Elly taking nursing off the sidelines

Ratih Sayidun and Santi W.E. Soekanto, Contributors/Jakarta

Countless parents want their children to become doctors, but they would be less than enthusiastic -- probably downright angry -- if the latter wished to become a nurse.

Maybe they should meet Elly Nurachmah, the first Indonesian nurse to become professor of medical surgery nursing at the School of Nursing, University of Indonesia, of which she is now the dean.

She acknowledged recently that people often look down on the nursing profession, believing that it is of lesser status than doctors. Her speech when she was made professor last May clearly defined the problem of nursing in Indonesia, in that the profession has yet to develop the way its "colleague" (the medical profession) has developed.

"Nurses are so often sidelined among health professionals ... the government has yet to allow nursing professionals to significantly contribute to health development of the nation," she said.

"The prevailing image of the nurse in the public is that of an assistant or merely the servant of doctors. Evidence of this can be found in the kind of appreciation and financial compensation for nurses, the poor esteem that the public holds for them."

Part of the problem carries over into training of nurses, which remains focused on having them do the bidding of others.

"Many nurses have not been given adequate training and understanding about patients as human beings," she explained. "Nurses are often trained to just carry out tasks given by doctors, (and this is one of the reasons why) they tend to disregard patients' feelings."

Historically, nursing in this country was a profession that developed from a low level of education. Nursing training here was first initiated in the 1890s by nuns, so the discipline was at first not as scientifically rigorous in nature and mostly took less than a year to complete.

In 1962, Indonesia established the first nursing academy, offering a three-year training course for high school graduates, and the profession began to have regulations and organizations. The development of the profession was strengthened in 1983 during a national nursing seminar that declared nurses to be health professionals, just as doctors are.

Higher studies in nursing began when the University of Indonesia set up a five-year nursing studies program, and then the D3, or three years of training, for high school graduates. Elly was the first D3 graduate who went on to further her studies.

The higher level of education is therefore expected to polish the nurses' bedside manner, she said, so they would be more sensitive to patients' feelings.

"It's very often the case that patients who are already anxious about their ill health become even more anxious because of the nurses' unfriendly manner," she said.

"What we need now are nurses who are critical and rational about their profession. Nurses used to work only by instinct, intuition, but now they really know what they are doing."

Even today, more than 60 percent of the approximately 250,000 nurses and midwives in Indonesia are graduates of the nursing academy. Less than 2 percent are graduates of university schools of nursing; many of the latter choose to work as academics rather in hospitals, where they would be able to give the best quality nursing to patients.

"This is a fact because health care facilities such as hospitals do not appreciate the graduates enough, while other nurses with lower education in the hospitals often feel threatened by them," Elly said.

"It's regrettable but if more nursing graduates go to work in the universities and education centers, rather than go to work in hospitals, they will end up as poor educators with no experience in the field."

One of the ways to overcome the various obstacles facing the nursing profession is to develop criteria of nursing education. State-run Cipto Mangunkusumo Hospital in Jakarta and other hospitals have developed programs where graduates of university- level nursing schools can apply their knowledge in facilities while undergoing training.

Born in Bogor, West Java, on Aug. 17, 1948, Elly is the daughter of a housewife who did not believe in education for girls, because they would have to spend their life in the kitchen anyway.

Upon graduating from high school, Elly pleaded with her father to allow her to continue to university. He relented, and she applied to the University of Indonesia's School of Medicine.

On the day that she learned she did not pass the medical school entrance test, she wandered sadly around the Cipto Mangunkusumo Hospital and chanced upon its nurses' dormitory.

"I thought, this is it, the right school for me so I could be independent from my parents," she told d'Maestro magazine. "So I took its entrance examination, with confidence."

Elly found independence and her true calling.

"Many people do look down upon us nurses, but personally I am happy to be a nurse because it makes me feel I can do something good for other people," she said. "I am happy every time I see a patient leave the hospital in good health."

Elly began her career as a nurse in the Intensive Coronary Care Unit (ICCU) of Cipto Mangunkusumo Hospital in 1971. Four years later, she won a Colombo Plan scholarship to a coronary care course at the Royal Melbourne Hospital in Australia.

In 1988, when she was working and studying for her master's degree in Sydney, Australia, she had her first experience in caring for AIDS patients.

"The disease had been first revealed in 1983, but not many Indonesian nurses knew about it or how to care for the patients, because the government was not forthcoming on the subject."

None of her colleagues in Sydney were willing to care for the AIDS patients then, but Elly came forward.

"I took double precautions, including putting on two sets of gloves and put one gown over the other, but that was all right. I was sure that God wouldn't allow bad things to happen to me because I had only good intentions," she said.

She took part in the Leadership Training for HIV/AIDS in Chicago last year. Upon her return, Elly established the AIDS Team of University of Indonesia's School of Medicine, which, in cooperation with the College of Nursing of the University of Illinois in Chicago, regularly disseminates information on HIV/AIDS.