chapterthree




Chapter Three Nursing My motivation was not to be a nurse but to be near my brother whose boarding school was along the road from the nursing school. There were few other occupational opportunities for girls which provided lodging and education. Nursing education and training offered a whole different way of looking at the world. Being an individual for the first time apparently unattached to a hapu and without a family or a past was exhilarating. I was out of the social class in which I had been reared which was interesting in itself. The possibility of creating another identity, not Irakehu, was seductive. My grandmother sent me small letters on lined Croxley paper reminding me of my responsibilities in relation to our land throughout my training. I sent my proxies in to the land meetings but otherwise tried to keep out of traditional matters. Although Maori people still had a low demographic profile in Wellington, Ngati Poneke Young Maori Association flourished and I continued to be a member of the Association and part of kapa haka. Church activities were relinquished by my brother Peter and me within months of my return. There were few Maori in the hospital as employees, I was the only apparent Maori student nurse. Thirty years later, two other students in our intake discussed their Maori descent with me, one from our own hapu. Their family socialisation was not Maori and they were not physically distinguishable as Polynesian. It was not important to them to identify as Maori, and remains so. I consider myself to have been alone as a student. Other Maori were in the kitchen, laundry, garden or working as orderlies. My attempts to blend with the nursing student world were constantly foiled by Maori people who knew that there was a Maori nurse in the hospital. One notable day I was escorting a patient to theatre in what I fondly imagined was my neutral student nurse identity, the orderly pushing the trolley removed his mask, it was my mother’s brother. He winked, I laughed. Because our family was well known in the small Maori community, people sought help from one of the few sources of contact they felt that they knew and could anticipate some degree of trust from in the local health services. This situation continued throughout my student years and into the early years of my new graduate practice. I was called upon by relatives, friends,and also people whom I did not know, who were Maori. They wanted me to be at the front door when their ill relative was admitted to hospital, to be waiting for them in the Intensive Care Unit, to mediate between them and the staff. I was constantly asked to reinterpret the information which medical and nursing staff thought that they had given, into more accessible English. Sometimes people asked me to wash the bodies or hair of older family members, alive or dead, or simply to sit with them. Once I was asked to sleep beside a treasured grandmother while family travelled to be with her. Anecdotally, people expressed extreme anxiety about entering the hospital system. Hospital was viewed as a place where people went to die and was regarded with consistent misgivings. The experience of many Maori of secondary care as a final option after poor access to pakeha sponsored service had led to generalised suspicion of the institutions. My roles were to anticipate tension and stress, protect, interpret and mediate. To help to create a border, a safety zone, a place where trust could happen. There were legacies at work which I did not fully understand but whose shapes I recognised very well. Henri Giroux (1992) discusses the politics of location of knowledge, ideologies, histories, and the boundaries that claim the status of master narratives. At stake here is deconstructing not only those forms of privilege that benefit males, heterosexuality, and property holders, but also those conditions that have disabled others to speak in places where those who are privileged by virtue of the legacy of colonial power assume authority and the human agency. (p. 27) Not only was I suddenly responsible for negotiating the invisible boundaries of history and ideology but the tangible borders of the geography of contemporary hospital realms. This was very difficult indeed for a teenage student nurse socialised into the hospital hierarchy. I was very well aware of the restrictions on movements and the provincial boundaries invisibly maintained by each ward and department, guarded by Ward Sisters and patrolled by Staff Nurses. In a social climate which contended that there was no difference between Maori and others, and that people should be nursed regardless of who they were, it was also very difficult to validate any role as mediator and to justify the rights of Maori people to have access to service which needed in some ways to be different. I did not have a political vocabulary that could explain the needs let alone the rights of the tangata whenua. I needed the proper words to create a praxis to help me to understand what was happening around us all. Later when I began to read the work of Brazilian liberatory educationalist Paolo Freire (1996), the words came and the meanings were finally accessible. Human existence cannot be silent, nor can it be nourished by false words, but only by true words, with which men and women transform the world. To exist, humanly, is to name the world, to change it. Once named the world in its turn reappears to the namers as a problem and requires of them a new naming. Human beings are not built in silence, but in word, in work, in action - reflection. But while to say the true word - which is work, which is praxis - is to transform the world, saying that word is not the privilege of some few persons, but the right of everyone. (p. 69) Maori political status was something of which I had more experience than most young women of my age but I had no way of analysing or explaining the situations of which we were inevitably a part. It was clear to me that different things worked for different people and there was an obligation on the part of those of us with the power to do so, to instigate change. As a young Maori woman reared in a gerontocratic society I had little choice but to respond to the clear needs expressed by Maori who were almost all older than I was, and as a student nurse I also had few choices. A large part of my life was occupied with avoiding overt racism, trying to be as inconspicuous as possible and being part of my peer group. Negotiating my way through the morass of situations exercised the diplomatic and people skills that I had observed in the aunts and from all the human diversity of my childhood. This experience stood me in good stead later when negotiating for change became a way of life. New Graduate Early attempts at nursing leadership and transformative activism Early practice was interesting and stimulating. Working in Accident and Emergency suited my personality until I felt that I was losing sympathy for the less dramatic situations in which people found themselves. I then enjoyed being Charge Nurse of a very busy medical ward but was prevailed upon by my family to take my skills into an area where there were more Maori. In 1970 that area was respiratory medicine, more particularly caring for men who had pulmonary or renal tuberculosis. The wards were separated from the rest of the hospital and the people in them had developed a distinctive culture of their own. I learned a great deal about nursing from the men who were confined to hospital for a basic twelve weeks and often for a great deal longer. Many were Maori. I also learned a great deal from the nurses whom I was supposed to lead. Long term hospitalisation presented special issues for which I or indeed the culture of nursing was not prepared. Often young and feeling comparatively well but requiring stabilising on very repellent medication, these men became easily bored and recalcitrant. There were issues of sexuality that were not addressed as well as the simpler matters such as appealing and familiar food. Most significant of all were the power relations between medical and nursing staff, and the men. Because I was from the marginalised group, as a Maori but was also part of the inner professional group, I was in a position to identify the symbolic margins and boundaries between each group although I still could not name them. I recognised that these men had rights, which were undefined, and that the inactivation of these rights were related to the health service culture and ideology, autonomy and control. Slowly, from my position as Charge Nurse with some authority in our own little province, I realised that the major right of patients was to information and that we health professionals were manipulating information for reasons that related more to our need for routine and control than they did to empowerment of the people we were there to serve. It was also obvious that the control was unsuccessful because many of the men were not taking their medication and were occupying themselves in very non-theraputic ways such as disposing of their unpalatable medication in very creative ways, absenting themselves from the ward for long periods and enjoying vast amounts of alcohol. With the men and one supportive staff nurse we embarked on a process of giving them information. They enjoyed learning to read their serial x-rays and interpreting their laboratory forms. We used teaching examples from their normal lives to explain the process of tuberculosis. I also encouraged people to show their families their data and films to trace the progress of their recovery. Most people had worked in freezing works and were familiar with Tb in the animals they handled. It was simply a matter of obtaining sheep lungs with tuberculous cavities and caseinous material, having them preserved by the mortuary technicians and making them available for people to examine and to show their families along with their films and notes. It gave me pleasure to hear men explaining to families, in Maori, in the inner sanctum of the ward, the office, using the equipment to view their films and reclaiming their own information. They were becoming powerful. People did not abuse their access to information, times and situations were negotiated so that the flow of the ward was not interrupted. There was a clear and consistent change in the attitude of the men toward their unpleasant medication once they were clear about its effect on their disease. They could evaluate the information for themselves in a framework of their own lives. With their agreement I backed up their new compliance with a new system of drug administration. Matters of sexuality were recognised and given the importance that they should in the presence of highly infectious disease. Nurse and patient roles at this time maintained a neutrality of sexual identity that made it very difficult to address fundamental human issues. With the co-operation of the younger members of the nursing and medical staff and the men, we established a system of anonymous question and answer sessions in a weekly staff and patient forum. The questions the men asked were often so simple and so obvious that their reluctance to discuss them said a great deal about our denial of their sexuality, our poor communication and facilitation, and the moral climate of the mid 1970s. I was also greatly concerned with tobacco use in a respiratory ward. It seemed a contradiction in terms to admit people who were gasping for air, running oxygen and smoking tobacco simultaneously. Cigarettes and tobacco were sold daily from a trolley wheeled through the ward sponsored by the Returned Servicemen’s Association. The hospital did not have a policy on tobacco use and smoking was institutionalised. A supportive staff nurse and I created an admission cubicle which was smoke free. Perhaps it was the first in the country? When people were over their acute admission phase they would move to another cubicle and resume tobacco smoking. Of all the change I attempted to institute, this met with the most resistance from nurses and from the men. When I left the ward the non-smoking cubicle was dismantled. A further concern to me was the education of student nurses. Formal clinical teaching had not been established in wards at this time. I believed and still do that the education of our potential professional nurses should be as wide, as varied and as well informed as possible. The clinical area should hold stimulating challenge and excitement and should be a constant site of learning, with such learning being a privilege and a pleasure, underpinned by the responsibility for the care and wellbeing of other human beings. To this end I provided as much variety and information for students as possible, taking the responsibility for education very seriously. Two staff nurses of my own age assisted with this aspect of our work. Other nurses devalued and undermined it. We found clinical teaching material which we had carefully prepared for each student nurse and sent on to our supervisors, in the rubbish bin more than once. Team Building? As a young and new charge nurse I had not developed the team skills necessary to bring all the members of staff along with these radical changes. Tuberculosis and long term respiratory wards tended at that time to be staffed by older conservative nurses who were very skilled in their area but were rapidly depleted of the technical knowledge and ideas that were then entering nursing. For example Cardio Pulmonary Resuscitation was being introduced to general wards but there were no staff development opportunities provided which would have given our nursing colleagues confidence. The physical isolation of the Tb wards, generally uncomplicated technology (but very complex pharmacology) held low status and enabled them to avoid the mainstream of change for a considerable time. Nurses working in these wards long term became nervous of being identified as needing to increase their general knowledge, competencies and clinical skill base. My socialisation as Maori required me to see all contributors to the hospital community as valuable. Therefore occupational therapists, social workers, the cooks and orderlies were people without whom the wellbeing of the patients would be directly affected. As the nurse leader it was essential for me to respect and work with them. This redefinition of hierarchy and role also caused strained relationships within the nursing staff. On a personal level medical staff were very supportive to me because they could see positive change in the response of the men. They did not see it as their role to take part in nursing interactions and tensions. "Doctor power" and "nurse servant/good wife" behaviour was deeply embedded in the hospital culture and the stratification between professional groups was formally maintained against my efforts to integrate them. Other staff members were also supportive because they were now included in the culture of the ward. This led to a high level of communication with allied staff, for example my time spent listening to the men about their food preferences translated into discussions with the cook who had no difficulty changing menus to provide emotional as well as nutritional sustenance. Boil-ups entered the regular diet as did rewana bread and other delicacies provided by the Tb Association. Occupational Therapists provided carving tools and wood. The men carved a tekoteko which stood at the entrance to the ward to welcome patients and visitors. When I left the ward the orderly told me that this carving was put into the boiler. One response of nursing colleagues to my attempts to create what I saw as progress and to my poor management skills, was to ostracise me at communal gathering times. There was a quiet and steady resistance to any variation I and my younger colleagues might attempt. It was significant that the resistance came only from nurses. Medical and other allied staff as well as patients responded well to new ideas and changes. At one stage the pakeha story of the mysterious elves who cleaned the house and made shoes overnight came to mind as the changes we made during the day were quietly reverted during the night by the long established night staff. The horizontal violence I experienced was a useful early lesson although at the time it led to severe depression. Quality Assurance Both my grandmother and my whangai mother visited the ward, knew several of the men and their families and checked with them about the quality of the service they were receiving from the staff and from me. The men were frank and supportive and made helpful suggestions which my family relayed to me. After three years, illness and subsequent surgery took me out of the Tb and respiratory environment. My reputation preceded me and I was not permitted to resume the status of Charge Nurse although medical staff and patients attempted to influence my return. I was offered a position in the Milk Room making up milk mixtures for babies. It was well known in the nursing world that this was that an area where aberrant nurses tended to be employed when their difference was obvious in the dominant professional environment. The Milk Room was known to be a place where identifiable lesbian nurses, Samoan nurses, nurses with poor English language skills or other apparently different nurses often worked. A nurse who was comfortable and open in her lesbian identity applied for employment in 1974 and was offered only the Milk Room, ultimately staying there for three years. In a letter to me about her experience in the milk room, which she has given me permission to publish, Tighe Instone (personal communication, Christchurch, Wellington, 2001) says; My introduction to Wellington Hospital led me to believe that the milkroom must be a holding pen for deviants…the tangible prejudice and veiled hostility left me with a feeling that I had been betrayed by the nursing profession…the relationships that my son, my friend and my neighbours forged with the Samoan milkroom staff and the wider Samoan community will always be treasured. A process of refusing my applications to work in areas of my choice finally saw me working in the Fracture Clinic where I stayed for eight years, eventually working several evenings a week while my children were small. Lessons learned from these experiences • That leadership is as much about timing as about the quality of ideas. • That the ideas which potential leaders wish to convey must have beneficial meaning for most of the people for them to risk becoming involved in the process of change. • That ideas must be marketed in a way which motivates people to create and adapt to change. • That institutions consist of cultures within cultures. • That the attitudes held by health professionals have a direct impact on the wellbeing of the people in their care. • That frequently professionals are not alerted to their own attitudes. • That horizontal violence in nursing extends beyond racism and sexism to homophobia and resistance to the wide spectrum of human difference, and is also institutionalised. Expanding Horizons/Epiphanies Etcetera The birth of my son was the powerful catalyst for the intellectual, emotional and political examination of what it meant to be Irakehu in 1973. Later my daughter’s 1977 birth consolidated the commitment to extract a viable legacy for them from the colonial chaos. Now I understood the political action of my grandmother in keeping me linked to the land through the little Croxley letters. It was also time to go home regularly to Koukourarata with the children. Realisation that our reserve land was the most marginal in the area and that the rest of the land was in pakeha ownership, and that those pakeha had benefited generationally and my people were generationally poor, led me to investigate Land Court records and legal activities according to the pakeha law. Although the daughter of an historian I had little knowledge of the political history or the legislative manipulation of the ownership of Maori land and the social, economic, educational and legislative processes which led to the poverty of Maori people. I did not understand why Maori were stereotyped as unintelligent, irresponsible and lazy. Why Maori were demonised in the media, filled the prisons and hospitals and were told that they had the same opportunities for successful social accomplishment as everyone else. My whole experience showed me that there were fundamental and brutal injustices in our society and I wanted to know how and why they got there, how they worked and how they were sustained. The Crown, a local family firm of lawyers (again through three generations) and local farmers contributed to a story of deliberate and regular deprivation of land from my family. Interviews with family members revealed stories of land shares signed away while owners were drunk or unable to work or borrow from banks, and a dependence on local farmers who were always able to supply cash in exchange for a few more land shares. Having to walk with my children past the house which my great-grandfather built for my grandmother and her family, knowing the history of the illegal purchase and immediate resale in 1943 verified through the records of the Maori Trustee, caused me physical and emotional anguish. It was a lonely time because my family had coped with the facts in a range of ways, most commonly by ignoring and often denying or forgetting the history in their helplessness to confront it and to change the outcomes. As their world had become smaller they seemed to have shrunk with it. They appeared to accept the processes of economic colonisation and social deprivation as natural. I was shocked and saw this outcome as the ultimate colonisation, that of the memory and therefore of the mind. Like bell hooks (1994) I often felt alien in both my families. Her experience of trying to articulate what was happening to her family through theory as a child had ringing resonances for me. hooks’ mother wondered how she had come by the subversive ideas that threatened to undermine the constructs by which her people had enabled themselves to live. In frustration her mother wondered where hooks had appeared from and wished she could be "sent back" (p. 60). Those were sentiments which I heard from my father’s and my mother’s people as I tried to make sense of what was happening. The most common phrases were about my being 'different’, a dreadful indictment in a kinship based and highly co-operative setting. In later years my family became dependent on my skills in the Land Court and in formal settings, as well as supporting my undertakings greatly, but the apprenticeship was arduous. I had to be very careful indeed to allow the erasure of institutional memory to regenerate in a manner which my family members could control at a pace which was safe for them. For some it was rapid, violent and shocking, for others it did not happen at all. The manifestation of powerlessness and helplessness as anger and grief and its progress to transformative intellectual activism was a process which I had to experience in order to rearrange my realities so that I could survive the transition and be intellectually and emotionally intact. This has happened to me several times, each time refining my emotional and political identity as an Irakehu woman more clearly. Like hooks I learned that theory could be a healing place. bell hooks discusses her initial response to the work of Paulo Friere in her book, Teaching to Transgress, published in 1994. She identifies Friere’s work as giving her a language as a young student when she began to think deeply about the construction of an identity in resistance. And so Friere’s work, in its global understanding of liberation struggles, always emphasises that this is the important initial stage of transformation - that historical moment when one begins to think critically about the self and identity in relation to one’s political circumstance. (p. 47) The motivation to understand was now an imperative. I knew that the pain, anger and grief I was experiencing were potentially detrimental to my functioning. My peers, my husband and most of my family had no apparent understanding of this pain. Those who did have insight also could not articulate its political origins and its social presence. Seeing what was happening to my mother’s people and its structural inevitability was enraging. The energy from that rage and grief needed to be harnessed constructively because it was isolating me from objectivity. Without some distance I could not view the realities around me let alone attempt to change them. By this time I was seeking to grasp the reasons for the depth and breadth of racism in New Zealand society and to comprehend the nature of its institution. I thought that university was the route to the theoretical insight I needed. Those evenings in Fracture Clinic proved very profitable for me because I was able to use the quiet time to study. I completed my undergraduate degree in Anthropology in 1983 specialising in Maori Studies, Criminology and Women’s Studies. Learning to use the university system and to order my thinking gave me the tools I needed to observe the world and to consider the possibilities for change. At this point the most useful analysis came from feminist theory because it examined power relations and the patriarchy and with little modification could be applied to the English colonisation of New Zealand. Our cousin, Miriama Evans, joined me in Women’s Studies and together we found that we had to defend the histories, social class experiences and identities of Maori women from being subsumed by the analysis of pakeha feminists. This was very useful practice for future work. Again, bell hooks (1994) comments on the same experience: Though the call for sisterhood was often motivated by a sincere longing to transform the present, expressing white female desire to create a new context for bonding was no attempt to acknowledge history or the barriers that might make such bonding difficult if not impossible. (p. 102) Now I was able to move from curiosity to investigation. From being integrated into a wide range of circumstances in which I was relatively comfortable I had now experienced what Trinh T. Minh-ha has called a "mutation of identity" (1995, p. 216). By defining the 'other’, I had begun to define myself. Henri Giroux (1992) writes of Eurocentric culture and its assumption that its own meta-narrative can ruthlessly expunge the stories, traditions and voices of those who by virtue of race, class, and gender constitute the 'other’. Although I could not agree with the definition of my mother’s people and myself as 'other’ since I consider ourselves to be normal, residing in our own country and living in our own history albeit in grotesque circumstances, I could certainly see where Giroux derived his thinking from and knew that those with the power to call our people 'other’, would continue to do so as a function of their power. the bone people/The Spiral Collective In 1984 as a new graduate from university in the formidable company of Marian Evans and Miriama Evans, I entered the world of publishing books. It was not an unfamiliar world and as the daughter of a wordsmith did not hold many mysteries for me. I was fortunate not to have been brought up with the awe of printed words and their perceived authority which many New Zealanders’ recency of literacy, created. The opposite was true for me. Words were to be protected and viewed cautiously if I suspected that they were being overused until their meanings vanished, or that they were cynically employed to sell newspapers or advertising or were being manipulated unethically. For me books and the words in them are potential friends and tools to be mindfully selected, examined and chosen for their perfection of expression, their potential for joy, as well as their prosaic function. They are above all human constructs employed for human purposes. Making a book is part of that process. Our small collective was named "Spiral". We undertook to physically create and publish a book while maintaining its integrity which we believed in as literature. The manuscript written by our cousin, expressed a series of realities that had rarely appeared in New Zealand writing. Physical and mental domestic violence, Maori allegory and metaphor, and recipes, did not fit the standard novel form and the manuscript had been regularly turned down by several publishers. The author had given up and had decided to encase the manuscript in resin and use it for a doorstop. Once between covers 'the bone people’ swept most of the major literary prizes available in New Zealand, went on to collect the Pegasus Prize for indigenous literature sponsored internationally by Mobil Oil, and then won the English Booker McConnell Prize which remains the major award in English literature. Our whanaunga Keri Hulme has her place in the New Zealand literary firmament and I learned very valuable lessons from the experience about pushing out parameters, staying true to beliefs, and hard nosed international literary contract negotiation. 'the bone people’ took us to England to attend the Booker Prize presentation dinner and to receive the prize for Keri at the Guildhall in London. I was astonished and irritated to see that the very English weeds between the railway lines had their counterparts between railway lines in New Zealand and that the streets of wealthy Kensington were lined with houses bearing the dates of the colonial economic stripping of the country of our whakapapa and those of other native peoples. I was reminded of Barry Barclay’s words: "Stone by stone, grain by grain, stone by stone, grain by grain" (1993, p. 204). The colonial office was of great interest to me but in five subsequent visits to England I have not been able to bother myself to look at Buckingham Palace. That symbolism I understand very well. In the United States I helped negotiate Keri’s contracts with Baton Rouge University and Mobil Oil. They were creative contracts because we held the rights to the greatest literary prize of the year. I had some time with African American writers in New York and later worked with indigenous and feminist writers in Norway and Spain. In later years I became a regular judge of literary awards in New Zealand and have contributed to many publications. Although I was grateful for the solid grounding in literature and the classics in English which I had from my father, I was also profoundly grateful for the classics in the Maori song record which our childhood grounding in Ngati Poneke provided us with. The social institutions of the times taught me that punishment could be swift and enduring for perceived transgressions or the threat of destabilisation. The systems and culture which were called "nursing" taught me about inflexibility, conformity, control and oppression and fear of change. Those were significant lessons because they made me think critically about power, how it was managed, and who the beneficiaries of power and control really were. This exploration led to further formal education and enabled me to recognise and analyse personal and institutional racism as well as the ambivalence of social and cultural boundaries and the issues they represent for nursing practice. This information was invaluable in providing me ways to view challenge and change and how that might be achieved at both a personal and systems level. The next movement in my nursing career would take me out into direct contact with families in their personal home and community environments. With this move would come further practice experiences requiring other skills and considerations in terms of negotiating power and moving between borders.