Jane Starfield
DIVIDED SISTERHOOD: Race, Class and Gender in the South African Nursing Profession, by Shula Marks (Witwatersrand University Press, R82,00)
SHULA Marks’ study of the South African nursing profession is as pioneering as her other monographs and collections of essays have been. Her attention to gender was notably voiced in Not Either an Experimental Doll: The Separate Worlds of Three South African Women (1987), while her sensitivity to the social position of the African petty bourgeoisie provided that remarkable set of essays, The Ambiguities of Dependence: Class and Nationalism and the State in Twentieth Century Natal (1986). Earlier, her doctoral study of the 1906 armed African uprising in central Natal, Reluctant Rebellion, demonstrated her understanding of the role of imperialism as ideology and practice in the making of white supremacy in South Africa, and the resistance to it. The very titles of these works reveal her outstanding ability to draw out a finely nuanced explication of the themes and discourses tying her subjects to first the segregationist, then the apartheid state.
Marks has always worked closely with fellow historians, but has branched out in Divided Sisterhood to exchange ideas with health workers of all kinds, especially nurses. In so doing, she has also encouraged a new generation of South African historians and sociologists to investigate the unequal provision of health care for blacks and whites.
Divided Sisterhood, an ingeniously punning title, shows how women in the nursing profession have over a century and a half been segregated along class, gender and racial lines. This is hardly surprising: the structure of the profession which came into being in the nineteenth century was modelled closely on the social fractures of that epoch. Marks notes that “the analogies of father-doctor, mother- matron/’lady nurse’; servant/paid nurse; child-patient” are not the sole preserve of the South African nursing profession. However, in South Africa, the racial question adds an almost satiric quality to the picture. In this context, white nurses (implicitly “ladies”) were initially intended to nurse white patients. They were also meant to be in a position of authority over black nurses, who, as far as possible did the rough work (scrubbing, for example) in the hospital and some, in separate hospitals, nursed black patients.
So entrenched was segregation in South African hospitals by the 1920s, that the total white nursing staff at the Victoria Hospital in (then) Mafeking, gave notice when an African doctor, qualified in 1918 from Glasgow University (black doctors could not, until 1940, train in South Africa), admitted white patients to the hospital. The then matron stated: “We objected very strongly as South Africans … to being ordered about by any native doctor and to have to stand by while he conducted operations on white women.” It is beside the point that many white citizens of Mafeking and elsewhere went out of their way to consult Molema’s diagnostic expertise and that he set up a private clinic to cater for them –employing nurses from all South Africa’s racial groups.
As Marks suggests, much that underlay the segregationist practices and “revulsions” were almost subliminal. Could black hands touch white flesh and vice versa and, furthermore, how well-qualified were the hands? If the idea of a black doctor’s touch and orders elicited opprobrium from certain white nurses, how could South Africa increasingly “tolerate” the work of black nurses in so- called white hospitals?
National prejudices notwithstanding, by 1990, by far the largest contingent of nurses in the country was black — the professional descendants of the Bantu Nightingales whom the missionaries had trained in the early twentieth century. So although the National Party’s desire was to professionalise nursing and train more white nurses, they were thwarted by the low financial status of the profession in the white community. Indeed, in the rural areas, the large burden of health care has fallen onto the shoulders of well-trained black sisters, who carry out the duties that would — if one were present — befall a doctor.
Marks is peerless among historians of South Africa for her ability to integrate social history and social theory. This is undoubtedly why she has focused on the crucial issues of race, class and gender — issues which she has previously delineated as central to the making of twentieth century history in South Africa. The only major issue absent from her title, but implicit in her work, as the Molema incident indicates, is nationalism. Nursing was, to a large extent, influenced by both Afrikaner and black nationalism. However, the needs of the workplace, the hospital, predominated, especially in the apartheid years, over those of ideology. Marks argues that the introduction of more and more black nurses –staff nurses and sisters — into white hospitals was the result of poor staffing: nursing, as a profession, appealed less and less to white women, whereas its status rose among the black community.
This is a book that all South Africans will find readable and filled with a wealth of knowledge about health-care in South Africa. It is remarkably well-researched and no reviewer can do justice to the more than 1 000 footnotes Marks has carefully prepared. More studies of professions in South Africa should be conducted along these lines.