This chapter explores the formal emergence of local systems of managed diabetes care, and situates them in relation to tools used to integrate hospital clinics and primary care into shared care arrangements. The respatialisation of care in the 1970s and 1980s, together with a growing emphasis on surveillance and blood glucose control, raised questions about how patient care could be effectively co-ordinated. In response, GPs and specialists drew upon a rich culture of regulatory bureaucracy within British medicine and mobilised a combination of tools – from recall systems and medical records to local care protocols – to regulate the timing, nature and content of medical engagements. These tools embodied an increasingly standard view of ‘good diabetes care’, and inherently ordered medical labour. The implicit politics of these instruments, however, became explicit within in a context of mounting political and professional concerns about professional competence, and in relation to concerns about the deputation of care to previously inexperienced practitioners. Especially once practitioners began to use standards to audit care, this ‘technology of quality’ subjected routine practice to a novel form of bureaucratic management and provided new forms of evidence for later national initiatives.
Through a study of diabetes care in post-war Britain, this book is the first historical monograph to explore the emergence of managed medicine within the National Health Service. Much of the extant literature has cast the development of systems for structuring and reviewing clinical care as either a political imposition in pursuit of cost control or a professional reaction to state pressure. By contrast, Managing Diabetes, Managing Medicine argues that managerial medicine was a co-constructed venture between profession and state. Despite possessing diverse motives – and though clearly influenced by post-war Britain’s rapid political, technological, economic, and cultural changes – general practitioners (GPs), hospital specialists, national professional and patient bodies, a range of British government agencies, and influential international organisations were all integral to the creation of managerial systems in Britain. By focusing on changes within the management of a single disease at the forefront of broader developments, this book ties together innovations across varied sites at different scales of change, from the very local programmes of single towns to the debates of specialists and professional leaders in international fora. Drawing on a broad range of archival materials, published journals, and medical textbooks, as well as newspapers and oral histories, Managing Diabetes, Managing Medicine not only develops fresh insights into the history of managed healthcare, but also contributes to histories of the NHS, medical professionalism, and post-war government more broadly.
This chapter outlines how diabetes re-emerged as a concern of central government during the late 1970s, setting the scene for the move of managed care from clinical settings to policy arenas. It does so by examining the tribulations of efforts to secure Department for Health and Social Security funding for retinopathy screening and photocoagulation treatment trials between 1977 and 1985. The trials were by no means the biggest intervention that central government made into diabetes care during the 1970s and 1980s. Examining their history, however, reveals the ways in which post-war policy networks developed in relation to diabetes, and the shifting ways in which they framed diabetes to garner government attention in a period of considerable economic and political change. Crucially, underpinning debates about the trials were new concepts of risk management, disease prevention, and standard-setting that became central to policy discussions of diabetes care and managed medicine at the end of the century.
This chapter analyses shifting dynamics within medical missionary work in Nigeria, from support for British colonialism to humanitarianism. It explores Irish Catholic missionaries as nurses, midwives and physicians from c.1937-1970, to the end of the Nigerian Civil War in 1970. It uses unpublished documents to disentangle, although not disconnect, modern missionary work from colonialism. Using gender as a category of analysis it focuses on women’s work during the Nigerian civil war compared to men’s activities, and how the media focused on one but not the other. By giving voice to the “silenced” in history it argues that there was a significant Nigerian presence in relief work during the war, differing from most research which focuses only on the work of whites. Significantly, in the 1960s and 1970s, Catholic mission hospitals became sites for shifts in the understanding of mission during periods of violence and upheaval. As Catholic women renegotiated their place in an emerging decolonised world, complex relationships developed among Irish sisters, Nigerian nuns, priests, Nigerian chiefs and international peacekeepers. Whereas in the 1930s and 1940s, Catholic sisters saw Africa as a fertile ground for converts, over time the Catholic mission tradition liberalised to promote humanitarianism.
Colonial Caring covers over a century of colonial nursing by nurses from a wide range of countries including: Denmark, Britain, USA, Holland and Italy; with the colonised countries including South Africa, Australia, New Zealand, Ethiopia, Nigeria, India, Indonesia (Dutch East Indies) and the Danish West Indies. It presents unique perspectives from which to interrogate colonialism and post-colonialism including aspects of race, cultural difference and implications of warfare and politics upon nursing. Viewing nursing’s development under colonial and post-colonial rule reveals different faces of a profession that superficially may appear to be consistent and coherent, yet in reality is constantly reinventing itself. Considering such areas as transnational relationships, class, gender, race and politics, this book aims to present current work in progress within the field, to better understand the complex entanglements in nursing’s development as it was imagined and practised in local imperial, colonial and post-colonial contexts. Taking a chronologically-based structure, early chapters examine nursing in situations of conflict in the post-Crimean period from the Indian Rebellion to the Anglo-Boer War. Recruitment, professionalisation of nursing and of military nursing in particular, are therefore considered before moving deeper into the twentieth century reflecting upon later periods of colonialism in which religion and humanitarianism become more central. Drawing from a wide range of sources from official documents to diaries, memoirs and oral sources, and using a variety of methodologies including qualitative and quantitative approaches, the book represents ground-breaking work.
From 1900 Dutch nurses arrived in the East Indies, but their numbers were wholly insufficient to meet the colony’s increased demand for competent nursing staff. Therefore European physicians started training native women as nurses. Initial endeavours were disappointing with problems closely connected to the position young women occupied in native society. Young women from poor families were uneducated, whilst those from middle and upper classes often considered it culturally improper to live outside their parents’ home at marriageable age. The poor reputation of governmental hospitals made them only appropriate as work places for lower-class women and women with dubious reputations. European nurses taught and supervised nursing and provided role models. After qualifying, nurses could spend a further two years studying midwifery which combined hospital and community experience. The nurses and midwives were deployed as intermediaries to spread the ideology of western care among the native population, who nevertheless continued to have an aversion to western medicine. The (student) midwives were distrusted because of their youth and unmarried status. Native women variously rejected or embraced such advice or accommodated it selectively. In the main they remained loyal to the indigenous healers, the dukun bayi.
Disease, conflict and nursing in the British Empire, 1880–1914
Transnational developments in biomedicine and technology together with broader social changes, not only reshaped disease prevention and healthcare policy, but facilitated mass migrations of people, creating new pathways for spreading disease, simultaneously helping form various conduits, including nursing, for the “new” medical knowledge required to combat this spread. Additionally, this period (1900-1914) was characterised by global crises, which provide important contexts for reappraising the history of nursing at local, national and transnational levels, while creating an important lens through which to study the changing profession. The geographical focus of this chapter is on three port cities: Cape Town, Melbourne and Hong Kong, selected as representing different types of colonial administration, and colonial histories, which naturally affected the implementation of healthcare systems. Traditional approaches to nursing’s history are enclavist in arguing that nursing practice, education and policy was established and solidified in the metropole before being exported to the colonies by British nurses. Consequently, professional nursing developed independently in each of the colonial outposts. The chapter argues that nursing practice is equally constituted on the peripheries of Empire, so that complex networks of nursing ideas existed within the British Empire, fuelled and expanded by mass migration of nurses.
Contextualising colonial and post-colonial nursing
Helen Sweet and Sue Hawkins
The introduction provides an overview of the book’s focus, structure and remit, outlining commonalities as well as differences between the experiences of colonial nurses discussed in the book. Drawing from their experience in researching and writing gender and racial social histories and in colonial and post-colonial nursing history respectively, the editors tease out emerging themes placing them within a clear chronological and historiographical framework. They examine how this field has developed in the history of medicine and identify questions which current research still leaves unanswered, but for which nursing’s history is uniquely placed. The chapters in this book reveal the presence (or absence) of underlying racial and cultural tensions between nurses and their patients, nurses and professional colleagues or their indigenous counterparts; and the editors question whether past histories have not been grossly oversimplified by projecting images of imperial collaboration/cooperation onto all forms of colonial nursing, by all countries, across a long timespan. We evaluate the difficulties of discussing and analysing the impact of colonial nursing from the indigenous population’s viewpoint to present balanced analyses, and explore different experiences of colonial/ post-colonial nursing over more than a century whilst considering the impact of peacetime or conflict on nurses and nursing.
The Indian Rebellion (1857) occupies a central position in the mythology of late nineteenth-century British history. The shock throughout British colonial society was expressed through a medium synonymous with the British experience in India, namely diaries or journals. Differing to accounts from other conflicts of the period, the prolonged and localised nature of fighting at Lucknow and Cawnpore meant that chroniclers represented a cross-section of gender, class and professional status in colonial society, including a range of medical practitioners but also women of various social ranks who had volunteered for medical service. Drawing on printed and manuscript sources from c.1857-c.1900, this chapter argues that the Indian Mutiny diary functions as both a vital record of women’s voices in the history of British colonial experience and a unique example of a nineteenth-century practitioner narrative told from a female perspective. The chapter largely focuses on journals published by participants of the Siege of Lucknow, and will explore the way in which a range of women eyewitnesses acting as nurses were able to participate in the defence of British interests in a time of national emergency thereby contributing to the culture of imperial myth-making that surrounds the Indian Rebellion.