Seeds That May Have Been Planted May Take Root: International Aid Nurses and Projects of Professionalism in Postindependence India, 1947–65

Abstract

Upon the creation of an independent India in 1947, a cadre of international nurse advisors was dispatched to the new state, bringing with them ambitious plans for remaking the local profession.1 These women, among the most highly qualified nurses in the world, were backed by the considerable wealth of international governmental organizations and nongovernmental organizations (NGOs), including the Rockefeller Foundation, United States Agency for International Development (USAID), and World Health Organization (WHO). Their nursing programs attempted to institutionalize the values and infrastructure of the nurse professionalism that had evolved in early-twentieth-century North America. They pursued these aims in three main ways-support for university-based nursing programs, encouragement of a strong public health role for nurses, and education of Indian nurses overseas. This article draws on Rockefeller and USAID records, as well as secondary literature on other organizations, to examine their influence on Indian nursing from 1947 to 1965. I argue that, although they made some significant contributions-the institutionalization of degree education for the elite, a better infrastructure for the preparation of teachers and administrators, a broader awareness of the importance of public health-their projects were ultimately flawed by a passionate commitment to American educational models that was insufficiently tempered by awareness of the sociocultural context in which they intervened. International nurses encountered a local profession that was numerically small, almost without leadership, subject to dire working conditions, and stigmatized in wider Indian society. It was felt that the answer to these problems lay in the preparation of a small elite who would be broadly educated and skilled as leaders. This would produce a trickle-down effect, raising teaching standards, elevating the profession in the public eye, and eventually producing large numbers of more empowered nurses. The attempt to achieve this solution, however, was beset by a range of difficulties. With overcrowded wards, underequipped hospitals, a frequently hostile medical profession, and unsupportive governments, degree programs struggled to function at all. The view that high-level projects of professionalism were the best way to use the considerable resources and expertise invested in nursing is ultimately questionable. Breaking with the Past? Nursing under Colonial Rule When international nurses arrived to plan postindependence Indian projects, they found a small and struggling local profession. This underdevelopment in nursing was to some extent a consequence of a more general underdevelopment in public health and hospital care under colonial rule. During the eighteenth and early nineteenth centuries, there had been a general absence of state-provided health care for the Indian population, with allopathic medicine chiefly confined to European military and civil enclaves. Throughout the period of British rule, the vast bulk of the population, living in rural areas, had minimal access to allopathic medicine; village India continued to rely on indigenous systems of medicine such as ayurveda and unani. For the majority of women, the main contact with medical practitioners of any kind was with the dai, or village midwife.2 The late nineteenth century saw some expansion in health services, mainly focused on urban areas. David Arnold suggests that from this period onward there was an attempt to provide a public health and hospital system that catered to Indian as well as European health needs, although Radhika Ramasubban has asserted the ongoing lack of state interest in Indian needs.3 Mridula Ramanna's account of medicine in mid- to late-nineteenth-century Bombay highlights the strong role of the increasingly numerous and assertive Indian medical profession there, and its philanthropic role in funding hospitals and dispensaries.4 The Dufferin Fund, a privately supported philanthropic organization established in 1885 by the vicereine, Lady Dufferin, was designed to provide hospitals for women and children and to train Indian women doctors and nurses. …