Metodología del proyecto de Gestión de Aula

In the west, especially during the eighteenth and nineteenth centuries, the professional recognition of nursing developed gradually following a long series of struggles. Likewise, historiography in nursing developed and has kept developing as an increasing number of historical accounts on nursing were written, especially during the last quarter of the twentieth century (Rafferty, 1997).

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This development is reflected in the increasing number of nurse historians as well as the increase in approaches to historical enquiry and the diversity of topics on the history of nursing. One of the notable trends in nursing history is the decline in the production of historical accounts of the life of Florence Nightingale. Another more recent change, in the UK in particular, is that there is a new generation of nursing historians who no longer worry about issues such as regulations, registration or nursing’s recognition and status in the society (Maggs, 1987). Maggs asserts that nurse historians are no longer part of movements to fight the battle of registration; they are now more interested in issues which have emerged post winning the battles.

Some historians such as Carpenter (Carpenter, 1980) are more concerned about the dominance of general nursing in history of nursing and not about the change of the themes within the writings on the history of nursing. In this work, Carpenter addresses the issues relating to ‘asylum nursing’ (currently mental health nursing) and states that at that time there are no or very few accounts on this branch of nursing and other specialities within the profession of nursing such as community, psychiatric and mental health nursing.

On the subject of branches within the discipline of nursing, one of the areas that have always been seen as one of nursing profession’s branches is midwifery. Many accounts were committed to establish a line between nursing and midwifery as the latter has always been viewed as one of nursing discipline’s branches. A very recent book that covers Nursing and Midwifery in Britain since 1700, written (Borsay and Hunter, 2012), contains a number of essays and has some unique analysis, which can be summarised as follows: first, it places the two professions as if running along a parallel lines, and it asserts that midwifery is a professional discipline on its own right; it is not secondary to nursing or one of its branches. Instead, the book emphasises the complementary position of the two disciplines to each other.

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In the twentieth century, historiography in nursing moved on to cover broader themes, such as: politics, gender and feminism, religion, and recently and perhaps during the last decade, colonial and military nursing (Rafferty, 1997).

Accounts on colonial nursing or nursing in the colonies have started to attract the attention of many nurse historians. Previously in this chapter a mention was made on Jenkins’s (Jenkins and Munslow, 2003) urging historians to look at history from beyond their modern thinking. He was an advocate of using the different ‘posts’, such as post-colonialism, in writing historical accounts. Nurse historians seem to have responded to Jenkins call as we can see an increasing historical accounts of colonial nursing or in other words, nursing in the colonies. The British colonial power is the main concern in this study, and it will be of the main focus in reviewing accounts on the history of colonial nursing. However, before reviewing these accounts, and since we are attempting to explore the history of nursing during the British colonialism of SA, it would be beneficial to review the term colonialism.

2.2.5.1 Colonialism

Colonial periods have been well considered by many writers and theorists among whom are Bhabha, (1990); Spivak and Harasym, (1990) and Memmi, (1991). In their writings these theorists have intensively and critically considered the process of colonialism as well as (Fanon, 1967; and Said, 1979) the relationship between the colonizer and the colonized (Memmi, 1991).

The term colonialism itself is considered as a notion with different perspectives; it has been defined and characterized differently. According to Williams (Williams and Chrisman, 1994:4) for example, the term colonialism is:

“A way of maintaining an unequal international relation of economic and political power'”

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In addition to the political and the economic subjugation, an ongoing programme of cultural colonisation was essential to support and maintain the hegemony of the colonized (Thiong and Apos, 1998). On the other hand, Chatterjee (Chatterjee, 1993:10) in the Nation and its Fragments describes the colonial process as:

“The normalizing rule of colonial difference, namely the preservation of the alienness of the ruling group”.

This difference from Chatterjee’s point of view represents the 'other' as inferior and radically different, and hence incorrigibly inferior. The idea of creating an 'other' has been further explained by Edward Said (Said, 1979) who believes that the colonizer or the imperialist powers needed to create an ‘other' in order to define themselves as centre. Although the policies of colonialism varied from one 'centre' to the next, Said, believes that they systematically programmed colonized people to understand themselves as other, as marginalised, in relation to this centre. In this case how the two parts will work, interact and live together should be at the heart of any studies that consider the history of any phenomenon in the colonies during colonial era, such as this study. This study is attempting to explore a small part of the history of nursing in SA during the British colonial era specifically in the period 1950-1967. In the next section, studies or accounts on the history of colonial nursing will be reviewed.

2.2.5.2 Accounts on the history of Colonial Nursing

British Colonial nursing history is considered to have started with the establishment of the Colonial Nursing Association (CNA) in 1896. Since then more than 8400 registered nurses were sent abroad to provide nursing care for the sick and injured between the period 1896 until 1966 (Howell et al., 2011). Perhaps the main reason behind the foundation of the CNA was the concerns of Frances Piggott which were expressed in a number of public meetings. Mrs Piggott was at that time concerned about the health and the wellbeing of British men, women and children who had to live in the British

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colonies. According to her, British settlers in the British colonies often lived in unhealthy environments, risking their lives and safety (Howell et al, 2011). Nurses sent to the colonies were hoping that they would be able to provide a more ‘civilised’ levels of care similar to what is available in their home land (Howell et al, 2011; 1159). Regardless of the motives behind the establishments CNA, some historians believe that nursing in the colonies enhanced the existence and control of the colonial state, by creating conflicts and struggles within the profession in the colonies.

Deacon (Deacon, 1997) and Marks (Marks, 1994), both biographers, wrote on nursing in South Africa during the Apartheid system. Deacon examined the history of nursing in South Africa from a colonial context. She describes three characteristics of the colonial medical history in the Cape of the period between 1846- 1910 and they are as follows: firstly, at that time, the government had almost no rule in the provision of health services; secondly, the mid- nineteenth century, witnessed an increase of racism and the dominance of the medical profession; and thirdly, the Anglican Church’s main role in the provision of health care in the infirmaries, as the colonial administration did not get involved in the welfare provision in the Cape. In this article, Deacon also assesses two issues which are gender and race within nurses in two different hospitals, the mental asylum and a leper hospital from the time of their foundation until their shutting down. Deacon (Deacon, 1997) suggests that racism in hospital employment did exist at that time and increased after the arrival of Nightingale’s nurses in 1870s. The colonial state’s sense of responsibility towards these nurses made them favour these nurses by providing them with, first the privilege of housing and then in the 1860s white nurses of better class were recruited in the new asylum as they were thought of as more respectable and better in delivering care. Consequently, by the early twentieth century, colonial hospitals in the whole country stopped recruiting black nurses. Furthermore, Deacon goes on to argue that by the late nineteenth century, doctors in Cape Town were regarded as ‘agent of empire’; they were constantly coordinating with the colonial power and have had a high status in the society and full support from the government. Deacon notes that there was continuous apprehension in the colonial nursing service about what kind of women would be employed.

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Marks (Marks, 1994) also in relation to South Africa wrote about ‘divided sisterhood’ within nursing profession. Divided sisterhood to Marks means more than talking about history of nursing. It also uses this history to propose a clearer and more comprehensive view of the clashes and conflicts within the history of South Africa. In relation to nursing, Marks points out that nursing had a role to play in relation to the foundation of class in South Africa. As it was originally lead by middle-class English women and nursing sisters, it was also one of the most important jobs available for African women educated by missionaries, which transformed these women to become members of the middle-classes.

Nursing was also a means of the introduction of the colonial standards and approaches (Marks, 1994). Conflicts in controlling the profession of nursing existed between, middle-class mainly English- speaking registered nurses and the lower class, largely African women with nursing positions. These class conflicts were mainly concerning whether nursing staff should be regarded as health professionals like male nurses, or whether they should be regarded as health attendants or as lower paid workers. Here, one can hear the beginnings of echoes of gender conflicts, in addition to class conflicts. Furthermore, Marks (Marks, 1994) emphasises that questions such as how African women would be part of the nursing force, gave room to racial struggles within the profession. The class, gender or racial struggles and conflicts in the history of nursing profession in south Africa was never elucidated Marks on this blames the less skilled historians.

In India for example, Basuray (Basuray, 1997) examines the significance of ethno- history as a perspective in order to make sense of the nature of social subjugation in the colonies. Basuray (Basuray, 1997;15) asserts that:

“Nightingale’s model of nursing prevailed through Europe

colonial and Post-colonial period. Nurse Miss Sahib in the title is intended as an icon of the juxtaposition of caring and social oppression in a cultural – bound education process in India”

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She goes on to assert that the idea of Miss Sahib Nurses was used by the colonial power with the aim of eliminating the colony’s traditional ways of health care and its providers. The icon of Miss Sahib Nurses took over that of the native nurses of the local culture and traditions (Basuray, 1997).

The Heroines of Lonely outposts or tools of the empire? British nurses in Britain’s model colony: Ceylon, 1878-1948 (Jones, 2004) is an article written by Margaret Jones of the Welcome Unit for the History of Medicine. In this article, Jones examines the life history and experience of two British nurses who were among the first to be sent to Ceylon to work as nurses in the colony’s hospitals and to educate Ceylonese females in the profession of nursing. The work also evaluates these nurses’ achievements and their roles in the improvement of the nursing profession in the colony. However, Jones’s paper concludes that the existence of these nurses in the colony ultimately left an unclear legacy. As educators of the native females, the nurses contributed to the introduction of the colonial principles which enhanced and reinforced the dominance of the colonial power.

The accounts of colonial nursing have tended to focus on the issues of race, class and gender. This is especially true of accounts written by non-Western historians. Typically, the icon of the ‘Heroine of the empire’ is challenged and the nurses’ positions as colonisers and their relationship with the colonised in a specific colonial context is explored (Rafferty 2006). Many of the critical accounts dealt with the situations in South Africa, India and Ceylon.

SA which was also colonised by the British for over a century, was the recipient of a number of British nurses during the colonial period. Colonial nursing in SA did exist and has a story that has never been told or ever revealed. However, while this research has not set out to challenge the positive image of colonial nursing, it will not exclude discussion of the issues of race, class and gender where these emerge.

Before we consider SA the setting of focus in this study, its profile, historical overview, including political history, and nursing, it is profitable to review some

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of the historical accounts of nursing in the Arab world. The third and last part of this literature review deals with what has been written so far on the history of nursing in this region.