Katie Makanya and Florence Nightingale

¶ … Nursing and the Calling of Katie Makanya:

The longing for the lost pastoral and the longing for change

Florence Nightingale's seminal text Notes on Nursing was written after the author's experiences nursing during the Crimean War, and was part of her efforts to establish nursing as a unique profession of respect and dignity. During her wartime service, Nightingale had seen the horrific consequences of modern, industrialized warfare. Thus her perspective of the dangers and unhealthiness of city life were inevitably colored by her witnessing of the consequences. "The most frequent and fatal cause of all is sleeping, for even a few hours, much more for weeks and months, in foul air, a condition which, more than any other condition, disturbs the respiratory process, and tends to produce 'accidental' death in disease'" (Nightingale, Conclusion). For Nightingale, the unwholesome nature of city life was literally poisonous.

Nightingale had witnessed the shift to urban life from country life as one in which human beings were able to live relatively 'at one' with nature, in relatively pleasant and open surroundings vs. The cramped urban conditions in which disease was rampant. Given the relatively minimal knowledge about the state of public health at the time, few precautions were taken to minimize the transmission of diseases. Nightingale saw the shift away from the old ways as something entirely negative, despite her status as a 'woman of science' and an advocate for the nursing profession.

In fact, in Nightingale's perspective, clearly many of the old, intelligent ways of dealing with sickness were lost and were replaced with so-called modern notions that defied common sense, in terms of how sick people should be treated. The first chapter of her book entitled "Ventilation" illustrates this fact in which she speaks about "the extraordinary confusion between cold and ventilation, even in the minds of well-educated people…To make a room cold is by no means necessarily to ventilate it. Nor is it at all necessary, in order to ventilate a room, to chill it" (Nightingale I). Nightingale sensibly advises that when a room is cold, the windows should be closed but during the warmth of the day it behooves the patient to have fresh air. However, many nursing wards and nurses in sick rooms pursued a black-and-white policy and closed the windows all of the time, creating a hothouse atmosphere, or leave the windows open all the time even when the air was genuinely too cold for the sick patient.

No matter how fine and how lovely the beautiful houses of London might be, notes Nightingale, ignorance and the nature of urban life creates a veritable breeding-ground of disease. "I have met just as strong a stream of sewer air coming up the back staircase of a grand London house from the sink, as I have ever met at Scutari; and I have seen the rooms in that house all ventilated by the open doors, and the passages all unventilated by the closed windows, in order that as much of the sewer air as possible might be conducted into and retained in the bed-rooms" (Nightingale II). Nightingale's stress upon the fact that she found such conditions in a grand urban home in London, not a tenement, is extremely deliberate. The lack of knowledge of how to heal is endemic to all classes in urban life and is literally woven into the construction of the buildings. To live in a city means sickness is almost inevitable: whether one is rich or poor, old or young. The question is not if one will get sick, but when and how.

The cultural shift in life and health patterns created during Nightingale's era was mainly based on economics, namely the shift from a non-industrialized to an industrialized world. However, for the South African nurse as detailed in the book The Calling of Katie Makanya, the transition of Makanya's homeland to a more industrialized way of life brought mixed blessings. On one hand, as a black woman, Makanya faced tremendous prejudice based upon her skin color, and the cultural shift within her nation (which would eventually result in the apartheid system) was perpetuated and driven by whites. However, Makanya had an open mind and viewed many of the developments generated by European culture as positive, although she believed firmly in her own sense of equality. "You can't be a proper nurse," she was told, "the nursing schools here are only for white girls. If you go to work at a hospital, you will really be just a servant, mopping floors and cleaning up after the Europeans" (McCord 26). However, Makanya resisted such conventional wisdom and ultimately strived to persevere to realize her dreams. She worked with a white physicians for most of her life, despite the notion that black women could not be 'proper nurses' and despite her own bristling resentment at the racism she felt.

African-Americans were regarded as drudges in Makanya's South Africa -- ironically, much how nurses were regarded in Nightingale's time, before Nightingale begin to establish the respectability of the profession through her dissemination of knowledge. Makanya came to embrace Christianity and grew to admire many aspects of modern medicine -- the kind that was located in urban centers of development. Although she occasionally experienced internal conflict between the two worlds and worldviews she inhabited, the fact not all whites -- particularly those within the profession of medicine -- endorsed such prejudices regarding black inferiority heartened her and enabled her to believe she had a future within the medical profession and that Western medicine was a good thing. As one black woman said who was able to study medicine: "in my medical school we have learned about pigmentation, the blackness in our skins which God has given us to protect us from the sun…White people cannot stay too long in my country else they shrivel up and die. Poor things they don't have that special blackness to protect them from the sun" (McCord 53).

Makanya did not despise the ways of her non-Christian ancestors but she also did not feel a need to reject Christian civilization and aspects of the industrial world wholeheartedly, although it clearly may have been tempting to do so, given the way she was often treated. Despite her many gifts, she was limited to a great degree in her ability to gain full medical credentials on par with a white women, but her efforts to make the most of her life within the constraints in which she operated demonstrated that she did not allow herself to become embittered. Makanya's struggles thus indicate ambiguity about life in the countryside: on one hand, she perceives the superiority of modern medicine over folk medicine and prefers the organized religion of Christianity over native faiths which she regards as superstition, but she does so with a clear-eyed view that many of the persons who support the cultural ideals of Europe regard her as innately inferior.