Nursing in the Philippines

Women in society
The history of nursing in the Philippines stems from the caregiving
provided by women, priests, and herb doctors during precolonial Philippines.
This trend continue during the Spanish colonial era, although women did not
have much opportunity to be formally educated in schools because only a
limited number of Filipino women received primary education in charitable
institutions established by Spaniards. During the Philippine revolution
against, Filipino women also became the providers of care for wounded
revolutionaries. During the American period in the Philippines, Filipino
women were given the chance to become educated as nurses, guided by their
American nurse and missionary mentors, until nursing became a full-pledged
profession in the Philippines, a professional career not only for modern-day
women in the country but also for men in the Philippines (as male nurses).

The advance of nursing in the Philippines as a career is pioneered by a culture of care which was intrinsic in the Filipino
people. This was also the case even before Spanish colonization in communities. The evolution of the way the health
system was delivered also developed.[1]

History

Early Philippines

Early beliefs of health and illness in the Philippines were in conjunction with beliefs of mysticism and superstitions. [2] The
cause of a disease was believed to be due to either another person, whom which was an enemy, or a witch or evil spirits.
Filipinos were careful not to upset other people or the evil spirits for the good of their health. These evil spirits could be
driven away by persons with power to banish demons. The individuals who were known to rid of demons were either
priests or herb doctors. Filipinos who became sick were usually cared for by the female family members or friends in the
home.[3]

People thought their health were directly related to many superstitions and legends. Back then, there were no medical
professionals but men known to practice magic and the supernatural. These herb men were known as “herbicheros.”
Victims that suffered from unidentified illnesses were thought to be cursed by witches and wizards known as
“mangkukulam/mangagaway.” Dangerous birthing and “pamao” were thought to come from “nunos”. While in labor, the
“mabuting hilot” (good midwife) was usually present. If the birth became too dangerous, bad omens and evil sorcerers
were thought to be the cause. Exploding gunpowder from a bamboo cane near the head of the person going through the
suffering would usually get rid if the bad omen.[4]

Spanish colonial rule

During Spain's colonial rule (1521-1898) the Philippine education system offered distinct and unequal opportunities for
Filipinos based on gender. An example of this sexism, was allowing only limited numbers of females receive primary
education in Spanish charitable institutions.[3] Without an education women were unable to gain much knowledge or
power. The knowledge of caring for others came from family members and personal experience with the sick. Nursing
other individuals was seen as a task not a job or a profession. During the Spanish regime many specialized hospitals were
established to care for Spanish king’s soldiers and civilians. [2] To many elite Filipinos the Spanish colonial hospitals were
places where those who were not so fortunate to have homes, spent their last days until death. [3]

Philippine Revolution

At the time of the Philippine Revolution many women transformed their homes into quarters to nurse Filipino soldiers and
revolutionaries.[2] One of these women was Melchora Aquino, also known as the Mother of the Philippine revolution. In
her old age of about 80, Aquino was a supporter of the revolution by providing food and shelter to the revolutionists. In
addition she provided care for those who became sick or wounded. However, a few days after the revolution began,
Aquino was arrested by the Spaniards for providing care to the rebels. In her strong will to not reveal any information to
the Spanish about the location of the rebel leader, Aquino was deported to Guam in the Marianas. After six years of being
exiled, the Mother of the Philippine revolution was able to return in 1903, when the Philippines finally gained
independence from the Americans. Aquino’s work caring for the ill and the wounded during the revolution has brought
comparisons to the British Florence Nightingale. Both these women cared for soldiers during war and paved the way for
nursing practice.[5]

American colonial rule

Union Mission Hospital Training School for Nurses which was established in 1906 by Presbyterian American
missionaries, pioneered the Nursing education in the Philippines. The school was later transferred to Central Philippine
University.

Although the Philippines had gained independence from Spain, the United States began to instill their power upon the
islands and this broke out in conflict between the Filipinos and the Americans. It was the start of the Philippine–American
War. The presence of Americans played a vital role in influencing the development of nursing into a profession. Nurses
and missionaries from the United States came to act as nurse mentors for the Filipina women. Nursing education, like
teaching and missionary work in the Philippines provided white American women with a sense of purpose in the colony. [3]
This influence then continued with the building of many hospitals where American nurses took charge and Filipino
women began to learn under careful eyes. An example of this was the development of the Iloilo Mission Hospital.[6] In
1901, through the efforts of Dr. and Mrs. Andrew J. Hall, missionaries of the Presbyterian Foreign Mission Board from
the United States, a temporary bamboo clinic was erected at Calle Amparo (now Ledesma Street), Iloilo City; to serve as a
venue for the treatment of health care to the very poor. This was made possible because Andrew Hall was a doctor and his
wife was a nurse. Like other professions, nursing in the Philippines evolved only from the apprenticeship system.

This system laid the foundation upon which the Union Mission Hospital Tranining School for Nurses (now Central
Philippine University College of Nursing and Allied Health Sciences) was built in 1906. Between the time that this school
was built and the time that the Philippines gained their independence from US colonial rule in 1946, the nursing
profession continued to grow with the development of more nursing schools and the growth of Filipina women seeking
the title of a nurse.[2] While taking advantage of these learning opportunities Filipinos began to learn more about the
United States and the opportunities that the country could hold for them, such as extending their education and increased
pay. This began the migration of nurses to the United States. As individuals began travelling to and from United States,
the stories they brought home began to spark the interest of others to follow. [7]

Post-colonial Philippines

After World War II, when Manuel Roxas assumed the presidency of the Republic of the Philippines on July 4, 1946, it
officially marked the end of the colonialism between the United States and the Philippines. Like much of the rest of the
world, the Philippine islands were in ruins and Roxas was determined to rebuild his country. He made it clear to his
constituents that the new government was still going to rely heavily on US financial support in order to rehabilitate its
national economy. Roxas’ first attempts to balance the Philippines budget included collecting unpaid taxes, reducing
expenses and promoting foreign trade. Forms of foreign trade would include the exportation of Filipino nurses. Already
trained by Americans, Filipino nurses were the perfect candidates to assist the United States and other countries
experiencing post World War II shortages. At the time in the Philippines there was also rumor of nursing shortage
however it was questioned to be true do to the expanding health programs, inefficient use of nurses’ time and skills and
loss of qualified nurses to other countries. By the mid 1960s, Filipino nurses were entering the United States by the
thousands.[8] The benefit to the travelling nurses was that they were able to make nearly 20 times as much as they were
earning back home. Part of this money would be sent back to their families as remittance and this remittance would in turn
assist in boosting the Philippine economy. The negative effects of the high exportation rate, was that the nurses were
adding to their own country’s nursing shortage problem. As well the Philippines faced losing one of its greatest sources of
social capital, which are educated workers. The negative effects are also seen in the United States as American salaries
decrease because Philippine nurses that newly arrive would work the same job at a lower wage.

Early 1900s

Many states in the United States passed reforms in licensure for nurses. Decreased training mandates were created as well
as stricter adequacies for getting into a nursing institution. For instance, one prerequisite was at least one year of high
school education. The idea of having students work in a more active role prior to seeing patients was a new idea that was
beginning to pay off.[9]

In the Philippines, it was also the early 1900s when the first school for nursing was established. The program of study was
still shattered and unclear. Only few students are enrolled informally to this kind of education. A legislation or law was
needed at the time, contributing to the establishment of the First True Nursing Law in 1919. [10]

Today

See also: History of Philippine nurses in the United States

The Philippines is the leader in exporting nurses to meet the demands of the United States and other developed nations. It
has been argued however, that The Philippines' persistent production of nurses for the global market is a state strategy to
develop an export industry for economic development. Things such as immigration services and nursing licensing
authorities encourage the production of nurses for export. [8]

Brief Profile of Healthcare

Of all registered health practitioners, nurses are among the largest group even though there are very few nursing positions
or jobs available to them. Only 15-25% of jobs in the Philippines are provided for the nursing population and with that,
the remainder of the work force go on to seek out other professional career opportunities outside of the country. Per year,
the national government has approximately 18,000 nursing positions with an eventual turnover of 1,000 careers. The
increase of Filipino nurses overseas has attracted the curiosity of other countries to better understand nursing in the
Philippines and what makes Filipino nurses accommodating. [11]

Education

The first two years of general education is grounded on liberal arts that strengthen the values and character of the person
as a caregiver. The language of instruction that is taught in all local institutions is English. This prepares the student for
licensure both locally and and internationally. This also gives the nurses access to ever growing literature in health
sciences. The community skills, competency and confidence in the use of English certainly contributes to healthcare in
any setting. The curriculum also strengthens the capabilities of the students to participate in research in nursing and other
health sciences, provides flexibility in the openness to the use of new teaching approaches, and encourages active
involvement in extension work that reaches out to the other sectors. [12] All registered nurses in the Philippines are required
to have a Bachelor's degree in Nursing.[13]

The very first pursuit to constitute the nursing practice was made by the Director of Health in 1913, but was not officially
enacted upon by Filipino Legislature. In 1915, Act No. 2493 was made known, this amended Gov Ph Act 310 so nursing
could be practiced. This law allowed “for the registration of graduate nurses under the Bureau of Health” (Philippines).
Pre-qualifications were not mandatory in order to become an RN since nurses simply signed up. Each candidate however,
needed to be at least 20 years of age at the time of sign up, and be of adequate health and upstanding character [14] A law
that allowed the practice of nursing in was reformed in April 1919. Act 2808, also known as “the First True Nursing Law”
established the Board of Examiners for Nurses and soon, the very first board exam for nurses was given in 1920.
Today, nurses must acquire their degree through a “combination of competency-based and community-oriented courses."
The Philippine curriculum has several advantages compared with those of other Asia Pacific Economic Cooperation
(APEC) Institutions. This kind of education offers much more than a solely skill-based curriculum can (Rogado 229). The
four year requirement to earn a Bachelor degree in nursing meets the minimum entry requirement for professional nursing
practice.[15]

The first two years of general education is grounded on liberal arts that strengthen the values and character of the person
as a caregiver. The language of instruction that is taught in all local institutions is English. This prepares the student for
licensure both locally and and internationally. This also gives the nurses access to ever growing literature in health
sciences. The community skills, competency and confidence in the use of English certainly contribute to healthcare in any
setting. The curriculum also strengthens the capabilities of the students to participate in research in nursing and other
health sciences, provides flexibility in the openness to the use of new teaching approaches, and encourages active
involvement in extension work that reaches out to the other sectors. [16]

Legal regulation

The Professional Regulation Commission (PRC) oversees the licensing of registered nurses as authorized by the
Philippine Nursing Act of 2002.

A Professional Regulatory Nursing Board implements and enforces the Nursing Act. The board is composed of a
chairperson and six additional members, all of whom are nurses with at least a master's degree and ten years of nursing
experience. The board inspects nursing schools, conducts licensure examinations, issues and monitors certificates of
licensure, promulgates a code of ethics, participates in recognizing nursing specialty organizations, and prescribes
guidelines and regulations governing the profession under the Nursing Act.

In 2009, the Commission on Higher Education of the Philippines released a report showing the Top 20 nursing schools in
country based on average passing rates in nursing board examinations. The top 20 Nursing Schools in the Philippines with
1000 or more examinees are the following: Silliman University clinched the top post having an average of 96.57 percent
followed by the Saint Louis University, 95.42; Trinity University of Asia with 95.06; University of Sto. Tomas, 95.06;
Cebu Doctors' University, 91.89; Saint Paul University, 89.79; Central Philippine University, 86.72; De La Salle
University-Health Sciences campus, 85.26; Saint Mary’s University, 84.10; San Pedro College, 83. 10; Manila Doctors
College, 82.56; Centro Escolar University-Manila, 81.50; Angeles University Foundation, 76.37; Mariano Marcos
University, 75.55; University of San Agustin, 73.25; University of Cebu, 70.99; Metropolitan Hospital College of
Nursing, 70.54; Ateneo de Davao University, 70.20; San Juan De Dios Education Foundation, 69. 91; and University of
St. La Salle, 67.55.[17]

For 100 to 999 takers the following are the top 20 Nursing Schools in the Philippines: University of the Philippines
Manila topped the list with 99.41 percent; followed by Xavier University with 97.82; West Visayas State University,
96.75; St. Paul University-Iloilo, 96.16; University of the East Ramon Magsaysay Memorial Medical Center, 95.80; Cebu
Normal University, 94.64; Pamantasan ng Lungsod ng Maynila, 93.14; St. Paul University-Dumaguete, 92.29; Mindanao
State University, 92.15; Palawan State University, 92.05; Philippine Christian University, 91.35; Velez College, 90.92;
Colegio de Sta. Lourdes of Leyte Foundation, 88. 55; Chinese General Hospital College of Nursing and Liberal Arts,
87.60; St. Paul University-Manila, 85.31; Easter College, 85.26; Southville International School and Colleges, 84.77; St.
Paul University-Quezon City, 83.87; Adamson University, 83.57; and Lyceum of the Philippines University with 82.20.[18]

Only three schools had 100% passing rate (with 10 or more examinees) from November 2009 to July 2011:
University of the Philippines Manila, Philippine Christian University, andNegros Oriental university

Generation of Animals. The first reputable book dealing with reproduction, Generation of Animals, was written by
Aristotle. Aristotle's outlook, although not always accurate, was rational considering the breadth of facts available during
his time. Aristotle proposed that the fetus was modeled from menstrual blood coagulated by seminal fluid - after all,
menstrual bleeding ceased during pregnancy. Menstrual fluid contained all the potential body parts. Semen provided
"form" to the menstrual "matter" and contributed the soul. Although Aristotle had no knowledge of the paired ovaries, he
(in chauvinistic style) surmised that the right (dominant) side of the body was "hotter and nobler" than the left, and
therefore produced male fetuses. Aristotle described the nutritive role of the placenta and reasoned that the uterus was
always internal to "protect the young creature." Lengths of gestation were presumably governed by cosmic forces.
The (conspicuous) testes were of particular interest to Aristotle. Aristotle documented the role of the testes in male
reproductive functions by observing effects of castration in peripuberal and mature animals and men (that castration was
used as punishment for sexual offenses and adultery can be traced to 1500 BC). It was evident that castrates did not
usually "generate" - nonetheless, Aristotle was perplexed that a steer (soon after castration) was able to mount a cow and
effect impregnation. Eunuchs (prepuberal castrates) did not develop secondary sex characteristics typical of adults; nor, in
men, did they become bald (a sex-influenced trait expressed by androgen).

Incidentally, the Greeks called the testes "didymi" (twins); the curious comma-shaped organ attached to the posterior
surface of each testis was the epididymis. The word testis was derived from the Latin, to "testify." Evidently during
primeval times men would put a hand over their genitals when taking an oath.

Anatomical observations. Many endocrine organs were undoubtedly discovered in antiquity. The abdominal
counterparts of the testes were not described until shortly after the publication of Generation of Animals; Herophilus, an
Alexandrine Greek physician, is acknowledged for this finding (he named the ovaries the "female didymi").

Herophilus is also given credit for discovery of the human pineal gland. Due to its geographic location within the center of
the brain, it was assumed to be the "seat-of-the-soul" (according to Aristotle the final resting place of the soul was in the
heart). The pineal gland received its name from Galen around the time of Christ; he considered the gland to resemble a
pine cone. The notion that the pineal gland and soul were synonymous was propagated by Descartes (seventeenth century)
in his Treatise of Man. Descartes intuitively linked the function of the pineal gland with the optic nerves and eyes. By the
early part of the twentieth century the pineal gland had fallen from fame - most scientists deemed the gland nothing more
than a vestigial relic. Only during the last several decades has the photosensory role of the pineal gland in the seasonal
control of reproduction been validated.

Galen described the pituitary gland in a less than flattering light - it was regarded as the area of the brain through which
metabolic waste was filtered to the nasal passages (pituita = phlegm). This false perception endured beyond the Dark Ages
and into the Renaissance. Ironically, the pituitary organ would later be elevated to the status of "master gland."

The systematic study of reproductive anatomy did not resume in earnest until the sixteenth century when Gabriele
Fallopius described the oviducts. Vague accounts of ovarian structures were provided by Vesalius, Fallopius, Coiter, and
Fabricius. Testicular tubules, the mature follicle, and corpus luteum (CL) were characterized in detail by Regnier de Graaf
during the seventeenth century; the preovulatory follicle (Figure 1-1) bears his name. Malpighi, who worked with cow
ovaries, named (posthumous, 1697) the CL ("yellow body"). By the close of the nineteenth century it had been deduced
that the CL originated from the ovulated follicle.

Evidently de Graaf had mistaken the follicle for an egg. A definitive description of the follicle-enclosed "ovulum" was
contributed by Karl Ernst von Baer in 1827. Early investigators assumed that ova were derived from epithelial cells that
covered the surface of the ovary - hence, the misnomer "germinal" epithelium (germ cells actually emanate from an
extragonadal source).

During the last half of the seventeenth century Antonie van Leeuwenhoek used a simple lens to examine semen of several
animal species; he described the appearance of live "animalcules" within these samples. A flurry of heated debates
followed concerning whether sperm cells had anything to do with formation of the embryo. Traditional preformationists
contended that the embryo was fully formed in germ cells - probably within the egg. Epigenists argued that fusion of
sperm ("seed") with an egg was required to concoct an embryo. The controversy was put to rest by the middle part of the
nineteenth century when spermatozoa were proven to be the fertilizing agent (the site was the oviduct). Indeed, the
technology to collect, split, and transfer embryos was on the horizon.

Meanwhile, early versions of the microscope were used to study embryonic development and to delineate the cellular
components of the gonads. Histological studies by Kaspar Wolff (an active proponent of epigenesis) and Johannes Müller
indicated that the reproductive tracts formed differentially from a primitive urogenital system common to both sexes. The
embryonic origin of the anterior pituitary gland was traced from the roof-of-the-mouth by Martin Rathke.

Human fertility control. Contraception (temporary aversion of pregnancy), sterilization (permanent prevention of
pregnancy), and induced abortion (artificial termination of pregnancy) have been practiced for thousands of years.
Much of the archaic literature dealing with contraception is of oriental descent. Systemic approaches of fertility control
included ingesting quicksilver (mercury) fried in oil, live tadpoles, or mule uteri. Vaginal pessaries were composed of
honey (which inhibited sperm motility) and crocodile dung. Rock salt, alum, and quinacrine were unknowingly used as
spermicides. Sea sponges, inserted into the vagina to soak up semen, were used for centuries. Later, cervical caps and
diaphragms were molded from wax, oil silk paper, and linen cloth.

Use of the intrauterine device (IUD) has also been linked to early Asian times. Rocks were apparently placed in the uteri
of camels to prevent pregnancy. As far as we know, the first IUDs for human contraception were designed during the
early 1900s - rings of silkworm gut wrapped with silver wire.

The origin of the condom (from the Latin condus, meaning receptacle) dates to the ancient Romans - they fashioned
bladders of animals into repositories. Fallopius devised an archetype condom from a linen sheath; he advised its use to
protect against "pleasure and danger" - the scavenging effects of venereal (after Venus, the goddess of love) diseases,
mainly syphilis (hero of the 1530 French poem, Syphilus sive Morbus Gallicus), were well known.

Two natural time-honored methods of contraception are coitus interruptus (withdrawal of the penis before ejaculation) and
breast-feeding. Withdrawal was denounced by some religious factions. As extreme as it may seem, it is stated in the Book
of Genesis that Onan was put to death for "spilling semen on the ground." Women have suckled their babies for years to
avoid pregnancy (menstrual cyclicity is repressed during lactation). Not surprisingly, these approaches have high failure
rates (after six months with nursing).

The first tubal sterilization was performed in 1823. Until recently, tubal ligations were used mainly to prevent pregnancy
in women who would require repeated cesarean sections. Vasectomies were first carried out in Sweden and England in
1894.

In early times physical trauma to the abdomen was the usual method of abortion. Greek women, as advocated by
Hippocrates, used vehement exercise to achieve abortion. Direct invasive procedures, such as cervical dilation and
curettage (scraping of the uterine wall) (D & C) and uterine infusions of irritants, were put into practice during the
nineteenth century. The Comstock Law of 1873 was part of a campaign to legislate public morality in the United States -
making the distribution of literature on sexuality, contraception, and abortion illegal; soon thereafter, elective abortions
were banned in most states.

Finally, plants have been used for birth control and as abortifacients for centuries. One of the oldest known efficacious
plants was called silphium; it was apparently used to extinction by the third or fourth century AD. Hippocrates mentioned
the use of Queen Anne's Lace (Wild Carrot), an inhibitor of progesterone production and fetal growth - the seeds of which
are evidently still in use today (eg., in parts of the rural United States). Other plants/fruits of alleged use are pennyroyal
(which is toxic), asafoetida, artemisia, myrrh, rue, willow, date palm, pomegranate, cabbage, juniper, pine, onions, and
acacia gum. The main problem with natural plant-based contraceptives is inconsistency of action.

History does matter. This statement must have been self-evident over the years, decades, and centuries past. It is
inescapable. Far from being a ‘dull and boring’ subject, its depth excitingly connects things through time and encourages
starters to take a long view of such connections for a better understanding of their chosen path.

Nursing in the Philippines has a deep and enigmatic history. This article illustrates the considerable weight and influence
of nursing history while at the same time disclosing the challenges of applying the past to the present.

Early Beliefs & Practices

Two words—mysticism and superstitions. These were the early beliefs of health and illness in the Philippines. The cause
of a disease was primarily believed to be due to either another person, whom which was an enemy, or a witch or evil
spirits. In the early times, Filipinos were very cautious not to disturb other people or the evil spirits for the good of their
health. These evil spirits could be driven away by persons with power to banish demons.Belief in special gods of healing,
with the priest -physician (called “word doctors”) as intermediary. If they used leaves or roots, they were called herb
doctors (“herbolarios”) Filipinos who became sick were usually cared for by the female family members or friends in the
home.
Early Care of the Sick

The early Filipinos subscribed to superstitious belief and practices in relation to health and sickness. Herb men were
called “herbicheros” meaning one who practiced witchcraft. Persons suffering from diseases without any identified cause
were believed bewitched by “mangkukulam” or “manggagaway”. Difficult childbirth and some diseases (called
“pamao”) were attributed to “nunos”. Midwives assisted in childbirth. During labor, the “mabuting hilot” (good
midwife) was called in. If the birth became difficult, witches were supposed to be the cause. To disperse their influence,
gunpowder were exploded from a bamboo cane close to the head of the sufferer.

Health Care During the Spanish Regime

The context of nursing has manifested through simple nutrition, wound care, and taking care of an ill member of the
family. Certain practices when taking care of a sick individuals entails interventions from babaylan (priest physicians) or
albularyo (herb doctor). In 1578, male nurses were acknowledged as Spanish Friars’ assistants for caring sick individuals
in the hospital. These male nurses were referred as practicante or enfermero.

The religious orders exerted their efforts to care for the sick by building hospitals in different parts of the Philippines. The
earliest hospitals were:

Hospital Real de Manila (1577) – it was established mainly to care for the Spanish king’s soldiers, but also admitted
Spanish civilians; founded by Gov. Francisco de Sande.

San Lazaro Hospital (1578) – founded by Brother Juan Clemente and was administered for many years by the
Hospitalliers of San Juan de Dios; built exclusively for patients with leprosy.

Hospital de Indios (1586) – established by the Franciscan Order; service was in general supported by alms and
contributions from charitable persons.

Hospital de Aguas Santas (1590) – established in Laguna; near a medicinal spring, founded by Brother J. Bautista of the
Franciscan Order.

San Juan de Dios Hospital (1596) – founded by the Brotherhood of Misericordia and administered by the Hospitaliers of
San Juan de Dios; support was delivered from alms and rents; rendered general health service to the public.

Nursing During the Philippine Revolution

In the late 1890’s, the war between Philippines and Spain emerges which resulted to significant amount of casualties.
With this, many women have assumed the role of nurses in order to assist the wounded soldiers. The emergence of
Filipina nurses brought about the development of Philippines Red Cross.

Josephine Bracken — wife of Jose Rizal, installed a field hospital in an estate house in Tejeros. She provided nursing
care to the wounded night and day.

Rosa Sevilla de Alvero — converted their house into quarters for the Filipino soldiers; during the Philippine-American
War that broke out in 1899

Dona Hilaria de Aguinaldo — wife of Emilio Aguinaldo who organized that Filipino Red Cross under the inspiration of
Mabini.

Dona Maria Agoncillo de Aguinaldo — second wife of Emilio Aguinaldo; provided nursing care to Filipino soldiers
during the revolution, President of the Filipino Red Cross branch in Batangas.

Melchora Aquino a.k.a. “Tandang Sora” — nursed the wounded Filipino soldiers and gave them shelter and food.
Capitan Salome — a revolutionary leader in Nueva Ecija; provided nursing care to the wounded when not in combat.

Agueda Kahabagan — revolutionary leader in Laguna, also provided nursing services to her troops

Trinidad Tecson (“Ina ng Biak-na-Bato”) — stayed in the hospital at Biak na Bato to care for wounded soldiers

Hospitals and Nursing Schools

Americans began training the first Filipino nursing students in 1907. Nursing students in the Philippines studied many of
the same subjects as nursing students in the U.S. However, it was believed that the curriculum in the Philippines “was
never a mirror-image reproduction of the American nursing curriculum” and involved more than a simple transfer of
knowledge from American nurses to Filipino nurses. The first Filipino nursing students also studied subjects that were
more relevant to their patients, such as “the nursing of tropical diseases” and “industrial and living conditions in the
islands,” as described by Lavinia L. Dock’s 1912 book A History of Nursing: From the Earliest Times to the Present Day
with Special Reference to the Work of the Past Thirty Years.

Hospital School of Nursing’s Formal Training (1901 – 1911)

Formal training in hospital school of nursing transpire. This began when American missionary doctors and nurses realized
that they manpower is insufficient. Thus it resulted to a decision of training Filipino nurses that would be catering to the
hospitals that Americans established in the 20th century.

The first hospital in the Philippines which trained Filipino nurses in 1906 was Iloilo Mission Hospital, established by the
Baptist Missionaries. When this health institution was built, there were no strict requirements for the applicants as long as
they are all willing to work. This has been the beginning of development of more nursing schools in the country. In this
period, Pensionado Act of 1903 (or Act 854) was mandated, allowing Filipino nursing student to study in United States.
Among of the first wave of nurses who went to United States

History of Nursing in the Philippines

FUNDAMENTALS OF NURSING

The Earliest Hospitals Established were the following:

a. Hospital Real de Manila (1577). It was established mainly to care for the Spanish King’s

soldiers, but also admitted Spanish civilians.Founded by Gov. Francisco de Sande

b. San Lazaro Hospital (1578) – built exclusively for patients with leprosy. Founded by Brother Juan Clemente

The Earliest Hospitals Established

a. Hospital de Indio (1586) –Established by the Franciscan Order; Service was in general

supported by alms and contribution from charitable persons.

b. Hospital de Aguas Santas (1590). Established in Laguna, near a medicinal spring, Founded by

Brother J. Bautista of the Franciscan Order.

c. San Juan de Dios Hospital (1596) Founded by the Brotherhood de Misericordia and support was derived from alms and
rents. Rendered general health service to the public.
Nursing During the Philippine Revolution

The prominent persons involved in the nursing works were:

a. Josephine Bracken – wife of Jose Rizal. Installed a field hospital in an estate house in Tejeros. Provided nursing care to
thw wounded night and day.

b. b.Rosa Sevilla De Alvero – converted their house into quarters for the filipino soldier,during the Philippine-American
war that broke out in 1899.

c. Dona Hilaria de Aguinaldo – Wife of Emilio Aguinaldo; Organized the Filipino Red Cross under the inspiration of
Apolinario Mabini.

d. Dona Maria de Aguinaldo- second wife of Emilio Aguinaldo.Provided nursing care for the Filipino soldier during the
revolution. President of the Filipino Red Cross branch in Batangas.

e. Melchora Aquino (Tandang Sora) – Nurse the wounded Filipino soldiers and gave them shelter and food.

f. Captain Salome – A revolutionary leader in Nueva Ecija; provided nursing care to the wounded when not in combat.

g. Agueda Kahabagan – Revolutionary leader in Laguna, also provided nursing services to her troop.

h. Trinidad Tecson – “Ina ng Biac na Bato”, stayed in the hospital at Biac na Bato to care for the wounded soldier.

Hospitals and Nursing Schools

1.Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)

Ø It was ran by the Baptist Foreign Mission Society of America.

Ø Miss Rose Nicolet, a graduate of New England Hospital for woman and children in Boston, Massechusettes, was the
first superintendent.

Ø Miss Flora Ernst, an American nurse, took charge of the school in 1942.

2. St. Paul’s Hospital School of Nursing (Manila, 1907)

Ø The hospital was established by the Archbishop of Manila, The Most Reverend Jeremiah Harty, under the supervision
of the Sisters of St. Paul de Chartres.

Ø It was located in Intramuros and it provided general hospital services.

3. Philippine general Hospital School of Nursing (1907)

Ø In 1907, with the support of the Governor General Forbes and the Director of Health and among others, she opened
classes in nursing under the auspices of the Bureau of Education.

Ø Anastacia Giron-Tupas, was the first Filipino to occupy the position of chief nurse and superintendent in the
Philippines, succeded her.

4.St. Luke’s Hospital School of Nursing (Quezon City, 1907)

Ø The Hospital is an Episcopalian Institution. It began as a small dispensary in 1903. In 1907, the school opened with
three Filipino girls admitted.

Ø Mrs. Vitiliana Beltran was the first Filipino superintendent of nurses.

Ø It started as a small dispensary on Calle Cervantes (now Avenida)

Ø It was called Bethany Dispensary and was founded by the Methodist Mission.

Ø Miss Librada Javelera was the first Filipino director of the school.

6. Philippine Christian mission Institute School of Nursing.

The United Christian Missionary of Indianapolis, operated Three schools of Nursing:

1. Sallie Long Read Memorial Hospital School of Nursing (Laoag, Ilocos Norte,1903)

2. Mary Chiles Hospital school of Nursing (Manila, 1911)

3. Frank Dunn Memorial hospital

7. San Juan de Dios hospital School of Nursing (Manila, 1913)

8. Emmanuel Hospital School of Nursing (Capiz,1913)

9. Southern Island Hospital School of Nursing (Cebu,1918)

Ø The hospital was established under the Bureau of Health with Anastacia Giron-Tupas as the organizer.

The First Colleges of Nursing in the Philippines

Ø University of Santo Tomas .College of Nursing (1946)

Ø Manila Central University College of Nursing (1948)

Ø University of the Philippines College of Nursing (1948). Ms.Julita Sotejo was its first Dean

The Basic Human Needs

Ø Each individual has unique characteristics, but certain needs are common to all people.

Ø A need is something that is desirable,useful or necessary.

Ø Human needs are physiologic and psychologic conditions that an individual must meet to achieve a state of health or
well-being.

When it started

19th Century (1880s)

1897
History of nursing in the USA begins with the formation of the Nurse’s Associated Alumnae of the United States when it
became apparent that training was necessary to protect the sick and injured from nurses that were incompetent and unable
to provide adequate care.
1898
While in the Philippines, it is embedded in the history of the Department of Public Works, Education, and Hygiene in
1898.

Establishment of Nursing Profession’s Associations in each countries

1897-1911
Nurse’s Associated Alumnae of the United States was established in meeting at Baltimore, Maryland in 1897 and was
renamed as the now famous American Nurses Association in 1911.

1922-1966
September 2, 1922 as Filipino Nurses Association (FNA) was founded in a meeting of 150 nurses presided by then
Anastacia Giron (Mrs. Tupas), the FNA was incorporated in 1924. The International Council of Nurses accepted the FNA
as one of the member organizations during the congress held in Montreal, Canada on July 8-13, 1929. The FNA became
the PNA (Philippine Nurses Association) in 1966, which was the same year that the office at 1663 F.T. Benitez Street,
Malate, Manila was inaugurated.

Reemergence of need of nursing profession

World War II
With the onset of World War II, there was a re-emergence of nursing needs as well as new programs to entice women into
training. They were offered tuition, books, housing, and stipends if they would train as nurses and help with the war
efforts. These recruitment efforts were handled by the US Cadet Nurses Corps from 1943 to 1948.

In 1941 in the Philippines, when World War 2 broke out, public health nurses in Manila were assigned to devastated areas
to attend the sick and the wounded. In July 1942, the thirty one nurses who were taken prisoners of war by the Japanese
army and confined at the Bilibid Prison in Manila were released to the Director of the Bureau of Health. Many public
health nurses joined the guerillas or went to hide in the mountains during World War 2.

Post War Records and the Emergence of Nursing Laws/Act

1946
In the Philippines, 1946 post war records of the Bureau of Health showed that there were 308 public health nurses and 38
supervisors compared to the pre-war 556 public health nurses and 38 supervisors. In the same year Mrs. Genera De
Guzman, technical assistant in nursing of the Department of Health and concurrent President of the Filipino Nurses
Association recommended the creation of a Nursing Office in the Department of Health. From then onwards, recreation
and improvement for the nursing profession in the Philippines were established. In 1953, The Philippine Nursing Law,
otherwise known as Republic Act 877 was enacted. Provisions included the organization of the Board of examiners for
nurses, provisions regarding nursing schools and colleges, examination, registration of nurses including sundry provisions
relative to the practice of nursing. Some portions of this law was amended in the year 1996, 1970, to the 1991 “Philippine
Nursing Act” which had redefined the scope of nursing and reestablished a new requirements for the Board of Nursing
and Nursing Faculties. It was again amended on July 22, 2002 as the latest Philippine Nursing Law.

1950s
After the war ended in the United States, the 1950s ushered in the ‘baby boom’ during which more health care was needed
for the ever-growing population. Nurses were in high demand like never before, as more than 75 million infants were born
from 1946 to 1964. Complicating the demand surge, some nurses opted to get married and stay home with their new
family, leading to a shortage in care. 1951, the Nursing Act in USA was established. It is related to the practice of
professional nursing, providing for the licensing of nurses and for the revocation and suspension of such licenses. This
law was amended in the year 1959. The 1960s brought Medicare and Medicaid to the country, allowing more people to
receive health care. And while the fight for fair wages and hours raged on for nurses, the overall nursing field was still in
high demand and growing each year. The 1970s showed an expansion of the nursing fields, allowing for more specialties
as well as the need for nurses in Vietnam. On December 9, 2002, the nursing law was again amended. It is known as the
latest “The Professional Nursing Law”. The law for nurses was expanded and more regulated than the previous laws.
Establishment of Education

Early 1990s
Several states in America passed nurse licensure laws, including New York, North Carolina, Virginia, and New Jersey.
Shorter training hours were established as well as stricter qualifications for getting into nursing school. For instance, one
prerequisite was at least one year of high school education. The idea of having students work in a more active role prior to
seeing patients was a new idea that was beginning to pay off.

In the Philippines, it was also early 1990’s when the first school for nursing was established. The program of study was
still shattered and unclear. Only few students are enrolled informally to this kind of education. A legislation or law was
clearly needed at the time, contributing to the establishment of the First True Nursing Law in 1919, Act 2808.

Final Thoughts

Nursing has been around for centuries, but it was not always considered a profession. Though the women of many
households were accustomed to treating ill members of their family, they were not trained in the medical arts, but rather
relied on handed down information from their mothers and grandmothers. However, as time passed and the value of
women in nursing professions became more apparent predispose by the events in our nursing history, the building blocks
of the nursing profession and formal training were laid out.

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