(Un)fit to Nurse: Efficiency and Discipline at the Philippine General Hospital, 1898–1916

Ren Capucao, MSN, RN will speak on Thursday, April 25, 2024 at 2:00 PM ET. This talk will be live-streamed globally, and archived, by NIH VideoCasting and live-streamed on the NLM YouTube Channel. Mr. Capucao is a PhD Candidate at the Bjoring Center for Nursing Historical Inquiry in the School of Nursing at the University of Virginia. Circulating Now interviewed him about his research and upcoming talk.

Circulating Now: Please tell us a little about yourself. Where are you from? What do you do? What is your typical workday like?

Ren Capucao: I currently reside in Virginia Beach, Virginia, where I was born and raised. I’m also a doctoral nursing student at the University of Virginia working on my dissertation that examines the transnational history of Filipino nurses through the critical lens of (dis)ability, so you can find me busy toiling away on my computer right now. I hope to defend this summer (fingers crossed)! When not writing, my breaks entail outdoor adventures with my dog, Enkidu.

The quotidian flow of my “typical workday,” however, is only a recent event. At the start of my doctoral program, I worked as a guest service associate at the Virginia Museum of History and Culture. As coursework went virtual due to the COVID-19 pandemic, I determined this was the best time to undergo my first nursing position. I worked as a pediatric nurse at the Virginia Commonwealth University Health System until I received a Fulbright fellowship to conduct historical and ethnographical research at the University of the Philippines College of Nursing. My ten months abroad required many adjustments, but I learned something new about Philippine culture and myself daily. For example, I formerly feared riding motorcycles, but for the sake of affordability and getting around traffic, I came to enjoy riding motorbike taxis. Overall, I have embraced the chaos surrounding my education and self-growth as a great adventure still unfolding.

CN: What initially sparked your interest in the History of Medicine?

RC: The spark that drew me to the history of medicine ignited during my childhood. I spent a lot of time at the hospital, whether being hospitalized due to my accident-prone nature or just visiting my mother—also a nurse—at work. The fondness I developed in experiencing the healthcare environment intertwined with my favorite school subject, history. History helped me understand the cultural and intergenerational dissonance I experienced growing up under Filipino immigrant parents. I learned about my mother and her career path as a nurse, including its joys and tribulations, so my interest in the history of medicine is deeply personal. My mother’s narrative and mine are interwoven into the broader colonial history of the Filipino nurse diaspora.

My professional interest in the history of medicine took place during my master’s entry program in nursing at the University of Virginia. While learning how to be a nurse, I was also learning how to become a historian of nursing; I wanted to gain broader insight into the uneven life chances and unilateral migration patterns nurses face in the Global South. I was taken under the wing of Dr. Barbra Mann Wall, then director of the Bjoring Center for Nursing Historical Inquiry, who instilled in me a sense of curiosity and confidence to pursue doctoral studies. Since then, I have also become indebted to the mentorship of the current director, Dr. Dominique Tobbell, who has continued to help me grow and refine my scholarship. I also show gratitude to the Filipino communities I have worked alongside who continue to fuel my fervor to drive change toward decolonization and global health equity, such as the Philippine Nurses Association of America, specifically its Virginia chapter, the Filipino Nursing Diaspora Network, and the University of the Philippines College of Nursing.

CN: Your talk, “(Un)fit to Nurse: Efficiency and Discipline at the Philippine General Hospital, 1898–1916,” explores a dramatic event in 1916 at the Philippine General Hospital. What happened?

RC: I myself was surprised by the events that unfolded! So, in mid-August 1916, Florentina Papa, a student nurse with exceptional record at the Philippine General Hospital (PGH), the government hospital serving the entire archipelago, committed suicide after being chastised by the American superintendent of nursing for breaking nursing’s code of conduct. Previously, she had gotten into a heated exchange with a patient on the ward who lambasted her and demeaned the professional status of nursing to servitude. She could not live with the dishonor or disrespect and chose to end her life.

On August 29, up to 150 student nurses walked out of the hospital to protest the disciplinary culture that led to Florentina’s death. Some believe politicians orchestrated the strike in the background, as on the same day the U.S. Congress enacted the Jones Law, which laid out the conditions for Philippine independence. One of these conditions was a stable government, and the strike indicated otherwise. In the student nurse’s petition to the hospital director, the most evident grievances surrounded the mandatory physical training course that began in June earlier that year and the associated punishments for absence and tardiness. On top of coursework and ward duty, all students were required to participate in calisthenics outdoors for forty-five minutes five times a week. The hospital director reasoned the course would overcome the physical weakness of Filipino nurses, whose bodies he deemed inferior to their American counterparts. He also considered the improved fitness of these nurses as a boon to the hospital’s efficiency.

In the aftermath of the two-day strike the director of civil service conducted an investigation. His report exonerated the hospital, which caused a public uproar. Shortly thereafter, the hospital director and nursing superintendent resigned, leading to the Filipinization of nursing services at the hospital. While the chain of events proves interesting, this particular moment in time must be examined within the history of PGH, a modern medical institution constructed under the American colonial government and its “benevolent” project of establishing the fitness of Filipinos for life under liberal modernity. Through this history, we can better understand the emotions, behaviors, and desires of the actors driving the development of professional nursing, the culture of discipline at the hospital, and the abledment of the Filipino nurse.

CN: The event touched many lives. In researching this subject, were you drawn to any particular event or individual’s story?

RC: One particular event that piqued my attention emerged from  the investigative report on the strike, which included an analysis of past issues at PGH. One of the thematic problems reported was suicides and the alleged suicide attempts of Filipino nurses within the span of three years. I learned that Florentina was not the first suicide, as another nurse had died two years prior. There were also three cases of alleged suicide attempts. Through a nursing and (dis)ability lens, the pattern of mortality, or heightened risk of death, does not appear accidental but rather intentional. To me, all of the nurses in these cases felt pressured by being unable to live up to the ableist and racialized image of the ideal nurse. The affective labor of these nurses further stimulated my curiosity about the culture of discipline at the hospital and the various subjectivities formed under the pressure of the American model of nursing. These morbid accounts must be recounted with empathy. They provide necessary interventions to rupture the linear narrative of progress lauded by benevolent colonialism, the notion of care and nursing as inherently benign, and the image of the Filipino nurse as an object of care with an unfailing body.

CN: In your research at NLM what materials were most enlightening for you? Was there a particular document that stood out?

RC: For this research project, I found materials pertinent to detailing the institutional history of PGH and its training school, including the History and Description of the Philippine General Hospital: Manila, Philippine Islands, 1900 to 1911 and the 1913 and 1915 school catalogs. Furthermore, the NLM’s extensive collection of The Filipino Nurse, the professional journal of the Filipino Nurses Association (now the Philippine Nurses Association) dating back to 1926, greatly assisted me in exhuming the lived experience of Filipino nurses during the formative years of Philippine nursing. Despite the publishing start date, many of the pioneering nurses at the hospital would become leaders in the professional organization, so biographies and interviews of these nurses can be found dispersed across the journal’s issues.

Beyond this project, one item that caught my attention was the Philippines Nurses’ Directory published by the Filipino Nurses Association. This directory, more or less, compiles a list of all known nurses from 1911 to 1941, with entries including name, alma mater, graduation year, last known address, and current employment. Overall, I’m excited about harnessing the potential of this geospatial dataset through digital mapping.

Watch on YouTube

Ren Capucao’s presentation is part of our NLM History Talks, which promote awareness and use of the National Library of Medicine and other historical collections for research, education, and public service in biomedicine, the social sciences, and the humanities. All talks are live-streamed globally, and subsequently archived, by NIH VideoCasting. Stay informed about the lecture series on Twitter at #NLMHistTalk.