Last week, the Office for National Statistics confirmed what many had suspected since the start of this pandemic – black, Asian and minority ethnic people are far more likely to get and die from coronavirus. But it is the scale of difference that is so worrying. Black people are more than four times more likely to die from Covid-19 than white people. Even after taking into account age, underlying health and income factors, they are still almost twice as likely as white people to die from the virus.
The government has promised that a review by Public Health England into how ethnicity affects vulnerability to coronavirus will be published by the end of May. It can’t come soon enough: among frontline NHS and social care workers, the difference is all too stark: despite accounting for just 20% of the workforce, rising to 44% among medics, 94% of doctors and 71% of nurses who have died from Covid-19 were black, Asian and minority ethnic. It has prompted NHS England to recommend risk assessments for BAME frontline staff to reduce their exposure to the virus.
Other pandemics have also proven deadly for medical staff. Health workers caught flu during both the 1918 and 1957 and 1968 flu pandemics. And while an ethnic breakdown of the data is not available, some of the casualties of the 1957 and 1968 epidemics will have been black, Asian or from ethnic minorities. It is even possible some BAME nurses working in the UK died in the 1918 epidemic. We just don’t know. But nurses from BAME backgrounds have been working in the NHS for generations. Although many were part of the Windrush generation, coming from the Caribbean to the UK from 1948 to 1971 to work in the newly established NHS, they were not the first arrivals.
By 1954, more than 3,000 Caribbean women were training in British hospitals. By 1959, official statistics showed 6,365 nursing students in Britain who had come here from overseas. By 1966-67 the total number of nurses and midwives from overseas who trained here had risen to 16,745.
Research (Aunt Esther) by social historian Stephen Bourne has revealed that black nurses worked in the healthcare system long before the NHS was even thought of. Most would have been from within the British empire, including the Caribbean, India and countries in Africa.
Bourne believes that their experiences were far less negative than current thinking might have us believe. “We shouldn’t stereotype black nurses’ experiences, nor victimise the nurses who came as part of the Windrush generation,” says Bourne.
“We know that black nurses from Britain’s former colonies, including the Windrush generation, began to arrive in Britain soon after the founding of the NHS. However, the back story of the nurses who came here before 1948 is not known.
“As far as I am aware, none left any testimonies, so we do not know their point of view. They would have confronted some racist attitudes, but they would also have been loved and respected by their contemporaries in the medical profession, and their patients.”
Most will have at least heard of the Jamaican nurse Mary Seacole, a contemporary of Florence Nightingale, who also nursed troops in the Crimean war. Other, less well-known black nurses include Annie Brewster , a nurse originally from St Vincent , who moved to London as a child in the 1860s, worked at the London hospital in Whitechapel from 1881 for 20 years and died in 1902, aged 42.
Brewster worked with elderly patients who were losing their sight. “Brewster was much loved,” says Bourne.
Fast forward to the early 1930s, when Eva Lowe came to the UK from Jamaica looking for work. She eventually trained at St Nicholas’ hospital in Plumstead, south London, from 1932, registering with the Royal College of Nursing as a qualified nurse in 1935.
But it was a difficult time for any black nurse to gain employment in the pre-NHS healthcare system. Before working at St Nicholas, Lowe had applied to 28 hospitals. All rejected her.
One hospital said they had to consider the feelings of the patients; another that she would have difficulty being accepted by other nurses, some of whom were daughters of army officers.
According to the Royal College of Nursing, there are many other stories, as yet untold, of women who trained here and were admitted to the nursing register before the 1930s. No one knows who they were, as the nurse’s ethnicity was not recorded on the register. However, it is known that hospitals in London and Birmingham admitted black nurses for training before that time.
Today, one in every five nurses and midwives are from BAME backgrounds, rising to much higher levels (up to 40%) in some regions and parts of the country, such as London.
“Black nurses in Britain entering the profession today have more role models than I did,” says Dame Donna Kinnair, chief executive and general secretary of the Royal College of Nursing, who trained in the 1980s. “There are far more visible black leaders in health and social care now. But even now, there aren’t nearly enough.
“If the stories of these nurses who made great strides in the early days of modern nursing had been more well known, it may have brought comfort to black nurses who faced prejudice and discrimination, and maybe even stopped some leaving the profession altogether.”
Some black women who nursed in the UK before the NHS started had more positive experiences. Princess Tsehai, the daughter of the exiled Ethiopian king Haile Selassie, trained at Great Ormond Street hospital in London, qualifying as a nurse in 1939, before returning home in 1941 to work there.
“It was a real surprise to find out about her,” says Karen Bonner, a senior nurse and trustee of the Mary Seacole Trust. “The idea of her training here but going back to her own country, I found really impressive.”
Princess Tsehai died in childbirth in 1942, a year after returning home, so never had the chance to pass on her knowledge. But in 1946 Selassie set up a hospital and nursing school in Addis Ababa in her name.
In 1938, another African royal, Princess Ademola, daughter of the chief of northern Nigeria, trained at Guy’s hospital, becoming a state registered nurse (SRN). “Everyone was very kind to me,” she told newspaper journalists at the time. Her patients fondly called her “fairy”.
“The NHS owes a great debt to migrant nurses the world over who answered the call to tend a welfare state in its infancy,” says Kinnair. ‘We mustn’t forget the nurses from Africa, India and the Caribbean who lit the path.
For black nurses working in the UK, just knowing there were others before them is vitally important, says Wendy Irwin, equality lead at the Royal College of Nursing. “For many black nurses this will be a real surprise,” she says. “It’s often been presented that black nurses are a very new thing. But this creates a sense of belonging. It shows that the presence of BAME people isn’t new, but that it is woven into the texture of this country.
“This is a story here that needs to be told,” adds Irwin. “These nurses were not exotic – they were already here.”
