But in a country that has exported over 780,000 nurses overseas in recent years, including as many as 5,000 to Ireland, the frenzy of recrimination, political indecision and accusations of a cover-up was inevitable.

The alleged cheating that has so far been identified relates to the distribution of exam questions in this year's exam, taken by 42,000 nursing students and held on 11 and 12 June. So far, a special investigation by detectives at the Filipino national bureau of investigations (NBI) has identified three out of 17 centres where cheating is likely to have occurred.

Concerns The shocking concerns were raised by a number of nurses who passed the exam fairly, but only after they found out that others who sat the exam had seen as many as 90 out of the 100 questions in one test beforehand.

There was panic at Filipino government level when the complaints were upheld by a large number of witnesses.

The Philippines supplies nurses in large numbers to a handful of countries in particular, among them Ireland, Saudi Arabia and the US. The accusations could seriously tarnish the international reputation of the entire country, and the revenue sent home by nurses working abroad can be measured in millions of dollars to the Filipino economy.

It is only in the past weeks that nursing agencies around the world have gradually become aware that there was any controversy at all. Now many, including Ireland's main nursing regulatory body, An Bord Altranais, are set to turn up the heat and demand to know what has been going on.

The comments of Mary Grace Lacanaria, chapter president of the Association of Deans of Nursing Schools in the Philippines, set the tone of concern for many involved in Filipino nursing education. She said the alleged cheating raised the frightening spectre that the Philippines had been exporting "incompetent and unreliable" professionals.

Investigation She made the statement during a rally in Baguio City in recent weeks, attended by a large number of academic, qualified nurses and their families, who were demanding a transparent investigation by the Philippines Nursing Association (PNA).

The association has been criticised by many in the Filipino nursing industry, who claim it is not supportive of a transparent and independent investigation into the alleged cheating as it is too eager to keep the revelations from affecting the country's international reputation.

Lacanaria contends the PNA wants to avoid jeopardising negotiations with the American National Council of State Boards of Nursing for the creation of a Philippinebased testing centre that will offer migrating nurses the United States National Council Licensure Examination.

A NBI investigation has found that the alleged cheating in the nursing licensure examination was limited only to centres in cities of Metro Manila and in Baguio City. NBI director Nestor Mantaring last week said that charges are being prepared. As many as 17 review centre officials could face prison terms of up to 12 years.

The NBI can not yet reveal how many examinees from Baguio and Metro Manila would be affected because the bureau was still matching the list of examinees who passed with the list of those who had enrolled in the three suspected review centres. The count would be useful should the government decide to order some students to undergo a partial retake of the exam. What remains in doubt is whether the alleged cheating was ongoing for years but went undetected.

Prior to being contacted by the Sunday Tribune, An Bord Altranais had not been informed of the investigation into alleged cheating in nursing exams by the relevant Filipino authorities, according to the chief education officer, Anne Marie Ryan.

Ryan told the Sunday Tribune that strict measures are in place here to ensure that the training of foreign nurses is up to standard. "The main hospitals interview locally [in the Philippines] and that is a long convoluted process and it sets a very high standard in what it seeks from potential recruits. We require experienced nurses. When they arrive here we do a full review and they go through a process of 'adaptation' in training hospitals before they are registered."

However, Ryan added that An Bord Altranais would be seeking information directly from the Filipino authorities.

"Certainly we'd be concerned if there was any issue in relation to cheating or alleged cheating in nursing exams and we will be seeking more information in relation to this."

Information has reached other countries. While there has been no evidence that the cheating occurred in any exams conducted before this year, there is obvious worry that the recent revelations might point to a problem that could have gone undetected for some time.

Concerns had been raised not only by nursing profession bodies but also by foreign governments. Filipino labour minister Arturo Brion spent most of the last week divided between dealing with calls from reporters and calls from foreign medical agencies. A representative of the Japanese embassy met with Filipino officials from the labour ministry in recent days to express his nation's concern, Brion told the media.

The countries recently agreed a deal allowing for the employment of Filipino nurses and caregivers in Japan.

European bodies are also slowly learning of the developments and are asking for an explanation. The office of the Philippine labour attache in Brussels informed the Filipino government last week that some queries had been made by European agencies in relation to the scandal.

"[The labour attache] asked me what had happened because Brussels is asking.

And when you speak of Brussels, you speak of the EU, " Brion said last week.