Portal de Periódicos da CAPES

Let's celebrate contemporary black nurses, not create a modern myth

2016; Wiley; Volume: 73; Issue: 9 Linguagem: Inglês

10.1111/jan.13045

1365-2648

Niall McCrae,

Migration, Health and Trauma

The history of the National Health Service in Britain is a history of immigration. Many of the hospitals taken over by the NHS in 1948 were in a dilapidated state, and staff shortages were reaching critical levels. From the 1950s onwards, thousands of young women and men were lured to nursing in Britain from the pink-shaded areas of the globe – the former colonies of the West Indies, the Indian subcontinent, Mauritius, Malaysia and great swaths of Africa. As nurse training places were decreasingly filled by local people, by the 1970s, a high proportion of the workforce in general hospitals was of black or Asian ethnicity. In some large mental institutions, where recruitment problems were worst, the majority of ward staff were from distant shores. From doctors to domestic staff, NHS hospitals were a multicultural community long before the diversification of wider British society after immigration surged in the 1990s. In our history of mental health nursing, Peter Nolan and I devoted a chapter to this phenomenon, illuminating the experiences of foreign nurses and the challenges they faced (McCrae & Nolan 2016). They overcame prejudice to play a vital role in patient care, keeping hospitals afloat in parts of the NHS eschewed by British nurses. Many were unduly directed to Enrolled Nurse training, thwarting their career progress. Although wards were staffed day and night by black and Asian nurses, the nursing managers were almost entirely white. Hospital authorities paid inadequate attention to the ‘culture shock’ for foreign nurses, who sometimes struggled to relate to patients (and vice versa). Many lived on site, and having no connection with the community beyond the hospital gate, nurses from old colonial outposts such as Mauritius, Trinidad and Hong Kong worked overtime to save for their family future. Stepping into a British hospital today, one sees a kaleidoscope of humanity. Patients and staff come from every region of the world, and rapidly growing diasporas in major towns and cities have transformed the catchment areas of hospital and community services. Ethnic minority communities bring new challenges to healthcare provision, and it is important that medicine and nursing reflect the populations served. Black and Asian nurses are rising to the highest ranks of the nursing establishment, although we should not be complacent about latent bias in appointments. Meanwhile, through schemes such as Black History Month, there are efforts to raise the profile of black figures in a ‘pale, male and stale’ landscape of social history. The nursing profession has promoted Mary Seacole as a pioneer of nursing and as a symbol of the major contribution of black nurses to the British health service. However, some claims for Seacole, described by Smith (1984) as a ‘black British nurse’, are exaggerated. As respected historian Lyn McDonald (2014) explains, Seacole was neither black nor British, and did not describe herself as a nurse. Born in Jamaica, she was a businesswoman, herbalist and (her term) ‘doctress’. Having a wealth of assets in her home country of Jamaica, she made visits to London to manage her gold stocks. Encouraged to help the war effort in Crimea, she ran a catering service for officers, gave remedies with or without payment to those in need, performed first aid at the battlefield, and served tea and lemonade to wounded soldiers awaiting transport to hospital. Undeniably, she was a talented and compassionate woman, whose caring endeavours have been illuminated by Staring-Derks et al. (2015), but she did not work in a hospital, or devise any model of nurse training or practice. The quest to elevate Seacole to the highest pedestal has gained momentum. In 2006, she was named as one of ten ‘great Britons’ for a series of postage stamps, where Nightingale was conspicuously absent. A charitable foundation, supported by government funding, has erected a statue of Seacole in prime position in the forecourt of St Thomas’ Hospital, opposite the Houses of Parliament. Undoubtedly Seacole deserves to be honoured, as indeed she has been in several television documentaries, learning material in schools, and in the naming of wards and university nursing buildings across the country. Revisionist perspectives on the birth of nursing have downplayed or denigrated the achievements of Nightingale, portraying her as a fastidious, privileged woman of high Victorian imperialism, who was more of a statistician than a nurse. A subtle message seems to have crept into our historical narrative of ‘Seacole good, Nightingale bad’, with the latter scurrilously (and quite improbably, given her political stance) presented as looking down on people of colour. There is a danger of an ahistorical narrative being allowed to usurp the rightful place of ‘our lady with the lamp’ as the founder of nursing. Seacole had no dealings at St Thomas’, which should properly be celebrated as the site where Nightingale introduced her system of nursing and nurse training. There is no need to subvert historical truth to celebrate black British achievement in our health services. As a modest corrective to the lack of black figures in the modern history of nursing, I would like to highlight the work of a black nurse and midwife, Comfort Momoh. Raised in Lagos, to Nigerian and Ghanaian parents, Comfort started nurse training at Lagos University Teaching Hospital in 1981. By her second year she planned to move to London, where some relatives lived. On arrival in Britain in 1985, she was unable to practise before completing a 6-month adaptation course, but the matron at Addenbrooke's Hospital was so impressed with Comfort that she signed off all the competences after 3 months. Returning to London, she started midwifery training at Middlesex University in 1987, and after 10 years as a midwife at North Middlesex Hospital, Comfort applied for a new post at Guy's & St Thomas’ Hospitals. Comfort was appointed to run a clinic for women and girls who had experienced female genital mutilation (FGM), the second in the country after a similar venture at Northwick Park Hospital in north-west London. Her family in Nigeria had been blissfully ignorant of this cultural ritual, and in nurse training she was horrified to hear peers tell of girls in their neighbourhood who had died as a result of the cutting. As a midwife in London, Comfort observed how little support women received, despite the drastic impact of FGM on pregnancy. The FGM clinic provides support for women and girls who have undergone FGM, safeguarding intervention for girls at risk, and corrective surgical procedure for severe cases. Comfort performs deinfibulation, under local anaesthesia, on at least one woman per week. This is often requested by women at the time of marriage. Many patients are asylum-seekers fleeing forced marriage in Africa: there is strong correlation between FGM and other types of abuse. Alongside her day job, Comfort devotes much time to tackling FGM in Nigeria and other west African nations. She has received funding from The Guardian newspaper's Global Media Campaign to raise awareness of FGM, and has an active role in bodies such as NigeriaEndFGM. In a recent meeting at the House of Commons, a Nigerian man asserted that FGM is a thing of the past, but Comfort refuted this. Although the Nigerian government outlawed FGM in 2015, it remains highly prevalent in traditional rural communities (Christian and Muslim). Educated middle-class people may be out of touch with reality, unwittingly perpetuating the problem. Comfort also believes that male circumcision should be challenged, having met several men who complain of lasting psychological and sexual problems. Her husband was circumcised at the age of 15, a painful rite of passage which the boy is expected to endure quietly. Comfort feels strongly that no boy or girl should be subjected to forceful removal of healthy tissue without consent; she collaborates with an organisation Genital Autonomy to pursue the case for protecting all children. I was pleased to hear this from Comfort, having spoken out against inconsistent government policy in a recent article (McCrae and Mayer 2013). Colour is not the key to good practice with minority ethnic patients, Comfort opines. Compassion and competence are the most important attributes, and cultural sensitivity is integral to these. For example, Comfort regularly meets a white nurse who leads a FGM clinic elsewhere in London, who she describes as ‘brilliant’. Practitioners should not be pigeon-holed by their race or religion. Yet inevitably, some patients readily feel comfortable with a practitioner of similar background. As society changes, nursing and midwifery change too. Passing the new statue daily, Comfort has detected some disgruntlement about its prominence in a hospital famed for Florence Nightingale's work. A black role model has great symbolic value, and Seacole should certainly be remembered for saving lives in the horrors of the Crimean war, but the mother of the modern nursing profession should not be sidelined. We must strive to celebrate our history rather than revising it for ideological motives. There is no shortage of contemporary black nurses to celebrate, and no need to wait for sculptors.