Apr. 15—JOHNSTOWN, Pa. — Conemaugh Memorial Medical Center in Johnstown employs 31 nurses through an employment-based immigration program that the hospital entered into more than a year ago as the local labor market tightened.

Nurses from southeast Asia, Africa, Jamaica, Antigua and the Bahamas obtained immigration documentation, including Green Cards for permanent residency in the United States, through Avant Healthcare Professionals, an agency for immigration and licensure of registered nurses for short-staffed institutions.

Many of the nurses arrived first in Florida, where Avant is based. They worked through cultural transition and orientation, then were subsequently placed in Johnstown. Most of them arrived last summer and have completed about eight months of their three-year contracts with Conemaugh.

Encouraged by her husband to apply for a job in the United States, mental health nurse Britney Roberts, 32, from the Bahamas, arranged the process with Avant. She had been through the application process before, but turned down an opportunity in England.

Gaining experience in the United States was more attractive to her.

"I got a contract within a few days of applying for the United States, so I was like, 'Wow, it seems like the nursing shortage in the U.S. is pretty bad,' " Roberts said.

She arrived in Johnstown at the same time as Victor Murono, 37, who came from Kenya.

Murono is a medical surgical nurse, providing care for Conemaugh hospital patients preparing for or recovering from surgery.

He said he researched the population of Pennsylvania before arriving last summer.

"I knew the population was older, but I didn't think about it until I came here — I'm the youngest in my neighborhood," he said at the house he rents in Richland Township, "and at the hospital where I work, everyone is older, except the nursing staff and the medical staff."

Trouble finding child care

In Cambria County, about 24% of the population — roughly one out of four people — is age 65 or older, according to the United States Census Bureau. The area's aging population is a factor in its shrinking labor market.

Employment-based immigration programs of United States Citizenship and Immigration Services give preference to regions with the most need for workers.

Cambria County's labor force participation rate is 55% of adults, compared to the United States' overall rate of 63%, U.S. Census Bureau estimates show.

"People ask me, 'Why did you come to Johnstown?' " Murono said.

Aside from the area's aging population, the young immigrant families have encountered another workforce participation barrier that Johnstown natives face.

Roberts has been on a waiting list for child care for her youngest son since she arrived in the area last summer.

The nurses work three 12-hour shifts a week at Conemaugh hospital.

"I watch the sun rise and I watch it set at work," she said. "I can't be wondering where my kids are. Of course, when you live back home, next door is a relative, and a relative across the street, and grandparents live that way, so child care is not such an issue — but when you go to a foreign place, you have to have those things sorted out before anything else can happen."

Roberts said she was lucky to find a babysitter — the wife of another nurse who landed in Johnstown through the same immigration program.

"That worked out for me, but day care is extremely expensive and it's extremely hard to get into," she said, "and that was extremely stressful. How am I going to provide if I can't work?"

In Murono's home country of Kenya, nannies are affordable and available, he said.

"Finding child care here is tricky," he said. "All of the day cares were full, and they were telling us, 'You have to be on the waiting list, and we don't know how long it's going to take.' "

Murono spoke to The Tribune-Democrat with his son Darrel, 6, and daughter Ayla, 2, at their house in Richland Township. Not present for the interview was Murono's wife, Florence Owinyo, who has found work locally as a certified nursing assistant.

The couple have arranged their work schedules so that one of them is at home to care for the children while the other works.

"That is tricky because we never have time together as a couple," Murono said. "If one is at home, the other is at work. In Kenya, there are affordable nannies and babysitters. It is $40 per month for a nanny to take care of the babies, do everything from washing, cleaning."

Child care in the United States annually costs $10,000 or more — that's roughly the cost Murono found at $40 a day for 260 work days in the year, though he and his wife could afford that, if it was available.

When the couple went to a day care a few miles from Conemaugh Memorial Medical Center, "they also told us there was a waiting list," he said. "We've been waiting for three months now. Every time we call, they say there is no chance, so it's taking forever, and they are taking $40 a day, which is no problem. If they can take care of the kids for a whole day for $40, while we go to work, we would make much more money, so it makes economic sense."

"I was earning $3 per hour in Kenya," he said with a laugh because of his much improved situation in Johnstown. "In Kenya, there's high competition, and this gives the employers leverage to give you whatever they feel like. When I came here, I started earning $32 per hour, which is great, and it's one of the motivating factors, the higher salary."

There was no language barrier for the nurses. The Bahamas is an English-speaking nation of 700 islands and keys — 12 of which are inhabited. Both the Bahamas and Kenya were British colonies before gaining independence.

Kenya's population is made up of 42 tribes, all with their own languages, Murono said. But English is widely spoken across the whole country, especially in job interviews as a measure of educational attainment, he said.

For Murono and his wife, the first three months in Johnstown were hard, he said.

"It was a new country, new culture — and at the workplace, technology is so high," he said. "In Kenya and Africa at large, we are still lagging behind in terms of technology. That was a challenge adjusting, but as far as we've come now, we are adapting so well, and now it's become like a home here."

His son, Darrel, has adapted easily to Richland School District. He spoke excitedly about pizza and juice served at lunch and playing video games with friends. He will celebrate his seventh birthday on Wednesday, his first such milestone in a new country.

Roberts also said there was a stretch of time after arriving in Johnstown that she couldn't wait to complete her three-year contract so that she could move. Adjusting to the new system at work was rocky, finding child care was a dead end, and the weather was foggy, she said.

"I felt it was hitting me all at once," she said. "I am an emotional person, so I was freaking out."

However, living in Johnstown has grown on her, she said. She began to feel more positive after her family found a church to join.

New friends from her church helped her adjust to culture shock and even fixed the furnace at the house she's renting as winter reared its head.

"Right before the winter, we didn't know about turning on the heat," she said. "The heating bill — talk about culture shock."

Murono said he wanted to point out that while in Kenya, people who knew he was going to the United States believed he would encounter racism. He and his family have found the opposite in Johnstown.

"Americans are kind," he said. "I don't want to go back to Kenya. I invite my friends to come. It's nothing like racism. Those are extreme few cases that happens once in a while and they happen everywhere — in Kenya, too."

After he fulfills his three-year contract at Conemaugh, he's free to find a job anywhere in the United States. Or if he wishes, he can return to Kenya because he has a Green Card, officially called a Permanent Resident Card.

After living in the United States for 10 years, Murono could apply to be a U.S. citizen, he said.

Roberts said the United States is the best country for her to further her medical education.

"I want to eventually teach nursing education at the master's level," she said. "Step one is getting U.S. experience."