|Dr Helen Sweet, Associate Researcher (Retired), University of Oxford||The UKAHN Bulletin|
|Volume 9 (1) 2021|
Whilst focusing on a generation of nurses who entered the profession during the second half of the twentieth century in Zimbabwe, Clement Masakure also manages to place this history of nursing within a wider timeframe taking a chronological historical approach to the whole of the century. A theme running throughout the book is that African nurses and nursing auxiliaries played a pivotal role, not only in the provision of healthcare to their fellow Africans, and later to include the nursing of white Zimbabweans, but also in transforming hospitals and nursing practices into places and methods respectively, that were adapted to suit the needs of their patients. Furthermore, he claims that the evidence strongly suggests that these (mostly although not exclusively) women also substantially reshaped the practices of indigenous healers as well as western biomedicine.
African Nurses and Everyday Work is informed principally by the 34 oral histories recorded between 2007-2020, plus the written testimony of (male and female) African nurses and various healthcare workers who trained and worked in Zimbabwean hospitals during the twentieth century. Whilst these clearly reveal some fascinating insights, it would perhaps have been helpful and more interesting had these interviews been used a little more directly to illustrate points. There are surprisingly few direct quotes from his oral history informants, but where these are introduced – particularly in Chapter 6, discussing nursing in independent Zimbabwe – their testimony illustrates his points with the immediacy and poignancy of personal experience. The author supports these primary sources using a wide range of secondary material, together with state public health records and written reports. Whilst recognising the patriarchal colonial bias of these, he has attempted to provide balance by reference to several African journals and periodicals although he does not appear to have consulted African nursing periodicals.
He shows that the training of (mostly female) nurses in what was until 1979 ‘Rhodesia’, had its origins within racist and gendered colonialist attitudes towards patient care. However, this was further complicated by the training of male African ‘Medical Orderlies’ who were able to provide rural community medical services. This gendered division within the development of an already divided profession, reinforces similar observations made of South Africa’s nursing history, by Shula Marks in Divided Sisterhood. Nevertheless, the introduction of nurse training, initially by nursing and medical missionaries in rudimentary hospitals, and by mining companies, and later in government hospitals, was felt to have been highly significant within African communities – particularly for women. Masakure looks at their experiences both within hospitals and what it meant for them in the wider communities of colonial and post-colonial Zimbabwe, arguing that, irrespective of their subordinate position to their white counterparts, nurses developed and then retained a degree of autonomy over their work process as ‘de facto medical authorities’. This placed them in a position of power and control over their work which eluded most of their fellow countrymen throughout much of the twentieth century and which is therefore of particular significance to nursing history. This, he claims, at times virtually blurred boundaries between medical and nursing practices.
I was disappointed to find the evidence for the final aim of the book viz. to demonstrate that the development of nursing by African women changed the practices of indigenous healers, was largely unsubstantiated. Masakure tantalisingly refers to the special needs of the African patient and to ‘co-opting cultural understandings of therapy’ whilst pushing nursing’s cultural boundaries as ‘cultural interlocutors’. However, the emphasis appears to have been on the challenges (cultural and otherwise) faced by these nurses, and how western biomedicine became the main form of medical and nursing practice. He claims that they ‘were not tools of biomedical practices’ but I failed to see that he supported this claim with very convincing evidence from his oral histories or elsewhere.
Despite this criticism, the book is a valuable addition to colonial and post-colonial nursing history within sub-Saharan Africa. It has been well-researched and manages to incorporate essential and fascinating elements of Zimbabwe’s recent history including the military conflict between 1972-8, the subsequent challenges in adjusting a healthcare system to independence and deracialisation, the impact of HIV/AIDS and the impact of measures of austerity on this transformation culminating in the nurses’ and junior doctors’ strikes of 1996. The book would, of course, be of considerable interest to nurse and medical historians but it also adds a fresh and arguably more balanced dimension to the histories of race, politics and gender in colonial and post-colonial history.