Three Trailblazing Hawaiian Nurses: Part 3 – Hawaii’s First Nurse Midwife

Three Trailblazing Hawaiian Nurses: Part 3 – Hawaii’s First Nurse Midwife

Welcome to part three of Three Trailblazing Hawaiian Nurses blog series – Alice Ting Hong Young – 1911- 1992:  Hawaii’s First Nurse Midwife.

Hawai’i’ is one of the most multicultural and ethnically diverse places on Earth. This rich blend is reflective of its nursing history. Pioneer Registered Nurses in Hawaii include nurses of Native Hawaiian, English, Chinese, Japanese, and Filipino heritage. Their lives and work create a beautiful kaleidoscope of service that has improved the lives of residents in this tropical paradise for over 100 years. The life stories of three groundbreaking Hawaiian RNs can inspire us all.

Alice Ting Hong Young – 1911- 1992:  Hawaii’s first Nurse Midwife

Alice Ting Hong Young was born on October 24, 1911, in the Chinatown section of Honolulu. Her father, Wah Kam Young, was a Chinese immigrant and fish merchant. Her mother, Bow Ngan Sum, was of Chinese and Hawaiian descent. Mr. Young died when Alice was twelve, leaving her mother with nine young children to raise.

Alice’s hopes to attend medical school were dashed due to the family’s financial hardships. Instead, after graduating from McKinley High School in 1929, at age 18, Alice entered nursing school at the St. Luke’s Hospital School of Nursing in San Francisco. There, students exchanged their labor for tuition, making it possible for poor students like Young to become RNs. In 1932, Young graduated, passed the Registered Nurse examinations, and returned home. She quickly entered the one-year public health nursing course at the University of Hawaii that Mable Smyth had co-founded six years earlier.

The Palama Settlement hired young to provide various public health nursing services upon graduation. After two years, Smyth, then the Territorial Board of Health Nursing Director, hired Young to be a public health nurse with the Territorial Board of Health on the island of Molokai. Young worked in the maternal-child, school, home health, and tubercular nursing programs.

In 1900, the population of Hawaii was 154,001. Hawaii’s four most prominent ethnic groups listed in that year’s census (in round numbers) were Japanese – 61,000, Native Hawaiians – 38,000, Caucasians – 29,000, and Chinese – 26,000. By 1930, the Territory’s population had more than doubled to 368,336, and new ethnic groups appeared in the census.

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The 1930 Hawaiian Census listed 140,000 Japanese, 80,000 Caucasians, 63,000 Filipinos (none were listed in 1900), 51,000 Native Hawaiians, 27,000 Chinese, and 6,000 Koreans (also newly listed since 1900), while African Americans and Other groups combined made up fewer than 1,000 residents. This growth and change reflected the large number of Asians immigrating to Hawaii for work, primarily as plantation laborers. Among each ethnic group were educated and skilled midwives and untrained and dangerous midwives, all of whom attended home births.

In 1931 the Territorial Legislature passed Act 67, the first law to regulate the practice of midwifery in Hawaii. Midwives were required to register with the Board of Health. They were required to show proof of “being reasonably skilled and competent” in delivering babies and post-partum care, be of good moral character, and be at least 21 years old. In addition, they could only attend to women with no significant health problems and with no difficulties during their pregnancies.

Each registered midwife was issued a standard set of supplies and lengthy instructions by the Board of Health. In the first year, 168 midwives registered. Most were Japanese. Others were Filipino, Hawaiian, and Portuguese. During the 1930s, approximately a quarter of babies born in Hawaii were attended by midwives. While the law was generally successful in upgrading midwifery practice in Hawaii, there was no provision for supervision to ensure the regulations were being observed.

Young Becomes Hawaii’s First Nurse Midwife

In 1935, the U.S. Congress passed the Social Security Act, which provided funds to enhance maternal-child health services by expanding public health nurses’ skills and education. In 1936 the Hawaiian Territorial Board of Health selected Young to become the first Nurse Midwife and Midwife Supervisor for the Territory. It paid for her to go to the mainland for advanced education.

Young spent the academic year 1936-37 in New York City, earning a certificate in midwifery from a combined program sponsored by the Maternity Center Association of New York, Teacher’s College, Columbia University, and the Lobenstine Clinic in Harlem. In 1937, Young was awarded her Nurse-Midwife certificate and returned home to start her new duties.

Young visited every midwife in the Territory at least twice a year, observing and demonstrating new techniques. She inspected midwife bags to ensure all the necessary equipment was present and clean, and she followed up on reports of lay midwives practicing without a license. In addition, Young taught classes for midwives on each island. Although she spoke English, Cantonese, and Pidgin, she did not speak Japanese, so public health nurses fluent in Japanese taught the Japanese midwives. In 1940, Young wrote a manual for midwives, drawing on materials used in other states but adapting it to Hawaiian mores.

By 1940, maternal and infant mortality and morbidity rates were improving on the island, due in no small part to Young’s work. However, things changed drastically on December 7, 1941, when the Japanese attacked Pearl Harbor. Within hours, martial law was declared in the Territory; it stayed in effect until 1944. Travel was restricted, especially for Japanese residents.   Because most midwives were Japanese, this forced many women to deliver babies without help or in a hospital. She told a reporter in a 1984 interview that World War II “wiped out” midwifery on the islands and that all births were mandated to occur in a hospital under martial law.

Soon after WWII began, Young met Lieutenant Commander Drew Kohler, a Caucasian from Minnesota working in naval intelligence stationed at Pearl Harbor. They fell in love and married on November 14, 1942. She continued her work with the Board of Health until she became pregnant in 1943. For several years she focused on being a new wife and mother of three small children.

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Alice Ting Hong Young Kohler on left giving advice to another nurse circa 1950s

Although she was no longer with the Board of Health, Kohler’s pioneering work as a nurse midwife continued. As she documented in her 1953 article in Nursing Outlook, Kohler initiated and coordinated the first childbirth education classes in Hawaii with obstetricians in private practice. In 1949, she approached a busy obstetrical office in Honolulu and was hired to create a series of six two-hour classes about pregnancy, labor and delivery, and infant care. Attendance was always high. There was a morning and afternoon class, but soon an evening class was added to include expectant fathers.

In the first 30 months of the program, 1,338 people attended the sessions. Kohler used materials from the Board of Health and the Red Cross, but, as with the Midwife Manual a decade earlier, she adapted the information to meet the cultural needs of her patients. Kohler sought donations of materials and equipment, wrote the course curriculum, and recruited public health nurses to teach the classes.

Over the following decades, Lieutenant Commander Koher’s career took the family to Japan, Taiwan, and Washington, DC. While in Taiwan, Alice Kohler worked in the obstetrics ward at the U.S. Navy Hospital.

The Kohlers retired to Hawaii in the mid-1960s. In 1984, the University of Hawaii honored Kohler with the first Distinguished Alumna Award for her commitment to nursing and the people of Hawaii. She passed away in 1992 and is buried in Honolulu.

Mabel Isabel Wilcox, Mabel Leilani Smyth, and Alice Ting Hong Young are three pioneer nurses that broke new ground in a new profession to help the people of Hawaii. They freely gave their time, energy, money, and knowledge to ensure care for the most vulnerable. Their lives and careers illuminate the best of nursing. All nurses can benefit from their examples of extraordinary service.

Three Trailblazing Hawaiian Nurses: Part 2 – First Hawaiian Registered Nurse

Three Trailblazing Hawaiian Nurses: Part 2 – First Hawaiian Registered Nurse

Welcome to part two of Three Trailblazing Hawaiian Nurses blog series – Mabel Leilani Smyth, First Hawaiian Registered Nurse with Hawaiian ancestry, often referred to as “Hawaiʻi’s Florence Nightingale.”

Hawai’i’ is one of the most multicultural and ethnically diverse places on Earth. This rich blend is reflective of its nursing history. Pioneer Registered Nurses in Hawaii include nurses of Native Hawaiian, English, Chinese, Japanese, and Filipino heritage. Their lives and work create a beautiful kaleidoscope of service that has improved the lives of residents in this tropical paradise for over 100 years. The life stories of three groundbreaking Hawaiian RNs can inspire us all.

Mabel Leilani Smyth 1892 – 1936 First Hawaiian Registered Nurse with Hawaiian Ancestry “Hawaiʻi’s Florence Nightingale

Mabel Leilani Smyth was born in Honolulu on September 1. 1892, to Julia Goo and Halford Hamill Smyth. Like many Hawai’ians, she had an ethnically mixed lineage. Smyth’s ancestors included people from Hawai’i, England, China, and Ireland. Smyth’s older sister Eva was born visually impaired, and from a young age, Mabel was Eva’s companion and guide while her mother tended to the three younger children and her father was at sea. Caring for her sister foreshadowed a lifetime of caring for others.

Smyth spent her childhood on her mother’s Kona coffee farm in Hawaii. All the Smyth children worked hard picking and cleaning coffee beans and cultivating and pounding taro root to make poi, a national dish of Hawai’i. Julia Smyth earned additional money weaving and selling lauhala hats. The family was trilingual, speaking Hawaiian, English, and Pidgin in the home. Being fluent in three languages helped her cross racial and ethnic boundaries and gain acceptance in multiple communities. After Smyth’s father died around 1907, the family moved to the Palama neighborhood, a suburb of Honolulu on the island of Oahu. In 1910, Smyth graduated from President William McKinley High School and began working as a nanny for the Rath family.

Mabel Smyth Begins Career as a Nurse 

James and Ragna Rath, Caucasian social workers, moved from Massachusetts to Hawaii in 1905 for James to direct the Palama Settlement, a multifaceted community service agency. In 1900 at least five cases of bubonic plague were reported in the Chinatown section of Honolulu. To eradicate the threat, city officials decided to burn the homes of the plague victims. Unfortunately, the fire burned out of control, destroying at least four blocks of Chinatown. As a result, thousands of recent impoverished immigrants were homeless, and many lost their jobs and businesses. The Central Union Church created the Palama Settlement (PS) in response to these dire conditions. Church officials founded and supported many programs, including visiting nurses, a pure milk station, a day camp for children with tuberculosis, an adult night school where English lessons were taught, a day care center for working mothers, and a swimming pool with hot showers. James Rath was busy overseeing these efforts, and Regna Rath worked by his side. The Raths had five children and needed at-home childcare, so they hired Mabel Smyth.

In 1912 the Raths took their five children and Smyth to Massachusetts for a sabbatical. Before the Raths returned to Honolulu, they encouraged and arranged for payment for Smyth to attend the Springfield Hospital Training School for Nurses. Upon her graduation in 1915, Smyth returned to her family in Honolulu. She spent two years as the “agent” of the Hawaiian Humane Society. The Society had a mission to relieve suffering wherever it was found – among children, animals, and even battered wives. Smyth left the Society to become the first nursing supervisor at the PS. Organizationally, the PS divided the city of Honolulu into seven districts, with a nurse assigned to each. Each nurse was responsible for providing their district school nursing, home visiting, and clinic hours. At age 26, Smyth oversaw the entire nursing program.

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Mabel Leilani Smyth was the first Hawaiian Registered Nurse with Hawaiian ancestry, often referred to as “Hawaiʻi’s Florence Nightingale”

Smyth is First Hawaiian Nurse to Earn Advanced Certificate in Nursing

Smyth took a year off from the PS, from August 1921 to August 1922, to pursue graduate work in public health nursing at Simmons College in Boston. She was the first Hawaiian nurse to earn an advanced certificate in nursing. After her year of graduate studies, she continued her supervisory work at PS until 1927, when she accepted a position with the Territorial Board of Health as the first Director of the Public Nursing Service for the Territory of Hawaii. Up to that time, the Board of Health had hired nurses in either tuberculosis work or maternal child health work. Under her leadership, these programs merged and expanded to create a generalized public health nursing program covering all the islands in the Territory. Two years later, the nurses at the PS came under the auspices of the Department of Public Health Nursing to better coordinate care and reduced duplication of services.

Smyth gave many lectures to community and professional groups on the islands to increase public understanding and support for public health nursing. She successfully strove to upgrade lay midwives’ skills and standards, instituted immunization drives against diphtheria, coordinated chest x-ray screenings for TB, organized well-baby clinics across the islands, and represented Hawaii at several national public health meetings on the mainland.

In addition to her work, Smyth was a leader in professional nursing organizations. She was a charter member of the Nurse Association of the Territory of Hawaii when it was formed in 1920 and then elected president of the organization in 1925 and 1932. Smyth was also president of the City and County of Honolulu Nurses Association, a leader of the Honolulu Chapter of the American Red Cross, and a member of the Board of Registration of Nurses from 1925 to 1935. In 1926, Smyth was a small group of nurses who created a public health nursing course at the University of Hawaii to prepare nurses who wanted to practice public health nursing.

Hawaiian Florence Nightingale

Sadly, Smyth’s life was cut short at the young age of 43 after spending half her life serving others. A sewing needle had been lodged in her chest since she was a child. On March 24, 1936, she underwent an operation to remove the needle and tragically died of a post-surgical embolism that same day.

Smyth was widely mourned both in Hawaii and in the nursing community. Her obituary in the American Journal of Nursing read in part:

Endowed with charm and a dynamic personality, she had attained a high position in the ranks of Hawaiian women of achievement. Through her devotion, sympathy, keen sense of community responsibility, spirit of cooperation, and intelligently directed energy, Miss Smyth was, at the time of her untimely death, at the very height of her powers, the outstanding leader in nursing in the Territory of Hawaii.

After her death, a committee was formed to establish a memorial to the “Hawaiian Florence Nightingale.”  It raised over $110,000 for the Mabel Smyth Memorial Building, with over 4,000 people contributing. The building was dedicated on January 4, 1941, with Hawaiian chants and music. It housed offices of the medical and nursing professional organization on the island, classrooms, a library, and an auditorium. The building was a fitting memorial to a nurse who did so much for her family, neighbors, and all Hawaiians.

Check back next week for part 3 of the Three Trailblazing Hawaiian Nurses blog series – Alice Ting Hong Young, Hawaii’s First Nurse Midwife.

Three Trailblazing Hawaiian Nurses: Part 1 – First Registered Nurse in Hawaii

Three Trailblazing Hawaiian Nurses: Part 1 – First Registered Nurse in Hawaii

Welcome to part one of Three Trailblazing Hawaiian Nurses blog series – Mabel Isabel Wilcox, First Registered Nurse in Hawaii. 

Hawai’i’ is one of the most multicultural and ethnically diverse places on Earth. This rich blend is reflective of its nursing history. Pioneer Registered Nurses in Hawaii include nurses of Native Hawaiian, English, Chinese, Japanese, and Filipino heritage. Their lives and work create a beautiful kaleidoscope of service that has improved the lives of residents in this tropical paradise for over 100 years. The life stories of three groundbreaking Hawaiian RNs can inspire us all.

Mabel Isabel Wilcox 1882-1978 First Registered Nurse in Hawaii

The first Registered Nurse in Hawaii was Mabel Isabel Wilcox. Her maternal (David and Sarah Lyman) and paternal (Abner and Lucy Wilcox) grandparents were Caucasian Christian missionaries who traveled from New England to the Kingdom of Hawaii in the 1830s to establish schools and preach the Gospel.

Mabel was born on the island of Kauai on November 4, 1882, to the Wilcox’s son Samuel and the Lyman’s daughter Emma. She remembered a carefree childhood in a family that valued religion, philanthropy, education, and public service. When Wilcox was in her teens, there were no college preparatory high schools in Hawaii, so her parents sent her to California to complete her high school education. However, she stayed on the mainland, and in 1911 she graduated from the Johns Hopkins School of Nursing in Baltimore and passed her Registered Nurse examinations. Soon after graduation, Wilcox returned to Hawaii and began her career as the resident school nurse at the Kawaiahao Seminary, a Congregational Church-sponsored girls’ school in Honolulu, becoming the first Registered Nurse in Hawaii.

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An early photo of Mabel Wilcox Hawaii’s first Registered Nurse

Earned the Moniker “Kauku Wilikoki”

Wilcox missed her extended family on Kauai, so in 1913 she accepted an assignment to begin and head the Territorial Board of Health’s anti-tuberculosis (TB) campaign on the island. She was the only Board of Health nurse on the island and served approximately 5,000 people. Often on foot or horseback, she did case investigations, collected sputum samples, educated the community about the disease, and provided follow-up care to those diagnosed with TB. Wilcox quickly saw the need for a TB Hospital on Kauai. She convinced service clubs and business organizations on the island to support her idea and solicited most of the funds needed from her aunt and uncle, Emma and Albert Wilcox. After a year of construction, the Samuel Mahelona Memorial Hospital opened in 1917.

Although Wilcox was hired to reduce the number of tuberculosis cases on Kauai, in 1920, Hawaii reported a 25% infant mortality rate, double that of the mainland. In addition, there were no maternal/infant health nursing programs on Kauai, so Wilcox added education on nutrition, sanitation, and healthy birthing practices to her rounds when she encountered pregnant women and young children. As a result, she earned the moniker “Kauku Wilikoki” or Doctor Wilcox for her work.

As soon as the U.S entered WWI in April 1917, Wilcox was anxious to do her part. She wrote the American Red Cross nursing service requesting an overseas assignment. Her work with maternal/child health in Hawaii gave her knowledge and experiences she would draw on during her war years.

Nurse Behind the Lines During WWI

Beginning in the winter of 1918, Wilcox was the Head Nurse of a hospital and outpatient clinic for women and children in Le Havre, France. The facility was relatively safe miles from the battlefront lines when Wilcox arrived. After that, however, the fighting grew closer. In September of 1918, Wilcox was sent into nearby Belgium, directly behind the advancing Allied troops, to inspect maternal and child health conditions and conduct clinics. While there during the final Allied campaign, she wrote to her family: “One night we were bombed, crawled under the bed, two of us trying to get into one helmet. Scared.” After the war ended, Wilcox spent another year in France helping mothers and children, many of whom were orphaned or refugees. Once the French government was stable enough to take over her work, she returned to Hawaii. She was awarded medals from the Queen of Belgium and the mayor of Le Havre for her service.

Kauai’s First Territorial Maternity and Child Health Hygiene Nurse

In 1921 Congress passed the Sheppard-Towner Act providing funds for maternal-child health programs. With these new monies, Wilcox was hired as Kauai’s first Territorial Maternity and Child Health Hygiene Nurse to focus full-time on improving the health of women and children. As they began hiring more nurses, she became the Supervising Nurse, a position she held until her retirement in 1935. In the first year, public health nurses made nearly 1,000 home visits, and newly organized “demonstration clinics” recorded an attendance of 4,403 mothers. Infant mortality dropped by 14% in the first year of the program. The program successfully provided care to 8,398 mothers and infants in 1927.

Congress discontinued funding the Sheppard-Towner programs in 1929. Then in 1930,  Wilcox became the supervisor of the new generalized public health nursing program on Kauai. She oversaw tuberculosis, maternal-child health, and school and home health nursing programs on the island. During this time, Wilcox was a leader in many professional associations. She launched the Kauai Nurses Association, served as its first president from 1932-1946, served as the first executive director of the Kauai TB Association, and was on the Board of the Mahelona Hospital.

G.N. Wilcox Memorial Hospital

On Kauai, many sugar plantations maintained small, often inadequate, hospitals for their workers and families. After Wilcox’s father and mother died (1929 and 1934, respectively), she and her siblings decided to build a new, modern general hospital in their memory. She retired in 1935 and spent her time and energy making the G.N. Wilcox Memorial Hospital a reality for the next few years. It was dedicated on November 1, 1938, with 96 beds in wards and semi-private private rooms, 17 physicians and 50 employees, and 14 graduate nurses. The hospital provided more than 10,000 days of care in the first year of operation.

Upon Wilcox’s retirement, Mabel Smyth, RN, the Head Nurse of the Territorial Board of Health, wrote a tribute to her in The Pacific Coast Journal of Nursing.

It read in part: “With clarity of purpose and wisdom in leadership Miss Wilcox has developed an unusual spirit of loyalty and devotion among her corps of nurses and superiors … every nurse … on the island turns to her for inspiration and leadership in matters pertaining to individual and community well-being.” (Smyth, M, “Public Health Nursing in Hawaii: A Tribute to Mabel I. Wilcox,” (1935) The Pacific Coast Journal of Nursing,  297-98).

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Mabel Wilcox circa 1911 and 1951

Influence of Wilcox Lives On

In her late 50s and 60s, Wilcox stayed active with the Wilcox Hospital in an unpaid capacity. She served on the hospital board, raised money for expansions, and recruited nurses. During this time, Wilcox also became very interested in historic preservation. Because both sides of her family tree had been missionaries and plantation owners in Hawaii for over 125 years, she and her living siblings began restoration efforts to preserve their ancestral homes and papers. Today the Waiolo Mission House, the Lyman House Memorial, and Grove Farm all stand as testimonies to their efforts, as do many manuscripts, records, and correspondence housed at the Grove Farm library.

After years of declining health, Wilcox died on December 27, 1978, at age 96. Before her death, the Kauai Tuberculosis Society honored her with these words: Through the years, there has been little in the health and welfare fields on this island that does not owe its beginnings to Miss Wilcox’s vision and active support. Her scope has been not only island-wide but territorial and even national.

Wilcox is is buried on her beloved Kauai Island.

Check back next week for part 2 of the Three Trailblazing Hawaiian Nurses blog series – Mabel Leilani Smyth, First Hawaiian Registered Nurse with Hawaiian Ancestry.

Trailblazers in Nursing History: Chinese-American Nurse Elsie Chin Yuen Seetoo, RN (Part Two)

Trailblazers in Nursing History: Chinese-American Nurse Elsie Chin Yuen Seetoo, RN (Part Two)

Part Two: Nursing in War-Torn China

(To read Part One, click here)

At the beginning of the war, rural China had very few hospitals, medical supplies, equipment or trained personnel. Malnutrition, lack of basic sanitation, overwork and disease were commonplace, making the provision of health care very challenging.  Rural people usually relied on traditional Chinese medicine and practitioners. The Chinese Army Medical Corps was unprepared to care for hundreds of thousands of ill and injured soldiers, much less help a large civilian population.  Some Western-trained Chinese physicians, along with European and North American doctors practicing in China, had founded the CRCMRC early in the twentieth century. The organization was invaluable in free China during World War II by supplying medical personnel, training and equipment (Mamlok, 2018).  Seetoo was familiar with their work and had spearheaded financial collections for the CRCMRC while she was a student nurse. The lack of adequate supplies is illustrated by this recollection of Seetoo’s time with the CRCMRC:

“When I was at the Chinese Red Cross in Guiyang I saw how they were very economical in using their materials, like the dressings …  the very soiled dressings would be thrown out, but there was a great big vat or a pond they had that was full of bleach and whatever, that they throw some of the …  not-so-soiled [dressings] …  to kind of bleach them clean, and after they were clean they would autoclave them and reuse those dressings again …” (Trojanowski, 2005).

Her work with the CRCMRC did not last long. She explained:

“My schoolmate, whose sister had been at Women’s College [of the University of North Carolina] … had gone up to Yenan back in 1938, and Yenan was where the Chinese Communists had holed out during Chiang Kai-shek’s time … she had finished high school and she wanted to join them, because she thought …  they were doing the job of fighting the Japanese better than the Nationalists …  because I knew the family, before I left Hong Kong to come inland I had gone to see the mother, and the mother said, “When you have a chance once you get inland, will you please write my daughter to tell her that we’re safe.” So that was all I did. But then the Chinese Nationalists have a way of censoring all the mail, opening all the mail that goes up there, or at least they take note of it, and the next thing I know they got hold of the nursing superintendent … my supervisor at the Chinese Red Cross, and asked about me … But, you know, the Chinese Nationalists were very—even during my high school years I hear all kinds of stories about people disappearing.  So, when there was an opportunity to volunteer to go to India, I volunteered … But after I went over to India and then came back to Kunming, they lost my trail. That was the end of it.” (Trojanowski, 2005).

Seetoo spent the months from late December 1942 until the monsoons began in June 1943 at Camp Ramgarh, India, training Chinese Army medics in first aid and rudimentary medical procedures.  She said this about her time in India, “For several months we lived kind of the Boy Scout, Girl Scout type of a camping life. I enjoyed it as long as I didn’t have to cook.”  (Trojanowski, 2005).

US citizenship: lost and regained

The CRCMRC trainers shared space at Camp Ramgarh with the US Army 95th Station Hospital.  In the summer of 1943, the two groups left India together for Kunming.  After returning to Kunming the CRCMRC training unit was disbanded, and Seetoo applied to work at the 95th Station Hospital as a member of the US Army Nurse Corps. She was turned down because she had “performed military service for another country” and thus, unbeknownst to her, lost her US citizenship.  She later recalled:

“They [US Army] considered that because of my being in the medical service training unit, it was part of the Chinese army … to regain my U.S. citizenship I had to take the oath of allegiance again, and oath of renunciation and allegiance, which I did.” (Trojanowski, 2005)

Now she was a US citizen both by birth and by naturalization. A year passed between the time it took for her to apply to the Army Nurse Corps, learn she was rejected due to her lost citizenship, regain her US citizenship, and apply again.  She was accepted and on June 17, 1944, she became the first Chinese American nurse to serve in the US Army Nurse Corps.  She entered at the rank of First Lieutenant.  Although she did not serve near the ground war, her hospital was attacked repeatedly by the Japanese Air Force.  “The planes came over to drop their bombs. The Japanese would penetrate [the defensive perimeter of the hospital] and we would hear the sirens and run for cover” (Lee, 2019).

The 95th Station Hospital’s official Army history notes the hospital was:

” … Reached by plane over the Himalayan mountain range-one of the most picturesque, albeit dangerous, flights in the world … having weathered monsoons, air raids, and indoctrination in the treatment and prevention of various tropical diseases …. It functioned as a station hospital to care for battle casualties from the various fronts in China … Officers, nurses and enlisted men were required to learn and carry out duties in addition to those for which they were trained. Long hours of work, doubling-up on duties and diligent application to new tasks were the rule rather than the exception.” (History of the 95th, 1951)

She was the only nurse with the unit fluent in both English and Chinese and was highly valued for both her nursing and her language skills.  Seetoo spent the last months of her military duty, after the war, with the 172nd General Hospital in Shanghai and was discharged to the United States in the spring of 1946.

Years later, Seetoo reflected on her time in China:

“I had spent a total of fifteen years in China. I had had a huge opportunity to dig deeper into my roots and learn more about my Chinese heritage, its history, geography, and traditions. The war years gave me the opportunity to sample places I knew in earlier times only through a geography book, and met people from diverse backgrounds and walks of life. I was able to personally taste Guangxi’s famous pomelos, admire Guilin’s landscapes, read the couplets framing the temple by Kunming Lake, felt the dusty loess blow against my face in northwest China, heard the drum roll from towers over city gates, and see the flickering ghost fires dance outside city walls. It was truly, to quote Dickens, ‘the worst of times and the best of times,’ and on touching U.S. soil I felt I was really straddling two cultures.” (Trojanowski, 2005)

After visiting her family in Stockton, Seetoo visited friends on the east coast.  In Washington, DC she met Joe Yuen, who worked on electrical systems for satellites at the Naval Research Laboratory.  They had a whirlwind courtship and married after six weeks. When Seetoo met Yuen, she was already admitted into the new Bachelor of Science in Nursing degree program at Women’s College of North Carolina (now the University of North Carolina at Greensboro).  Using veteran’s benefits to pay for college, from 1946-1948, she took classes during the week in Greensboro and commuted to Washington to see her new husband on weekends and during school breaks (.

After graduation she moved permanently to the Washington, DC area and spent the next 15 years focused on caring for her husband and their four children. During this time, Seetoo became a freelance translator of English/Chinese medical literature for a company in Washington. Perhaps her best-known translation is the Chinese paramedic text, “A Barefoot Doctor’s Manual.”  In the 1970s she worked as a technical publication writer and editor at the Naval Medical Center and the National Institutes of Health (Moy, 2014).

Receiving the Congressional Gold Medal

Elsie Chin Yuen Seetoo, RN.

On December 20, 2018, President Trump signed the Chinese American World War II Veteran Congressional Gold Medal Act, which had passed Congress unanimously.  Soon after, on January 29, 2019, Seetoo was selected to receive the Congressional Gold Medal, the highest civilian honor awarded by Congress, on behalf of all Chinese American World War II veterans. Several high-ranking elected officials and officers of all the military branches expressed their gratitude to these veterans (U.S. Department, 2019).  During the ceremony, Seetoo said:

“We have waited a long time for this moment. I am deeply honored to receive this Congressional Gold Medal on behalf of my sisters and brothers. I hope our perseverance, commitment, and hard work will further inspire our young people to serve this wonderful country.” (Eng, 2020)

Today, at 102, Seetoo is living outside Washington DC enjoying her friends and family.

Trailblazers in Nursing History: Chinese-American Nurse Elsie Chin Yuen Seetoo, RN (Part One)

Trailblazers in Nursing History: Chinese-American Nurse Elsie Chin Yuen Seetoo, RN (Part One)

When Elsie Chin Yuen Seetoo was born on September 14, 1918, in Stockton, California, no one could imagine that by the time she was 30 she would work in a hospital under attack by the Japanese Army; escape occupied Hong Kong disguised as a Chinese servant; travel by boat, truck and foot across 700 miles of war-torn China; become the first Chinese-American nurse to join the US Army Nurse Corps; and then graduate from Women’s College in Greensboro, North Carolina, with a Bachelor of Science in Nursing degree.  Her unique and harrowing tale begins decades before her birth. Elsie Chin Yuen Seetoo, RN.

Early Life

Seetoo’s father, along with thousands of other Chinese men, came to California seeking jobs and opportunities unavailable to them in their homeland.  When he arrived, Mr. Chin first worked as a laborer and then as a cook for a private family. He saved enough money to open an import-export grocery store business in Stockton.  He became a merchant because it provided the legal status he needed in order to bring his Chinese wife and son to the United States.  After settling in Stockton as a family, the Chins had two daughters. Although she was the only Chinese student in her public-school classroom. she remembers her childhood fondly. The Chin children attended Chinese school from 5-9 pm, in Stockton’s small Chinatown, here they learned to read and write Chinese characters.  In addition to her schooling, she was an active Camp Fire Girl (Lee, 2019)

In 1930 the United States was in the middle of the Great Depression.  The family business was failing, so the Chins decided to return to China.  Because Seetoo and her younger sister were born in California, they were United States citizens.  After completing high school in China, she wanted to further her education.  However, in the 1930s, Japan invaded China and controlled most of coastal and eastern China where the major cities and universities were located.  Many Chinese universities closed during the Japanese invasion and occupation.  In any event, the Chin family did not have enough money to help Seetoo with college expenses.  So, in October 1938 she began her studies at the English language Queen Mary Hospital School of Nursing in the British Colony of Hong Kong (Moy, 2014).

Student Nurse Days

On December 7, 1941, the Japanese attacked Pearl Harbor, bringing the United States into World War II.  That same day Japan also attacked the Philippines, Hong Kong, Burma and other Asian countries.  Seetoo recalled:

“… it was the morning of December the eighth, when we were greeted by Japanese bombs and shelling. Of course, we were placed on a wartime footing right away …  All patients that could go home were sent home, and then we were taking in battle casualties that very first morning … after two weeks Hong Kong surrendered … we knew after that the Japanese are going to want the hospitals … the British sisters [nursing faculty] had the foresight to know that they were going to be interned, so they gave us our temporary certificates, RN certificates.  (Trojanowski, 2005).”

On December 10, 1941 during the Battle of Hong Kong, nursing school administrators issued each third-year student a Certificate of Training from the Medical Department of the Government of Hong Kong.  These certificates were on par with diplomas and conferred the title Registered Nurse (Chung, Ching & Wong, 2011).  Chinese, British, Indian and Canadian forces defended Hong Kong during two weeks of fierce fighting.  Facing overwhelming Japanese forces, the allies surrendered on Christmas Day, 1941. By then, Queen Mary Hospital was full of casualties.  Seetoo, alongside hospital staff and fellow student nurses, worked tirelessly caring for the wounded soldiers.  On December 26, 1941, Japanese Army troops entered the hospital, interned the foreign patients and staff, and turned the hospital into a Japanese Military Hospital (Copp, 2001).  Seetoo was 23 years old, a Registered Nurse and living under Japanese rule in occupied Hong Kong.  In an oral history interview she remembered:

“A few days after the surrender we saw some Japanese officers come to inspect the hospital …  as soon as we saw them, we were kind of on edge, because you’d hear all these stories about rape, and rape of Nanking, and the Japanese had been very bad about commandeering women to be part of their—they called it comfort women, which is actually making sex slaves of them. Anyway, we had heard stories of that, so naturally we were very, very concerned.” (Trojanowski, 2005).

Rita Wong, one of Seetoo’s classmates, remembered the early days after the Japanese invasion,

“All foreigners working at the hospital were sent to a concentration camp, and the Chinese were gathered at a hospital where they had nothing to do but wait for their meager food rations.  The Japanese made it a rule that no doctors or nurses were to leave Hong Kong, and those who were caught doing so would be killed.” (Macfie, 2007, p.1)

Escaping Hong Kong

Despite this Japanese edict, Seetoo and several of her Chinese classmates, including Rita Wong, Rebecca Chan Chung, Daisy Pui-Ying Chan, Cynthia Chan and Irene Yu, were determined to help their country and its American and British allies.  They knew they had to make their way to Free China, which was in southwestern China and unoccupied by the Japanese.  Individually and in small groups, these nurses disguised themselves as peasants and slipped past Japanese guards as they escaped from Hong Kong, making the 700-mile journey inland towards Kunming, the capital of Free China (Chung, Chung & Wong, 2012).

Seetoo, her brother and three of her classmates began the journey together.  They traveled to Macao by boat, then hitched a ride with a truck driver to the Chin family home in Xinhui.  After a short visit, the group walked four hours to Shuiko where they boarded a ferry. On the ferry was a classmate of Seetoo’s brother, Mr. Liao.  She recalled their encounter:

“[Mr. Liao said] I’m going to write a letter to the pastor of the Baptist Church at your next stop, Gaoyao, and ask him to let you folks sleep in the church sanctuary – and to provide whatever assistance you need.  And when you leave for the next stop, ask him to write a letter to the Baptist preacher there in Wuzhou asking for the same favor … That was how we finally got to Guiyang – by stopping at various churches along the way.” (Trojanowski, 2005).

In April 1942 they reached Guiyang, headquarters of the Chinese Red Cross Medical Relief Corps (CRCMRC).   There she met Dr. Robert Lim, the director of the organization, who offered her a position in the operating room of the Red Cross sponsored hospital in the city.  Seetoo accepted the offer and went to work.

Click here on Wednesday to see Part Two!

The Importance of Diversity, Equity, and Inclusion in Nursing

The Importance of Diversity, Equity, and Inclusion in Nursing

Diversity, equity, and inclusion (DEI) are hot topics in the healthcare world, but including a DEI module in our yearly education isn’t enough to address these issues. Policy is a valuable tool, but actual change needs to come from a more personal level, from each and every staff member.

Before we can have a meaningful conversation about DEI that might lead us toward significant change, we need to understand the meaning of diversity, equity, and inclusion and why it is important in healthcare.

First, the issues often relate to our biases, especially those so deeply ingrained in our life circumstances that we aren’t aware of them. We can’t advocate for what we don’t understand, and if we don’t advocate for change, we will stay in our “safe” silos, which only strengthens the idea that we are separate and different.

Understanding that we are separate and different and what that means is the first step in making diversity, equity, and inclusion a part of our workspace and nurse recruitment.

Diversity

Diversity is simply including people with different backgrounds. For example, when healthcare systems conduct nurse staffing while considering different cultural, gender, religious, sexual orientation, and socioeconomic backgrounds, the staff benefits from exposure to differences among coworkers, and patients feel more comfortable knowing they aren’t alone.

Our healthcare system has been lacking in diversity from the beginning, and although we’ve seen a lot of progress since the days when only white males could practice medicine, we are far from diverse.

In one study, over 56% of physicians identified as White and 64% as male, according to the Association of American Medical Colleges (AAMC). According to Minority Nurse, about 75% of RNs identify as White, and 91% are female. So if most doctors and nurses are white, most doctors are male, and most nurses are female, who are we really serving?

When we don’t have a common background, it’s easy to make the mistake of seeing the patient through our own lens instead of their reality. Our lenses place them where we want them to be—fully able and capable of taking the steps we want them to take for their health. The outcomes we desire assume the tools, processes, and understanding are within their reach and that they have the same goals we do.

Textbook knowledge can never make up for the lack of diversity in our own lives. And our lack of understanding of our patients’ reality can lead to misunderstanding or errors in care, creating inequity. Hiring a diverse workforce promotes understanding and creates a more comfortable environment for patients and coworkers alike.

Equity

Equity is a concept that often gets confused with equality. In healthcare, equality means giving everybody the same resource or opportunity to achieve their health goals. Equity is recognizing that each person has different circumstances and honoring that by allocating opportunities and resources to allow them to reach an equal outcome.

Simply giving someone an opportunity isn’t enough if they don’t have the means to use it. Equity can only be achieved when nobody is allowed to be disadvantaged due to age, race, ethnicity, nationality, gender identity, sexual orientation, geographical background, or socioeconomic status.

Access to life-saving medication is an example of inequity we see every day. A medication that costs hundreds of dollars every month may not be out of reach for someone with superb insurance coverage and a large bank account. For someone whose job doesn’t offer prescription coverage or who doesn’t make a living wage, that life-saving medication is technically available but far out of their reach. Far too many patients fail to fill the prescriptions they need for this reason.

Healthcare policy can promote equity, but we can also change how we treat and educate patients. In our medication example, we could address a patient’s ability to obtain a prescription before they leave the office or hospital. No patient should walk out the door with a prescription they can’t fill.

Inclusion

Inclusion is about deliberately creating a respectful and safe environment for all staff and patients. Inclusion means giving patients and staff a voice in giving and receiving care and encouraging diversity. Healthcare isn’t the place for a one-size-fits-all approach. We must all strive to embrace diversity and promote equity.

Nurses Are Uniquely Positioned to Champion DEI

Nurses may have little say in enacting policy within their healthcare systems but are very likely the first and last staff member a patient sees and the role they interact with most frequently. That close relationship with our patients makes nurses the most important role to champion diversity, equity, and inclusion with our patients, in nursing education, and within our own workspaces.

One of the most essential directives we learned in nursing school may have been to meet patients where they’re at. Let’s add and coworkers to that and, together, we can create a more effective healthcare system that serves all people.

 

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