Ryan Lianko has been a registered nurse for 16 years. Now 38 years old, he had dreamt of working abroad, maybe in the US or Europe, after he graduated in 2003 – a dream shared by millions of Filipinos. Almost 19,000 nurses leave the country every year, according to the Philippine Overseas Employment Agency.

But emigrating isn’t cheap, particularly with all the required tests and procedures, so Lianko found a job in the communicable diseases section of the state-owned Philippine Children’s Medical Center (PCMC), the country’s premier children’s hospital.