MANILA - For years, the Philippines has provided nurses to the hospitals in rich nations, but a recent escalation in the exodus of medics has left the local health-care system on the verge of collapse.
Lured by higher salaries abroad and fed up with political instability at home, over 100,000 nurses - including former doctors - have left the Philippines in the last decade and are now working overseas, studies show.
Experts say the "brain drain" is also a result of the Government's policy of encouraging Filipinos to work abroad so they can send back billions of dollars a year to fuel local consumption, the main engine of economic growth.
"In two to three years, the health-care system would collapse," said Jossel Ebesate, secretary general of the Alliance of Health Workers (AHW), a group of medical workers.
He added that of the roughly 1600 private hospitals in the country, only 700 were now operational due to the shortage of nurses and doctors.
Former health secretary Jaime Galvez Tan says the nurses who remain are overwhelmed by the number of patients they must care for.
At some hospitals on the southern island of Mindanao, there is one nurse for 55 patients, said Tan, now a professor at the University of the Philippines.
The ideal ratio is one nurse to four patients, he said.
Even at the Government-run Philippine General Hospital in Manila, the country's largest medical institution, the nurse-to-patient ratio is 1-to-26, a study by Tan shows.
What is even more worrying, Tan said, is the recent trend of doctors leaving the Philippines after enrolling in nursing schools so they can work as nurses overseas.
"I expect more negative impact because 80 per cent of doctors have taken up nursing," he said.
While many developed countries impose high barriers for allowing foreign doctors to continue to practise, they are willing to accept nurses with open arms due to the shortage at home, which is expected to continue due to ageing populations.
Tan says that in the United States alone, there was a shortfall of 150,000 nurses in 2005 and the number is predicted to hit 800,000 in 2010.
Doctors from the Philippines can expect higher wages abroad, even if they work as nurses.
Pepi Ocampo, a student at Manila's De La Salle University, says he's decided to join a nursing school rather than a medical school after graduating from college.
"At first, I wanted to become a doctor, but I realised that it was not practical," he said. "I decided to go into nursing as I want to earn lots of money ... My parents suggested that I become a nurse. They were interested more in the pay."
The basic monthly salary for nurses working in public hospitals in the Philippines is around 9900 pesos ($291.54) and 7000 pesos for those in private institutions.
In the United States or Britain, they would earn between 100,000 to 120,000 pesos, AHW's Ebesate said.
The entry level salary for doctors at public hospitals in the Philippines is about 12,500 pesos, while doctors at private clinics earn about 17,000 a month.
Richer countries do not just tempt medical staff - more than eight million people, or about a tenth of the Philippines' population, work overseas.
Last year, remittances from these overseas workers totalled a record US$10.85 billion ($16.64 billion), up from US$8.81 billion in 2004, which makes up about 70 per cent of the Philippines' gross domestic product.
Underpinned by the cash inflow, the economy last year grew 5.1 per cent from 2004, which was at the top end of the Government's forecast of 4.8 to 5.1 per cent.
Experts say the Government's reliance on remittances to spur growth is hindering efforts to address the medical exodus.
"On one side, you have a part of the Government saying: 'Lets export as much as possible and let's bring back money," said Jean-Marc Olive, the World Health Organisation's representative in the Philippines.
"And on the other side, they are saying: 'Hey come on, we are losing all of our good guys."
Health Secretary Francisco Duque says the Government plans to draw up a law to stop doctors leaving.
"We're focusing on keeping doctors here and legislation is the only way to do that. We want to plug the hole," he said.
College student Ocampo says it is difficult to leave his country but says ultimately, most Filipinos have their hands full looking after their families.
"People nowadays don't care for the country that much. They only care about their family."
Medical emergency system strain
International medical graduates make up 23pc to 28pc of doctors in wealthy countries and 40pc to 75pc of those come from lower-income nations.
75pc of all international medical graduates in Britain come from poorer countries. The rate is 60pc in the US, 43pc in Canada and 40pc in Australia.
Nurses from the Philippines account for the largest proportion of new foreign nurses in the US.
Lured by higher salaries abroad and fed up with political instability at home, over 100,000 nurses - including former doctors - have left the Philippines in the last decade and are now working overseas.
Of the roughly 1600 private hospitals in the country, only 700 are now operational due to the shortage of staff.