Notes on Hispanic Heritage Month
What We Are Learning Along The Way
For those joining us for the first time — welcome! To those who’ve joined us since day one, thank you for your commitment to diversifying our nursing history.
Hispanic Heritage Week was designated by the United States Congress in 1968 and later expanded to a month in 1988. The heritage month is designed to celebrate and honor the heritage, cultures, and contributions of Americans whose ancestors come from Spain and Latin America. The significance of September 15 — October 15 is designed to coincide with the national independence days from Spanish rule for several Latin American countries: Guatemala, Honduras, El Salvador, Nicaragua and Costa Rica (9/15), Mexico (9/16), Chile (9/18), Belize (9/21). The dates also coincide with Dia de La Raza (10/12) which began in Mexico in 1917 and has since been officially celebrated across many Latin American countries to honor the indigenous traditions and cultures that were wiped out from Columbus’ and Spain’s colonization effort and to reflect on the current challenges indigenous people continue to face through the present day.
The basis of the term Hispanic connotates Spanish-speaking countries, which are a reflection of the colonial era of Spain that lasted from 1492–1976. A “discovery” that began in 1492 on what are now the countries of Haiti and Dominican Republic, Columbus termed the island Little Spain (Espanola / Hispaniola) upon his arrival. The creation of terms such as Asian Pacific Islander and Hispanic used to designate dozens of culturally and geographically distinct ethnic groups as a single entity are evidently flawed, controversial, and continue to evolve over time. The way in which “professional” Nightingale nursing established itself in these regions of the world is understood through multiple eras of colonization, war, and immigration policies that spanned centuries. Some countries, such as the Philippines (named “Felipinas” after Philip II of Spain during Spanish expeditions in the 1500s) or the Puerto Rican commonwealth have endured multiple and subsequent centuries of colonialization — initially by Spain and followed directly by America as a result of the Spanish-American War in 1898.
This brief overview of related history serves as a companion aid to leave our audience with available resources we have learned from thus far, as well as to deepen curiosity to learn more about nursing’s cultural and professional origins. This overview is by no means definitive. As trained nurses, not historians, we are plainly indebted to the noted faculty, researchers, journalists, and authors, who have illuminated the historical socio-political context that has unfolded in the background and foreground of our subsequent nurses’ stories. Whether the nurses profiled in this project come from the 33 countries of Latin America, or their families immigrated to America before they began their nursing careers, there is a clear opportunity to grow the research and understanding of Latin American nurses and to amplify their stories and contributions to the nursing profession.
Some History You Should Know
The following sections focus on select political, military, and socio-cultural events that have shaped professional nursing in Latin America. To connect the Latin American timelines below with the rise of Nightingale nursing in England, see section on Relevance of Victorian Era. This section focuses on three select regions — Spain, Mexico/America Southwest, and the Caribbean — to demonstrate the way Nightingale nursing arrived on a foundation of pre-existing knowledge and healing practices in the regions. The sections detail:
- The first known nursing textbook written by a Spanish male religious order in the 1600s and traveled throughout the “New World.”
- The Curanderismo folk healing practice and the impact of Manifest Destiny and the Mexican Revolution on the Mexican American Southwest in the 1800–1900s.
- The Puerto Rican and Cuban rebellions in the 1860s and the Spanish-American War in the 1890s in establishing Nightingale nursing in Puerto Rican and open migration to the U.S. at the turn of the century, while closing Cuba’s healthcare system to corporate interests.
The section concludes with what is lost when nursing knowledge and literature is predominately described in English. Although there are dozens of regions across Latin America on which to focus, these three regions were selected to expand awareness of Hispanic cultural contributions with the most relevance to U.S. nursing. This overview is intentionally a work in progress. Updates or revisions are welcomed and will be added as needed. Join the conversation by sending articles/edits to nursesyoushouldknow@gmail.com.
Spain: The First Known Nursing Text, 1617
The earliest European nurse training was part of religious orders. These religious congregations and early hospital healthcare facilities were open to both men and women, but frequently segregated by gender with male ‘brothers’ attending to male patients and ‘sisters’ attending to female patients. Partnerships between religious institutions and the monarchy of the late Medieval era formed the basis of the healthcare system in Spain. In Madrid, the male Obregonian religious order of Catholic brothers (“Junta de Caballeros” in Spanish) provided the nursing (“enfermeros” in Spanish) caregiver role to for male patients and the order’s founder, Bernadino Gomez de Obregon, a close friend and colleague of Philip II, served as hospital administrator of what would become The Madrid General Hospital, as well as coordinating and deploying Obregonian nurses to assist the Spanish military and during transatlantic crossings. He spent decades of his life providing direct patient care as well as working to improve early healthcare in both Spain and Portugal. He focused on the following domains of health:
- Improvement of the physical environment
- Adequate training of the nursing staff
- Care for the convalescent poor
- Extension of care throughout the kingdom
In what was arguably the first known nursing text written, the Obregonian brotherhood first published Training Nurses and a Method for applying Remedies to all Forms of Illness (or “ Instrucción de Enfermeros y Método de Aplicar los Remedios a Todo Tipo de Enfermedades” in Spanish) in 1617 to train those in the brotherhood in clinical nursing care. The initial version was an 82-page text peer-reviewed by leading doctors, monarchy, and the Church. The second version, published in 1625 was expanded to 232 pages by a Senior Brother, Andres Fernandez, with over 20 years of nursing experience. A total of five versions of the text would be published through 1728 which would make their way to the New World during the centuries of Spanish exploration and colonialization.
Thanks to a comprehensive 2020 PhD dissertation by nurse Dr. Tanya Langtree focused on the second edition of the text, we will present translated excerpts here to illustrate the comprehensive nature of nursing knowledge during the pre and post European Enlightenment and the Obregonian brothers’ attempt to teach and disseminate their learning.
The text presented more than 40 nursing interventions for respiratory infections, skin conditions, plague, smallpox, burns, measles, and dozens of other common medical conditions recognized today:
The text additionally included a theoretical approach to clinical thinking:
The nursing expectations of being “under great obligation to serve” even in an “under-resourced, constrained, or pressure environment” (Langtree, Birks, & Biedermann, 2019, p. 6) remains an enduring attribute of the profession’s ethos centuries later. This instructional text and the Obregonian brotherhood are noteworthy in nursing’s origin precisely because they have, for centuries, been omitted from nursing’s professional narrative in favor of an Anglo-female-centered professional origin story. Just as American History is recently debated to be centered on the arrival of the first slave ship in 1619 rather than focusing on 1776 as the “birth of the nation,” so too should nursing consider the relevance of this text as foundational to its professional origin, which would date this early effort at standardizing nursing training and knowledge more than two centuries earlier than the “birth of professional nursing,” generally considered as singularly stemming from Nightingale’s experience in the mid 1860s Crimean War.
Curanderismo & Colonists
A 2015 dissertation by colonial medicine scholar Dr. Edward Anthony Polanco, details how documented early remedies (remedios) in the 1500–1600s Central Mexico integrated forms of indigenous healing knowledge as understood, interpreted, and practiced by Spanish colonists, effectively creating a mixed (mestizo) combination of Latin and Spanish Catholic healing arts. Yet Catholic leaders subsequently attacked, outlawed, and delegitimized the local female healers from whom they learned their cures. The thesis demonstrates the ways indigenous healers both preserved their healing practices and ritual customs for centuries, yet bore the brunt of brutality and bias in the colonial era. Below is a translated description from the Aztec language Náhuatl of medicinal herbs, which was later translated to Latin and used by Spanish colonists as early as the 1550s. This sample describes a remedy used to induce labor:
Catholic influence broadly termed this indigenous medicine Curanderismo, a coherent folk healing system with eight philosophical premises that can be traced to the Aztecs and was practiced by Mexican women and midwives centuries before Spaniards arrived and the southwestern territory of the U.S. became parceled into Texas, New Mexico, and California. The folk healers who used medicinal herbs and ritual cures are known as Curanderas (Curanderos for male healers). These healers are described as having a gift or calling (llamada) to serve their community in healing roles. Curanderas include four specialties: the midwife (Partera), herbalist (Yerbera), spiritual healer (Curandera Espiritual), and folk chiropractor (Sobadora). The worldview of Curanderismo includes the premise that mind and body are inseparable, illness can be caused by imbalance, a soul exists, an ill person is not to be blamed for being ill and should be an active participate in their healing, and patient cures require interdependence with their family.
As we’ve seen in the stories of other cultures we’ve profiled, women in warfare situations have often found themselves in caregiving roles, providing safehouses or working to heal injured soldiers regardless of formal professional nurse training — the same was true in Mexico. Women in the 1800s and into the 1900s lived under decades of intermittent war and joined the war efforts either in distinct roles or as multi-hyphenate spies, curanderas, nurses, cooks, couriers, and soldiers (solderas). As in other regions of the world, western medicine, “professional nursing,” and what we now consider pharmacology was nascent at the turn of the 19th century — agrarian economies like Mexico not only raised food, but also their own herbal remedies (remedios caseros). As the few doctors of this time were unaffordable, curanderas were the trusted and accessible health providers. Trained orally by other curanderas over generations, they were the ones sought for house calls and who provided remedies for common ailments.
In 1821, Mexico had battled and won their independence from Spanish rule after a decade-long war. The Mexican Tejas (Spanish name for Texas) and Coahuila territory remained independent from Spanish and American rule for over a decade, but an initial need for population growth created a security vulnerability to their sovereignty. So many thousands of Anglo-American settlers and enslaved Africans settled in Mexican Texas, they would ultimately outnumber Mexican Texans (Tejanas / Tejanos) six to one, even after laws were passed to halt immigration and encourage relocation out of the area by 1830. Abolition of slavery, passed in 1829, became a point of conflict with the Anglo settlers, who created an armed militia for their independence against Mexican Tejanos. In what became known as the Texas Revolution, the Anglo militia were initially defeated by the Tejanos at the Alamo before they carried out a mass slaughter of Mexican soldiers. In 1836 Sam Houston was declared the president of the Republic of Texas and memorialized as the state’s “greatest hero.”
This short-lived period of Mexican Tejas independence occurred just a few decades after the U.S. claimed their independence from Britain after the Revolutionary War. While France and Spain had been credited with assisting America’s win during the Revolution, the U.S. adopted the Monroe Doctrine in 1823, which warned European nations that the United States would not tolerate further colonization or puppet monarchs. The subsequent Manifest Destiny of 1839 would thus be used to rationalize military effort in North, Central, and South American territory previously colonized by France and Spain and inhabited by Indigenous peoples. The policy’s religious basis divined that acquiring land of Indigenous and non-white populations was both the distinct right and fundamental destiny of the young country. Texas would become the 28th U.S. state by 1845 and Houston would go on to represent Texas as one of its first U.S. Senators. Later he would become the seventh governor of Texas, though he was removed from office when he opposed Texas’ secession from the U.S. leading up to the Civil War.
The U.S. annexation of Tejas was considered an act of war by Mexico and in the subsequent Mexican-American War from 1846–1848, Mexico would end up ceding half of the Mexican territory that would become California, Nevada, Utah, New Mexico, most of Arizona and Colorado, and parts of Oklahoma, Kansas, and Wyoming for $18 million dollars. The land transfer to the United States’ also cut the territorial size of Mexico in half and, as a result, over 100,000 Mexicans received collective naturalization as U.S. citizens. The addition of new states and U.S. territories, and by extension regions in which to expand slavery, served to alter the dynamic between free and slave states that exacerbated the political friction ahead of the 1861 Civil War.
- Early Professional Nursing in Mexico / Tejas
Nine European nuns from the Sisters of Charity arrived in Mexico City in 1844 and served in local hospitals as apothecaries, administrators, and nurses. In recruiting Mexican women to join their religious order and serve in hospitals, prisons, and charitable institutions, they adhered to Victorian era-European standards of the time: upper-class women in age between 16–28 years old, “without bodily defect; come from a legitimate marriage and have ancestry without blemish in honor and fame; possess physical strength to withstand fatigue;” and have a good reputation and impeccable conduct. During Mexican Reform Laws of 1874, designed to separate the Church and State, an estimated 53 European and 357 Mexican nuns were expelled from Mexico, which created a need to formally and secularly train nurses to provide patient care. Starting in 1888 Dr. Eduardo Liceaga sought to build a workforce of nurses to staff his General Hospital of Mexico. During his two decade effort involving American Nightingale nurses to establish Mexico’s first Nightingale nursing school, recruitment expanded to include both men and women students with an expected commitment of serving in the hospital for at least one year following graduation for a salary of $4 a month.
The Mexican Revolution battles, which began in 1901 in an attempt to establish more egalitarian economic opportunities for the farming class, occurred along and within the Laredo, Texas border. Though the Mexican Red Cross (La Cruz Roja) was established in 1910, they would not treat soldiers they deemed as insurgents to the government (the revolutionaries), so a neutral volunteer organization, La Cruz Blanca (The White Cross) was founded by Tejana nurses. They converted a home in Laredo to shelter Mexicans fleeing persecution and, later, into a hospital to treat soldiers from either side of the Revolution. In the coming weeks, we will profile these nurses, as well as one of the earliest known Tejana nurses.
Tensions from the Mexican Revolution along and within U.S. Texas territory escalated Anglo Texan violence against Mexicans. Despite the formation of the Mexican Congress to address the needs of the Tejano community diplomatically in 1911, military efforts to liberate Texas, New Mexico, Arizona, California, and Colorado from the U.S. were underway by mobilizing Mexicans Americans, African Americans, and Japanese in 1915. Attempting to create a free society on the original Mexican territory, they were ultimately unsuccessful. The year the liberation was attempted, half of the lynchings in Texas were of Tejanos. Between the late 1800s and mid-1900s, Texas was considered third in the use of lynchings by white citizens after Mississippi and Georgia.
The disruption to civil life caused by the Mexican Revolution initiated the first and largest single influx of Mexican immigrants in the twentieth century, during which many joined family already living north of the Rio Grande in a time period of high anti-Mexican immigrant sentiment. In reaction to lack of opportunities and discrimination, mutual aid societies (sociedades mutualistas) were formed to support access to legal aid, education, healthcare, as well as assistance during childbirth and post-partum. The societies could be found in almost every barrio by the 1920s, as they offered a more culturally coherent experience than the Settlement Houses founded during the same era.
- Parteras in Present-Day
Partera (midwives of the Curanderismo practice) legacy remains a present-day, evidence-based solution for improving maternal health outcomes. In states like New Mexico, partera licensing began in 1912, which protected them from prosecution, enabled free standing, midwife-run birth centers, and sustained partnership with the state’s Department of Health. New Mexico, with a model that includes both direct-entry certified professional midwives (non-nurses) and nurse midwives, is one of 10 states which provides compensation for midwifery care under Medicaid — and boasts one of the lowest cesarean section rates in the country. A recent $17 million investment by the MacArthur Foundation, designed to accelerate professional midwifery “as a permanent feature of the maternal health care system to help reduce the burden of over-hospitalization for normal low-risk births, enhance quality of care, and contribute in the long run to reducing high cesarean rates and improve health outcomes” was launched in Mexico in 2015. One of the goals includes collaboration and standard-setting between traditional and professional midwives, with grants given directly to both types of midwives. One outcome of the funding was development of an accessible online platform for disseminating knowledge and supporting the parteria community. As we saw when Texas effectively banned access to abortion the same month that the Mexican Supreme Court ordered the state of Coahuila to decriminalize abortion, access to reproductive health in this geographic region — and the continent at large — remains a relevant issue for gender rights and health equity through the present day.
A Tale of Nursing in Two Caribbean Islands
The genocide of the Caribbean Indigenous population in the “New World” by Spaniards’ arrival has been documented as early as the 1500s. By the late 1800s, the remaining territory of Spain’s expansive empire were the Philippines in the Pacific, the Carolina, Marshall, and Mariana Islands (including Guam) in Micronesia, and Cuba and Puerto Rico in the Caribbean. After four centuries of Spanish colonial rule in Cuba and Puerto Rico, the period between the 1860s and 1890s witnessed strong political opposition against Spain’s rule. To fund its troops in an effort to regain control of the Dominican Republic, Spain increased tariffs and taxes on most import and export goods in Puerto Rico which created an economic crisis and extreme poverty. With agriculture as the main source of income, the crises was compounded by limited by lack of roads, the impact of hurricanes and droughts, and rudimentary tools and equipment. During this time, Puerto Ricans seeking independence from Spain were jailed or exiled.
By 1868, there was a coordinated armed rebellion in Puerto Rico to overthrow the Spanish government. Meanwhile, that same year in Cuba, rebellion against the Spanish government turned into the Ten Years’ War, with Spain able (temporarily) to hold onto to Cuba as its colony. While the armed rebellions were not successful in gaining independence, Spain began to gradually liberalize its Caribbean rule in attempt to appease the opposition to its rule. The first national political parties were established and Cubans and Puerto Ricans were able to send representatives to the Spanish Cortes. During this time, the U.S. was in the aftermath of its own Civil War and not resourced to intervene, but interest in the territories steadily grew in relationship to the adoption of Manifest Destiny as U.S. foreign and domestic policy. Although Puerto Ricans were finally granted constitutional autonomy of self-government by Spain in 1897, within a month, the Spanish-American war would begin.
In what was publicly communicated to the American public as a war to “liberate” Cubans from Spanish colonial rule, was also a direct strategy to display U.S. naval might, gain Caribbean and Pacific Island territory as an extension of the Manifest Destiny, as well as the control of the sugar, tobacco, and fruit markets. The U.S. overtook Spanish troops within four months, but initially struggled to coordinate nurses as the U.S. Army Nurse Corps would not be established until 1901, as a direct result of the Spanish-American War. Cuba would end up losing Guantanamo Bay and parts of its northeastern land to American fruit corporations (or what is now Chiquita), though it did gain nearly complete independence by 1902 — and obtained full independence, minus U.S. control of Guantanamo Bay, by 1934. During the subsequent treaty process between the U.S. and Spain, in which Cubans, Filipinos, Micronesian Islands, and Puerto Ricans could not participate, the Philippines, Guam, and Puerto Rico were to remain under U.S. rule where “tutelary colonialism” was enacted.
Tutelary colonialism presumes that those living in these new American colonies were “unfit to to govern themselves,” thus making it necessary for the U.S. to rule until an undetermined and unspecified date wherein they would presumably gain fitness for American-style democratic rule, either to rule themselves or potentially gain incorporation as a state. Of note, Hawaii, another tactical territory of the U.S. naval and economic strategy, was acquired by the U.S. as a result of a coup the same year as the Spanish-American War and would became an incorporated American state along with Alaska by 1959. While Philippines gained their independence in 1946, Guam and Puerto Rico both remain incomplete democracies and under the plenary power of U.S. Congress through the present day.
- Early Professional Nursing in Puerto Rico
Following colonization by Spain and then America, Puerto Rico is considered the oldest colony in the world. The U.S. colonial governor mandated school instruction to be in English and set up no representative government for Puerto Ricans to participate democratically. In 1917, Puerto Ricans were given the right to travel to and from the U.S. , as if Puerto Rico was a state of the union, but when living on the island they have no right to vote in federal elections, have representation in U.S. Congress, nor have an independent island-based government that represents its population. In the aftermath of the Spanish-American War, the U.S. took over Puerto Rico on social, religious, and governmental levels with an American military governor installed until 1949, when Puerto Rico became a commonwealth.
Like elsewhere in Latin America, Curanderismo and botanical medicine had been the basis of healthcare in Puerto Rico. Both colonial and missionary leaders needed trained nurses to help run public health and hospitals on the island. According to nurse PhD Winifred Connerton who studied nursing in Puerto Rico between 1900–1930, the annual reports to the Department of War reveal nurse training as a strategy to “improve” Puerto Rican society, Americanize culture in preparation for eventual statehood or self-governance, and support Christianity over Catholicism (any religion but Catholicism had been outlawed under Spanish rule). This was accomplished through the use of Protestant-run schools and nursing missions who worked in tandem and cooperation with the American government leaders.
Under the centuries of Spanish rule, middle and upper class women did not work outside of the home or obtain higher education, and nursing care was provided by untrained men or Catholic nursing sister. Sixty three men and sixty four women were counted as nurses on the 1899 census, with attested low levels of literacy and training. To “Americanize” nursing as a profession in Puerto Rico at the turn of the twentieth century meant creating a model of modern Puerto Rico healthcare whereby female nurses of the middle and upper classes trained in English would be perceived as beneficent reformers that duly advanced colonial aims. By 1901 three nurse training schools were established in Ponce, San Juan, and Mayaguez by the Board of Health. As was also the case on the American mainland at the turn of the 20th century, nursing schools since their inception in Puerto Rico explicitly recruited and admitted Puerto Ricans with lighter skin color to “uphold the reputation” of the profession. The few students admitted with darker skin received a lower salary and fewer job opportunities after graduation. This, in turn, was used as reason to rationalize the informal exclusionary admission policy through at least the 1930s (Connerton, 2015, p. 138–139). A diverse island with Spanish European, African, and Indigenous roots, Puerto Ricans continue to grapple with how to identify their racial heritage within the context of racial caste.
To distance health care and nurse training from existing Catholic hospitals and nursing care by sisterhoods, a Presbyterian hospital and nurse training school was founded in San Juan under the supervision of American nurses in 1904 and St. Luke’s Episcopal Hospital was founded in 1906 in Ponce. American nurses were given the roles of nursing superintendents even when they had sufficiently trained Puerto Rican nurses to hold the positions and a successful graduate was deemed as one who could be mistaken for a white American nurse.
Following the Great Depression and with more affordable airfare that reduced the trip by steamship, unrestricted Puerto Rican migration to the U.S. (also know as the “mainland”) resulted in decades where Puerto Rican immigration exceeded migration from any other country. Today millions more Puerto Ricans choose to live in the U.S. than on the island. Puerto Ricans account for nearly 2% of the U.S. population and comprise 9% of the Hispanic population. For decades, the majority of Puerto Ricans lived in New York City (80% of Puerto Ricans lived in new York City in the 1940s), but following Hurricane Maria, Florida has become the most populated state with Puerto Ricans making up 21% of the states’ Hispanic population.
- Professional Nursing in Cuba: Pre and Post-Revolution
Hospitals existed in Cuba since the 16th century and the University of Havana trained about 300 doctors annually since 1728 with nursing care provided by Spanish nursing sisters. As Spain withdrew from the island following their defeat in the Spanish-American War in 1898, so did the Spanish Catholic sister nursing support. American influence in Cuba during this early 20th century period was strong, with 84% of the currency in circulation in U.S. dollars due to the American role the sugar, coffee, and tobacco industries. The information detailed in this section is referenced from The Journal of the New York State Nurses Association and the International Journal of Nursing Studies based on nurse researchers’ travel to Cuba and historical research, unless otherwise indicated.
Hospital-based Nightingale nursing schools were brought by the U.S. Army starting in 1899 and staffed by several dozen American Nightingale nurses. Nine hospital-based nursing diploma schools were established in Cuba by 1910, and the same pattern of exploitation by hospitals of free nursing student labor as was seen in the U.S. repeated in Cuba. At the time, men were accepted to nursing schools, but restricted to psychiatry and urology, and nursing journal articles were authored by physicians. In 1924 Cuba joined the International Council of Nurses. The U.S. ties to Cuba were officially severed in 1934 and within a few decades growing antagonism and an attempted U.S. invasion would result in a trade embargo between the countries estimated to cost the country hundreds of billions in economic trade.
Cuba’s socialist revolution in 1959 dramatically impacted the population’s health and the nursing profession. Prior to the revolution just 13% of the workforce were women, most healthcare resources were located in Havana, and private practitioners served paying upper class patients. An estimated 6300 doctors and 1000 nurses served the population and the only medical school and half the nursing schools at the time were also located in Havana. Following the socialist revolution almost 1.5 million Cubans left the island, including an estimated half of Cuba’s physicians and many nurses, who mostly fled to the U.S., predominately to Miami. By 1966 Cubans were permitted to apply for permanent U.S. residency after living in the U.S. for a total of one year. Some nurses who stayed and fought with the revolutionaries, ran hospitals during the guerilla war and later took responsibility for nursing with the new regime. A goal of the socialist government was to improve social determinants of health such as literacy and education, housing, employment, nutrition, and community infrastructure to support those aims were launched.
Private sector medical care was terminated, midwifery training was re-established, men were encouraged to enter any type of nursing, and wages were equalized between male and female nurses. Principles of practice at that time included: universal coverage became guaranteed without discrimination, prevention of illness, active participation by citizens in their health, and placing health of Cubans as the responsibility of the state. By 1961, mass literacy campaigns resulted in a drop of illiteracy to less than 4% of the population and today the population remains 99% literate. Participants and teachers in the literacy campaign would go on to become community health nurses. As the government built infrastructure, employment improved as Cubans were employed to construct roads, hospitals, schools, and clinics, and to keep them staffed, but challenges of child-rearing for the female workforce remained. The 1975 Cuban Family Code (photos inserted above and below) documented marital rights as equal for both partners and to be “mutually helpful to each other…[and] have the right to practice their profession or skill and the duty of helping each other and cooperation in order to make this possible.” The law has been updated numerous times and remains in national conversation today. As a result of the attempt to have women more fully participate in the workforce, affordable day care, universal pre-k, and guaranteed job protection for mothers returning to work were also implemented.
Following the revolution twenty times more nurses and ten times the number of nursing teachers were trained. Re-prioritizing rural infrastructure outside of Havana became a priority to support prevention-oriented, decentralized primary care. Known as community medicine (medicina en la comunidad), this model went into effect after successful pilots in the mid-70s. During this time, the healthcare model “gave nursing a new position along side, rather than under, medicine.” Original Cuban nursing texts were published and the Cuban Nursing Society was founded. In the subsequent decades, 66% of hospitals were constructed outside the city along with polyclinics that covered geographic catchments areas of about 3000 people and were staffed by healthcare teams of physician, nurse, sanitarian, and lay activists in health who also made home visits to those who could not attend the clinic. Local health commissions also gave decision-making power to the community to determine the health resources needed in their neighborhood.
Community health preparation for trained nurses and preventative care became universal across nursing curriculum. With hospital care perceived as tertiary in nature to the core of the community medicine model, nursing programs included field work based in community clinic with courses in epidemiology and biostatistics. In contrast to the Nightingale model which recruited from middle and upper class families to schools physically located within and centered upon the needs of the hospitals, Cuban nursing schools post-revolution recruited qualified students from working-class and poor families who already lived in the neighborhoods in which they would ultimately practice.
Prior to the revolution, life expectancy in Cuba in 1958 was 57 years old, which increased to 73 years old by 1982, and was 79.5 by 2015. When the U.S. and Cuba restored diplomatic relations in 2015, U.S. nursing schools were able to visit Cuban nursing schools. Included here are the experiences of nurses from University of Alabama, UCLA, and Columbia University. Despite the gains achieved in healthcare and life expectancy, Cuba has been under economic embargo from the U.S. for sixty years, which the U.N. has recommended ending for 29 years. The pandemic has brought renewed attention to Cuba, simultaneously exacerbating political protests and tenuous economic conditions, as well as prompting calls for Cuban healthcare missionaries to receive a Nobel Peace Prize for their work traveling to dozens of countries to reinforce and support other countries’ COVID-19 response.
Cubans comprise the third largest percentage of Hispanic-origin immigrants living in the U.S. and since 2000 the Cuban population in the U.S. has more than doubled. Once-reliable immigration policies granting Cubans protections in the U.S., have shifted, with travel visas also being restricted from the island. While its political future and relationship with the U.S. is still being written, what Cuban healthcare has achieved under great economic pressure, remains a widely researched model of how to eliminate health outcome disparities by prioritizing the needs of the most vulnerable and providing universal access to prevention-based primary care.
Hispanic Nurses in the U.S. Today
Currently 3.6% of nurses identify as Hispanic, even though Hispanics make up 18.7% of the total U.S. population in the most recent census and account for over half of the population’s growth. This year nurse scholars Daniel F. M. Suarez-Baquero and Lorraine Olszewski Walker described what is lost when nursing knowledge becomes limited to the English language and argue that “so much about nursing has been gradually forgotten in English-speaking countries, with an increasingly threatening loss of nursing identity.” Let this Hispanic Heritage Month be a time of centering Latin nurses’ stories, experience, and knowledge that can translate into more diversity, equity, and inclusion year-round.
Build Your Library
The core texts and articles which prepared us to profile nurses this month are listed here. We profusely thank these authors, as their contributions demonstrate the undeniable benefit of interdisciplinary collaboration in advancing what we know about the history of our field.
Books
- Inventing Latinos by Laura E. Gomez
- Las Tejanas 300 Years of History by Teresa Palomo Acosta and Ruthe Winegarten
- Colonial Caring edited by Helen Sweet and Sue Hawkins (links to full text)
Dissertations
- Notes on Pre-Nightingale Nursing: What It Was and What It Was Not by Tanya Gai Langtree (links to full text)
- The Devil’s Midwives: Titiçih, Gender, Religion, and Medicine in Central Mexico, 1535–1650 by Edward Anthony Polanco
Videos
- Cuba Platform includes microfilms on Cuban life such as healthcare, economics, art, and agriculture in collaboration with Atlantic Fellows.
Articles
- “What a nurse suffers”: Care Left Undone in Seventeenth-Century Madrid by Langtree, Birks, & Biedermann
- Curanderismo and Latino Views of Disease and Curing by Renaldo Maduro
- The Circulation of Bodily Knowledge in the Seventeenth-Century Black Spanish Caribbean by Pablo Gomez
- The Birth of the School of Nursing in Mexico City (1888–1911)by Josefina Torres Galán and José Sanfilippo Borrás
Curanderismo Resources
- Curanderismo traditional medicine course from University of New Mexico
- Book an appointment with a curandera
Thank you to Dr. Olga Jarrin Montaner of the Latino Nurses Network for her collaboration, shared resources, and feedback on this overview. Should you know of books, articles, resources, relevant historical context — or even corrections — that should be added here, always feel free to contact us and we will update this shared list: email nursesyoushouldknow@gmail.com.
