This week saw the celebration of International Nurses Day. Amira El-Noshokaty visits hospitals to investigate the every day challenges of the workplace To assist with the upbringing of her seven siblings, Dorria Hassan decided to pursue a career. She trained as a nurse, and 15 years later she is now an underpaid, undervalued and overworked member of the lower socio-economic strata of the medical profession. Hassan is tired of dealing with the negative connotations associated with her job. "All I want are my rights," she says. Nurses generally stem from underprivileged backgrounds; the fact that many of these women may have scored badly in school or missed out on third-level education and are required to spend nights away from home has contributed to the profession's poor reputation. "Egypt's nursing staff comprises 140,000 individuals nationwide, which translates into 21.5 nurses per 10,000 inhabitants," explained Bahya Ahmed, head of the Central Nursing Department at the Ministry of Health and Population. There are three types of nurses: college graduates, technical institute graduates and nursing school graduates, also known as diploma nurses. The first two types of nurses comprise four and two per cent of the Egyptian nursing staff respectively, while diploma nurses make up the remaining 94 per cent. The main problems associated with nurses in Egypt relate to their efficiency -- particularly in the case of diploma nurses -- and the question of ongoing education. The condition of nurses in Egypt was thrown into stark relief with the Aida scandal: Aida was a nurse in Alexandria who was accused of killing patients in the intensive care unit of her hospital. Nurses are often blamed for fatal errors, and are generally treated as scapegoats by other members of the medical profession. Public discussion on whether nurses are angels of death or angels of mercy has not helped the situation either. "The media has created a false image of nurses which society has fallen for," explained Hoda Hussein, director of the Nursing Education Centre at a private hospital. The government-run Al-Galaa hospital specialises in obstetrics and employs 250 nurses: 100 work on the wards and the rest are administrative staff. It is difficult for the nurses to talk of their working conditions. The intimation, though, is of a working atmosphere filled with insults and harassment from doctors; patients, too, abuse the nursing staff, and their professional credentials are constantly called into question. According to one of their stories, some years ago a nurse was beaten by a patient and the family for simply following orders and closing a shutter. The nurse, who had just started training, was temporarily blinded. And the violence continues. A few weeks ago a doctor on the night shift hit a nurse during a heated argument. No apology was forthcoming. "The excuse was that he was having a bad day at home. How valid would that had been if he had hit a fellow doctor?" asked one of the nurses who, for obvious reasons, requested to remain anonymous. Not only are nurses subject to constant harassment, they receive a mere pittance for their work. Hassan is paid LE204 per month, a small remuneration compared to the amount of hours she works. "I have to work double shifts, so that means I work 12 hours in a row four times a month: I get 90 piastres per double shift," she explained. Nurses on the night shift have no breaks and a single nurse is responsible for 36 patients. Understaffing is the reason why nurses are often refused the opportunity to take part in further education courses. "Conditions like these discourage young girls from looking for work in government hospitals; they look for employment in private hospitals instead," explained Hassan. Wafaa Mostafa has always wanted to be a nurse. But the real life conditions at Al- Galaa educational hospital took her by surprise. Lack of training courses, questionable hygiene conditions and the small salary prompted her to seek work as a part-timer at a private hospital where she gets respect, education, experience and a decent salary. "At first I wanted to create some form of system at the Al-Galaa hospital," Mostafa explained, but gave up when she realised the overall system required attention. "I can't change the world on my own." In one of Cairo's well-known private hospitals the nurses update their skills at the education centre established specifically for its 320 strong nursing staff. According to Marjorie Barratt, director of nursing at this hospital, the nursing conditions strive to comply with international standards, which means nurses on general wards care for one to six patients. Not that private hospitals are safe havens either. There are still a lot of problems to deal with, such as annual contract renewal; the fact that foreign nurses are paid more; and the existence of discrimination between diploma nurses and college graduates. Ahmed admits that nurses are under a great deal of pressure. "They may get paid only 90 piastres for double shifts in Cairo government hospitals, but in some other governorates nurses sometimes work for six months without either payment or days off because of shortage of funds." These pressures can create difficult patient-nurse relationships. Taxi driver Maher Galal, sees the attitude of nurses as quite problematic. "They are supposed to be carrying out humanitarian work, but the nurses in public hospitals always ask for tips. 'We want the price of our tea' was all we heard when my mother was in hospital," he complained. According to Ahmed, though, the ministry has made some improvements. Al-Galaa hospital is currently involved in providing training courses for staff -- also for some diploma nurses -- who will gradually train all staff nurses; training the trainers, in other words. Moreover, the Ministry of Health and Population has adopted 14 central training programmes which will apply to all hospitals. Nurses do make some mistakes, agrees Ahmed, but all medical errors are usually blamed on the nurses. Which is why the Ministry of Health and Population has passed a law stipulating the legal obligations of nurses, their quality of education as well as the number of graduates required annually. "Part of the problem with nursing lies with the diploma nurses," notes Ahmed. Because they are young, she explained, it is almost like having children dealing with the patients. If the nurse finishes high school before going to nursing school, then she is mature enough to deal with the patients and doctors. "She would be fit to teach health education to the whole family," she said. If the nursing schools could be gradually phased out and replaced with technical institutes, the entire community would benefit: the nurses themselves would have better training and would be able to specialise, which would lead to an improved self-image and better treatment by colleagues. Nazli Qabil, head of the nursing syndicate, said that nurses' problems are those of all working women. "Tolerance is part of the nurse's job," she said. "She should understand that it is her job to help suffering patients." "So if you see her as an angel, put her in an angelic environment. Treat her as a human being and she will excel," concluded Ahmed. Florence Nightingale Born on 12 May 1820 in Florence, Italy, she was the youngest daughter of an English aristocrat. Back in England, she grew up on sprawling estates in Derbyshire and Hampshire. Restless and fond of travel, she never married. By 1845 she was convinced her role was to be a nurse, and eight years later she left home to supervise an infirmary for women. In 1854 she became the pioneer of modern nursing during the bloody Crimean War, a conflict which claimed some 250,000 lives. When she returned to England in 1856, she was acclaimed as a national heroine and became personally acquainted with Queen Victoria and Prince Albert. After stimulating a wide-sweeping reform of the army's medical system, she published the classic Notes on Nursing: What It Is, and What It Is Not in 1860. The same year, she opened the Nightingale Training School for Nurses in London, and spent the rest of her life directing the school. She died on 13 August 1910. The above information was gathered from www.heroesofhistory.com
