During the “Decolonizing Nursing: What? Why? How? webinar on September 23rd, there were questions posed for the panelists that could not be addressed due to time constraints. We promised to post responses to these questions on the Nursology.net blog – and here is the first of those responses!
The first question we are addressing is from nursologist Rudolf Cymorr Kirby Martinez in the Philippines, and a blog contributor to Nursology.net! The Philippines has provided well educated and competent nurses to fill nursing shortages in the United States for decades. Dr. Martinez posed the following question:
From the perspective of a developing country who supplied nurses for developed countries, colonization of nursing, especially education, is often masked as globalization. In the process of conforming to the requirements for working abroad and in the guise of being “globally competitive”, the local and distinct practice of nursing is set aside. The nursing curriculum of some developing countries are more American than local.
Panelist Responses
Daniel Suárez-Baquero
I would like to begin by stating that the idea of developed and developing countries is one of the most colonial ideas. It centers the vision of superiority made by the “developed” nations over the others. These “developed” nations have been characterized for invading and exploiting the resources of other countries. Also, this notion underlies that the “developing” want to be like the “developed,” rather than considering their greatness and contributing to their self and authentic growing.
I agree in that, in many instances, globalization is a masked form of colonization. The “international cooperation” must be a “reparation” made by the colonizer for more than 500 years of historic colonization of other nations, which remains even today. This critical state of oppression, exclusion, and discrimination is a product of an historical political and economical relationship between the invaders and the invaded, in which the dominant nations must be accountable of their acts dating back to before the invasion of Abya Yala (word used by the native tribes of Latin America to refer to their territory as an indivisible macrocontinent from south to north (from Argentina to Canada) and that I will use here instead of “America” as a form of vindication..)
Having this global perspective, the idea that we have been sold (to us, the developing ones, the others) grounded in otherness is that we want to be like them (the dominant and developed). Such an idea has led, in many instances, to lose our own identities and, even nowadays in the north, the very identity of nursing is blurred. Then, the invitation is to reclaim what is ours, what has been denied to us and, in the other hand, to the dominant white elite of the discipline to recognize the epistemologies outside of what they consider the core of the discipline. This will be the first step in a co-construction of a new epistemology of Nursing and in the rescuing of the local identities and practices of Nursing.
Barbara Hatcher
I do not believe nursing education in some countries is masked as globalization. I note you are from the Philippines and nursing education is part of the economic development blueprint of your country. As a past member of the National Council of State Boards of Nursing, I can remember vividly and somewhat in shock, a presentation by government officials telling us emphatically that nursing was part of their blueprint for globalization. Even today, physicians who would have a hard time getting credentialed in this country are retrained in your country as nurses who then immigrant to the US. Economists suggest that countries taking part in the global economy are experiencing more economic growth and poverty reduction than those countries which remain in isolation. So, globalization is both good and bad. However, the nursing community can turn this around by also seeing it as an opportunity for increased communication, and cultural exchange. How might beliefs and practices of other countries humanize and change nursing worldwide. How might nurses from other countries help nursing in your country design a more authentic part of your curriculum as well. You can certainly honor and embrace your cultural heritage as is done in the US, Canada, and other parts of the world. As an African American woman, I honor and embrace my ancestry and believe that it makes me unique and powerfully different. Others can do the same.
Catherine Ceniza Choy, author of “Empire of Care: Nursing and Migration in Filipino American History”, discusses how the “culture of American imperialism persists today, continuing to shape the reception of Filipino nurses in the United States”. In her book, she argues that the origins of migration of Filipino nurses to the US were created by the Americanized hospital training system developed during US colonial rule of the Philippines. She provides deep, critical theory analysis of the US exploitation of foreign-trained nurses through temporary work visas, lack of professional solidarity between Filipino and American nurses, and scapegoating of Filipino nurses during times of political strife.
The discipline of nursing in the US has fully, and uncritically, embraced neoliberal economic theory and fails to understand how the global economic system actually works. The South African physician and global health expert, Quentin Eichenbaum, asks us, “Who is ‘developing’ who”? $192 billion is extracted out of the African continent each year and deposited into American and European bank accounts while it receives 30 billion in foreign “aid” (Sharples, Jones, & Martin, 2014). In 2012, “developing’ countries received a little over $2 trillion- including all aid, investment, and income from abroad- while twice that amount, $5 trillion flowed out of those countries that same year (Global Financial Integrity & Center for Applied Research at the Norwegian School of Economics, 2016).
Haiti was forced to pay a $22 billion “indemnity” (some would characterize this as a “ransom”) to France for the loss of “its” most lucrative colony, a debt that took 120 years (paying out 80% of GDP yearly) to repay. US cotton farmers are paid a 41% subsidy by the US government (illegal under WTO rules) that drives down the global price of cotton by 10%. This translates into 300 million dollars in lost revenue, yearly, for the cotton farmers in Benin, Chad, Burkina Faso, and Mali whose governments are not allowed to subsidize their crops because the WTO enforces subsidy rules in impoverished countries (Hickel, 2017).
The 1994 North American Free Trade Agreement between the US, Canada, and Mexico, resulted in the Mexican market being flooded with cheap US and Canadian corn. The results? Over two million Mexican corn farmers lost their livelihoods, leading to large scale immigration to the US, millions moving to urban slums within Mexico, Monsanto gaining control over indigenous seeds, and the growing of poppies used to make black tar heroin which is being sold in every state in the US.
I fail to see how engaging with the global economy has improved the lives or health of the citizens of these countries.
Colonization is not something that happened “over there” in the “past” and now it is over. Colonization is a form of structural violence that continues on because its structures have never been dismantled. As Burgis (2015) notes, “As European colonialists departed and African states won their sovereignty, the corporate behemoths of the resource industry retained their interests”.
Eichenbaum (2021), based on the work of anti-colonial scholars such as Ngũgĩ wa Thiong’o , Angus Deaton, and Rupa Marya, suggests a path forward towards decolonization that includes both structural and cognitive aspects. Structural decolonization includes interrogating partnerships ( think Teja Cole’s White Savior Industrial Complex), foreign aid, and the problematic use of metrics that often reproduce both racism and colonialism.
Cognitive decolonization involves critical self-reflection, awareness, and rethinking (Eichenbaum, 2021). This includes self-reflection on cognitive bias and engaging in debiasing strategies such as ending the use of the colonial era’s exoticizing language, e.g. game vs. bushmeat, burials vs. funerary rites, or “traditional” used as code for “primitive” (Farmer, 2020). The transparent teaching of history, such as the Partition of Africa or the German holocaust in Namibia, is part of the awareness of colonialism and its ongoing legacy (Eichenbaum. 2021).
Decolonization also includes deconstruction of the Western intellectual cannon, e.g. racism in revered intellects such as Hegel, Hume, Heidegger, and Jefferson (Eichenbaum, 2021). We have to come to terms with the fact that Hegel provided us useful ways to engage in qualitative research while simultaneously propagating a racist discourse, “The negro is an example of animal man in all his savagery and lawlessness”, a foundational racist idea that justified Europe’s ongoing colonization of Africa (Kendi, 2016, p. 171).
Dr. Martinez and Dr. Suárez-Baquero are speaking truth to power about their personal and scholarly knowledge regarding colonization. Maybe power will start to listen.
Dear Rastaus,
I totally agree with you. Also, you provide clear examples of colonization, invasion, and the effects of globalization that many people in the “developed” countries refuse to acknowledge.
Coming from Colombia, I have seen the effects of Free Trade Agreements, the involvement of The States in the control and repression of Abya Yala; one significant example was Operation Condor. United States-backed campaigns of political repression and state terror involving intelligence operations and assassination of opponents and civilians. It was officially and formally implemented in November 1975 by the right-wing dictatorships in the South of Abya Yala. There are multiple examples of the colonization made by The States in our territories and more than 28 military interventions from the North since 1775.
The epistemological colonization and, as you described, the impact and influence of US Nursing are evident. Around the world, thousands of Nurses are trained to fulfill the need of Nurses in The States and Europe. This landscape has led to the detriment of the Nursing identity in our regions, a lack of labor stability, and an under acknowledgment of our own Nursing theorists and leaders because the images and world views that prevail in our “other Nursing” are those from the North.
It is hard to see this situation from the other side, and I appreciate all the awareness that you are providing. I agree about the steps that you indicate of critical self-reflection, awareness, and rethinking. These are the first steps in a process that is more than a deconstruction, is a path to an epistemological turn, a paradigm shift in which our existence outside the “core of Nursing” will be recognized.
Thank you so much for your post!