AGUNSA:

In Malawi especially for males… when you say I am a nurse people laugh: ‘what a man a nurse, what is wrong with you?’

James, 2002 RN UK

Men have not always been part of the nursing profession in Malawi, and they have faced many challenges in finding their place in a traditionally female role (Simukonda and Rappsilber 1989). Before males were accepted into KCN in 1985, nursing was exclusively female, and women continue to outnumber men in the profession. This is especially true at EN level, although males are increasingly occupying RN degree level training places21. The wording ‘occupy training places’ is intentional, as evidence suggests that attendance at nursing school does not necessarily equate with working as a nurse. A widely held belief is that male nurses take the opportunity to study at KCN, but then do not stay in the profession. Nurse leaders claim that male nurses

20

She is referring to the 2009 memorandum of agreement which facilitates study exchanges between Malawi and South Africa.

21

In 2004, 16 out of the 19 students at KCN were male (the reason given for the high male intake was because very few students that year had adequate grades).

commonly forgo bedside nursing to go into managerial positions or NGO employment soon after graduation. A senior matron said:

… that’s where you find a lot of male nurses, they just want a loophole to get jobs in the NGOs. It’s easy to find a job.

Members of KCN have evidence to back these claims. They traced a number of men who passed through the nursing programme to administrative positions in NGOs and managerial positions. They blamed the university admissions system, as in the past males were redirected (not through choice) into nursing because they tended to have higher marks in mathematics and sciences. Increasingly nurse leaders, including senior matrons, tutors and senior MoH officials have tried to discourage men from entering the profession. KCN has also limited the number of males accepted onto its degree level course.

We don’t have many male nurses, for an intake of 100 we only take 20 males. We don’t want men because they don’t stay at the bedside of the patient. Most of the boys who have qualified as nurses have gone into the projects they are not at the bedside.(KCN senior member).

Many male nurses felt that even if they were accepted by KCN they faced several challenges. These difficulties were the main topic emphatically discussed by first year KCN nursing students during our focus group discussion. In the 2009 class, 24 out of the 105 students were male. Already feeling vulnerable and ‘stamped upon’ because they were in the minority, many of the male students believed that they were

discriminated against by a system that favoured women. Examples of such behaviour included scholarships being awarded to more females than to males, and men

commonly being the last to be promoted in the clinical area. Male nurses also faced discrimination from patients, with some female patients refusing to be cared for by them. Men also felt that, because the profession had long been dominated by women, the matriarchy was intentionally…

…delaying the progression of men in this profession. In the college less men hold high positions, if there are scholarships they go to girls with the aim of promoting girl child education.

Fellow female students also commonly perceived male nurses as disinterested in bedside care. One male student rationalised this by explaining that it was precisely this kind of attitude from other nurses, in addition to the nursing environment, that made them not want to stay at the bedside:

You are working with five nurses and you are the only male you feel like you are isolated. Most men prefer to go outside and be with NGOs.

A senior matron believed that male nurses did not stay in clinical care because of the white uniforms (precisely the thing that attracted many nurses to the profession). She observed that males often wore a white coat over their normal clothes, as a clinician would do, because they did not like to wear the classic nursing uniform. This behaviour may be related to the fact that, for many years, the only role models for males working in health care were white coat wearing doctors and clinical officers (Simukonda and Rappsilber 1989). A senior manager at the Malawi NMC found this behaviour very frustrating, adding, “they are not proud to be nurses! They would rather be seen as clinicians”. Many believed that male nurses had wanted to become doctors and were bitter because they could not.

What about the men who actively chose to pursue nursing? Interview findings suggest that there is more to the career trajectories of male nurses than the pursuit of a degree and a managerial level job. Firstly, leaving the bedside to work with an NGO is not exclusively a male activity, as many female graduates also follow this route. Secondly, it is important to assess the extent to which patterns of employment choice are

determined by how male nurses are treated by a society which has strict gender identities and where males do not take on such roles. As Silvia explained, “in Malawian culture the caring role is done by the woman, so it is hard to accept a man as the carer. Even if their wife is sick the husband will not care for the wife, he will get female friends and relatives to look after her.”

Interviews with five male nurses revealed that they often faced discrimination from their colleagues, managers and patients. The quote at the beginning of the section tells a common story of how male nurses are received by their colleagues. Another nurse recalled that fellow health professionals would often deliberately call him sister in an attempt to tease him. Alfred believed that many people still held negative attitudes about male nurses and thought that men should not be nurses because it is a female profession. His understanding was that people thought that he was stupid and chose nursing because he could not do anything else. These findings are consistent with those of Simukonda and Rappsilber (1989), who found that male nurses at KCN experienced high levels of anxiety, particularly in relation to the role differences between nurses and other male health workers.

Aubrey felt that it was often the older generation of nurses who behaved

study in which women in Malawi were found to prefer a male midwife as they were not under as much pressure to show that they were strong and not in pain. Alfred

rationalised the negative behaviour of nurses as intrinsic to Malawian culture, in which females are used to being more submissive (for example following orders without making decisions), and this has grown to become a part of the nursing profession. Now that men were coming into the profession, people perceived their unwillingness to be submissive as rudeness. One male nurse who qualified in 2004 believed that male nurses had done little to elicit this type of treatment, and that it was a general movement of nurse leaders wanting to protect their positions from male nurses with degrees. It is unclear to what extent the discrimination that male nurses feel put them off from pursuing a career in clinical nursing and pushed them into NGOs. My findings suggest that there may be additional factors that both male and female nursing

aspirants consider in their employment choices and in their career decisions. These factors are explored in the next section.