Stephen Cherry, Ph.D., associate professor in the department of sociology at University of Houston-Clear Lake and the lead author of the report, wanted to examine the relationship between foreign-born health care workers and the city of Houston.
Stephen Cherry, Ph.D., associate professor in the department of sociology at University of Houston-Clear Lake and the lead author of the report, wanted to examine the relationship between foreign-born health care workers and the city of Houston.
Maregina N. Shankar, nurse manager for the Head and Neck Specialty Clinics at Harris Health System’s Ben Taub Hospital, came to Houston in 1988 from the Philippines.
Maregina N. Shankar, nurse manager for the Head and Neck Specialty Clinics at Harris Health System’s Ben Taub Hospital, came to Houston in 1988 from the Philippines.
People

Discovering Diversity

Researchers explore how foreign-born health care workers are impacting their communities and connecting with patients in the one of the most ethnically diverse metropolitan areas in the country

Discovering Diversity

7 Minute Read

In 1988, Maregina N. Shankar, currently nurse manager for the Head and Neck Specialty Clinics at Harris Health System’s Ben Taub Hospital, looked across the expanses of the Texas Medical Center for the first time. For Shankar, who traveled to Texas from the Philippines, the world’s largest medical center reflected a prism of possibility. Arriving on the cusp of a large immigration influx—roughly 25,000 Filipino nurses immigrated to the United States between 1966 and 1985—her journey is just one example of foreign-born health care workers sharing their expertise in one of the most racially and ethnically diverse metropolitan cities in the country.

“I came to Houston thanks to a very good friend who was hired by a recruiting agency based here in the city,” Shankar said. “There were 10 of us, all from the same hospital in the Philippines, who came here together and were hired by Harris Health System—they hired something like 20 to 30 nurses from different countries across the globe that year. Actually, that same close friend is still working here at Ben Taub Hospital, where we’ve both been for the past 27 years.”

The American health care industry relies heavily on foreign-born workers like Shankar. In 2010, according to the Migration Policy Institute, 16 percent of all U.S. health care workers—1.8 million people—were foreign-born. Among physicians and surgeons, 27 percent are foreign-born, in addition to 22 percent of nurses, psychiatrists and home health aides. While it’s clear that immigrant health care employees play a vital role in the fabric of the Texas Medical Center and Houston at large, the dynamic between those workers and the evolving culture of the city itself is less transparent. How are foreign-born health care workers in Houston assimilating to American culture and changing the city’s DNA in the process?

In an effort to lend some clarity and precision to an almost overwhelmingly expansive question, researchers Stephen M. Cherry, Ph.D., and Amy E. Lucas, Ph.D., from the University of Houston-Clear Lake, wanted to take a closer look at that relationship between foreign health workers and the city. Entitled, “Assimilation and Transformation through Healthcare: Case of Houston Foreign-born Healthcare Workers and their Community Engagement,” the study was commissioned by Rice University’s Kinder Institute for Urban Research.

“A study like this is really a big deal,” said Cherry, associate professor in the department of sociology at University of Houston-Clear Lake and the lead author of the report. “It gives us some insight in understanding that we have a high percentage of people who are native-born but aren’t following through with their degrees. That’s particularly the case with nursing, where there’s a disproportionate number of native-born citizens who go into nursing and then never use their degree. They might go through their training and realize, ‘This is a tough job.’ So you have this influx of foreign-born folks who are coming in.”

The researchers based their findings on a combination of data from the U.S. Census Bureau and interviews with members of nurse associations for Filipino, Indian, Nigerian and Vietnamese immigrants working in Houston-area hospitals.

“In this particular case, what’s really interesting is that here’s a situation where many health care workers, and not just high-level doctors, are immigrating from other countries and winding up working at the Texas Medical Center,” said William “Bill” Fulton, director of the Kinder Institute for Urban Research at Rice University. “What’s fascinating to me is the relationship between their work at the medical center and their influence in their communities where they live.”

The study provided a wealth of information to sift through. The researchers found that foreign-born health care workers were transforming Houston’s health care industry by improving its ability to effectively treat racially and ethnically diverse populations. Due to their ability to speak certain patients’ native languages and an awareness of specific cultural sensitivities, foreign doctors and nurses have a unique advantage over native-born professionals.

“As Houston has diversified, so has the number of patients coming in who need people who are culturally sensitive and versed in other languages,” added Cherry. “It’s like when you’re upset, you want to revert back to your native language, even if you’re completely fluent in English. We’re finding that these employees are able to address those populations.”

Effectively treating patients who share the same ethnic background doesn’t end at an enhanced ease of communication—foreign health care professionals can also raise awareness of health risks within certain communities. The Filipino community, for example, needs more attention for high blood pressure, while Helicobacter pylori infections disproportionately affect the Vietnamese community.

At the end of the day, simply understanding might have the most profound impact.

“I’m often on the street throughout the Texas Medical Center during my commute, and I run into a lot of people—they might be white, they might be black, they might be immigrants from Asia or Latin America—and they’re all really intimidated to be here. It’s this gigantic, kind of intimidating atmosphere,” Fulton said. “And for foreign-born health care workers in TMC institutions, to be able to understand the cultural and social cues and fears that these people might have walking through these hospitals, I think it makes for much better patient care. It allows the patients to relax and have much more confidence in the institution.”

In addition to the conclusion that foreign-born workers are doing much more to improve care than simply filling a demand for labor, the study aimed to determine whether those workers were joining large, community-based organizations and engaging with Houston’s broader civic conversations.

“A lot of the people who were interviewed for the paper talked about how, number one, ethnic diversity is an attraction to them,” Fulton said. “Number two, the fact that employees at the Texas Medical Center are well-paid is an economic asset to those communities. And number three, they spoke of a sense of commitment to their own ethnic community, bringing both their expertise in health care and that dedication to their communities to try and make them better places to live.”

Communities like Fort Bend County—now the most racially and ethnically diverse in the Houston area—attract immigrant groups not only due to their proximity to the TMC, but because of that vitality and ethnic diversity. While previous research paints a picture of a slow, steady march toward upward mobility for immigrants, medical professionals today are able to buy homes in Fort Bend County almost immediately.

“One of the important elements in understanding what this all means is that, because of their professional backgrounds and socio-economic status, those employees are able to move into rather diverse, multiracial, multiethnic neighborhoods, and quickly engage those communities,” Cherry said. “They have a lot of social capital. So when you look at civic engagement and health or resource fairs that are happening in Houston, they’re largely being staffed by foreign-born workers.”

According to Cherry, that commitment to civic engagement can send ripples throughout communities that billow into waves of potential impact. From voting percentages and volunteering rates that are higher than among average Houstonians, to the ability to quickly mobilize people and resources to address important issues, “in terms of what [foreign-born workers] bring to civil society, it’s just incredible.”

In contrast to previous theories about an immigrant population’s assimilation into American cities, a slow process where those immigrants would become indistinguishable from native-born residents, these health care workers are making an immediate impact on their communities and professions. Challenging previous assumptions about how immigrants integrate into their new homes and participate in civic life upon arrival, it’s an interplay that will only add to Houston’s richness and vibrancy. Many foreign-born health care workers like Shankar will continue to cherish and preserve their own distinct heritage.

“To be honest with you, I can identify as both Filipino and American,” Shankar said. “I guess it’s all about how you were brought up—whether you were going to church every Sunday, for example, or making sure that you have time to spend with your family. I still go home to see my parents and I still feel like I need to have that connection with my roots at home, which is why I long to go back to the Philippines pretty much every year. You never lose that need to reconnect with your friends and relatives back home.”

For Cherry and his colleagues, they envision the study as a pilot project for a much larger survey of the Texas Medical Center—and all of the people who make it what it is today. “There is still so much to learn,” he said. “It’s just the surface of what we can understand, especially considering that it’s such a large institution, but if we start negotiating those boundaries now, there’s a lot more that we can discover about the medical center.”

Back to top