The Establishment of Schools for Nurses in Cuba by Hibbard

The Establishment of Schools for Nurses in Cuba by M. Eugenie Hibbard^[1]

Member of the American Society of Superintendents of Training-Schools for Nurses, Late Superintendent of the Santa Isabel Hospital, Matanzas, Cuba, and Superintendent of Hospital No. 1, Havana.

With the military occupation by the United States of the Island of Cuba, a country so crossed and barred by events in its previous history, began a new regime, difficult for the people of tropical climes to appreciate, and possibly more difficult for them to imitate and sustain.

The conditions were such in 1898 that vigorous efforts were imperative to make the island habitable for those who were forced or chose to remain in Cuba, aside from the population whose heritage it is.

At once energetic minds set to work to evolve order out of chaos and enforce a sanitary administration that would eventually and effectually relieve the country of filth, disease, and the dread scourge, yellow fever, which limited the ingress of foreigners, enforcing quarantine laws extremely trying to travellers, and proving a serious menace to the business interests and development of the island.

It was also essential to arouse the inhabitants from their apathy to a sense of their personal national responsibilities, substituting the practical for the sentimental in actual work, which only could be accomplished by enlisting them as coworkers with those whose knowledge had been secured through experience, and to whom to-day the greatest credit should be generously given for the excellent results.

According to the latest record, Havana, the principal city of the island, has only one rival in the United States in presenting a lower death-rate.

In Cuba, as in most countries that have been dominated by strong religious views and where the government has been practically led by the church, a condition existed that prevented women from taking an active part in philanthropic work, outside the religious orders of Sisters of Charity or members of the various communities recognized by the church.

These sisters, among whom there are always some excellent women, had charge of the nursing and domestic departments of the various State institutions, such as hospitals, orphan asylums, and asylums for the poor and destitute, and were considered the legitimate persons to carry on such work.

Unfortunately, their vows restricted them in the performance of duties that are considered an important essential in the care of hospital patients, and which duties were delegated to persons of inferior position and ability to perform.

The strides that the medical profession has made in the line of progress during the last twenty-five years has demanded an evolution in the ranks of so-called nurses, and in countries where the religious orders do not rule the graduate nurse is the result.

A similar one we hope shortly to produce here—educated and trained on lines that will command the respect of the older sisters in the service of nursing.

As inheritors of customs and prejudices founded on Moorish habits, we find the women of Cuba an affectionate, emotional, and irresponsible people, without much moral, mental, or physical force, incapable of sustained effort, and — most to be deplored — without ideals or standards that excel, but with an innate sense of refinement and a disposition to be led through their affections which is most gratifying if properly directed.

The lack of education among the larger class of women in the ordinary branches, or even the rudiments of Spanish, is an obstacle which is difficult to overcome or overlook.

Out of this material (with the optimistic view predominating) we hope to evolve the traditional calm, self-poised, intelligent, industrious, and ambitious graduate nurse of the twentieth century.

Therefore upon whomsoever the duty falls of introducing new ways, imperceptibly though radically changing social customs, facing the traditions of the country, and to a certain extent the opposition of the church, an exquisite tact is required, which should be controlled by common-sense, good judgment, and a strong desire for the moment to work in harmony with existing conditions, with the end in view of creating such a picture of life and its possibilities for women that will both entice and charm, and be a factor strong enough to overcome scruples that at present prevent women of education and refinement from taking an active part in a life savoring of publicity.

With the passing of the religious to the secular regime, and the subsequent withdrawal of the “sisters” from the various hospitals, the establishment of schools for nurses became an absolute necessity in order to provide for the immediate care of the sick.

The first school for nurses in Cuba was started by Dr. Raimundo Menocal in connection with the “Sanitarium Havana”, in the city of Havana. It was opened in January, 1899, with twenty-two pupils, under the charge and theoretical instruction of Dr. Vidal Sotolongo. The sanitarium was closed in the month of May, the same year.

The permanent establishment of the schools for nurses, however, is due to the interest and influence of Dr. C. L. Furbush and General Ludlow, assisted ably by Drs. Emiliano Nuñez and Raimundo Menocal.

The first school for nurses was officially established and opened in August, 1899. Miss Mary O’Donnell, graduate of Bellevue Hospital, New York City, was appointed superintendent.

Later, and under the direction of Major E. St. J. Greble, Superintendent of the Department of Charities (which is under the general supervision of the Department of State and Government), schools for nurses were established in connection with the following hospitals, named in chronological order:

• Hospital Civil, Cienfuegos, March, 1900; Miss Jeanette Byers, superintendent.
• Hospital No. 1, Havana, September, 1900; Miss Gertrude W. Moore, superintendent.
• Hospital Santa Isabel, Matanzas, October, 1900; Miss M. E. Hibbard, superintendent.
• Hospital General, Puerto Principe, November, 1900; Miss Mitchell, superintendent.
• Hospital General, Remedios, November, 1900; Miss Samson, superintendent.
• Hospital Civil, Santiago de Cuba, January, 1901; Miss G. W. Moore, superintendent.

Making a total of seven. Changes have taken place in the supervision of some of the schools, but the names given are those of the first superintendents appointed.

On the retirement of Major E. St. J. Greble from the position of Superintendent of the Department of Charities, Major J. B. Kean received the appointment, and the subsequent success of the schools is due largely to his personal interest and keen appreciation of the actual requirements at this stage of the schools’ existence.

Shortly after assuming office, in July, 1901, the following order was issued:

Office Superintendent Department of Charities. Circular No. 14.

Havana, Cuba, July 16, 1901

By authority of the Military Governor, a Board will be convened to meet in the office of the Superintendent of Charities, Havana, Cuba, at twelve o’clock, July 22, 1901, or as soon thereafter as practicable, to draw up a system of regulations for the training-schools for nurses in Cuba.

They will also fix the course and duration of instruction, the requirements for admission, the standard to be required before graduation, and make recommendations with regard to salaries and allowances.

The board will also recommend a suitable manual for use in the nurses’ schools, and in the hospitals under State control.

The board will be composed as follows:

• Dr. Manuel Delfin, Vice-President of the Central Board of Charities of Cuba, Havana.
• Dr. Emiliano Nuño, Médico-Director of Mercedes Hospital, Havana.
• Dr. Enrique Diago, Médico-Director, Hospital No. 1, Havana.
• Mrs. L. W. Quintard, Inspector, Department of Charities.
• Miss M. Eugénie Hibbard, Superintendente, “Escuela de Enfermeras”, Matanzas.

The Superintendent of Charities will issue the necessary transportation.

J. R. Kean,
Major and Surgeon, United States Army, Superintendent Department of Charities.

The meetings, several in number, were well attended, and at the end of the month of August, 1901, a “Plan of General Regulations for the Schools for Nurses of the Island of Cuba” was submitted for the approbation of the Central Board of Charities of the Island of Cuba.

Later, in the month of October, 1901, these were made more comprehensive, were somewhat modified, and were again submitted for approval. Eventually, on January 3, 1902, the plan was approved of in its entirety by the Military Governor of the Island of Cuba, General Wood…

The aim and fixed intention of those interested in organizing schools for nurses in Cuba was to put them at once on the highest plane attainable, giving the result of similar work in other countries as sufficient reason to establish a standard that would at once command the respect of the people and the self-respect of the accepted student, defining emphatically a position for the nurse in a country until recently ignorant of her existence. To start with a high standard is a more effectual way of securing success than in placidly allowing conditions to evolve.

The science of nursing has passed the pioneer stage and has now a foundation firm as a rock. Hand in hand with the medical profession (as handmaiden of it), it claims respect for the assistance it gives to suffering humanity and to the advance of medical research.

To those who have so earnestly and so wisely encouraged the work of nursing in Cuba the profession owes a heavy debt of gratitude, for without the assistance, interest, and concentrated effort of men of influence and prestige and the hearty support of the Cuban doctors of reputation and influence the work that has been accomplished in Cuba could never have given to the world the history of its existence.

Today the number of pupils in training exceed one hundred and fifty, with at least thirty-seven instructors — American graduates…^[2]

[Note.—In the International Congress Report will be found the rules and regulations governing the Cuban schools, which are most interesting, but would occupy too much space to be given in these pages. We quote, however, several paragraphs from the General Regulations that are especially significant.—Ed.]

Article 3.

The heads of the schools will be: First, the medical director; second, the superintendent; and, next, the graduate nurses who may be designated to act as assistants to the superintendent.

Article 4.

A committee consisting of three members of the Central Board of Charities, appointed by the same; a professor of the School of Medicine, appointed by the dean; and a graduate nurse holding no position in any school, but having previously filled the position of superintendent, designated by the Department of Charities, will deal with all affairs of a general character affecting the schools. All correspondence will be transmitted through the Department of Charities. This committee will meet regularly once a month, and will hold special meetings as often as necessary.

Article 7.

At the expiration of the first and second courses, the examinations will take place before a board consisting of two professors belonging to the hospital, designated by the director, and presided over by him or his delegate. Said board will make the students acquainted with the list of subjects of the examination fifteen days in advance.

Article 9.

At the expiration of the third course, the examination will take place before a board consisting of three professors of the School of Medicine and Pharmacy, appointed by the dean of the faculty. The oldest professor will preside. The degrees in this examination will be those established in the regulations of the School of Medicine and will be noted in the documents of the student, to be kept on file in the Department of Charities.

Article 10.

The examinations corresponding to the third year will take place in the capital of each province, or in those cities where a large number of students exist, on the dates fixed by the dean of the faculty of medicine, who will notify the directors of the schools and the members of the board designated by them in advance, in order that they may take the necessary measures. The expenses incurred by the members of the board shall be paid by the Department of Charities and Hospitals. The amount assigned to cover said expenses will be eight dollars gold daily and free transportation.

Article 12.

After the examination of the third course the dean of the faculty will issue a diploma to each student whose exercises have been approved, which diploma shall state that said student is admitted to the practice of the profession of nursing. Said diploma will merit all authorities, as well as from the courts, the respect and consideration due all professional titles. Without this diploma the practice of the profession of nursing is not allowed. Each school will award a silver medal to every student who obtains the diploma of nurse.

Article 19.

The students will receive as remuneration for their services eight dollars per month during the first year, twelve dollars during the second, and twenty-five dollars gold during the third. Each student will provide all her necessary uniforms.

For the acquisition of these, the school will assign for each student of the first and second years thirty-six dollars yearly, which will remain in the charge of the treasurer to be spent when the superintendent may deem it convenient.

Should a balance remain at the end of the year, it will be given over in cash to the nurse to whom the amount is credited.

The nurses who abandon the school lose all right to their uniforms. They cannot be worn on the streets, unless when rendering service. Laundry of uniforms shall be provided for all the students at the expense of the school.

Article 21.

During the first two years the students will not render their services out of the school. During the third year they will be able to do so during a period which will not exceed three months whenever the director, in accordance with the superintendent, may deem it convenient.

When the services are rendered to the sick poor, a special agreement will be made with the municipal authorities. If attendance is rendered to private individuals outside, three dollars daily and cost of transportation will be charged.

This amount will be paid over to the treasurer, and after deducting a certain sum which the school may deem wise to give to the nurse as gratification, the balance remaining will be kept with the object of accumulating a fund destined to be used as a prize, which, in accordance with the Department of Charities, will be awarded to the student who may be deemed worthy of such a distinction.

Bibliografía y notas.

[1] Paper sent to the International Congress of Nurses at Buffalo, September, 1901.

[2] From Report of the Military Governor, January 3, 1902.

• Hibbard, Eugénie. ”Sketch of the Organization of Schools for Nurses in the Republic of Cuba.” Report on the Women’s Auxiliary Conference Held in the City of Washington, U. S. A: In Connection With the Second Pan American Scientific Congress, December 28, 1915 January 7, 1916. Washington: U.S. Government Printing Office, 1916.
• Hibbard, Eugénie. “The Establishment of Schools for Nurses in Cuba.” Third International Congress of Nurses. Pan-American Exposition Buffalo. Sep. 18, 19, 20, 21, 1901. Cleveland, Ohio: Press of J.B. Savage, 1901.
• Healy, Phyllis F. “Mary Eugenie Hibbard: Nurse, Gentlewoman, and Patriot.” University of Texas at Austin, 1990.
• Personalidades y Negocios de Matanzas.