Leslie Anne Hadfield. A Bold Profession: African Nurses in Rural Apartheid South Africa. Women in Africa and the Diaspora Series. Madison: University of Wisconsin Press, 2021. 304 pp. $79.95 (cloth), ISBN 978-0-299-33120-7.
Reviewed by Matt Heaton (Virginia Tech)
Published on H-Africa (November, 2021)
Commissioned by David D. Hurlbut (Independent Scholar)
In the midst of an ongoing global pandemic, it suddenly seems commonplace to be reminded of how crucial nurses are, and always have been, to the structure, operations, and humanity of biomedical institutions. And yet nurses have been neglected and marginalized within broader scholarship on the history of medicine and health care in most parts of the world. In A Bold Profession, Leslie Anne Hadfield seeks to bring some historiographical balance through a detailed accounting of the lived experience of African nurses in the Ciskei region of South Africa during the height of the apartheid regime. Using a variety of sources, including government archives, newspapers, institutional records, and, most centrally, dozens of personally conducted oral interviews with nurses who worked in the rural hospitals and dispensaries from the 1960s through the 1980s, Hadfield provides a glimpse into the complex worlds African nurses navigated, revealing them not only as cogs in the machinery of a modern, if inequitable, health-care apparatus but also as human beings navigating fraught political, economic, and cultural landscapes that affected, and were affected by, their professional identities.
Hadfield’s analysis draws significantly on a small but influential body of historical scholarship on African nurses, much of it also situated in South Africa. But what sets this book apart is the time and place under consideration. The emphasis on Ciskei, a rural district designated for “independence” as one of the African homelands that the apartheid government cynically established to deny responsibility for the welfare of the majority of South Africa’s indigenous population, creates opportunities to expand our understanding of African nursing beyond the colonial era and beyond the concentration on urban centers that characterizes much of the existing scholarship. On the one hand, Hadfield effectively demonstrates in the first two chapters the precarity of providing effective care in circumstances of such deliberate underdevelopment. Not only were hospitals and clinics inadequately funded, but nurses themselves struggled to find appropriate living arrangements, transportation, and a semblance of work-life balance. On the other hand, it is also clear that many of the nurses who worked in Ciskei took great pride in their work and in the institutions for which they provided it, emphasizing the autonomy they sometimes experienced, as well as the relatively higher standard of living that a professional job provided, which allowed them to care not just for patients but also for their own friends and families in ways that were all too rare for African women in an explicitly racist state. Indeed, if there is a counterintuitive finding anywhere in the book, it is in the general sense of optimism and qualified satisfaction that many of the nurses exhibited in discussing their experiences, as shown in chapter 3, though Hadfield recognizes that some of this may have been at least partially a function of interview dynamics.
Ultimately, however, it is the nurses more so than the nursing that are the central subject of the work, and Hadfield goes to great lengths to contextualize the rich, complex, and sometimes contradictory forces that shaped nurses’ lives. Chapter 4, for example, examines nurses’ relationship with the indigenous Xhosa healing system, which challenged the legitimacy and authority of biomedicine in myriad ways. Not only did most patients navigate medically plural landscapes, engaging with both Xhosa and biomedical treatment as they deemed appropriate, but so too did many of the nurses, the majority of whom also came from Xhosa cultural backgrounds. While this coexistence sometimes caused conflict between the two systems—for example, when treatments for diseases like tuberculosis, diarrhea, or psychosis were directly contradictory—in other ways biomedicine and Xhosa healing practices reinforced each other in a general context of health-care scarcity. Hadfield situates nurses as important intermediaries between the competing systems, both culturally and professionally. As an added layer of complexity, Hadfield focuses significant attention on the transition of biomedical facilities from their origins largely in Christian missionary medicine to secular, government-run operations in the 1970s, which created its own cultural tensions in many of the nurses’ accounts.
The home lives of nurses also feature heavily in Hadfield’s analysis. Chapter 5 explores how nurses’ professional responsibilities affected their families and vice versa. The high demands that the job placed on nurses’ time and energy obviously affected other aspects of life, but in ways that rarely receive scholarly attention. The professional goals of these women (they were almost all women) challenged prevailing gender norms in the lives of many nurses. Some found support from spouses and kin, who adjusted their gendered expectations as needed, while others saw their family dynamics devolve around their inability or unwillingness to fulfill the sole role of full-time wife and mother. Hadfield notes that gender dynamics within family units seem to have shifted over time to be more accommodating of women’s professional goals and duties, though “the expectation that women took primary responsibility for childcare and household management persisted” (p. 172).
A Bold Profession paints a deep, textured picture of life as an African nurse in a rural homeland setting at the apex of apartheid. It is perhaps most commendable for the way it elaborates the complexity of everyday life in this particular time and place. Its conclusions are far less bold. Most of the material, while compelling and well presented, fits quite neatly into preexisting frameworks developed by other historians of health and medicine in Africa. This leaves Hadfield struggling to make strong claims about the significance of her findings. The book concludes with some rather general observations, such as “this history has shown that having adequate funding and staff can support the diffusion of health care through community clinics that can reach more people in remote locations” (p. 183). Nevertheless, it is a solid addition to the social history of medicine in Africa and a sincere testament to the profound contributions of the nurses whose stories fill its pages.
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Matt Heaton. Review of Hadfield, Leslie Anne, A Bold Profession: African Nurses in Rural Apartheid South Africa.
H-Africa, H-Net Reviews.
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