CAIRO — Mechell Vencing Gimarangan, a Filipina nurse, strides into an upmarket restaurant in Sheikh Zayed City, part of the greater Cairo region. She speaks to the waiter in Egyptian Arabic and then transitions immediately to impeccable English. She appears totally at ease in her foreign surroundings.
Gimarangan has travelled a great distance to work as a nurse on the outskirts of the Egyptian capital. About 9,000 kilometers lie between her native Philippines and Dar al-Fouad Hospital, her employer in Egypt.
At present, Egyptian private hospitals employ a significant number of foreign nurses, from countries as far flung as India, Bulgaria and Algeria. A third of nurses from Gimarangan's unit are from the Philippines.
Egypt faces a chronic nursing shortage. A 2015 World Health Organization report found there are 14.8 nurses and midwives for every 10,000 Egyptians. This ratio amounts to almost half the global benchmark figure of 28.6 nurses. By comparison, Egypt does not suffer from a human resources shortfall as severe as this with doctors, pharmacists or dentists. In this climate, Egypt's private medical sector has turned its gaze overseas to fill nursing job vacancies even though these foreign nationals usually command much higher salaries than their Egyptian counterparts.
At first glance, this trend of hiring non-Egyptian nurses appears puzzling. Egypt's overall unemployment is currently about 13 percent, with more than 30% unemployment among youth. Educational institutions throughout the country offer nursing training courses. Labor laws protect Egyptian citizens against competition for jobs from foreign nationals and, in theory, companies may only employ non-Egyptians if no qualified citizen has applied for the same position. For these reasons, Egyptian nurses should have little difficulty obtaining employment after graduation.
Given high unemployment rates and job availability in the field, why do Egyptians shy away from careers in nursing? Ayman Sabae, a trained doctor and a health researcher for the Egyptian Initiative for Personal Rights, traces this widespread aversion to social stigma.
The work of nurses is undervalued. "They are often seen as second-class citizens, who provide services similar to a maid or cleaner," he says.
Sabae sees this social bias portrayed in popular culture. Nurses are shown as lazy, crass and "completely incompetent" characters in films and television. The Nurses Syndicate railed against this hurtful media image in 2010, unsuccessfully lobbying the Ministry of Culture to cancel a Ramadan soap opera that featured a corrupt and unethical nurse.
Salaries in this profession are also low. Egyptian nurses typically earn between $135 to $280 per month in public hospitals. This lowly remuneration provides little incentive for Egyptians to enter this profession. The government has not yet met its constitutional obligation to commit at least 3% of its GDP to healthcare.
Sabae says that this combination of social and economic concerns tends to drive young Egyptians with ambition away from a career in nursing.
Hassanat Naguib, dean of privately funded nursing college Gouna Technical Nursing Institute, concurs that adverse perceptions of the nursing sector stem from "ignorance regarding the nurse's role." She adds that a lack of proper nursing training has compounded this trend. Most Egyptians receive healthcare in public hospitals. This often brings patients into contact with inexperienced nurses, many of whom have completed only basic training. Naguib argues that until the quality of training improves, public confidence in nurses is unlikely to increase.
Social perceptions of nursing in the Philippines are markedly different from those prevalent in Egypt. Gimarangan describes the deep respect commanded by nurses in her home country. Her mother dreamed that her daughter would enter the profession, financially supporting Gimarangan on a long path to becoming a registered nurse. Filipino students must study four years at nursing school before completing — and paying for — various medical licensing courses. The student finally becomes a registered nurse upon passing a standardized bar exam.
Gimarangan has a straightforward answer as to why Filipinos go to such lengths to become nurses. "When you are wearing the white uniform, you are respected" in Philippines, she says.
Unlike Egypt, the Philippines has too many qualified nursing practitioners. Due to extreme competition for jobs, Filipinos typically begin their careers by paying a local hospital for the privilege of working as a volunteer nurse. Gimaragan worked under these conditions in her home country for 10 months. This unpaid work experience enabled her to obtain her current role at Dar al-Fouad Hospital. She views her job in Egypt as a "stepping stone" to other nursing opportunities, which she hopes will take her to countries such as the United States and Australia.
Naguib, the dean, encourages her graduates to pursue careers in the private healthcare sector, where hospitals tend to provide the latest training to nursing staff.
Mohamed Fakih, chief nursing officer at Cairo's Al-Salam International Hospital, says that public and university hospitals must progress away from practicing an "old school" type of nursing. Nurses in these institutions usually do not learn with up-to-date medical equipment, Fakih says, limiting the quality of care that publicly trained nurses can provide to patients.
Despite their misgivings, both Naguib and Fakih praise the ongoing efforts of the Egyptian Nursing Syndicate to promote better training practices. Over the past decade, the British University in Egypt has also developed a state of the art nursing faculty and Dar al-Fouad Hospital has its own plans to open a nursing academy in the future.
Sabae applauds the efforts of non-governmental organizations such as Misr al-Kheir Foundation, which aims to provide educational support to nurses working in university and government hospitals.
In a country rife with unemployment, nursing stands out as a field that can potentially provide jobs. But without significant funding and investment, a dearth of nursing staff will likely persist.