Beyond Florence
Nursing Justice: Filipino Immigrant Nurse Activism in the United States

Nursing Justice: Filipino Immigrant Nurse Activism in the United States

Catherine Ceniza Choy

When you think about trailblazing women in American nursing history, do Filipino nurses come to mind? Probably not. But they should.

The pioneering cancer prevention work of Ines Cayaban in the 1940s, the organizing work of Esther Hipol Simpson to defend two immigrant nurses wrongfully accused of murder in the 1970s, and the current leadership of National Nurses United Co-President Zenei Cortez to demand adequate personal protective equipment (PPE) are just three examples of notable Filipino immigrant nurse activism in the United States.

Attention to the impact of their lives and work is timely. The WHO designation of 2020 as the International Year of the Nurse and the Midwife was meant to be celebratory. Tragically, it has become a year of tremendous loss, grief, and anger. Many Filipino nurses have died on the COVID-19 front lines. As community educator Isa Cajulis has argued, Filipino nurses are not disposable. And as storyteller Christine Bumatay has emphasized, Filipino migrants deserve our attention.

Ines Cayaban: Public Health Nurse and Cancer Prevention Pioneer

Ines Cayaban was born in 1904 in the Philippine province of Ilocos Norte. American colonization of the Philippines had begun less than a decade prior, quickly shaping her formative years of schooling and her life ambitions.

A group of Filipino nurses standing on steps
Graduating class of student nurses from Philippine General Hospital. (Library of Congress)

Ines’s migration was part of a pioneering wave of early-twentieth-century Filipino student migrations that included nurses, a precursor to Filipino nurse mass migration to the United States in the second half of the twentieth century. As Ines completed her nursing studies in the Philippines in the 1920s, she set her sights on going to the United States.

By that time, a small group of Filipino nurses had returned after furthering their nursing studies in the United States and replaced white American nursing supervisors in Philippine hospitals. Thus, Ines and other nursing students quickly learned that education in the United States was the pathway for professional advancement in the Philippines. Three years after graduating from St. Luke’s School of Nursing as class valedictorian in 1928, she left the Philippines to further her studies at Columbia University.

The U.S. colonial government expected Filipino nurses on scholarship abroad to return to the Philippines. However, a stopover in Hawaii disrupted Ines’s intentions and American colonial plans. She married a Filipino American whom she met in Hawaii and settled there, becoming what historians Barbara Posadas and Roland Guyotte have called an “unintentional immigrant.”[1]

Ines initially worked as a public health nurse at Palama Settlement for low-income and immigrant communities. In 1949, she joined the Hawaii Cancer Control Society’s Education Department. In her autobiography, A Goodly Heritage, Ines wrote:

What I wish to point out is that during the early days of our cancer control programs, non-Caucasian women were ashamed to have a pelvic examination, especially in having a smear taken from the cervix for the Pap test. The Filipino women were very shy at being examined ‘down below’, particularly by a male physician. It took quite a long time to convince them that periodic pelvic examination was very essential in discovering cancer in its early stages, and insuring a high rate of cure.[2]

Ines Cayaban’s sensitivity to gender and racial differences, her ability to speak multiple languages and her willingness to learn new ones, and her skill in using different forms of media from print to radio to television contributed to the effectiveness of her work in cancer prevention. She lived the remainder of her life in Hawaii, and passed away in 1997 at age 92.

Esther Hipol Simpson: Anti-Martial Law and Anti-Racist Activist

By 1973, when Esther Hipol Simpson left the Philippines to work as a nurse in Chicago, so much had changed from the early 20th century. The Immigration Act of 1965 had overhauled U.S. immigration policy. It ended overtly discriminatory immigration policy toward Asia and other parts of the world and established a preference system that favored the immigration of highly-educated persons with needed skills. And what the United States needed then was nurses, especially in hard-to-recruit areas such as inner-city and rural hospitals.

Woman standing in front of water
Esther Simpson, photograph included with her obituary. (Dignity Memorial)

Recruiters targeted nurses in the Philippines because of their Americanized training. Beginning in the late 1960s, tens of thousands of Filipino nurses utilized the preferences of the 1965 Act to immigrate to the United States.

While dreams of travel and adventure enticed Filipino nurses, others left the Philippines because they were frustrated with the lack of job opportunities in their home country. I had the privilege of interviewing Esther in Seattle, Washington, in 1994. When I asked her why she decided to immigrate to the United States, she expressed ambivalence: “I wouldn’t have left the Philippines in the first place if the opportunities had been much better.”[3]

While Esther pursued job opportunities in Chicago, she also began to develop a new transnational political consciousness. She became involved in the nascent Anti-Martial Law Movement in the United States that opposed Philippine President Ferdinand Marcos’s imposition of martial law in 1972. She joined the Chicago chapter of the KDP (Union of Democratic Filipinos), an organization that focused on social and political issues in both the United States and the Philippines. The KDP took seriously racial discrimination faced by Filipinos in the United States, especially because of the rapidly increasing number of Filipino nurses.

As an activist, Esther was involved in multiple campaigns to support Filipino nurses. One included the defense of two Filipino immigrant nurses, Filipina Narciso and Leonara Perez, who were wrongfully accused of poisoning and murdering patients at the V.A. Hospital in Ann Arbor, Michigan. After determining that these nurses had been scapegoated because of their race, gender, and immigrant status, Esther worked with the KDP and the Chicago Support Group for the Defense of the Narciso-Perez Case to provide them with a proper defense and to demand a new trial after the two nurses were convicted of conspiracy and poisoning in July 1977.

Esther and fellow activists held forums, organized fundraisers, and coordinated demonstrations and petitions. In large part due to their efforts, the U.S. Attorney dismissed the case against Narciso and Perez in February 1978 and the immigrant nurses were set free.

Esther passed away in 2018 in Seattle, Washington. In the anthology A Time To Rise: Collective Memoirs of the Union of Democratic Filipinos, she reflected upon her activism: “This effort was a great and noble experience working for democratic rights and justice. I would do it all over again.”[4]

Zenei Cortez: Co-President of National Nurses United

Filipino laborers in the United States, most notably farm workers, have a century-long experience of organizing. Filipino immigrant nurses are also part of this formidable history. One prominent example is Zenei Cortez, the first Filipino to be elected president of the California Nurses Association/National Nurses Organizing Committee. Zenei is currently a co-president of National Nurses United, the largest union and professional association of registered nurses in U.S. history.

A crowd of people carrying signs "Stop Ebola"
Zenei Cortez’s Twitter profile picture. (Twitter)

Born and raised in the Philippines, Zenei migrated to the United States with her parents and siblings in 1974. As a registered nurse, she has worked through multiple pandemics and disease outbreaks, including AIDS, SARS, H1N1, Ebola, and now COVID-19.

Zenei’s decades-long work history in bedside, direct-care nursing has given her a critical historical lens to view the shortcomings of the United States’s handling of the current pandemic. In a March 2020 interview with Sarah Jaffe for The Nation, she decried the shortage of PPE for nurses:

“We are in America, one of the richest countries in the world and, yet, nurses who have given themselves to the frontlines are being denied something very important to protect ourselves and our patients. I have been a nurse for 40 years, and this is the first time this is happening.”

Zenei utilizes her leadership platform to also speak out against a broken American health care system where nurses and other health workers are being told to do more with less.

“COVID has exposed everything that has been wrong with our system,” Zenei said, during a National Day of Action in August 2020 that involved thousands of American nurses. “The old way was a huge failure. Now is the time to reenvision a world based on nurses’ values of caring, compassion, and community.”

We tend to think of Filipino nurse migration to the U.S. as something new. However, the lives and work of these three Filipino immigrant nurses span the early twentieth century into the twenty-first. Despite their longstanding presence and large numbers in the United States, Filipino nurses like Ines Cayaban, Esther Hipol Simpson, and Zenei Cortez are hidden figures in American nursing history. This too must change.


    1. Barbara M. Posadas and Roland M. Guyotte, “Unintentional Immigrants: Chicago’s Filipino Foreign Students Become Settlers, 1900–1941,” Journal of American Ethnic History 9, no. 2 (Spring 1990): 26–48.
    2. Ines V. Cayaban, A Goodly Heritage (Gulliver Books, 1981), 102–103.
    3. Catherine Ceniza Choy, Empire of Care: Nursing and Migration in Filipino American History (Duke University Press, 2003), 106.
    4. Rene Ciria Cruz, Cindy Domingo, and Bruce Occena, eds., A Time to Rise: Collective Memoirs of the Union of Democratic Filipinos (KDP) (University of Washington Press, 2017), 134.

Featured image caption: Filipino nurses walking down steps. (Courtesy Frank and Frances Carpenter Collection/Flickr)

Catherine Ceniza Choy is Professor of Ethnic Studies at the University of California, Berkeley. She is the author of Empire of Care: Nursing and Migration in Filipino American History (Duke University Press, 2003) and Global Families: A History of Asian International Adoption in America (New York University Press, 2013), and the co-editor of the Brill book series Gendering the Trans-Pacific World.

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