So THAT explains it

I used to blog about Harvard’s enormous blind spot about healthcare policy, practice and patient welfare, otherwise known as the conspicuous absence of degree granting undergraduate and graduate programs of nursing along with robust nursing research.  I never received any response to my righteously indignant posts, and so I came away with the impression that no one else was aware of it and/or no one cared, if they did know.

Last year, I attended a Harvard School of Public Health conference on transforming healthcare professionals’ education from discipline specific and siloed, as well as locally/nationally-based to one of an interdisciplinary, team-oriented style of problem-based learning with a global perspective. A team of blue ribbon international helping professions experts had been convened, had created a working document, the Lancet had published the resulting report, and now we were hearing about the process, the findings, the preliminary recommendations and were being included in asking questions and offering advice for next steps. That the public was invited, I found encouraging. That a well known and respected academic nurse,  Afaf Meleis of Penn – both researcher and theorist – was a member of the committee, was gratifying.

But for all of the breast beating about inter- and multi-disciplinary educational focus, the default assumption was that extant Western physicians’ education was paramount and was serving as the core curriculum and model by which everything else was revolving. New package, same old product.

I had many questions (having served on nursing faculties as a member of the curriculum committee at two institutions where new curricula were being simultaneously designed, implemented and evaluated, I am a veteran of this process). But I elected to hold them and listen to the questions of people with skin in the current game. In the afternoon, a woman strode up to the microphone and asserted to the Dean of HSPH, who was co-hosting, “As the former Dean of Nursing at Simmons (College, a block away from Harvard Medical School and the HSPH), I’ve said before to Harvard – there is no Nursing program at Harvard, so how can you justify speaking for Nursing when you don’t know the first thing about it?”

Huzzahs! Someone else DID know about the blind spot, and its implications. Dean Frenk swerved to her parry, and the Q and A’s went on with everyone but the nurses, and possibly some of the international educators, unperturbed in their anasognosia.

Three of the Ivies host nursing programs: Penn, Yale and Columbia, where I attended graduate school. Columbia hosted the first graduate program in nursing – at Teachers College, the college of education. Why there and not the College of Physicians and Surgeons uptown on the medical center campus? No one else would have it and consent to offer a degree in advanced nursing.

U.S. public health nursing, psychiatric nursing and the majority of nursing theory and theorists were birthed and developed there. Even when I attended, the dissertations were kept in open bookcases, free for the borrowing.  Nursing pioneers – graduates and faculty – routinely dropped by, dropped in and gave freely of their time to students. I met Virginia Henderson, Hildegard Peplau, Eleanor Barba, Eleanor Lambertson, Barbara Stevens Barnum, Patricia Moccia and Patricia Munhall. If you’re an academic or research nurse, you know those names. From them, I met Madeleine Leininger, Jeanne Watson, and many other movers and shakers.

But the dog that did not bark? None of the above are from Boston or were greatly influenced by Boston nursing leaders.  Indeed, Boston University, which used to host a College of Nursing, and produced some important leadership and administrative research and practice advancements via Muriel Poulin, closed up shop several decades ago. Boston College still has a School of Nursing with a theorist emeritus, but it is largely silent on the research and clinical advancement fronts. Boston had been a major immigrant port, yet public health nursing is largely invisible here. It’s nowhere in evidence at the Harvard School of Public Health, where I infuriated the resident hero, Paul Farmer, by asking about it relative to his Partners In Health organization and programs. It doesn’t earn a mention at Boston University’s School of Public Health, either. I’m not adding links. Google or Wiki any of the names, organizations and entities, and you will easily find all sorts of rewarding information.

Why the silence?

I think I uncovered some of it this past week. The Radcliffe Institute for Advanced Study is the animal transmogrified from Radcliffe College after it became fully incorporated into Harvard’s undergraduate College. It now hosts one year fellows-across-disciplines to do research, scholarship, teach and present their work.

Last week I attended a program aimed at Radcliffe College alumni as part of Harvard’s Celebrating 375 years events, titled, “It’s Complicated: 375 Years of Women at Harvard”. I had forgotten that Drew Faust, Harvard’s President, had formerly been the Dean of the Radcliffe Institute. As an historian, she has a keen interest in Harvard’s history and its relationship to culture and society. As Harvard’s first female at the administrative helm, she’s also personally invested in the topic. Her introductory remarks set the stage for the presentation. It’s not a pretty picture.

I’ve been mulling over what to write about the conference, but the Harvard Gazette reportage is fairly comprehensive and more cogent than what I could write, so take it away, Gazette:

Women’s exclusion from the University began “as a part of the social order of the time,” one that went largely unquestioned by both men and women and that was connected to both “tradition and privilege,” said historian Helen Lefkowitz Horowitz, speaking at the Radcliffe Institute, in a talk titled “It’s Complicated: 375 Years of Women at Harvard.”
Harvard’s history with women is indeed complicated, said historian Helen Lefkowitz Horowitz Monday at the Radcliffe Institute for Advanced Study.

In a talk titled “It’s Complicated: 375 Years of Women at Harvard,” the professor emerita of history and American studies at Smith College examined the University’s shifting gender landscape, contending that while the Harvard of today has much to celebrate in regards to women, it still has room to improve.

The lecture took shape as Harvard President Drew Faust and Radcliffe Dean Lizabeth Cohen discussed how the Radcliffe Institute could, said Cohen, “make an intellectual contribution” to commemorate Harvard’s 375th anniversary.
Just as important to the two historians, said Cohen, “was how the history of women at Harvard might be well represented in the course of the anniversary year.”

Faust offered opening remarks at Monday’s event, saying that the past 100 years can be seen as “a narrative of progress” for women at Harvard. Horowitz’s talk, she said, offered “important and enduring lessons for Harvard” — about how change happens, and about how those committed to learning and opportunity “can make their way into a world that comes increasingly to accept and embrace them.”

Women’s exclusion from the University began “as a part of the social order of the time,” said Horowitz, one that went largely unquestioned by both men and women and that was connected to both “tradition and privilege.”

Established in 1636 to educate an all-male clergy, Harvard by the 18th century had developed into a college to educate the “sons of the arriving mercantile elite.” During the industrial revolution of the 19th century, Boston bluebloods and Harvard, she said, “rose together.”

The first women to knock at Harvard’s doors came from the middle class, typically schoolteachers looking for extra instruction in the sciences. But they were merely “thrown crumbs,” such as access to lectures or labs, said Horowitz.
When a group of powerful women, including Elizabeth Cary Agassiz, widow of the famous Harvard scientist Louis Agassiz, founded the Women’s Education Association of Boston, in 1872, and sought to gain the entrance of women into Harvard, it was met with steady resistance.

“We were told not to disturb the present system of education which is the result of the experience and wisdom of the past,” read Horowitz from the group’s records. She noted that at the time both Harvard President Charles William Eliot and the Harvard Corporation were “deeply opposed” to allowing women into Harvard.

Because we said so. That’s the way it’s always been done. It’s our truth (veritas). It’s our tradition. It’s ours, ours, ours. Capitalism, free markets, doncha know.

The remainder of the presentation was focused on supposed gains by women at Harvard. Specifically, Radcliffe women’s gains. The Q and A session was enlightening, and unsurprisingly disappointing. They were all, but two, questions by Radcliffe alumnae who had personal stories of discrimination, rejection and ostracism to relate and wanted validation that those were the norm and not the exception (they were). But none reported or expressed any interest in advancing opportunities for others. It was still all about me, me, me. I got mine, or I didn’t get enough and I want more is the overarching Harvard theme. The Harvard experience is all about the networking and parlaying relationships for personal gain.

It’s why, I believe, to a large extent, medical ethics go down the drain here. And because Harvard is such an enormous, globally influential research, publication and clinical practice machine with that brand of Veritas – truth – up top, when its anasognosia is trampling people and patients, for the most part, it has no awareness of that and isn’t interested in looking for it.

Because if it ever did – and found it, that would come with a host of penalties – legal and ethical sanctions, funding via grants and donations being withheld, withdrawn and restricted, and the lustre of the Harvard brand tarnished with shareholder – alumni – disapproval and sanctions. Firing of administrators and faculty, board of directors membership questioned. A big skunky stink which is best avoided, if you are Harvard.

So of course Harvard wouldn’t have been interested in hosting a college of nursing. That would entail women scholars! Patient advocacy!  Patients’, women’s and civil rights! Questioning the norms and, God forbid – Veritas!

Indeed, even the presenter referenced nurses throughout as untrained, unskilled domestic help. You know, wet nurses and companions to invalids. Nursing is so buried that even scholars at Harvard and “seven sisters” colleges concerned with the history of women haven’t a clue about this profession and its critical role in women’s rights, women’s health, patient advocacy and safety and public health.

It’s why, when I once inquired at the Schlesinger Library for the History of Women, the reference librarian looked at me quizzically and was flummoxed when I asked about its history of nursing collection.  Of COURSE there isn’t one here. (There is, still, at BU.)

The bright spot?  There is still a nursing historian on the faculty at Wellesley,  just down the road.  It was Susan Reverby who uncovered the blatantly unethical and abusive physician practice of deliberately infecting Guatemalan patients and prostitutes with syphilis, and whose work energized the Obama administration to take action so that it can’t happen again. She wrote a pretty fine history of the forces at work in American Nursing, too.

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