Nursing in the Caribbean

Centuries before the arrival of Europeans, the practice of nursing care existed in the Caribbean. Amerindians were the earliest practitioners, using a variety of primitive methods to care for their seriously ill. The arrival of Europeans in the late fifteenth century brought a wider range of nursing challenges and new methods. However, few advances were made because the causes for the growing number of mostly tropical diseases remained unknown to health-care providers. The use of rational methods to alleviate these illnesses remained unknown. Similar to other parts of the world, early nursing care in the Caribbean remained in the hands of practitioners who addressed symptoms rather than the causes of illness.

The early Caribbean nursing care providers were dedicated, but mostly untrained, females who offered mostly a small measure of personal comfort and emotional support for patients. Nursing care was provided in homes, in privately operated sick houses, and later in modest hospitals provided by slave owners and colonial governments. Beginning in the mid-nineteenth century, nursing care in the Caribbean experienced gradual and significant changes, primarily through trial and error. New and bolder approaches to treating many tropical illnesses led to modest medical care discoveries and improvements. Nurse began to be trained and registered, and they were paid a wage and placed under the supervision of a regional medical officer. This practice was adopted in most British West Indian colonies and was supported by the most progressive members of these colonies' medical professionals.

At the beginning of the twentieth century, the nursing profession in the Caribbean benefited from the introduction of effective diagnoses and treatments of tropical and other diseases. During the 1950s, nursing care in the Caribbean made significant strides, and it emerged as one of the most progressive and innovative health-care and clinical-care systems in the nonindustrial areas of the world. These nursing advancements came as the result of introducing a series of carefully planned long- and short-term health-care measures and procedures. The coordination of local, regional, and international governmental and nongovernmental healthcare planners, educators, and administrators, along with the commitment of most Caribbean governments, is responsible for the high quality of nursing care available in the region during the first decade of the twenty-first century.

Caribbean Nursing During and After Slavery

Nursing-care practices in the Caribbean slowly shifted from being provided by family members in the sixteenth century to untrained providers of bed care and then to the more informed nursing care practitioners of the nineteenth century. Still, informal providers, sometimes referred to as "bush doctors" and "African healers," continued to use techniques that were practiced in Africa to care for many of the illnesses and diseases that frequently ravaged the Caribbean population, including malaria, yellow dengue, scarlet fever, smallpox, cholera, and typhoid. These conditions were frequently fatal or required long-term nursing care. Among the leading causes of these ailments were various demographic, cultural, and socioeconomic factors, with poor nutrition often playing a role.

During slavery, most slave owners provided some measure of health- and nursing-care assistance even for their slaves. Nevertheless, a number of studies have shown that broad segments of the Caribbean population experienced poor health during this period. After emancipation, most former slave owners felt no obligation to continue to provide the medical services granted during slavery. Studies show that the overall health of the majority of the Caribbean population deteriorated even further at this time because the colonial governments had no interest in providing health-care services. Privately operated sick houses were neglected and were in many cases abandoned. Additionally, little thought was given to preventive health care. Nursing in the Caribbean made little headway during this period because the conditions that led to serious illness existed throughout the society.

Nineteenth-Century Caribbean Nurses

Beginning in the 1850s, some of the more progressive Caribbean communities encouraged their local governments to support the creation of public dispensaries and public hospitals that employed an increased number of nursing-care providers. The introduction of a series of quarantine procedures also helped to improve nursing care. In some Caribbean countries, the establishment of ladies associations operated by upper-class women led to the creation of public hospitals. In addition, an increasing number of well-to-do Afro-Caribbean women operated lodging houses that served as nursing homes and private hospitals.

Two of the best-known pioneering figures in Caribbean nursing worked in Jamaica. These enterprising women were Cubah Cornwallis and Mary Seacole (1805–1881). Cornwallis operated a nursing home near Port Royal, and her most famous patient was the heir to the British throne (later King William IV), who became ill when visiting Jamaica as a midshipman. Cornwallis was later rewarded for her kindness to the Prince when Queen Adelaide, wife of King William, sent her an expensive gown in appreciation for her services. Mary Seacole operated a guesthouse and a private hospital in Kingston, and she won wide recognition for the manner in which she saved the lives of many during the cholera epidemic of 1850 to 1851, which killed between 40,000 to 50,000 persons in the Caribbean. When news of the Crimean War reached her in Jamaica, Seacole sought, but was denied, permission by the British to nurse the injured troops back to health. Using private funds, she traveled to the area of the conflict and nursed wounded British, French, and Turkish soldiers. For her heroic efforts, she was awarded the Crimean Medal, the French Legion of Honor, and a Turkish medal. Seacole wrote about her nursing adventures in The Wonderful Adventures of Mrs. Seacole in Many Lands, published in 1857.

During the last half of the nineteenth century, many within the European-trained medical profession began to push for additional improvements in nursing care. Colonial governments around the Caribbean opened publicly operated general hospitals and sick houses, and they employed nursing-care providers to meet the needs of the seriously ill. Stricter health quarantine regulations were also introduced, and boards of health were established to over-see the early government-operated general hospitals, maternity hospitals, leper houses, and lunatic asylums. Many of the newly created hospitals in the British West Indies were initially funded from the Slave Compensation Fund, and operated on very limited budgets. (The Slave Compensation Fund had been set up by the British Parliament under the British Emancipation Act of 1833. The fund comprised a grant of twenty million pounds to be distributed to slave owners for the loss of their slave property.) The general day-to-day nursing-care operations in these early hospitals were under the direction of a European-trained nurse, called a matron, who supervised the nursing staff and trained them in bedside procedures and in the rudiments of nursing care.

Early Twentieth-Century Nursing

By the turn of the twentieth century, the overall focus on health care in the Caribbean had led to a gradual improvement in overall health, particularly due to new medical discoveries in the treatment and prevention of various diseases. In addition, many colonial governments began to employ better-trained medical personnel. The creation of additional district hospitals and maternity hospital wards led to the increased training of nurses, including training in midwifery.

In some areas of the Caribbean, the latest American nursing techniques and methods were also introduced. An American-trained Barbadian Adventist physician, Charles J. B. Cave (1879–1939), a graduate of the American Medical Missionary College in Battle Creek, Michigan, and later of the Medical School at the University of Edinburgh, Scotland, operated a sanitarium and training school for Barbadian women in home nursing, including midwifery and first-aid classes, until his death in 1939. Cave was trained by Dr. John Harvey Kellogg, one of the foremost American advocates for improved nursing care. Many of Cave's nursing-class graduates were later employed at private and government nursing facilities in Barbados.

Across the region, Caribbean nurses worked under colonial labor policies that restricted women in the workplace. According to one scholar, "Women's labor outside the home was accepted as expedient in certain circumstances but restricted the occupations" (Reddock, 1994, p. 62). Nursing, teaching, and limited civil-service positions provided the majority of work for women outside of the home. As in other occupations where women were employed, the leading nursing positions were filled by the wives and daughters of the white upper classes and, to a lesser degree, by relatives of the colored middle class and the business class. The wages paid to nurses remained the lowest paid to government employees, as was also the case for the majority of single women employed by the governments of the Caribbean. These low wages often forced women to resign or get married. In addition, general working conditions remained substandard. Nurses worked an average of sixty-seven hours per week, and in many areas it was compulsory for nurses to reside in the hospital. One researcher observed that nurses virtually spent their lives in the hospital. While nurses received free board and lodging, most were forced to live in "open dormitories" that allowed little privacy. Meals were often badly prepared, and the nurses often went without staples such as fruits and vegetables.

Two of the most successful Caribbean nurses during the mid–twentieth century were Nita Barrow (1916–1995) and Ena Walters of Barbados. Both received their early education at St. Michael's Girls School near Bridgetown, and they completed their first nursing-care training at the Barbados General Hospital. After further overseas training, both returned to the Caribbean and became influential leaders in the nursing profession. Barrow became a nursing instructor in public health in Jamaica, a sister tutor, the first West Indian matron of the University College Hospital, and principal nursing officer in Jamaica. In 1959 she became the first Barbadian to be appointed matron of the Barbados General Hospital, and she served in that position for twenty-six years. Both nursing administrators brought revolutionary changes in nursing education, practice, and patient care to the English-speaking Caribbean. Walters would be selected as the first chairperson of the Caribbean Regional Nursing Body, and she held that position for three consecutive terms.

Caribbean Nursing Since the 1950s

The nursing profession in the Caribbean made significant strides during the 1950s. Specific standards for the training, certification, and registration of nurses were established throughout the region, and the first conference of nursing administrators in the Caribbean was held in Barbados in 1951. The group saw the need to continue to work together and created the Regional Nursing Body. The organization dealt with the collective nursing issues that regional members faced. These visionary nursing administrators wished to significantly elevate both the Caribbean nursing profession and the region's health-care systems. Among the most pressing issues addressed were related recruitment, training, specialization, working conditions, the exchange of staff and the interchange of technical opinion and information. The member states were part of the Commonwealth Caribbean.

The Caribbean Regional Nursing Body continues to conduct annual conferences, and in conjunction with the Caribbean Nursing Association it dedicated and promoted May 2003 to August 2004 as "The Year of the Caribbean Nurse." The coordinators collaborated with the national nursing associations in the Dutch-, French-, English- and Spanish-speaking countries of the Caribbean to broaden public awareness of the important role of the nursing profession. The groups' planning committee also organized a yearlong program of activities. Among the most outstanding achievements of this enterprise were efforts to promote the role and advancements of Caribbean nursing care to the public. The theme of the well-publicized celebration was "Nurses: Lighting the Way to Professional Excellence." These activities were meant to increase awareness among the Caribbean public of the nursing profession, and to assist with the recruitment and retention of nurses working in the Caribbean. The thirty-first annual general meeting of the Regional Nursing Body was held in late May 2004 in Paramaribo, Suriname. Over the years, the Caribbean nurses' organizations have worked closely with the Pan American Health Organization in efforts to broaden their impact on the Caribbean community.

See also Healing and the Arts in Afro-Caribbean Cultures; Mortality and Morbidity in Latin America and the Caribbean; Nursing in the United States

Bibliography

Abel-Smith, B. A. A History of the Nursing Profession. London: Heinemann, 1960.

Carrington, Sean, et al. A–Z of Barbados Heritage. Oxford, UK: Macmillan Caribbean, 1985.

Horwitz, Samuel J., and Edith F. Horwitz. Jamaica: A Historical Portrait. London: Pall Mall Press, 1971.

Nell Hodgson Woodruff School of Nursing, Emory University. "History of the Regional Nursing Body." Available from <http://prod-nursing.emory.edu/lecin/rnb/history.html>.

Nightingale, Florence. Notes on Nursing: What It Is and What It Is Not. London: Harrison, 1860.

Reddock, Rhoda E. Women, Labour, and Politics in Trinidad and Tobago. Kingston, Jamaica: Randle, 1994.

Seacole, Mary. The Wonderful Adventures of Mrs. Seacole in Many Lands. Kingston, Jamaica: Nursing Association of Jamaica, 1857. Reprint, New York: Oxford University Press, 1988.

Senior, Olive. A–Z of Jamaica Heritage. Kingston, Jamaica: Heinemann Educational, 1987.

Walters, Ena K. New Dimensions in Nursing. Bridgetown, Barbados: Ministry of Health, 1974.

Walters, Ena K. Report of the General Nursing Council of Barbados. Bridgetown, Barbados: Ministry of Health, 1981.

Walters, Ena K. Nursing in Barbados: A History from the Late 18th–20th Century. Bridgetown, Barbados: Caribbean Graphic Productions, 1995.

glenn o. phillips (2005)