Lord Winston must have known he placed a puss among the pigeons when he aired his view, a couple of weeks ago, that nurses from Eastern Europe are putting NHS patients in danger. Citing Romanians in particular, he remarked upon their limited communication skills and told the House of Lords that they had been trained ‘in a completely different way’ from British nurses.
Predictably, since then, there has been a flurry of concern about his first point; it is obviously troubling if medical professionals cannot speak adequate English, and it will continue to be troubling as long as the difference between a microgram and a milligram is a coffin. Nevertheless, learning to speak English is a relatively quick study, especially for the motivated, and it should not be beyond the wit of man to enforce standards of language. His second contention, however, although thus far unaddressed, is rather harder to reconcile.
Romanian nurses are trained in Romanian hospitals — institutions riddled with corruption (families routinely hand over brown envelopes for what they call ‘extras’ and you and I might call basic treatment), and in thrall to authoritarian efficiency. Compassion and humanity are not only surplus to requirements but largely unacceptable; the more brusque one is, the more ‘professional’. Lord knows, we have no shortage of stories of uncaring and unkind nursing in this country —but at least here they make headlines because the consensus declares it wrong. In my experience, no such consensus holds sway in Romania.
For many post-Ceausescu years I was in and out of Romanian hospitals, working with a charity that eschewed the favoured orphanage projects and aimed instead (how naive!) to bring light and warmth to the dark chill of a maimed mainstream society — to which end helping the sick seemed as good a starting point as any. Yet what we found in those hospitals and what, frankly, we scarcely dented after years of work was to our minds pervasive and unquestioned cruelty.
The following examples are not hearsay or urban myth — each one I saw for myself. In a large children’s hospital there was one all-purpose surgical ward. A child returning from theatre and still unconscious would be tied by the nurses, hand and foot, to a bed, there to wake in pain, confusion and terror — and alone because, once tied, he wouldn’t fall out of bed, so there was no need for anyone to sit with him. An efficient use of labour, see? And if you think that’s bad enough, try this: why furnish, heat and supervise two rooms when one will do? So watching the writhing child were the pre-op children, awaiting their own imminent surgery.
The parents couldn’t visit; not then, not later. I never saw a visitor in any hospital, not for babies, not for the dying. Excuses ran to: visitors bring in germs, upset the patients, nick things and get under the feet of the nurses. Very inefficient, that. Instead, relatives gathered outside each morning and updates on patients’ progress —even hopeless prognoses —were read out, alphabetically, to the entire group.
Meanwhile, in the maternity hospital, newly delivered mothers dragged themselves to barred windows to shout down news, including that of stillbirth, to the husbands waiting on the pavement below. It wasn’t part of a nurse’s job to assist the communication.
As with any authoritarian regime, hierarchy was all. Doctors at the top, nurses in the middle, patients at the bottom, discourse only between peers. Doctors didn’t speak to nurses and nurses didn’t speak to patients — save for necessary instruction — with each tier doffing caps to the one above. I stood in a room where three women at once were having unanaesthetised abortions, without as much as a curtain between them. One doctor scraped a uterus with his right hand and smoked a cigarette with his left; his nurse, in a ghastly mimicry of his attitude, did not reach a hand to help the ashen patient from her gurney at the finish.
Like many aid workers, we foolishly thought that if only they had more they could give more. So when we saw a disused tip of a quadrangle in the centre of a children’s hospital, we raised the money to clear and landscape it so that recovering children, on sunny days, might play in the fresh air. Stoopid us. For that to happen, nurses would have had to take them out there. Not on the job specification. Quad still empty.
The debate raged, not least within our charity, between calling such people ‘brutal’ or ‘brutalised’ — the latter implying blamelessness. I have argued both, depending on the fury or grief or exasperation of any given day, and given that I have not been back in a decade, it is possible that there have been changes. But I doubt it. First, because I am reliably told there have not, and second, because the difference is that this is not just what Robert Winston correctly calls ‘a completely different way’; it is actually their preferred way.
When it comes to race, most of us don’t give a fig who wields the bedpan or cools the brow. But when it comes to the stubbornly cultural, we might care to give serious thought to the chances of successful re-education. Were it my child in an NHS hospital, at the mercy of a nurse fresh from the easyJet special out of Bucharest, it would be rather more than her grasp of the English subjunctive that would worry me.