Visits by Nurse Nídia
Nurse Nídia Salgueiro graduated from the School of Nursing Dr. Ângelo da Fonseca in Coimbra. She performed her professional activity at the Hospitals of the University of Coimbra, where she was responsible for several services, including the Dermatology and Venerology Service of and of Medical Clinic and at the Dr. Ângelo da Fonseca School of Nursing (EEAF), where she was a monitor, teacher, coordinator of courses and member of the Installation and Management Commission (1977-1983).
Her vast and diversified professional experience was one of the important aspects for collect this testimony, because in addition to facilitating the framing of assistance in this area in the central region, it allowed to verify impact of the external image of the old Colónia Rovisco Pais Hospital (HCRP), built through visits by study carried out by portuguese and french nurses.
Nurse Nídia visited the Hospital, at least in three different moments of its operation. The first time, in 1955, when I was a finalist student in the General Nursing Course at the EEAF. The second time, in 1972, with the students of the General Nursing Course, as a teacher at that School. The third, in the 1990s when she accompanied students and teachers from french nursing schools (Écoles Cadres).
On the 1955 visit, the HCRP was at the peak of its operation. The systematic identification and social isolation of contagious Hansen patients was one of the measures provided for in Portuguese legislation. The fight against leprosy was based on early diagnosis, as a way to control injuries and the evolution of the disease, and on the prevention of contagion as a way to preserve public health. On this visit to the HCRP, Nídia, co-course and the instructors of Dr. Ângelo da Fonseca Nursing were accompanied by officials of the Hospital who were transmitting information about the activities and the operation of each sector. They started in the area reserved for the sick, going through all the buildings, but they were not allowed to enter the Preventory and Nursery because they had previously been in the hospital area, but their operation was explained to them.
From that visit, Nurse Nídia remembers explaining, given the existence of the prison and when passing in front of this “(…) that there were rules, and that control was tight. Patients could not leave if they were in the contagious phase. It was mainly men who ran away … and not women, to see their children”.
Nurse Nídia still preserves images of the patients in her memory – “with deformities in the face and hands, with ulcers in the legs and mobility difficulties” and injuries in several other areas of the body.
It is recalled that “the sensation of community was noticeable” and “(…) the houses of the sick marked me, and the coexistence of male and female patients, that is, couples of patients. That, for you, was a very interesting aspect … and, she adds, in some countries they would possibly be sterilized … I enjoyed seeing a family, seeing the patients cultivating … The little garden in each house impressed me a lot. It was something that I retained and that lasted. I have never been in favor of gender separation in hospitals, at the Nursing School, in the homes of the School. Perhaps, this feeling was due to the fact that, in a time when primary and secondary education took place in establishments separated by sex, the 4th grade was done with the Teacher and the boys. With the birth of the first child and some health problems, the students (two) spent at the beginning of the school year for the husband, also teacher, I think to relieve the wife, and, without an official character. For me, it was a great experience. The teacher was very demanding, stimulating the creativity of his students and creating a taste for gardening. Also decisive was the fact that I always dealt with boys, due to my parents company and to the contacts with the agricultural workers, who always respected me a lot. Hence, when I started teaching (1-1-1968), taking the coordination of the course, I fought for mixed activities. Students, in their commemorations of course, always invite me and emphasize this fact. Also proposing mixed classes at school and swimming, which was granted. As a member of the Installing Committee of the Nursing School, I fought for the transformation of the Home-Headquarters into a Mixed Home. It was a difficult process, which required a lot of diplomacy and an appeal to the boys’ “sensitive rope” to overcome their resistance. When the Nursing Home Alexandre Herculano became vacant, after the extinction of the Nursing Assistant Course, they took it by storm and did not give up on it. This mixed home experience was very important for the success of Mixed Residence in the new facilities of the Dr. Ângelo da Fonseca School of Nursing.
At HCRP, “those little houses had flower pots, as well as in the exterior spaces of the buildings, creating beauty and a pleasant and healthy environment… I was raised in the middle of nature, like a gazelle running free… I was enchanted.”
In the hospital building, she remembers the patients coming to the entrance to undergo treatments, as well as the wards.
These memories transported her to another moment, when she started her professional activity in the Dermatology service of the Hospitals of the University of Coimbra (26-04-1956). In which “(…) a lady came to the Dermatology consultation, whose lesions led her to suspect leprosy, having been referred to the HCRP”. She recalled that “(…) the treatments that existed at that time, with sulfonotherapy, had many side effects, causing many allergies. There was nothing, nor effective therapy … I don’t know what was better if it was the diseases, if it was those effects… Fortunately, then penicillin came… And everything evolved”.
Penicillin began to be introduced gradually in some countries from 1942, although initially it was very expensive and difficult to acquire.
Nurse Nídia recalls that “in the Medical Clinic service, at the end of the 1950s there was still difficulty in obtaining and carrying out treatment with penicillin, the then intramuscular injection known as Penadur 633, which they were going to fetch from the old Coimbra.”
The therapeutic solution for leprosy only appeared in 1977 with the introduction of Rifampicin, being effective later combined with Dapsone and Clofazimine. But it was only in 1981 that this combined treatment for multidrug therapy was recommended by WHO and included in control programs for the so-called Hansen’s disease.
In the context of “social hygiene” that Professor Bissaya Barreto was conductor and “hospital administration and organization”, of its Complementary Nursing Course, Teaching and Administration sections (CEC-1956/1957), the first visit to HCRP, whose memory lasted, was resumed in the light of the new knowledge, allowed Nurse Nídia to reinforce the “very positive impression of that hospital unit”. And that is why she said: “The HCRP was a model, with a pavilion design, with well-structured separations. It was based on a concept of a self-sustainable institution. The patients who could afford it resided in a house “their”. The most severely ill patients were admitted to the hospital wards or nursing homes in order to receive care appropriate to their condition.”
And she went on to say: that institution“(…) functioned in a network, very organized, fitting in with the prototype and conception of Professor Bissaya Barreto’s work: modeling in terms of structure and equipment, surrounded by nature, with beautiful gardens, with a means of dissemination and teaching – Revista Rovisco Pais… Because without knowledge there is no progress, just as he conceived for tuberculosis (1932-1942). ”
In 1972, when Nurse Nídia returned to the HCRP with her students, there were no longer many hospitalized patients, but it is recalled that there was a service of “Nursing at home and after hospitalization, in which nurses traveled the region on a scooter, taking the medicine to patients followed on an outpatient basis and watching their intake.”
Nurse Nídia went on to confide: “I must say that in these visits I was not aware of the breadth of this work, whose brigades (with nurses and social workers) were going from Minho to the Algarve, overcoming illness and the social and survival needs.”
Later, already in the 1990s, Nurse Nídia accompanied groups of nurses from the Escola de Quadros (France), under cooperation protocols with the EEAF. The program included visits to the Mira Health Center or the Figueira da Foz Hospital, passing by the Rovisco Pais Hospital, in Tocha. It is recalled that on one of these visits, they verified the existence of Hansen’s former patients on the premises of the former HCRP, whose stay was justified by those who guided the visit and, according to the retained, thus: “(…) the patients sacrificed themselves, fulfilling the social isolation, leaving their communities, their families and homes, in favor of the whole, that is, of society. This fact justifies a “debt of gratitude” towards them, and that the State guarantees the continuity of the support they need, after the cure, in cases in which family ties and age, and /or their weakness, have been lost, or the preference of staying there, as they consider it to be their home.”
These visitors, in the evaluation of the visit, shared with Nurse Nídia their “admiration for the organization of that hospital unit, considering it to be a model”. As she explained: “although they were going to see a reality that was no longer the initial one, but it was still possible to understand the original concept and see the houses with some ex-patients. It was quite noticeable that ex-patients considered those houses as their own, assuming that this was their world.”
At the end of this sharing of memories, Nurse Nídia, with a strong personality and convictions, built on the basis of an experience of eight decades of life, which supports her comprehensive vision of the environment, requested that this testimony also include a reflection with its interpretation of the facts and in a dialectic between the past and the present.
And it was in this sense, that she stated: “From what I lived and learned, I reacted badly to a report that passed a long time ago on television, in which a lady, who I did not realize was a doctor, admitting that she was not, in what clearly, by the gestures and words prompted the demand for compensation for a daughter removed from her mother and raised at the HCRP Preventory. I did not realize that the reason for this separation was well explained. No mother and/or father who had gone through the suffering caused by leprosy, the stigma of this disease, and who were disfigured by this disease, which when explained to them that the children of the lepers were not born lepers, but would be without preventive measures, like that, were against the protection of their children, despite the suffering caused by the separation. Being able to follow the development of their children, knowing them well cared for and with conditions that they would not have in their own homes, surrounded by beauty, by color, as were the works dedicated to children conceived by Professor Bissaya Barreto, certainly mitigated your suffering. For the mother, the greatest good is always that of her son, with very rare exceptions. I didn’t realize that it was explained to that daughter, that this measure was the greatest gift of love in her favor. ”
She continued, drawing a parallel with tuberculosis: “Throughout my professional practice, and not only, I heard of several cases of children infected by grandparents and other family members. Some, dramatic, in the hospital rounds, which took place at the Pediatric Service of the Hospitals of the University of Coimbra. The last I heard was in 2015, in an interview I conducted with a 95 year old woman who had four children, having lost a girl (10 months) and a boy (14 months) infected by tuberculosis by her paternal grandparents… Also in the HUC’s Medical Clinic, in 1959, we received a infected child by his father … who ended up staying in the infirmary for about two years before being adopted. But there were other cases with children as well… It was a reality that we were faced with at the time… ”
Nurse Nídia also said: “What we are experiencing now with the Coronavirus leads us to make a parallel with the social isolation of hansenians and with the acceptance of the established prevention measures. What happened then, will happen now, and will continue until there is effective therapy or vaccine. The difference is that the spectrum is now wider, and therefore much more difficult. With Leprosy, isolation of the infected was enough, and then therapy … to win the fight. ”
In summary, Nurse Nídia said: “the HCRP, was designed to detect and stop the spread of the scourge of leprosy in Portugal, at a time when there was no specific therapy, betting on prevention, even better days. It accomplished its objectives. Its design, organization and operation is paradigmatic of a work by Bissaya Barreto. The elements that characterize his works stand out: a pavilion design, in a network, implanted in the heart of nature, surrounded by gardens, which give it beauty and color, sun. Containing, also an agricultural part to fulfill the design of self-sustainable Institution. The hospital part complies with the Bissaya Barreto seal, from construction materials to equipment. In the hospital pavilion, exposure to the sun is very evident. As in the spaces dedicated to children. The rules, the discipline, the rigor, were breathed.”
And he added lastly “due to the bibliographic consultations that I have been doing over the years, HCRP was considered by the experts who visited it as a model leprosaria.”
(Text based on oral testimony, in 2020, validated by the interviewee. Interview and writing by Cristina Nogueira – CulturAge)