONALS INTRODUCED IN ONTARIO, CANADA, builds up on the statement above, but this time focusing on the actual Bill that was eventually passed: ?On 21 October 2009, the Ontario Provincial Government introduced Parliament Bill 210 entitled ?The Employment Protection for Foreign Nationals (Live-In Caregivers and Others) Act 2009 which has passed the First Reading. The proposed legislation, which was sponsored by the Provincial Minister of Labor  144 Peter Fonseca, has the support of Liberal Party members, which control the majority of the Ontario Provincial Parliament.   This particular market update recognizes the beginning of a more concrete legislation, Ontario Parliament Bill 210 that would protect the largest cohort of Canadian-bound OFW?s?live-in caregivers. Finally, this series concludes with Market Update No. 08 2011, CANADA ISSUES NEW RULES TO STRENGTHEN THE TEMPORARY WORKER PROGRAM:  Citizenship, Immigration and Multiculturalism Minister Jason Kenney recently announced that the Temporary Foreign Workers Program (TFWP) would be better protected after new safeguards take effect on April 1, 2011. Improvements to the TFWP will ensure that the program continues to be fair to employers and maintain its focus on alleviating temporary labor shortages. The regulatory improvements to the TFWP include the most significant changes to the program in many years, which are the following: (1) a more rigorous assessment of the genuineness of the job offer; (2) a two-year period of ineligibility of hiring temporary workers for employers who fail to meet their commitments with respect to wages, working conditions and occupation; and (3) a four-year limit on the length of time some temporary foreign workers may work in Canada before returning home. The TFWP is driven by employer demand and aimed at filling identified labor shortages where no suitable Canadian workers or permanent residents are available. It is jointly managed by Citizenship and Immigration Canada and Human Resources and Skills Development Canada??   In this market update above, the POEA takes note of the changes within the Canadian Temporary Foreign Worker Program (TFWP) in order to inform Philippine  145 private recruitment sector actors despite the fact that these changes will only have tangential effects on their on-the-ground work. The other two Market Updates in this period that are specifically targeted towards Canada renders information on the expanding job markets in Ontario and in Canada at large. In these market updates and advisories, we can see exactly how the Philippine state, through the POEA creates a knowledge base supported by the latest market and legal trends in migration?particularly as it relates to Canada. Through its circulation among actors and institutions, these bodies of knowledge become the foundation of most of the initiatives for as well as responses to the management by the Philippine state and the private sector of the recruitment and migration of health workers, as well as other temporary workers, bound for Canada. The market updates discussed above are projected by the Philippine state is connected in a subtle yet complex manner to the Oath taking Ceremony I narrated about through my field journal at the beginning of this chapter. Official government documents gets realized only through the action of people on the ground ? with vested political and economic interests ? who make nurse recruitment and migration work.  Conclusion    In Chapter One, I mentioned that the steady increase in the number of Filipinos immigrating to Canada in the same period?both in temporary and permanent resident streams?has made the Philippines the leading source of immigrants for Canada. While there are other factors contributing to this increase (including bilateral agreements between four Western Canadian provinces and the  146 Philippine government that will be discussed in Chapter Five), one can also posit that the patient, mundane practices of circulating knowledge about the openness of Canada?s labor market for Filipinos through updates and advisories is a considerable factor in raising relevant awareness about Canada. The POEA Marketing Department distributes and circulates this information to their private sector partners to support their work, thereby increasing the numbers of temporary workers the Philippine state brokers to Canada and the world.  Furthermore, while some updates and advisories shed light on particular professions or tackle individual jurisdictions (what might apply in Ontario does not necessarily apply in British Columbia), they are ultimately geared towards informing the public audience on knowledge that might otherwise escape their attention. They make tacit knowledge usually circulated primarily among experts within government and the industry manifest to the public domain.     147 CHAPTER FOUR   The Business of Migration  ?Amidst these challenging times posed by globalization and financial downturns, I am confident that the private recruitment and manning industry will continue to be a resilient and responsible ally of the government in creating millions of decent and quality jobs for our countrymen.?    ? Gloria Macapagal Arroyo, Former President of the Republic of the Philippines, 2009 Agency Performance Awards Program   Introduction    On April 29, 2010, the Head Administrator of the Philippine Overseas Employment Agency (POEA) extended an invitation to me to attend the 2009 Agency Performance Awards. A public awards ceremony, the POEA Awards ?acknowledged the indispensable role of the private sector in providing decent, gainful employment for millions of Overseas Filipino Workers (OFW).? (2009 Agency Performance Awards Programme) Sponsored by the POEA and held at the Philippine International Convention Centre (PICC), one of the Philippine's central space for national and international gatherings, the black-tie and ?Barong Tagalog? character of the event evoked both seriousness and grandeur. At the red-carpeted entrance of the PICC was a sign pointing to the Grand Ballroom, where the awards ceremony and the dinner  148 reception took place for the next four to five hours.36  The POEA Awards were first held in 1984 and since then, ?the POEA has honored outstanding licensed recruitment agencies that play an integral part in a world-renowned Philippine migration management program.? (2009 Agency Performance Awards Programme) The theme for the year, ?Sustaining Excellence and Professionalism Amid Challenging Times,? evoked the goal and thrust of the POEA and the Philippine private recruitment industry despite the effects of the global economic recession on the demand for OFW's to work overseas.    The program also mentioned a new accolade introduced by Arroyo in 2010 through Proclamation No. 1519, series of 2008: the Presidential Award of Excellence, an award given to ?licensed private employment and manning agencies that have attained excellence in the field of overseas recruitment and placement of OFW?s.? (2009 Agency Performance Awards Programme) The awards were divided into three categories: Top Performer Awards (for first-tier honorees), Awards of Excellence (for consistent Top Performers), and the Presidential Award of Excellence. The evaluation criteria include the following: ?volume and quality of workers/seafarers deployed, technical capabilities, compliance with recruitment rules and regulations, marketing capabilities, presence of welfare programs and human resource development plans, industry leadership, and social responsibility.? (2009 Agency Performance Awards Programme).    After more than two decades, a total of 171 agencies consisting of 44 Awardees of Excellence and 127 Top Performers have been conferred these accolades.                                                   36 Barong Tagalog is an embroidered garment and is widely known as the ?'national costume?' of men from the Philippines, although women also wear it.  149 At the 2009 Awards, thirty-seven (37) agencies were to be honored for their outstanding performance from July 2005 to June 2009. Nine land-based agencies and ten manning agencies received the Top Performer Award, while one land-based and four manning agencies were given the Award of Excellence. An elite group of four land-based agencies and nine manning agencies were conferred the Presidential Award of Excellence. (2009 Agency Performance Awards Programme). These awards are given by the Philippine state as incentives for private recruitment agencies for past and future performance in their industry. Exemplary performance produces a ?halo effect? in terms of the actual recommendation put forth by the Philippine state?s POEA, once foreign employers approach the agency for information. Success begets more success. For example, when I asked the POEA Marketing Director whether they recommend particular agencies, it was revealed to me that: Marketing Director: We only give general information about the top performing agencies. We have what we call awardees of ?top performing agencies?? Lawrence: Who gives the awards and what is awarded? MD: Yes, we? Because we license the agency, we evaluate their performance and we give, as much as we give penalties to those who go astray, we also give awards of recognition to those who perform well. So the POEA has this top-performer award for outstanding performance. We look at the volume of deployment, their track record of cases ? are they notorious, do they have cases and problems filed against them by the workers? So a lot of factors that we look into and then we award top performers the first level of award, and the consistent top performers become awardees of excellence which is like the hall of fame. And a recent one,  150 there?s now a presidential award for the awardees of excellence who are still?who continue to get more than 5 awards of excellence?(Interview with POEA Director of Marketing, Manila, February 2010)   As I discussed in the previous chapter, the POEA is the Philippine agency responsible for regulating private recruitment agencies. And as the quotes above suggest, it also supports the industry through symbolic public recognition, which often leads to more business rewards for those who already perform well in this sector. The support of the Philippine state for the private recruitment sector does not end in recognition through awards. The state also institutes policies that direct the business of brokering OFW?s to the industry. This is done through a ?ban on direct hiring,? prohibiting foreign employers to directly hire OFW?s without the active involvement of a private recruitment agency. The POEA Marketing Director explains this policy: MD: There?s a ban on direct hiring. But there are some nuances and loopholes in that plan, because in the actual market there are workers who are able to get jobs on their own. So the ban on direct hiring would prohibit a foreign employer to come here in Manila and recruit directly without a tie-up with an agency. But for those workers who are able to get employment on their own without the employer having to go into the Philippines, for example you get the referral of a relative in Canada told someone here about ?hey cousin, there?s a vacancy here??then I emailed them and I was offered employment. So those kinds of workers?there?s no agency there. The employer in Canada can go to the Philippines to recruit me, but I got offered through other technologies or mechanisms, I should be documented also by POEA as what we call a ?name-hire.? So even if I was recruited by an agency in the Philippines, but I got the employment without the intervention of a  151 licensing agency here, then I should also be processed by POEA. (Interview with POEA Director of Marketing, Manila, February 2010)   The statement above can be viewed as an indicator of the multiple strategies through which the private sector (with the support of the Philippine government through its branding mechanisms) and (as we saw in the previous section) alongside Filipino families (through channelling private funds as well as recruitment through immediate social networks) invest heavily on the future success of Philippine nurses both at home and abroad. From the point of view of the private recruiters and families, there are clear financial incentives in forming the socio economic and political environment that would make foreign employers seek the labor of Filipino nurses. To further clarify how such strategies play out on the ground, this section explores how expertise is deployed within the global labor recruitment and migration sector by looking at the pivotal role of Philippine private recruitment agencies in facilitating the recruitment of Philippine nurses to Canada. I argue that the concept and meaning of ?expertise? among professionals working inside the recruitment industry is crucial for human geographers and migration scholars to explore.   Those deemed to have the technical knowledge, professional skills, and personal networks concerning transnational migration are those who eventually become actors involved in its leadership, governance, and daily management. Likewise, the accumulation of various forms of capital? business knowledge and experience, combined with the extensive strategic use of other professionals inside the Philippine state and Canadian government and businesses?are crucial factors in sustaining one's operations in this hyper-competitive sector. My argument also applies to those who are in the public sector, as I discuss in the next section. Both private and  152 public sectors are fundamental to the creation of a pipeline that sustains the migration of nurses from the Philippines to countries like Canada. This is not to say that the perspectives of those who are not deemed experts do not matter. My point is that experts often have an enhanced role in the process and possessing expert knowledge allows them to influence and shape the course of the industry through competition and cooperation.  The Entrepreneurial State?s Strategic Partner    In this chapter, I focus on the perspectives of President/Chief Executive Officers (CEO's) of recruitment agencies based in Manila, Philippines who facilitate the recruitment of nurses and other workers to Canada and other countries. These CEO's were purposefully chosen based on my research as well as the specific recommendations of my nurse migrant housemates in Saskatoon, Saskatchewan. In short, these recruitment agencies whose leaders I describe here were the very same recruitment agencies in Manila to which my housemates applied when they looked for overseas work. They were likewise chosen since they possessed the most current/expert knowledge and strongest linkages with Canadian health regions.    A simple trip down to one of the busiest cross-streets of the Malate district in Manila make one quickly aware of the breadth of private recruitment agencies that serve both land-based (where nurses belong) and sea-based migrants. On any given day, including Sundays, hundreds of men and women line up at each of these agencies. I remember these places intimately because I accompanied my late father, who was then seeking jobs as a day construction worker in the Middle East, in his trips  153 along these very same alleys and streets. Some recruitment agencies, including the ones that facilitated my father?s contracts and departures, haven?t changed their company names: maintaining a track record in this industry counts. In these narrow streets, Filipinos look for a current job posting, attend informational sessions, or patiently wait in lines to get interviewed. These are the pre-migratory spaces of visceral embodied anxiety, felt by every unemployed and underemployed Filipino dreaming of a job overseas.    It was necessary for me to focus on just four agencies, as tackling the entire Philippine private recruitment industry would not only be an impossible task, but would also lose my emphasis on the specific functions served by each sector in the nurse migration pipeline from the Philippines to Canada. I contacted each CEO separately in the same manner I contacted everybody else in my fieldwork in Manila: through an official email introducing myself and my research project, along with a copy of the ?expert? questionnaire so the interviewee could prepare for the meeting. I asked each of them the following questions:  1. Please describe a typical recruitment case. Do recruiters contact potential migrants directly or do potential migrants contact you?    2. At what point in their career would health care workers such as nurses typically seek out a recruiter?   3. How do recruiters find potential clients in and outside the health care and nursing sectors?    4. What are the types of clients you have in and outside the health care and nursing sectors? 5. How do recruiters intersect with potential health care and nurse employers?   154   6. Where do your health care and nurse employers come from?  7. Do recruiters work directly for particular health care institutions seeking employees?   8. Around how many nurses and other health care professionals have you already deployed and currently deploying each year? 9. What educational and skill background are you looking for in clients who are applying to work as nurses abroad? 10. What are foreign employers looking for in nurses in general? 11. Why do you think foreign employers particularly seek Philippine educated and trained nurses? 12. What do you think are the ?best practices? of your recruitment agency that are worth mentioning?     As much as possible, I tried to stick with the script of the questionnaire above, but the open-ended nature of qualitative interviews allowed me to clarify certain issues that the interviewees raised, and inquire into subject matters that arose during the conversations.  There were also many digressions to a number of issues that I did not originally intend to ask about. Upon reading the full transcripts of my interviews, I realized that some of my prepared questions were not directly answered, or were circumvented by the interviewee so he could proceed with another topic that he wanted to pursue. During these in-person interviews, I observed non-verbal (body) language and emotional responses to my questions through paying attention to the tones of the voices of my interviewees as well as their various mannerisms. The very first interview I had with a recruitment agency that helped facilitate the recruitment and migration of nurses from the Philippines to Saskatchewan was probably the most  155 difficult interview I had during my entire fieldwork in Manila. I had not been easily intimidated by high-ranking government officials in the migration sector, nor by nursing leaders (mostly female). But all of these actors represented public offices and were therefore accountable to the public; they freely offered their time to help clarify the roles of the Philippine state and Philippine public institutions in my case studies.    Private business owners were an entirely different case, being outside the ambit of the public sector; allowing a researcher to understand how they work could compromise their business operations. I was aware that this was what I was entering into and it showed in my nervousness during this process. It was not a lack of confidence about the issue that made me nervous, but rather my utter unfamiliarity with the ways business leaders think. After being rejected for an interview request by one of the leading private recruitment agencies for nursing and health care via email and in person, and a string of other rejections from smaller-scale agencies, I realized that the strategy I used in eliciting information from public sector officials did not necessarily work in the private sector. Even my demeanor and my manner during the questioning process of the interview had to change. I was already wearing formal clothes (a well ironed long-sleeved shirt and pants, black shoes) for the duration of my fieldwork (except when I lived with the nurses in Saskatoon); but I had to impress business owners because they do care about appearances. I started wearing designer shoes and a tie. I also twisted my tongue to maintain a distinctly North American West Coast accent.    Also, I had to code-switch from being impassioned about the global health equity implications of recruiting migrant health workers from the Philippines to Canada (my original stance) to a more laidback tone and attitude (an inquisitive  156 stance) that would engage my interviewees, rather than make them feel attacked. For me, this was not ?faking,? but rather one way of adapting myself to the local environment I had to enter through these interviews. By embodying this ?business mode,? I also allowed myself to be less intimidated by my interviewees. It made the interview situation more comfortable for both parties: they picked up from my behavior that I did have a similar set of business skills and entrepreneurial savvy they themselves possessed. My interviews with these CEO's were conducted often on the same day as my interviews with Philippine state bureaucrats.    As an interviewer and ethnographer, I had to consciously code-switch between the language of government officials and the language of business leaders. The languages of government and business overlap, but they are buttressed by entirely different concerns. While they are concerned with the same issue?the brokerage of migrant health workers and other migrant laborers from the Philippines to Canada and the world?they definitely do not share the same daily practices or organizational structures that constitute recruitment work. Geographically, some of their offices are located within walking distance from the government bureaucracies I was visiting for research purposes. This is a business location strategy these firms use to be always ?in the know? about the operations of the Philippine migration bureaucracy, especially during periods of policy shifts and migration-driven policy crises. The closer the head office of the private recruitment agency is to a major Philippine migration state bureaucracy, the quicker the news gets to their heads and staff, and the faster they are able to recalibrate their business practices.    Before and after the interviews, I also had the opportunity to spend some time observing the physical surroundings of each recruitment agency?often through  157 a tour provided by the CEO or one of his/her staff members, typically an executive assistant or a secretary. In these tours, I was shown various brochures and office paraphernalia that they develop to ?market? Philippine migrant laborers. Their advertising materials provide extremely rich material for media and discursive analysis, and are useful in illustrating some points regarding the nature of the work done by these private recruitment agencies. However, I do not use these materials explicitly because these agencies are well known within the Philippines, and especially among Filipino workers migrating to Canada and elsewhere; acknowledging these sources would make the informants immediately identifiable.    Furthermore, these four agencies are leaders in the Philippine overseas labor recruitment industry, and it is not the intent of this thesis to foment further competition among these four. It became clear throughout my research process that they are already in direct and fierce competition with each other for particular labor market niches, such as nursing; and new migrant labor markets, such as Scandinavian countries. Canada was a common target market for these agencies, particularly for the various sectors needing immigrant labor, such as health care, the service industries, and long haul trucking.   Some of the tours that the CEO?s and their secretaries gave me within their facilities went beyond giving me their marketing and company brochures. On one occasion, I was allowed by the CEO to peek into the computer database and management software used to handle the constant flow of resumes and online applications the agency received every hour. As with most businesses that conduct employee searches, it is now standard practice within the private recruitment industry to use paper-less service systems where applicants do not come into direct physical  158 contact with the recruitment staff until they are finally called for an in-person interview. Company software sieves through the piles of (often thousands) of applications by locating particular keywords within the applicants? resumes that would fit the minimum set of requirements to fulfill the job order.    In a way, being selected through this system involves an algorithm that can lead to random selection. During one of my conversations with my nurse housemates in Saskatoon, I was told that the only way to get past the random selection process sometimes is to make persistent (but definitely not annoying) phone calls directly to the private recruitment agency?s staff or to make sure that somebody within the agency knows them directly (typically a mid-level staff, but rarely the CEO). They called this the ?padre padrino system,? literally, ?father taking care of his son?s business? (in Western terms, nepotism). Giving gifts and other kinds of favors to recruitment agency staff was fairly common practice and was not frowned upon as unprofessional, as it would be in Canada.   For this chapter, I am renaming the four agencies of my CEO interviewees to avoid further identification as Recruitment Agency A, Recruitment Agency B, Recruitment Agency C, and Recruitment Agency D; and their leaders CEO A, CEO B, CEO C, and CEO D respectively. Below is a distillation of the four CEOs? responses to the questions I posed above during my interviews. To reiterate, anonymity among my informants in this chapter is extremely crucial; just as I do not want to incite further competition, I also do not intend to promote one recruitment agency over another, or use the CEOs? statements against another recruitment agency. These agencies compete for contracts with foreign employer clients, and for the so-called ?favoritism? of Philippine state labor migration officials, as exemplified through the endowment of  159 the POEA awards during the annual POEA awards described above.    During my interviews, some CEOs expressed critical statements about how their competitors operated, especially during moments when I asked them about the issue of ?ethical recruitment.? However, some CEO's would also communicate how another CEO is a ?business leader,? and that another recruitment agency is worth emulating as a ?business model.? The nature of the competition among the recruitment agencies is driven by the scarcity of ?jackpot? contracts, especially during a period of global economic recession and the tightening of the US migrant labor market borders.  These so-called ?jackpot? contracts involve multiple and ongoing business relationships with foreign employers. It connotes the accumulation of business contracts that were often won unexpectedly. ?Jackpot? contracts were not easy to land. The CEOs have to be creative in their own intelligence work to secure such contracts; they spoke of having to make cold calls to Canada-based employers (and elsewhere) to inquire if they were interested in recruiting Filipino nurses and workers.    Recruitment Agency A    CEO A is touted as the Philippine recruitment industry?s major leader. In fact, during the POEA Agency Awards Ceremony, his firm was the recipient of one of two Presidential Awards for land-based and sea-based recruitment agencies. This external affirmation from the POEA enhances the proven track record of his particular agency in terms of sending volumes of overseas workers and securing contracts with overseas companies. The marketing mechanisms they use include print advertisement in major national newspapers. Potential migrants also contact them directly through  160 the search engine on their website, where posts about jobs abroad are updated on a regular basis. Since Recruitment Agency A is an industry leader, the majority of potential migrants have heard about them and rely heavily on ?word of mouth.? In the CEO?s words:    Some are referred by our ?deployees,? or people that are aware of the agency?s mode of operation.  Candidates contact the agency. (Interview with CEO A, Manila, February 2010)  Potential candidates contact the agency as soon as they finish nursing school and pass the local board exam. However, the CEO warns that this practice does not yield any job offers, as most health care facilities overseas explicitly require extensive clinical experience. According to him: Previously, potential candidates or aspirants would get in touch with the agency after they gainfully secured experience.  But nowadays? new graduates immediately get in touch? but definitely they are not qualified because you must have a sort of?health-care professionals like the nurses or the therapists?they must have at least one to two years solid experience in a hospital setting.  For example, for nurses, their exposure must be hospitals with a minimum 50-bed capacity.  And what I meant by solid experience is they should have uninterrupted stay on the job. (Interview with CEOA, Manila, February 2010)   His agency specifically looks for a good nursing education base as well as standard scores through the NLE (National Licensure Exam) and the IELTS (International English Language Testing Service) exams: For Canada, we lined up candidates with high scholastic record so that they won?t encounter any problems in their Canadian licensure examinations. They have to  161 have an overall IELTS score of 6.5 and a speaking score of 7. The rating of their PRC (Professional Regulatory Commission) board exam, at least 80% but the passing mark of 75% is a bit too low. (Interview with CEOA, Manila, February 2010)  Apart from requiring nurses to have a good education base and solid clinical experience, his agency also looks for particular qualities among potential nurse migrants that confirm the stereotypes that most foreign employers look for in Philippine nurses. He reinforces these stereotypes, as they are also a major selling point for his services, increasing the possibility of these nurses of getting job offers overseas. Establishing a marketable brand of Philippine nurses occurs in this sector. He emphasizes that Agency A primarily looks for nurses with experience and high scholastic records, as well as a third quality of attitude: It?s not basically surviving abroad but basically general traits and then I try to help those from the lower class of people because these are the people that can stand all extremities and difficulties. (Interview with CEOA, Manila, February 2010)   His reference to those potential candidates who come from so-called lower classes is fascinating as it goes to show his assumption that those who grew up in dire economic situations are more able to withstand difficulties that they can encounter overseas. In short, they are deemed to possess more resilience than those who grew up comfortably, and are thus potentially harder-working nurses overseas. Because they are potentially hard workers, they stand to represent his agency well. And they are the kinds of workers they eventually seek and favor for recruitment. As the leader in the nursing recruitment agency, this CEO?s company did not necessarily have to  162 constantly look for potential overseas employers to recruit Philippine nurses through them: I?m very proud to tell you that among the 1,040 agencies in the Philippines, I don?t believe in marketing.  I would rather knock at their doors, because if you knock at their doors you?re down below.  I would rather that they approach us so we get clients by referrals or assisting clients.  The workers that we deploy, they do advertise.  They do a referral of the company. A few organizations that do not advertise their services are accounting firms like SGV (the leading Philippine accounting company).  You will never see any advertisement.  Now it has been my thrust to professionalize the industry and I?m following that trend, although, we cannot get a good business out of it. I guess we have been quite successful. (Interview with CEOA, Manila, February 2010)   It is important to note that all of the recruitment agencies in this case study do not only handle health care recruitment. CEO A emphasized the need for his company to be flexible in terms of identifying their clientele. Recruitment Agency A provides a suite of services ranging from advertising positions and screening candidates to ensuring that candidates have the right paper work; these services can be customized for foreign employers or contractors looking for Philippine workers, regardless of the industry. These are the same services they provide for the nurses selected for recruitment to Canada. Outside health care, CEO A also favored working with construction companies in the Middle East for several reasons:  We are a little bit choosy.  I would not prefer handling construction companies because, number one, construction companies?normally, the employer is a contractor.  And most of them they don?t provide the best benefits.  Number two,  163 their employment is only for a limited period or short term, and unlike if you go directly with major entities you can be a regular employee until retirement. For you to be a recruitment agency you have to handle all sorts of industries, not just health care but other technical industries:  manufacturing, oil and gas, etc. Well, we handle the aviation industry, service industry, oil, gas, petrochemical, manufacturing, logging concessions, let?s say health care staffing companies, hospitals and health care institutions. We go for companies that can provide the best benefits for the Filipinos. Companies that would provide a longer tenure of employment, companies that are not run-down organizations.  I would rather handle ?A? and ?B? categories of companies.? (Interview with CEOA, Manila, February 2010)   For the recruitment drive to Saskatchewan in particular, he also highlighted to me that they had the highest success rate in terms of number of candidates lined up. Their success rate is high: 60 out of 89.  This is the highest success rate among all four agencies: ?Yes for Saskatchewan.  While we placed 60 out of 89 applicants, however, I believe only 56 made it because the others had withdrawn employment. But I?m very proud that we have the highest percentage. I believe it?s because of our prior exposure.  Among the four agencies we have the longest number of years of experience.? (Interview with CEOA, Manila, February 2010)   There are a number of practices that his agency does that are quite distinct among the four. First, he claims that he does not travel overseas to look for clients. Instead:  ?I only go abroad not to look for clients but to visit our existing clients.  Plus, I have  164 set my standard in the industry. We agencies are allowed, by law, to charge placement and processing fee[s].  We have never done it.? (Interview with CEOA, Manila, February 2010)   This last point is crucial. According to Philippine law, recruitment agencies are allowed to charge potential clients for the services they render to them. However, in his agency?s case, they only charge the foreign employer or contractor for the services they render. This has set an industry standard that other recruitment agencies are starting to practice as well: ?All agencies, when they advertise, they indicate that they don?t charge any fee.  That is the reason why my motto, no one can yet duplicate the same no-fee charging entity.  And I follow the trends.  After all, all foreign employers can afford the financial aspects in the recruitment. When they are getting expatriate workers, they can afford to pay all the recruitment fees so all agencies in the Philippines are paid but unfortunately, many are double paid.  Aside from the fee, they secure from the clients, they also charge the candidates a certain amount.  Some employers may be fully aware, some may not, but the majority is not aware of the charging of fee. Now in our case, we only rely on the fees paid by our employers.? (Interview with CEO A, Manila, February 2010)   They have also offered their own in-house pre-departure orientation before the migrants leave for overseas since 1978. This means that they do not send their recruits to the POEA for their orientation; rather, the POEA has authorized them to handle their own orientation. With regards to his experience of sending nurses to Canada, CEO A noted that the situation was definitely a lot less complex than it is now. He also noted that while the candidates who were sent to Canada were generally  165 satisfied with their services (he showed me an in-house survey result that showed 90% satisfaction), the number one choice for Philippine nurses in terms of their potential recruitment is still the United States because the US offers higher salaries for nurses compared to Canada: ?Generally, the nurses going to Canada were directly hired.  To give you the story, during the 60s and 70s it was easy for the nurses to go to Canada. They are immediately given an immigrant visa?health care professionals?in a matter of 6 months.  But I believe the recruitment slowed down in the late 80s and 90s and most of direct routes then are direct hire enticed from other countries, like, they go to Saudi Arabia, so they have direct applicants and they invite the applicants to go there.  But the problem with that scheme, the nurses shoulders basically all the expenses: airfare, and all the other recruitment expenses or the other registration expenses unlike when they are recruited in the Philippines, they have minimal cash-out.  Like, with the Saskatchewan nurses the only expense that they incurred was the registration with the CNA (Canadian Nurses Association).  That was about $200? But the salary given to them is lower compared to the salary given to the nurses in the USA.? (Interview with CEO A, Manila, February 2010)   I inquired about the general perception of the media, academia, and the public regarding the recruitment industry. His answer was frank and suggestive of his awareness that the industry is plagued with competitors who bring down the reputation of the industry at large (as with any kind of business): ?Actually let me tell you one point, Lawrence.  In my 32 years with my agency I can say that recruitment is one of the dirtiest businesses in town.  They try to capitalize on the ignorance of the people, their economic difficulties, and most of  166 them I can say when they get people they promise heaven on earth just to attract the candidates to join them. Amongst the 1,040 agencies, the Philippine government has given us?we?re the only recipient yet of a 10-year renewable license.  My competitors, they get a lower level license.? (Interview with CEO A, Manila, February 2010)   He also pointed out that it is crucial to keep the recruitment business within the borders of the Philippines. In the Canadian case, he alluded to the fact that a number of Canadian nationals and Filipino-Canadians are entering the industry but are not registered businesses in the Philippines and therefore not subject to the same Philippine taxation laws, something he calls an ?outward foreign exchange.? The Canadian authorities are apparently aware of the activities of recruiters who double-charge, but no further action followed: ?You know, the problem, Lawrence, is this:  Supposedly, recruitment in the Philippines of Filipinos for Canada, no placement fee.  The Canadian authorities have the record but they have not done anything to the Canadian nationals or the Filipino-Canadian migrants who are recruiters.  There were even newspaper clippings, reports made, but they have not done anything. As a recruiter, one of your thrusts is to help the country to generate foreign exchange.  But in the case of those charging, you cannot discount the possibility that there?s an outward foreign exchange from the Philippines especially so, if the agency is owned by the foreigner.  Of course they would put out money.  Plus, in placement fees, there are no receipts. They don?t pay taxes.? (Interview with CEO A, Manila, February 2010)   167 Recruitment Agency B    The second CEO I interviewed manages a recruitment agency that has a different model than the rest of the other agencies in this study. Unlike the other three, his agency has a ?parent company? in Canada that deals directly with their clients (employers) there. More importantly, they are also unique in that most (if not all) of the clients they handle are from Canada. Recruitment Agency B looks for potential workers in a number of ways that are strikingly similar to the practices of Recruitment Agency A: ?We have several avenues. Of course, first, through advertisement.  If we want to get specialist nurses of course we need to advertise in the newspapers.  Second is, we have this online database where nurses can apply online anywhere in the world, as long as you have access to the internet, computer, you can apply online and you can just simply upload your credentials, and your resume.  Third, we do have our own network of nurses because nurses that we have sent over, of course they recommend us, so that?s another resource.  And of course those workers that we have sent, not healthcare workers, but service workers, hospitality workers, they have friends, they have relatives they have recommended.  So those are the services.  And of course these people or these nurses, once they apply here, we ask in turn to submit the requirements to apply online.  And through our system, the system we call the I-Quest, we can stream, to extract the nurses according to their qualification, simple as that? you ask the employer what are your requirements, what are your qualifications.  From there, we can just extract it from the system.? (Interview with CEO B, Manila, March 2010)  168   Since Recruitment Agency B is directly tied to a parent company in Canada, it is not as difficult for them to look for Canadian clients. The parent company does the majority of the marketing work in Canada on their behalf. They do the back-end work of looking for potential employees in the Philippines. As CEO B explains the Saskatchewan case:  ?To give you just a background of what really happened there at least for the recruitment for the Saskatchewan nurses, it was actually us who identified that there was a requirement for Saskatchewan Health Regions.  Actually, our company is the pioneer. Again, it?s really the parent company that coordinated initially first with the?I forgot already the name of that organization in Saskatchewan.  It?s under the Ministry of Health.  So the whole health region, they have this committee.  It was through that committee wherein we initially got an invitation.  Because we have an agent in Saskatchewan working for the parent company that was able to talk to several committee members and actually offered our services, we got invited back in 2007.  Personally, myself, I went there together with my Canadian partner and some of his staff and we did a presentation for all the committee members of the health region.  The Health Regions in Saskatchewan were impressed with the presentation. And after, there were so many questions of the qualifications of the Filipino nurses, the experience, the hospitals, the licensing requirement, the Philippine nursing education system, everything.? (Interview with CEO B, Manila, March 2010)  The recruitment of nurses from the Philippines to Canada, through CEO B?s recruitment agency, was therefore also a business-to-business deal between the Canadian parent company and the Philippine company. While there is a parent  169 company in Canada working on their behalf, the Philippine counterpart still had to do the initiation in terms of developing the relationship with employers in Canada: ?Well, from our experience, actually, we were the ones who went to Canada. We initiated, yeah.  And if they?re willing, we arrange meetings, visits to Philippine hospitals, visits to Philippine government officials. And after that, that?s the time we?ll be deciding whether we can work together, because they will just be dealing with a third party, dealing with all those papers. Usually they need to hear from the government about the process, about the challenges, if ever, of the bureaucracy.  And afterwards, then they?ll be deciding whether they are pursuing recruitment after that.  Basically we?ll arrange everything for these employers.  At least for our own company, that?s how we serve their needs.? (Interview with CEOB, Manila, March 2010)   This quote goes to show the amount of back-end work recruitment agencies had to do prior to the recruitment process itself. One of the most distinct differences of this agency from the others is its extensive relationship with Canadian employers. For example, outside the nursing industry, they are also the ?exclusive? recruiters for restaurant workers for Tim Horton?s and Boston Pizza, two leading food chains in Canada. Recruitment Agency B is also a registered recruiter for the CRFA (Canadian Restaurant and Foodservices Association.) CEO B?s agency?s specialization in the Canadian market is unique and gives him a particularly adept perspective on the workings of the Canadian immigration system. In fact, among the four CEOs I interviewed, he had the most precise grasp of how the system works, both from a market perspective and a government perspective. He had a mastery of the Canadian bureaucratic system, with a level of attentiveness to details and terminologies  170 unparalleled among the four. While he maintains that the US was previously the top destination for nurses, he claims that Canada has since superseded that position: ?In terms of quality of life, of course Canada is the best country of destination nowadays.  I?ll talk about healthcare workers for the meantime.  Before, it?s really the US?the top destination.  If you can?t really qualify or don?t have the money to the US to take NCLEX and go through the visa application process, these nurses will of course be going to the Middle East.  Most of them get abused in terms of their salaries, in terms of their living conditions.  Women?we are hearing that their employers or whatever is abusing them physically or sexually.  So with Canada in the equation, actually these nurses of course would be having a better life, better quality of life, a better job, better opportunity. That?s of course the main difference between going to a Middle Eastern country than going to Canada.  I can also say the same thing with service sector workers.  Most of them are going to Dubai, UAE.  There are some going to Singapore, Malaysia but again, jobs are abundant in the Middle Eastern countries.  Instead of going there, of course, if you give them the opportunity to go to Canada, of course they will grab the opportunity because as you know, the minimum wage for Tim Horton?s is $11 an hour compared to the Middle East; it?s really just $5-7 an hour.? (Interview with CEO B, Manila, March 2010)   Like CEO A, CEO B also reinforces certain characteristics that he thinks distinguishes Filipinos from potential nursing candidates from other countries. He specifically mentioned the need to be aware and careful of the emerging nursing markets in China and Indonesia, and the much more established direct competitor of the Philippines, India. But he went beyond generalizations, pointing out how  171 characteristics such as a good nursing education and scholastic base translated to concrete results, such as performance in Canadian nursing regulatory exams and fitting into Canadian working culture: ?Well I think you need to revisit the success we had in Saskatchewan.  Initially there?s a few months there?s some difficulty that we heard from the nurses?I don?t know if I can say this but we?re discriminated by the Canadian nurses because the Filipino nurses weren?t here.  That?s what we heard, that?s the feedback that we get.  But the thing is when our nurses, of course through the health regions, they took the CRNA exam the first time.  We, the Philippine nurses, were the highest on record?the passing rate was 71% compared to the Canadian nurses whose average was just 40-50% passing rate.  But that alone proved that Filipino nurses are more intelligent than the Canadian nurses, no offense!  Theoretically they are more intelligent.  In terms of service, Filipinos are well known.  They are the most caring nurses in the whole world, right?  So we?re getting feedback from the health managers that patients are really appreciating the Filipino nurses unlike their Canadian nurses. We have evidence in Canada that Filipino nurses are working very well in the system.  Now it?s just that you need to look into the training that these nurses will be undergoing for them to facilitate their work in Canada.? (Interview with CEO B, Manila, March 2010)    In the quote above, CEO B not only reinforced widely held assumptions about Philippine nurses (such as their capacity for hard work, necessary in a field like nursing)?he went beyond to claim that Philippine nurses were even more intelligent than Canadian nurses in terms of their nursing knowledge, evidenced by his anecdote about the CRNE (Canadian Registered Nurse Exam) passing rates. Apart from these  172 few distinguishing features, Recruitment Agency B is different from the other three agencies in is its commitment to ?giving back? to the local (Philippine) health care system. A key argument made by most critics of the health care recruitment industry is that it undermines the needs of the local communities where nurses and other health workers are drawn (i.e. the brain drain argument). Like CEO A, CEO B is well aware of the repercussions of their activities and its impact on the image of the recruitment industry as a whole: CEO B: We donated 200,000 US DOLLARS.  We supply them with the medical kits and the medical box for these 10,000 nurses in the Philippine government?s NARS (Nurses Assigned in Rural Areas) program. Lawrence: So you have a clear sense of corporate social responsibility.  Does the government acknowledge this? CEO B: Of course.  We are acknowledged on their website.  You can find some articles acknowledging our donations, thanking us.  Actually I have another letter from the Department of Labor and Employment Secretary asking us if we can donate again this year because they?re trying to sustain the program.  Actually the program was very successful and we?re planning to have a second batch of this NARS project.  He asked again if we could donate again the same amount of money.   L: Was it money or goods? CEO: It?s actually goods.  But as government, we need to give them the bill just to show the amount of money that we donated.  For tax purposes, we can get exempt.  It?s in the form of goods but of course that?s $200 000 USD.  (Interview with CEO B, Manila, March 2010)  173   Interestingly, during the course of our interview, CEO B received a phone call from a high-ranking official of the Department of Labor and Employment asking if they could renew their commitment to the NARS (Nurses Assigned in Rural Services) program. I was also surprised by the arrival of a senior Canadian migration official, who had a stake in Recruitment Agency B as a senior consultant and advisor.    The timing of his office visit was uncanny, and enabled me to interview him on his role as a Canadian official in Manila overseeing the migration of Filipinos. Overlooking the flyovers, which connected the buildings housing Recruitment Agency B and the POEA, the three of us discussed how they (the recruitment agency and Canadian officials in Manila) provided the bridges for Filipino dreams to actually come true. As I exited the CEO B?s office, the Canadian immigration official exclaimed ?We?re going to talk business now.? (Field Journal, May 10, 2010, Manila, Philippines)  Recruitment Agency C    On the day of my interview with the CEO of the third recruitment agency, CEO C told me right away that we had to cut the interview time at exactly 3:00 pm, as they were preparing for a photo shoot. The photo shoot was for the program of the POEA Agency Awards; Recruitment Agency C had just won a Top Performer honors for land-based recruitment agencies, the second tier of these awards. He quickly mentioned that they were ultimately aspiring to win the Presidential Award of Excellence, the very first tier of the awards which Recruitment Agency A received. This comment made me aware that that CEO C wished to follow in CEO A?s footsteps, confirming that the latter was indeed the leader in the industry.  174   The strategies deployed by Recruitment Agency C to reach potential recruits were parallel to?and thus shared with?the practices mentioned by the first two agencies.  ?It all starts with marketing obviously, you know? It starts with us being able to reach potential clients, and that is done in many ways, but mostly we send out mailers, we subscribe to job portals and advertise there and really just try to get clients?we have to get the best advertising agencies here, because you know we want to brand. Because you know, Lawrence, that?s how they look at recruitment companies here. In Canada, for example, for the nurses particularly, we went on a business mission. You know, it was the business mission sponsored by the Philippines-Canada Business Council (PCBC).? (Interview with CEO C, Manila, March 2010)  Among all the four CEOs I interviewed, only CEO C mentioned participating in a ?business mission? to Canada through the Philippines-Canada Business Council: ?Yes, it?s actually headed by the former Secretary of the Department of Tourism (DOT). So she headed that, and they?re part of the Philippine Chamber of Commerce (PCC). And then? so we went there, we went to Canada, and met with prospective clients.? (Interview with CEO C, Manila, March 2010)   In other words, Recruitment Agency C used a business network formed and headed by Philippine government officials to spur business activities between the Philippines and Canada. As with Recruitment Agency B, they also specialize in sending Filipino workers to Canada. Nursing is just one of the industries they handle: ?Yes. And depending on where you are as a company?we?ve been serving the  175 Canadian market since 2005-2006, so most of the prospects that we saw, obviously put importance on that, because most of the other agents from the Philippines do not have a clue of how to get in temporary foreign workers into Canada. It?s a different process altogether. You know, if you?re talking about the LMO's (labor market opinions), if you?re talking about Alberta you?re talking about going through the AIT (Apprenticeship and Industry Training) for skilled workers, so it?s so different. Once you get that, once you decide with your client, then they appoint you, they give you all the documentary requirements, and then you start the recruitment already. First you have to register your client with the POEA. As you know we?re very regulated by the POEA, so it?s so difficult.? (Interview with CEO C, Manila, March 2010)   Almost all of the CEOs mentioned their relationship with the POEA. The descriptions ranged from highly favorable to neutral. But I felt they were unwise in giving negative remarks about the POEA as I had informed them beforehand that I had also interviewed the highest-ranking POEA officials. If they did make negative remarks, it usually pertained to the bureaucratic inefficiencies and fees levied against them. Rather than completely undermine what the POEA does with them and on their behalf, their critiques focused on how the POEA could improve the processes. It became clear to me that the CEOs maintained good working relationships with POEA officials as this was key to maintaining their businesses and reputation. This CEO in particular explained to me why and how his own recruitment agency maintained its good reputation by abiding to the rules and regulations imposed upon them by the POEA:   176 ?You know, some recruitment agencies are always taking advantage of applicants. And when I started 10 years ago that was the first thing that I did?I said, you know, we can?t be like that. It has to be altogether a different corporate culture. And that?s why our company policy number one is that we?re a 100% non-fee charging company. Meaning we don?t collect anything from the workers. That?s actually their way of circumventing, and to be able to charge the applicants. They will claim that there?s an immigration angle, and for that you?ll have to pay. But as you know, the MOUs between the Philippine government and Canada says that you cannot charge workers anything. So that?s their way of doing that. But you have to put your image of recruitment companies in perspective also Lawrence, you?ve spoken to Recruitment Agency A, and you?re speaking to Recruitment Agency B?you know I am not bashful to say, we are the most reputable companies in the country. If you go to the others, then therein lay the problem. Because to this day, even when it?s so clear through POEA Memorandum Circular Number 6 that you cannot charge anything from the workers ? you would hear, and you would see that workers are being charged up to 200,000, 300,000 PHP? (or roughly between 4,700 CAD to 7,000 CAD. (Interview with CEO C, Manila, March 2010)   Nurse recruitment is different from other groups: nurses are well educated and, in the Canadian case, their employers are government funded public health facilities?so they are very transparent in their practices. They also cannot charge fees because the Memorandum of Understanding governing these movements between the Philippines and Canada makes a clear stipulation against this. ?Yes, they don?t give you receipts for it, so you can?t claim against it if you say, ?hey they charged me money?no there?s no receipt?. And it?s an accepted practice  177 unfortunately because as you can imagine, it?s life changing for these people to land in Canada, so they?re willing to sell everything and pay anything just to get there. You know, however you?re concentrating in nurse recruitment, and this really does not happen in nurse recruitment. First of all they?re very well educated, they know the law, and? we?re dealing with government. You know, my client is the government of Manitoba.? (Interview with CEO C, Manila, March 2010)   CEO C also explained to me how his agency responds to ?job orders? from overseas employers, and how the process unfolds from there: ?OK, first of all we base everything on the job order. The job order will tell you how many they need, the salary, and the qualification requirements. And then you start from there. Since it?s Canada, we advertise, because if it?s the Middle East, even if you advertise people don?t come anymore?you have to headhunt. That?s what we do. However since it?s Canada, we know that we just have to advertise and, so you advertise with the Manila Bulletin on a Sunday only, as you would know, and then I think it?s a record for our hits because when we advertise for the nurses for Manitoba, that was exactly the same time? well until now, US was in a retrogression already? so everyone was ready with nowhere to go? we advertised and overnight?. Like we advertised on a Sunday and Monday morning we had like 500 CVs (curriculum vitaes) you know, hits already. And then people were walking in. So what do you do? You shortlist. Based on your qualification requirements, you shortlist against that. But since we?re proactive, once we get the qualification requirements, we call the client. We don?t stop with the job description?the HR (human resources) people. We, as much as possible, we try to talk to the end-users, line-managers, meaning nursing supervisors? what do you  178 need? What are you looking for?? (Interview with CEO C, Manila, March 2010)   Apart from their involvement in the Saskatchewan nurse recruitment process, CEO C also noted that his was the only recruitment agency that was given job orders for Manitoba health regions. For both nursing recruitment drives, he highlighted that: ?We did that, and as you know with nurses they have an IELTS requirement, you know a passing score of 6.5 speaking of 7. But because we had so many candidates available we were able to be picky, meaning the only candidates that we put forward to the clients already passed IELTS. Either they had valid IELTS or just expired. We sent the CVs, they short-list, they say, ?these are the people that we want to see.? For our requirements, normally our ratio is three to one. We send three CVs for one open position. So if it?s a 120-job order we have to send them 400 CVs. So we send it out, then they come back with their short list and then they say, ?we?re coming.? However, this is record time, because from the moment they got in touch with us, to the time they arrive here in the Philippines it was one month?which is not normally the case, it should be more. So anyways, everything was rushed. They sent a delegation of 30?? (Interview with CEO C, Manila, March 2010)   Just like the previous two CEOs, CEO C reinforced the many stereotypes about Philippine nurses which made them attractive to Canadian and foreign employers. He emphasized that the quality of Philippine nurses is good enough to transcend the required quality control process in recruitment prior to moving to Canada:   179 CEO C: We have to make sure that these are highly skilled, well-educated nurses with the experience. But in terms of the personality profile, that?s why you come here, that?s why the employers come here. You talk to them and you see what their backgrounds are. Lawrence: How do you assure the quality of nurses, not just on the basis of  their  education, but also in their practice, in their capacity to practice nursing in  Canada? I think it?s a difficult bridge to construct? CEO C: Yes, and it?s very difficult for someone like myself to guarantee that, or convince you of that. What I will tell you is there?s a big onus on the employer? there is a perfect example again would be Manitoba. You know, first of all, that is the reason for the technical interview. They cite specific cases?what do you do in this instance? You know? Do you decide, do you stop, or do you ask questions? And from there of course the employers would know, OK, her training is to listen, or is to follow orders? or no, her training is, you know, she does what is needed. So from there they get already the orientation of the person. Secondly, the family. You know Filipinos are very family-orientated, and my goodness, all the support that they can imagine from Manitoba they got. You know, and even if they wanted to they could have left with their spouses when they joined Manitoba. But they didn?t. One did?unfortunately she?s the only one who failed the exam in the first day in the first batch. Because you have to be able to review properly, but anyway, as long as the support of the community is there then these nurses would be able to adapt and to be flexible.      The statement above is key to understanding how recruitment agencies also maintain and keep in touch with the nurses they deploy. In particular, they help  180 ensure that Philippine communities as well as professional networks and migrant serving agencies in Canada would help welcome the new nurses. The welcoming experience of these nurses in Manitoba reverberated back to Manila and gave the recruitment agency CEO confidence about the results of his business transaction.  Recruitment Agency D    The last CEO I interviewed, the only female in the group, was unusual in terms of her agency?s history with the Saskatchewan nurse recruitment drive: the company was contacted by a former Vice President of one of the health regions, who eventually left her senior post and ended up creating her own recruitment agency for Filipino workers bound to Canada: Lawrence: So you?re the ones who initiated contact with healthcare regions and they responded with interest saying to you?   CEO D: Yeah. L: So they were the ones who said, ?Okay, we actually need the nurses here.  Can you help us get the nurses from there since you have the expertise of recruiting them?? CEO D: Yes, yes. In terms of their recruitment strategies, their practices run parallel with the rest of the agencies. You have to get the nurses in.  We didn?t have any difficulty with that.   L: So you do a sort of print ad? CEO D: Yeah, Internet, newspaper bulletins.  Word of mouth also because it was the first time for many to hear about nurse recruitment of Canada.  For the longest  181 time it was US then they found out about the retrogression so the nurses were asking, ?After this, what next?? ?Is the Middle East an option for them?  Is Singapore an option??  And then here they find out that Canada will be looking for these nurses.  But during the time when we sent out the advertisements, we were just pulling for these nurses.  That means that we?re not really sure that they?re actually going to get the nurses from us because there was no formal agreements yet and everything was exploratory and during the time when we were recruiting I was also talking with the Vice President on how it?ll be possible for us to send nurses there.  And then we also looked into the costs because during the time no one was discussing the cost yet:  how will the plane fare be?  How?s the CRNE?who is going to cover for that?  Who is going to cover for the visas?  At the time I was looking into getting lawyers, immigration lawyers, to help us with the visas and all those things... Also it?s the word of mouth.  Since they know that we?ve sent these nurses to Canada. (Interview with CEO D, Manila, March 2010)   The agency also goes beyond nurse recruitment and taps into other industries. However, the CEO was quick to reiterate that they do not send nannies, caregivers, and domestic workers, and focus only on professionals such as nurses and engineers: ?Yes.  That?s why I would want to just send nurses over because as opposed to other professions, of course, like if you send workers to factories and the conditions there?they get sick there or whatever, you know, it?s harder. For instance, there?s a reason why we don?t get foreign domestic workers to Singapore.  For instance, the placement fees paid for by the workers, and at least you won?t be getting anything until the 10th month because she?s paying the agency there and all those  182 things and then they?re subjected to all kinds of conditions because you can?t really be sure if she?s prone to abuse because this employer is different from this other employer.? (Interview with CEO D, Manila, March 2010)   Apart from not exclusively focusing on one profession, the geographic reach of Recruitment Agency D also goes beyond Canada:   L:  So are you deploying non-health professionals?   CEO D: Yes.  Engineers. L: People who are non-healthcare professionals? CEO D: Yes.   L: Only to Canada?   CEO D: No. The Middle East, Singapore, and Malaysia.   The background and credentials Recruitment Agency C seeks for prospective nurses are as follows: ?We just placed an ad and on a daily basis we received hundreds of applications and enquiries. They had basic qualifications that they were following.  Like, they would have at least one year of working experience in a tertiary hospital and their IELTS scores should be 6.5 for the overall band score and 7 in the speaking parts. That?s it. Whoever applied to us, it?s standard.  Most of them have graduated and they have passed the licensure exams here.? (Interview with CEO D, Manila, March 2010)   Beyond these basic qualifications, CEO D emphasized that there are other characteristics that make Philippine nurses stand out in the eyes of foreign employers, particularly their flexibility, adaptability, and their knowledge of the English language: L:  My question here is about what do you think employers particularly seek  183 among Philippine-educated healthcare nurses from the perspective of someone who?s dealt with foreign employers.  What are they looking for?  Why do you think they seek nurses from the Philippines to begin with? CEO D: So many things. First because they?re highly adaptable.  Anywhere you put them, they will thrive.  They could communicate well in English; our curriculum is not far from the curriculum that you?re teaching there, so of course we could adapt.  The nurses do wha