Global nursing and the lived experience of migration intermediaries

Abstract

Discussion of skilled migration often focuses on skill shortages and global labour market trends, with little attention directed to the individual experiences of the migrants themselves. ‘Divina’ is a migrant nurse who left her home country of the Philippines to gain work in Australia. In the process of this migration, Divina was drawn into a complex web of co-ethnic relationships with migration intermediaries that shaped much of her experiences with respect to entry and employment in Australia. Her story highlights how migration intermediaries can exacerbate the precarious and vulnerable position of skilled migrants. The dangers are particularly striking for those migrating from non-English-speaking and/or developing nations, where vulnerabilities can be entrenched by ‘trusting’ co-ethnic relations forged between sending and receiving countries.

Keywords

co-ethnic exploitation lived experience migration intermediaries narratives precariousness skilled migration trans-national trust

Introduction

Despite the ‘avalanche of writings on globalization in all its forms’ we still lack more micro-level, phenomenological studies of the everyday reality of global mobility (Favell et al., 2006; Van Manen, 1984). Demographic reports, indicating historical and contemporary trends of global mobility (Organisation for Economic Cooperation and Development (OECD), 2011; WHO, 2015) are important markers of broad patterns of migration. Much could be gained however by knowing about how the socio-political, cultural, demographic and geographic context interlinks individual experiences of migration (Holvino and Kamp, 2009) at both the workplace (Coe et al., 2010; Forde and Mackenzie, 2010; Sporton, 2013) and the kinship/friendship level (Van Riemsdijk, 2014; Velayutham, 2013).

One of the challenges for migration researchers is to understand the complex relationships that link the global to the local, the political to the personal and the industrial to the individual. Divina’s¹ migration story from the front line begins with her decision to migrate from her home country in the Philippines, and ends when she secures a resident visa in Australia many years later. Divina’s narrative provides a ‘human face’ that shows ‘the challenges and opportunities that skilled migrants face’ (Favell et al., 2006) and provides detailed and provocative insights about how familial and commercial inter-relationships result in co-ethnic exploitation (Velayutham, 2013). Her story warns against the trends toward greater deregulation of migration governance processes (Groutsis et al., 2015; van den Broek et al., 2016) and highlights the importance of local infrastructure agencies, including trade unions and community groups, in assisting her battle to regain employment and residency in Australia.

A related challenge facing migration researchers, and migrants themselves, is then to critically assess the varying quality of migration intermediaries ranging from formal agencies such as recruitment firms, migration agents and educational institutions to informal kinship networks. In recent decades, the process of migration governance by state apparatuses has increasingly come to be replaced by, or work alongside, commercially driven migration intermediaries who provide various fee-for-service arrangements to assist migrant mobility (Betts, 2013; Groutsis et al., 2015; van den Broek et al., 2016; Xiang, 2012; Yamamoto, 2008). While many migration intermediaries provide reliable information and resources, others operate on a more tenuous legal and practical footing, with deleterious implications for the migrant workers using them (Barrientos, 2013; Lindquist et al., 2012; Xiang, 2012).

Divina’s story shows that private migration intermediary actors, based on a fee-for-service arrangement, often overlap with trust relationships based on kinship and friendship connections. As such, dichotomies between (less trusting) commercial and (more trusting) familial intermediaries may be less apparent than assumed. Levels of trust that develop through kinship and friendship networks can also expose migrants to exploitation in the same way as private intermediaries might (Anderson, 2010; De Haas, 2010; Ryan et al., 2008; Tilly, 2007; Velayutham, 2013). As De Haas (2010: 1603) notes, the ‘amount and quality of resources that can be accessed through such relationships’ differ according to the migrant group involved. The assumption that skilled migrants are less vulnerable to the vagaries of migration intermediaries than less skilled workers is also highly contested by Divina’s experiences (Anderson, 2010; Cangiano and Walsh, 2014). This is particularly the case with respect to employer-sponsored workers who rely heavily on the goodwill of employers and their intermediaries throughout the migration and labour market integration process (Boese et al., 2013; Groutsis et al., 2015; Somerville and Walsworth, 2009; van den Broek et al., 2016; Velayutham, 2013; Wright, 2012).

Nurse shortages and demand-driven migration

The World Health Organization has described the shortage of health professionals as a global crisis (WHO, 2015). While this crisis plays out differently in each country, the shortage of skilled health professionals (including midwives, nurses and physicians) has led to unprecedented demand for overseas-qualified health workers, particularly nurses. Countries, including Australia, Canada, the United Kingdom and the United States, have actively recruited nurses to staff their increasingly stretched healthcare systems for many decades (Buchan et al., 2005; Choy, 2010; Connell, 2010; Kingma, 2006) while others have actively trained and exported their citizens to service this demand.

Having one of the highest rates of out-migration in the nursing profession, the Philippines, often referred to as a ‘migration factory’ (Choy, 2003; Mahler and Pessar, 2006), has pursued a strategy of training, recruiting and exporting (mainly female) nurses by releasing work permits and licences as a direct response to global nursing shortages for many decades. The contribution to the national economy of significant remittances that migrant workers send back to their home country represents their long honoured ‘nation building strategy’ (Choy, 2010; Mahler and Pessar, 2006: 50; Masselink and Lee, 2010).

Many Filipino nurses who come to work in Australia initially arrive through temporary sponsored work visa pathways, or as students hoping to secure employment post graduation and subsequent nurse registration. While not entirely unique to Australia, there has been a strong focus on the use of temporary entry employer-sponsored skilled workers, particularly in the field of nursing in this country (Hawthorne, 2011; Negin et al., 2013). The subclass 457 visa, established in 1996 under the Business Long Stay scheme, allows employers in ‘high demand’ occupations, such as nursing, to sponsor workers for up to four years. Holders of the 457 visa work under binding employment contracts and gain temporary (and restricted) resident status. For example, if visa holders want to leave their employer and remain in Australia they must secure a sponsorship agreement with a willing and eligible employer. Since the visa pathway has been introduced, many visa applicants have subsequently converted to permanent residency status in Australia (Department of Immigration and Citizenship, 2012; Hawthorne, 2011; Khoo et al., 2007).

Given the political economy of nation-and-healthcare building strategies, many Filipino nurses, including Divina, develop the realistic expectation that their training will secure them employment in positions representative of their pre-migration skills and qualifications, leading to improved personal and professional opportunities (Nifo and Vecchione, 2014). Many are successful in this undertaking: however, the networks that can develop around these (particularly temporary migration entry) pathways become an important variable on the quality of employment outcomes and successful social and workplace integration.

A number of controversies about the subclass 457 visa scheme has drawn attention to the vulnerabilities of workers employed under such schemes in Australia, including accusations that 457 workers face inferior wages and conditions and are shunted into poorer performing areas of the labour market where exploitation is more intense (Boese et al., 2013; Coe et al., 2010; Groutsis et al., 2015; Salt and Stein, 1997; van den Broek et al., 2016). Yet, despite the escalation of the visa programme and the greater mobility of migrant nurses globally, we know very little about how relationships develop between intermediaries and migrant workers, and what the implications of these relationships might be.

Divina’s individual story from the ‘front line’ provides a unique opportunity to shed light on the journeys that overseas-qualified migrant nurses have made, and continue to make, as they follow employment opportunities into new frontiers. It is important to note that while her experiences cannot be directly translated to others, they are a legitimate reference point from which to interrogate the mediating role intermediaries play in both the private and public lives of migrant workers. Therefore, her account encapsulates important features that individual migrant nurses face, both individually and collectively.

As researchers engaged in investigating the experiences of migrant nurses for many years (Groutsis et al., 2015; van den Broek et al., 2016), we became aware of Divina’s story through a mutual connection within the Filipino community organization Migrante (http://migrante.org.au). This organization put Divina in touch with us and we interviewed her three times between 2012 and 2015. During this period we also interviewed officials from the New South Wales (NSW) Nurses Federation who were supporting her attempts to redress wages owed to her and representatives from Migrante who were helping her gain permanent residency.

Trust was gained through our contact with a key representative from Migrante, as well as the NSW Nurses Federation and through our subsequent support for her seeking permanent residency from the Australian Department of Border Protection. Consent from Divina to undertake interviews and ethics clearance from our university allowed us to undertake the research. All interviews were conducted in English; however, English was Divina’s second language and there were many occasions where it was difficult to establish clarity around the events that took place. As such, we sought clarification from her, the trade union and the community organization on numerous occasions to ensure the accuracy of the information. Interview transcripts were emailed to Divina after each interview for her to provide feedback and confirm our use of the material.

Throughout this period Divina was concerned to remain anonymous in case of any reprisals that she feared might result from her connections in Australia and in the Philippines; however, she did want her experiences to become public to warn other migrant nurses about the opportunism of intermediaries. Given her lack of confidence with verbal and written expression, the narrative presented below is based on a first-person narrative which paraphrases Divina’s story through a very close approximation of the interview transcripts confirmed by Divina.

What this story shows is that like many migrant workers, Divina relied heavily on the accurate information and resources of intermediaries, which in this case were firmly built on trust and familial and community-based friendship relationships. Divina’s story sensitizes researchers to the changing nature of migration processes and the labyrinthine nature of interconnected intermediaries operating at various critical junctures in the migration process: shaping worker agency and labour market outcomes. Her story echoes wider research into the ethics of migrant nurse recruitment (Buchan et al., 2005; Groutsis et al., 2015; Pillinger, 2012; van den Broek et al., 2016) and serves as a reminder of the opportunistic relations founded on misguided ‘trust’ that can develop between the migrant and migration intermediaries (De Haas, 2010; Gammeltoft-Hansen and Sorensen, 2013; Rhodes, 2007; Velayutham, 2013) and the implications of this for migrant worker exploitation.

Divina’s story: labouring in good faith

I was born in 1962, and was the third child in a relatively poor family of 12 children, of which only seven survived. I liked my life growing up in a northern province in the Philippines with my family. We grew vegetables like potatoes, cabbages, carrots and peas to sell to the local shops. As I got older I looked for better opportunities beyond the traditional rural farm life. Nursing was a common path for many of the Filipino women I knew so I set about trying to find a better future. This didn’t seem like an impossible dream at the time because my country had a long history of sending nurses overseas.

At 21 I already had two sons after marrying a man who lived close to my family farm. After five years we separated and then I became a single mother. Soon after, I moved to the city and found a job, and some years later I trained as a nurse in the Philippines. After I completed my training I secured a position as a casual nursing attendant at a government hospital and completed my Bachelor of Nursing in 2003. My position as a registered nurse followed in 2005 and the next year I set about fulfilling my ambition to leave the Philippines and to migrate to a better country.

I knew there was demand abroad for nurses and so I initially sought employment in the United States, where my niece had already built a nursing career. However, a prominent local Chinese businesswoman who was closely connected to my family recommended that I contact her sister-in-law ‘Joanie’ because she was operating a business placing Filipino nurses into employer-sponsored positions in Australia. Joanie was a registered nurse herself, an Australian citizen and often returned to the Philippines to recruit nurses through family and friendship networks.

Within hours of contacting Joanie, I was already signing up to start working at a Sydney-based aged care home on a 457 employer sponsorship agreement. As part of the agreement, Joanie advised that I would receive a four-year employer sponsorship contract which included lawful wage rates and working conditions and an assurance that ‘Yalumba’ would assist me in gaining nurse registration and accreditation in Australia.

After paying Joanie AU$10,600 to secure the visa for me and my family I arrived in Australia to work at Yalumba, expecting that my children would follow when I had settled somewhere. In the meantime, I was taken to Joanie’s house, along with 11 other Filipino nurses that Joanie had also arranged employer sponsorships for and I lived at her house for three months while I was working at the aged care facility. Like the other Filipino nurses, I paid Joanie AU$90 a week in rent for accommodation at her house, excluding the gas and the telephone bills. This arrangement strengthened the trust and bonds that I, and the other nurses who lived there, had with Joanie.

Throughout this period, Joanie acted as my recruitment agent, my migration agent, my landlord and my workplace negotiator at Yalumba. The relationship between Joanie and I was very informal and I trusted and respected her. So while I might not have been completely happy with the living arrangements, I was eager to commence my employment at Yalumba and bring my family over to join me once I had found a suitable place to live.

Very soon after I started working at Yalumba I discovered that I was not working as a nurse; rather, I worked as a residential care worker and was being paid less money than Joanie had initially promised me. I did not feel that I was in any position to complain about these conditions due to the dependencies of the employer sponsorship arrangement and potential threats surrounding contract breaches and deportation. There were also very important issues of culture and respect. I felt a lot of gratitude to Joanie, despite the fact that I knew all of the Filipino nurses that she had recruited were being underpaid. Complaining to Yalumba could result in the termination of my contract and if that happened I would need to find a new employer sponsor which would also limit my ability to pay back the money I borrowed to come to Australia. So of course, like a robot, I did not complain to Yalumba about my working conditions until my contract finished. Eventually I did take these complaints to the NSW Nursing Association and they successfully reclaimed unpaid wages that were owing to me from Yalumba.

The misinformation that developed around the wages and conditions of my employment at Yalumba was just the beginning of the breaches in trust, illegal dealings and betrayals that I faced by people who claimed they were trying to help me. There were to be further miscommunications and betrayals. I learnt that my sponsorship at the aged care facility was being terminated because the Australian government had removed the residential care workers position from the employer sponsorship nomination scheme. This meant I faced either returning to the Philippines or quickly finding another employer sponsor somewhere in Australia.

During my final months of the sponsorship period, I met another Filipino nurse, called ‘Nita’, who after learning that my contract at Yalumba was about to expire said her company could help me to remain in Australia under a student visa while studying for a bridging course that would give me my registration papers, allowing me to work freely and independently as a registered nurse. Nita convinced me to remain in Australia on the promise that her company would give me a two-year sponsorship through her Australian-listed company. She charged me AU$4000 for her services as well as another AU$1000 for migration agent fees, which were passed on to the agent who she said she was collaborating with. I trusted Nita because she was Filipino and she also had a connection to my family. So I went to her house and checked her licence and trusted that she would deliver on her promises. As I found out later, while she had a licence to operate a registered company, she did not have a training school that could provide me a bridging course and therefore a pathway to nurse registration, work and residency.

Having paid Nita AU$5000 for her services, I found that my visa had lapsed and was now void. I believed that Nita misinformed me about when my visa expired so she could make sure that I would be deported and out of her life, muzzling the potential complaints I might make about her corrupt business dealings. After some days and in desperation, I contacted a local Filipino community group, Migrante, and also got some independent legal assistance about my situation. I also lodged a complaint against Nita’s company with the New South Wales Department of Fair Trading. At the same time, the Department of Immigration and Border Protection threatened me with deportation or detention. At this point I felt like I had completely shamed my family. I was thinking: I came here in good faith to work for a better future for my children – but I’ll go back home feeling just like I’m a criminal.

At this moment in time and since my current visa had expired, the only visa that I could apply for was a Permanent Protection Visa (subclass 866). I did this on the grounds that I believed that if I were deported back to the Philippines, the people that I had exposed in the local newspapers and to various Australian authorities would try to hurt members of my family. So I waited and hoped to hear from the immigration department that my family and I could stay in Australia.

Eight years have passed since I initially arrived in Australia to take up employment at Yalumba. During that time I believed I gave the best quality of care that your old people need. I told them, ‘yes, I work in a nursing home and yes my heart is in your old people’. I really did my best to look after your old people. Sadly, four of those eight years have been spent waiting for the Australian government to decide whether they would allow me, and my family, to reside and work legally in Australia. During this time my family and I have been unable to secure paid work under the temporary visa restrictions, so we have survived largely off the goodwill of community members and our local church. For years I have been waiting for the decision of the Immigration Minister and praying that everything will be alright.

The informalities of migrant recruitment

Since I have been in Australia I have faced many very difficult moments, which has caused me a lot of anxiety about how I could survive in a country with limited legal status. For many years my family and I have faced the threat of deportation and detention and while I may have been naïve in putting my trust in people that I knew, I honestly thought that because they were connected to my family that they would genuinely help me.

My family had built up a strong connection with this prominent Chinese businesswoman in the Philippines over many years and this was a relationship that was important to my family. However, her connections to Joanie and Nita caused me much pain. When Joanie did not deliver on the promises she initially made to me I felt that I could not jeopardize these family connections by complaining about her actions. Also, my relations with Nita were based on family trust and respect. I was sure that because they are Filipino, they wouldn’t mislead me. That’s what is in my mind, and they are also family.

I was naïve to think that they would look after me. These people ran commercial businesses, and businesses that turned out to be illegal. I found out too late about that. After I lost AU$5000 to Nita I eventually acted on these injustices and sought help from independent agencies, although I never got my money back.

What made it worse was that due to my temporary visa status I was dependent on people to help me – close contacts who would act as intermediaries to help me secure an employer sponsored position in Australia. I felt that I genuinely responded to Australia’s need for skilled nurses and I came here to work in good faith. My limited access to reliable information and my dependence on two unscrupulous connections made my life very hard for many years. Joanie misinformed me about my wage entitlements at Yalumba and it wasn’t until the trade union helped me that I was able to recover the back-pay from my employer. In surviving my experience with Joanie, Nita also lied to me about being able to provide me with a legitimate bridging course that would secure me nurse registration and accreditation in Australia. I was given inaccurate information about my migration status and it was only when the government and independent agencies, like Migrante, came to my assistance that I could try to turn my situation around.

In the first few years of arriving in Australia it was very difficult for me to access independent and accurate information or to know how to fight for my rights. I am not a local worker who understands my industrial and legal rights and I did not want to complain because of my position as a sponsored worker. Because of this I had a strong reliance on my employer sponsor and the people who connected me to them. My journey began when I migrated from a low-income country, encouraged by Joanie to secure employment at Yalumba. I did this in good faith. It’s not that I wanted to stay here in Australia because I want a luxurious life. I earnt it. I laboured for it and I came here in good faith to work. In the end I felt like a victim of exploitative and greedy people who took advantage of my situation and just wanted to make money out of me.

Postscript

In 2015, after four years of living in legal limbo and unable to work legally in Australia, Divina and her family were granted permanent residency in Australia by the Department of Immigration and Border Protection.

Footnotes

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Notes

Diane van den Broek is Associate Professor in the Discipline of Work and Organisational Studies at the University of Sydney Business School and is Co-Convenor of the Migrants@Work Research Group. Diane undertakes research into skilled mobility and migrant work; workplace diversity and inclusion; and lookism, identity and aesthetic labour. Her work has appeared in national and international peer review journals.

Dimitria Groutsis is a Senior Lecturer in the Discipline of Work and Organisational Studies at the University of Sydney Business School and is Co-Convenor of the Migrants@Work Research Group. Her research focuses on high and low skilled labour mobility and diversity management. Her work has appeared in national and international peer review journals. She currently serves as the Regional Editor (Australasia) for Equality Diversity and Inclusion: An International Journal and is an Advisory Board member of the Journal of Immigrant and Refugee Studies.

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