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Visiting Nurses and the Rockefeller Foundation in Colombia, 1929-1932

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Visiting Nurses and the Rockefeller Foundation in Colombia, 1929-1932
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   ROCKEFELLER ARCHIVE CENTER RESEARCH REPORTS  Visiting Nurses and the Rockefeller Foundation in Colombia, 1929-1932   by    Natalia María Gutiérrez Urquijo Centro de Estudios Históricos, El Colegio de México © 2019 by Natalia María Gutiérrez Urquijo    2 RAC RESEARCH REPORTS    Visiting Nurses and the Rockefeller Foundation in Colombia, 1929-1932 1   Colombia and the United States strengthened their trade, scientific and cultural exchanges during the 1920s. In regards to health and medicine issues, the Rockefeller Foundation played a pivotal role between 1919 and 1945, when it conducted scientific research and financed the battle against infectious diseases, above all yellow fever and hookworm. 2  It also encouraged the development of a public health system in Colombia by creating American-inspired institutions and training health professionals. 3  Scholars have analyzed how the Rockefeller Foundation fought to eradicate tropical diseases and created scientific laboratories. Although sanitary education was an important element of the Rockefeller Foundation international policies −  a factor that influenced Colombian health practices and helped strengthen thereby the national government −  specialists have not gone into this matter in depth. An analysis of the implementation of this program proves to be important so as to understand how the United States replaced France as the main scientific and academic benchmark in Colombian medicine. 4   We must consider that Colombia received 264 scholarships from the Rockefeller Foundation between 1917 and 1962, a very significant number, only surpassed  by Brazil and Mexico. These scholarships helped train physicians, nurses and engineers who later spread the American health model and occupied key positions in Colombian government. The Rockefeller Foundation also sent trainers who prepared Colombian students and professionals, as well as officials and consultants, who later influenced Colombian health policies. 5  Some experts have studied the role of the Rockefeller Foundation in the professionalization of nursing in Colombia in the 1940s. 6  Nevertheless, they have omitted its contribution of the School of Visiting Nurses to the development of Colombia public health, which operated in Bogotá between 1930 and 1932. 7  It should be noted that Colombia and Brazil were the only Latin  American countries receiving grants to raise the professional standards of  3 female nurses in their own territory. It was a consequence of the Rockefeller Foundation interest in strengthening their sanitary units in those countries. 8   Although there were no sanitary units or a solid administrative health structure in Colombia at that time, the international prestige of the National Director of Hygiene, Pablo Garcia Medina, helped bring in the Rockefeller Foundation ’s  support for the formation of the School. Because of its relationship with maternal care, the work of visiting nurses in the child protection campaign was considered fundamental. They would serve as a connection between mothers and health professionals in health centers and through home visits. 9  Within this framework, the state aimed at reaching out to poor families, especially mothers, through the professionalization of nurses  based on the American model. In this way, the Colombian government would not only legitimize its action but also strengthen the national health institutions and stimulate preventive programs.   School of Visiting Nurses During the Pan American Conference of National Directors of Health held in  Washington D.C. in 1926, Pablo Garcia Medina requested Frederick Russell, Director of the International Health Division (hereinafter IHD) between 1923 and 1935, to send two competent visiting nurses to work for some public assistance branches in Colombia. 10  This first approach served to obtain the cooperation of the IHD. The formal request was made in 1928, when the National Directorate of Hygiene and Public Assistance (hereinafter NDHPA) received funds to support the fight against tuberculosis and infant mortality. Pablo Garcia Medina took advantage of his good relationship with George Bevier, the Rockefeller Foundation’s representative in Colombia since 1920, to make the request again. He wanted to prepare women to work in scientific campaigns when the government could afford the setting up of dispensaries in most of the departments of the country. In Garcia’s opinion, the United States’      4 RAC RESEARCH REPORTS    work in the hygiene field through the “  brave nurses armies ”  had demonstrated to be crucial in the implementation of national campaigns and the popularization of hygienic measures among the population. 11  The Rockefeller Foundation nurses were to be sent to Colombia to train some of the National Red Cross nurses who worked in Bogotá ’s  health service. 12  George Bevier considered nursing professionalization very important to replace the Catholic Church’s poorly  -trained nurses. However, he argued that the project would be difficult because the Colombian elite undervalued nursing –  a profession which they usually associated with the lower social classes. He added that the lack of a socio-economic middle class in Colombia would obstruct the professionalization of nursing because women coming from this social context  were the most adequate people to work outside hospitals. The “ladies” and their families rejected that kind of work because it required to deal with people from all social classes, visit sick people ’s homes, and spend time outside family’s home in paid activities. According to him, these reasons made it difficult “to get applicants of sufficient innate intelligence to make good nurses. ” 13   Despite Bevier’s concerns, the Rockefeller Foundation sent two registered nurses to Bogotá to found the School with Colombian government funds. Mary Beard, Director of the nursing program, which was part of the IHD, chose Carolyn Tenney Ladd (27 years old) and Jane Louise Cary White (24 years old),  both graduates of the School of Nursing at Yale University, and granted them a scholarship to be trained at East Harlem Nursing and Health Service, New  York. 14  The NDHPA agreed with the Minister of National Education, Jose  Vicente Huertas, to pay them 2,500 pesos a year, and cover all the trip expenses. They would provide public health services and train local visiting nurses. 15  Jane White and Carolyn Ladd arrived in Bogota on October 1929. During their first month in Colombia, they received an introduction to the Bogotá health care institutions. Primarily, they visited the institutions in charge of the sick and children ’s  well-being, such as the San Juan de Dios, San Jose and La Misericordia hospitals, Center for Children’s Protection and the municipal health services. However, the nurses were not paid immediately, because Pablo  5 Garcia Medina had not been able to meet with Huertas to appoint them as government employees.  Although Bevier and H.H Howard were worried about White and Ladd not  being paid for their first month in Colombia, they expected that the Colombian government would do it. In fact, the Rockefeller Foundation policy was to interfere as little as possible in the political, economic and social problems of the countries in which they were present. Howard stressed that the f  oundation’s role was to remain on the sidelines and observe and, if possible, strengthen, stabilize and support public health organizations. Given the lack of payment, Howard proposed that the nurses be sent to one of the city  ’ s health centers or to the new children's health station in Bogota. In doing so, Howard said, nurses  would become familiar with “ local conditions and customs”  and practice the Spanish language. 16  For the Rockefeller Foundation, sending American nurses to different countries meant an opportunity to improve their skills and knowledge, and establish nursing schools that would become an example to follow suit. In fact, Bevier  wanted White and Ladd to acquire experience by doing fieldwork and therefore  become school of visiting nurses ’ instructors. On January 1930, the NDHPA hired White and Ladd for eighteen months to work with children at the municipal and national dispensaries and to train the National Red Cross nurses. Thus, the two nurses could learn about the characteristics of the Colombian public health practices and adapt their knowledge and skills to the local requirements. White and Ladd worked for six months until the funds from the Colombian government were issued and the school building were adapted to the requirements of the project. 17  The School of Visiting Nurses was founded on June 1930 through Decree 905. The NDHPA oversaw its operation and lesson plan. Pablo Garcia Medina decided to invest in the school the money he had acquired to start an anti-tuberculosis campaign, arguing that the campaign could not be made without  well-trained nurses. According to the decree, the school’s purposes were to keep tuberculosis patients under observation, to advise patient’s families on how to avoid contagion, and to carry out prophylactic measures issued by health
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