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The coronavirus pandemic brought to light the inequities of America’s health care system — including access to care and underlying conditions that disproportionately affect certain communities. One particular subgroup has been suffering on the front lines: Filipino-American nurses. Filipinos make up about 4% of all registered nurses in the U.S., but accounted for 30% of COVID-19 related deaths among nurses in 2020, according to National Nurses United. Filipino nurses working abroad are an economic driver for the Phillipines, as their remittances help support family and consumer behavior at home. It’s why, despite a cap on the number of health care workers allowed abroad, the country’s labor minister is asking for permission to allow 5,000 more – double the annual cap – workers to be sent overseas. A deployment ban was lifted in November, but some were still restricted from leaving amid the pandemic, and the demand for health care workers in the country. And those already abroad have suffered. The disproportionate impact of COVID-19 on Filipino-American nurses in the U.S. is no coincidence. The U.S. colonized the island after the Spanish American war in 1898, setting up nursing schools that trained Filipinos in Western medicine and English. That strategy eventually became a convenient source to fill a nursing shortage in the U.S. After World War II, when government funding to scale up wartime nursing staff declined, the U.S. was left with a shortage that was filled by an Exchange Visitor Program. The program had a dual purpose — it filled the nurse shortage and was also a propaganda strategy against rising Soviet communist influences in the region. But many of the nurses were eventually sent back to the Philippines. The U.S. once again leaned on Filipino nurses to fill shortages in the 1960s, but this time immigration reform allowed them to remain in the states. The influx was mutually beneficial for the two countries, as the U.S. was looking for cheap labor and the Philippines was looking for a way to export its labor as joblessness soared at home. Its economy also benefited as the result of many immigrants sending money home to their families. Throughout these periods, Filipino nurses were paid poorly and given some of the most strenuous jobs. It’s why they are often found in critical and long term care settings, which have been the hardest hit by the pandemic. And it’s why they were among the most affected during the pandemic. (Photo by: Basilio H. Sepe/Majority World/Universal Images Group via Getty Images) Intolerance for intolerance Lourdes Careaga, president of the Metro District of Columbia Chapter of the Philippine Nurses Association, arrived in the U.S. in the 1980s to help support her family. She was in her early 20s at the time and came to earn money to help support her 7 younger siblings in order to help them get a better education. “My story was written for me my first 20 years. My parents said, ‘She has to go to college and she has to take up nursing.’ That’s the only way to, as a woman, have a career and help the family out. I didn’t want to be a nurse,” Careaga told Yahoo Finance. She said that by time she had arrived, the previous generation of nurses had established better advocacy networks within the community and the pay was better. Still, she said, there is still an underrepresentation of Filipino nurses in management positions. Careaga said she sees more Filipinos in middle management, but only recently have a few — largely from the younger, American-born generation — been breaking through to upper management. Careaga says she has witnessed the increase in hate crimes and bias against Asian Americans this year. She said the recent attacks are far more serious than the passive racism she experienced when she first arrived in the U.S.. She recalled once helping a white patient walk, with the help of an African-American colleague, through the hospital halls. A white surgeon commented that the trio looked like an Oreo cookie. “I was so new to the country I didn’t even know what an Oreo cookie is. Lucky for him I didn’t know,” Careaga said. Another time, a woman at a shoe store asked multiple times if she knew the cost of a shoe Careaga was asking to try on — insinuating she wouldn’t be able to afford it. She’d largely brushed off or quietly tolerated such experiences, but the attacks that have been reported in the past year have changed how she feels. “I’m getting more aware that I have to speak up and have to be more attuned to [bias] … I think I should be a little bit intolerant,” Careaga said. Written by Anjalee Khemlani. More from Anjalee: Moderna can’t afford to share its vaccine technology, CEO says China, Russia playing ‘greater-than-expected’ roles in global pandemic response Biden COVID-19 adviser: Vaccine news is great, but we still have a ways to go Read the latest financial and business news from Yahoo Finance. Follow Yahoo Finance on Twitter, Facebook, Instagram, Flipboard, SmartNews, LinkedIn, YouTube.