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Study: Filipino Migrants Transform Care


Migrant workers are increasingly hired as caregivers for older adults in Canada and in industrialized countries around the world.

Medical anthropologist Keren Mazuz (Hebrew University of Jerusalem, Jerusalem, Israel) recently described a unique practice among Filipinas working in Israel. As live-in caregivers for the dying, the workers use folding paper swans as a tool to organize the day and to transform care.

Mazuz observed Filipina caregivers at the homes of 30 Israeli patients in a town in southern Israel. She reported her findings online in the Medical Anthropology Quarterly on June 20, 2013.


Lori, a 39-year-old married woman and mother of four children in the Philippines, is part of a huge contingent of female workers known in Israel as Filipinas. Most migrants are uneducated Catholic women from the country’s poor rural areas. All of them support their families by sending money back to the Philippines.

The women obtain temporary contracts to care for dying patients for a monthly salary of from US$500 to $800. Contracts are arranged by local placement agencies that charge a fee of almost US$5000 to cover migration procedures. The fee is paid by all the migrants from their first year’s salaries.

On their day off, the women share rented apartments in Tel Aviv where they provide care and support to one another in their own Tagalog language.


Sarah, a 75-year-old widow with seven grown children, emigrated from Iraq in the 1950s and settled in Israel with her family. She suffered from Alzheimer’s disease and muscular dystrophy.

By the time Lori arrived to care for Sarah, she had already lost her ability to move, eat or identify the people around her.

Often when Sarah’s children visited, they showed Sarah’s old photos and shared stories of their mother.


According to the author, the craft of folding paper swans stemmed spontaneously from the interaction between the Filipina caregivers and their Israeli patients. Their specific swan-folding technique is unique to Filipinas in Israel. On their days off, the migrant workers learned the skill from each other.

The women constructed the swans as part of their daily routine of caregiving. They made the swans from pieces of recycled paper folded into triangles. Some of the patient’s families collected paper and bought glue. The differently coloured swans ranged in length from about 30 to 60cm.

The caregivers gave the completed swans as gifts to the patients’ families or the placement agency.

Caring and folding

Mazuz observed Lori’s care-giving practices at Sarah’s home. Here is part of one of her reports:

When I arrived, Lori was already awake, bending over Sarah’s bed, positioning the pillows under Sarah’s back and connecting her feeding tube to the nutritional drink Osmolite.

Afterward, Lori sat next to me at the dining table, took a bag containing pieces of paper and opened it. "Until now, I folded only 150 triangles and I need to fold more; I want a medium swan," she said. Lori had learned to fold paper swans in Israel from her friend Judith, who had also migrated from the Philippines.

She took out smooth white papers and drew 10 rectangles on each paper according to the shape of her telephone card. She drew the rectangles and then approached Sarah, saying, "You finished the bag," and disconnected Sarah’s feeding tube and checked her diaper. Lori returned to the table and continued to draw more rectangles precisely according to the card stencil. When she finished drawing on 10 sheets, she cut out the shapes along the lines she had drawn.

The author goes on:

After cutting the rectangles, [Lori] approached Sarah, disconnected the feeding tube, turned her onto her back, moistened her hands with cream, and massaged Sarah’s hands slowly and gently. Then she cut Sarah’s fingernails, returned to the table and continued cutting rectangles until late in the evening. We made an appointment for the next day.

New form of care

According to the author, the marginalized Filipina workers used the ritual of swan-folding as a coping mechanism. The ritual helped them to deal with the changing circumstances brought on by caring for a dying older person.

Within the cocoon of the patients’ homes, the women used simple paper and glue to establish a rhythm of caring and folding that encompassed both the dying patient and healthy caregiver.

By synchronizing the two worlds of folding and caring into one set of consecutive practices, the Filipinas transformed the caregiver-patient relationship. The caregiver was no longer dealing with a dying person but rather with life through the creation of the swan.

No more swans

And so, for five years during the day, Lori moved between Sarah’s needs and the swan folding. In March 2008, Sarah passed away during the night as Lori watched by her bed.

From that moment on, Lori stopped making swans.

After the patient dies, according to Israel’s immigration procedures, the migrant caregiver becomes illegal, eligible either for reassignment to another patient or for deportation to the Philippines.