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"The Turkish Red Crescent, part of the nongovernmental International Red Cross and Red Crescent Movement, is the largest humanitarian organization in Turkey." —F. Sevgi Hatýpoðlu |
THE STATE OF GLOBAL HEALTHA brief history of Turkish nursing
by F. Sevgi Hatýpoðlu Modern nursing is said to have had its birth in the country that is today known as Turkey. In 1854, Britain and France, responding to invasion of the Ottoman Empire by Russia, came to the empire’s aid in a conflict that became known as the Crimean War. Students of nursing are well aware of Florence Nightingale’s important role in caring for British soldiers involved in that war. By reforming army hospitals and improving sanitation practices, Nightingale, aided by 38 other nurses, dramatically reduced the death rates of soldiers suffering from war-inflicted wounds and from diseases that included cholera, malaria, typhus and dysentery. Nightingale was not the first, however, to introduce modern nursing practices to this area. In 1820— more than 30 years before Nightingale’s arrival in Anatolia, also known as Asia Minor—American missionaries brought improvements in nursing practice to this region. In 1842, female students were able to enroll in medical school courses for training in midwifery. In fact, 10 female nurses received graduate certificates in 1845, nearly a decade before the Crimean War. In the years that followed the Crimean War, nursing continued to advance in Anatolia. After the signing of the Geneva Agreement by the Ottoman Empire in 1865, national and international foundations were created in the region with the purpose of providing adequate health care for everyone. In 1868, the Ottoman Empire established a foundation in Istanbul called Hilal-i Ahmer. Founded by 50 members, 10 of whom were women, the organization provided care and education to the injured, operating on the principle that “we are all siblings.” Women joined the association on equal footing with men and played important roles in providing care to the poor and those without hope. It is interesting that the padishah, or great sultan of the Ottoman Empire, and his influential mother, the Valide Sultan, were both pioneers in this health care enterprise. Hilal-i Ahmer in its original form ceased operation in 1874, just six years after its birth. Its humanitarian benefits were unavailable, therefore, to combatants in the Russo-Ottoman War of the 1870s. In 1877, however, the association was reborn and named the Ottoman Hilal-i Ahmer Association. Infused with new life, the organization eventually provided care to 25,000 patients, with nine mobile hospitals and four helping stations in Istanbul. Established within the Ottoman Hilal-i Ahmer Association in 1912 was the Hilal-i Ahmer Center for Women. Beginning with the First and Second Balkan Wars (1912-13), continuing through the First World War (1913-18) and the Turkish War of Independence (1919-22), and culminating with the Treaty of Lausanne in 1923, the Center for Women helped relieve the suffering of the sick and wounded, including soldiers and their families, prisoners of war, orphans and immigrants. The leaders of the Center for Women placed high priority on the effective training of its caregivers, one of whom was Madame Antoniette, wife of Yahya Hospital head physician Ali Dervis Bey. Antoniette volunteered her services as a nurse’s aide during the Balkan Wars (Akgün & Ulugtekin, 2000). In his book Sihhi Hitabeler (Health Speeches), psychiatrist Mazhar Osman identifies Safiye Hüseyin Elbi, a nurse in the Hilal-i Ahmer Association’s Center for Women, as the first Turkish nurse to receive a diploma (Behmoaros, 2001). In 1921, Elbi was awarded the Florence Nightingale Medal by Monsieur de Clousie, president of the French Salib-i Ahmer. She was the first Turkish woman and nurse thus honored. Between World War I, in which the Ottoman Empire was allied with Germany, and the Treaty of Lausanne, when the Republic of Turkey achieved independence, British, French, Italian and Greek forces occupied various portions of the empire. In the large-scale exchange of populations that occurred between Turkey and Greece following Turkish independence, the center played a significant role in providing immigrants with clothing, transportation, health care and medical supplies. The women of Hilal-i Ahmer were ahead of their time. To illustrate the conventional perspectives of the period, in a 1908 newspaper article, a woman author defended the status quo that working for a living was off-limits to women, except for those who couldn’t get married or were widowed. In another newspaper article published that year, another woman author observed: “If woman and man become equal, how will harmony go on? It means the family will be in trouble. Also, it is opposite the law of nature [for a woman] to have the political rights of men.” She went on to state that she preferred that women be poor rather than perform work as an official, an engineer or other worker (Akgün & Ulugtekin, 2000, p. 144). Nurse leaders and others involved in the Center for Women contradicted this conventional wisdom by maintaining that men and women could work together. Physician Besim Ömer Pasha, founder of modern obstetrics and pediatrics in Turkey and author of 61 books, played an important role in the development and administration of the Center for Women, despite the fact that he was male. Wives of Turkish authorities contributed financial support to the association. Mediha Hanim, wife of Tahsin (Uzel) Bey, governor of Van, led the establishment of Hilal-i Ahmer Hospital and also looked after the injured in battles on the Eastern front. Influenced by increased acceptance of these changing roles for women, the Ottoman ruler—the padishah—awarded Hatice Çeker Hanim, head nurse of Haydarpasa Hospital, a bronze medal for her service (Akgün & Ulugtekin, 2000). Along with Turkish independence, achieved under the leadership of Gazi Mustafa Kemal Atatürk, came further advancements in the status of women. In a 1923 speech, the war hero called for an end to gender discrimination. Two years later, this founder and first president of the Turkish Republic accepted an invitation to be honorary president of Hilal-i Ahmer, and the name Turkey was added to the beginning of the association’s name. In 1935, Atatürk proposed that the association be renamed the Red Crescent, the name by which it is still known today. The Turkish Red Crescent, part of the nongovernmental International Red Cross and Red Crescent Movement, is the largest humanitarian organization in Turkey. As stated earlier, Elbi (1882-1964) is recognized as Turkey’s first nurse leader. The daughter of a vice admiral, she began her career in 1911 by attending a nurse’s aide course offered by Dr. Besim Ömer Akalin. During the Balkan Wars and the Çanakkale campaign (part of World War I), she worked diligently to raise financial support for the Hilal-i Ahmer Association while self-sacrificially caring for patients. At the suggestion of Professor Pasha, she became president of the Turkish Nurses Aides Association and Turkish Nurses Association, both founded in 1933. Today, she is honored with a certificate in the Museum of Atatürk’s Mausoleum that identifies her as the “first Turkish nurse,” and a classroom in the Gülhane Military Medical Academy School of Nursing is inscribed with her name. After World War I, the establishment of Turkish independence and the restructuring that followed, the Turkish Red Crescent expanded its operations and, as a result, played an important role in further refining the education and professional role of nurses in Turkey. Turkish nursing, initially learned through on-the-job training by those who volunteered their services, evolved toward a school-based curriculum after World War I and post-independence Turkish reconstruction. In 1925, Pasha, a close friend of Atatürk, founded The Red Crescent Nursing School. Turkish women accepted for admission to the school earned places in the nation’s history as leaders in nursing. Among these leaders, Fatma Acar, Hayriye Ece, Fatma Bengisu, Esma Deniz and Asuman Türer worked diligently to help the school reach European standards. In 1933, these women reorganized and strengthened the Turkish Nurses Association, established earlier with the help of Pasha (Birol, 1975). In addition to being an educated nurse, Esma Deniz worked as an administrator in the Red Crescent Nursing School for years, participating between 1940 and 1977 in many national and international nursing activities as a representative of the World Nurses Union. Deniz, who always reminded nurses that “a well-qualified nurse should learn something new every day,” identified three characteristics that every good nurse possesses: “True, deep and powerful tenderness for each patient, strong and practical care for the patient’s situation and, finally, ability to manage well” (Deniz, 1951, p. 4) As a result of Deniz’s leadership, a classroom at Gülhane Military Medical Academy School of Nursing is named in her honor. Publications—peer-reviewed and otherwise—have also contributed to the rise of nursing as a profession in Turkey. Following World War II, the Turkish Red Crescent began regular publication of a nursing journal titled Hemsireler Dergisi (Turkish Journal of Nursing). In a 1951 article published in that journal, a Turkish nurse wrote: “Our job is superior to all jobs because the words that raise the patient’s hopes are our words. Young persons should prefer to be a nurse in order to benefit the country” (Polisten, 1951, p. 35). In the same issue, another nurse leader provides information about the Law Draft for Nursing then being prepared by Fatma Bengisu who, along with her co-workers, was then assigned to the nursing office of the Ministry of Health and Social Help. It is clear from the content of the legislative draft that education of nurses was considered important (Türer, 1951). The excitement toward the profession expressed by Turkish nursing leaders during this period was shared by nursing students. One such student, author of a 1954 article in Hemsireler Dergisi titled “Nursing and I,” wrote: “People, except for a few, want to live in the best way; and for this, they always think about themselves first. But for a nurse, this is not true. ... For her, human beings are important. She devotes everything she has to her patient” (Balek, 1954, p. 15). Seminars and studies sponsored by the World Health Organization and the Turkish Ministry of Health also contributed to nursing’s increased professionalism following World War II. For example, in a 1954 study performed in Istanbul on teamwork in nursing services, nurses from 11 countries participated and shared their thoughts and opinions with physicians (Deniz, 1954). In the ensuing years, nursing schools have endeavored to further the nursing profession by developing a curriculum that provides students with an education that is practical, yet adaptive to changing trends and theories. To help them in this process, Turkish nursing leaders have come to value research and opportunities to interact with their colleagues both nationally and globally. The great historian Sühey Ünver (1943) stated that “medical history is the history of a physician’s own revolution” and “nursing history is also the history of a nurse’s development” (p. 9). Thus, a historical review of individual nurse leaders is useful in achieving a proper understanding of Turkey’s nursing history overall. History reminds us that political and military leaders of past wars—Churchill, MacArthur, Eisenhower, Montgomery and Atatürk—both influenced and were influenced by events in which they participated. The same principle holds true for nurses. In responding to the opportunities and demands of the information age, nurses can both influence and be influenced by the growth and dissemination of knowledge. In the process, new nurse leaders will come to the forefront. Who will they be? Perhaps one of them will be you. F. Sevgi Hatýpoðlu, RN, PhD, is professor colonel at Gülhane Military Medical Academy School of Nursing in Etlik, Ankara, Turkey. References: |
