Historiographic and biographic accounts of Faroese nurses’ training and health-promoting work from 1910 to the end of the 1930s

ABSTRACT

The Nordic country Faroe Islands consists of 18 mountain islands situated in the North Atlantic Sea. In the late 1800s, nursing in the Faroe Islands was behind international standards. A transition towards organised nursing commenced when Danish deaconesses arrived in 1897; their missions were to serve as nurses and train Faroese women in nursing. The overall aim of this research is to add to the history of Faroese nurses’ training and work during the first decades of the 1900s, decades when Faroese nursing became visible through the presence of deaconesses and trained nurses. With historiographic and biographic approaches and in the context of Faroese history and nursing theory and research, we present accounts about four Faroese nurses’ living, training and work during the three first decades of the 1900s. These years were progressive for Faroese nursing in hospital care and public health around on the islands, and a struggle to combat tuberculosis took place. We conclude by emphasising the importance of considering the beginning of professional nursing in a small faraway country where resilient nurses worked with ingenuity and often exceeded geographic and professional boundaries to help and support sick and injured compatriots, promoting their health and well-being.

KEYWORDS:

• Biography
• Faroe Islands
• historiography
• nursing education
• nursing history
• Pirka
• tuberculosis

Introduction

In the Faroe Islands, today an independent country, though a Danish county from the Kieler Treaty 1814 to the Faroese Home Rule Act of 1948, [1,2,3] organised nursing began in 1897 with the arrival of two Danish deaconesses. This was a landmark in Faroese nursing history, preceded by decades of preparing for better health and nutrition in this faraway and poor many-islands Danish county, which was quite unknown in mainland Denmark [4]. Active preparation began in the 1870s when the chief medical officer and the clergymen repeatedly expressed the need for trained nurses in the Faroe Islands [5]. They knew that order, cleanliness, and good hygiene were essential health factors in preventing the diseases and epidemics that caused havoc on the islands, such as measles, diphtheria, tuberculosis, and others. The wish was that local women not only should care for sick family members at home, as was the tradition; but they should also, as in other countries, be trained as professionals, as nurses [6].

If, in addition to an independent economy, a trained nurse was employed, there would be a greater guarantee that everything concerning the care of the sick would be as prescribed by the doctor. … The introduction of a trained nurse will cause Faroese young girls called to nursing also to seek training. Their skills can later be used partly in their homes and partly in the settlement they may live in later in life.¹

Over the years, correspondence continued between the medical health officer of the Faroe Islands and the principal pastor and the lady superintendent at the Danish Deaconess Foundation in Copenhagen, Denmark. All knew that health on the Faroe Islands was behind international standards, stressing that trained nurses would improve population health and wellbeing. From 1897 to 1948, 25 Danish deaconesses served on the Faroe Islands [7] and their nursing understanding coloured both hospital and homecare nursing in the country. To begin with, the deaconesses’ services in the Faroe Islands concerned hospital and home nursing; they were supposed to organise daily patient care, educate Faroese young women in hospital nursing, and improve health and nutrition for poor families. Furthermore, their task was to inspire young local women to become nurses and to establish a school of nursing in the Faroe Islands. The focus of this study is to account about the first trained Faroese-born nurses. After the arrival of the deaconesses, the chief medical officer and the deaconesses slowly but steadily managed to persuade the Faroese young women to start nursing training. And consequently, in the 1910s, more than ten years after the arrival of Danish deaconesses, the very first Faroese young women travelled to Denmark to be trained as nurses in the capital Copenhagen. Some of the girls trained at the Danish Deaconess Foundation [7], others trained at the newly founded nursing school at Rigshospitalet in Copenhagen. It took an additional 10 years before in 1920, a school of nursing was established in the Faroe Islands and staffed by Danish deaconesses and the chief medical doctor.

There were several hindrances that can explain the slow start into establishing a Faroese nursing school. Important issues to deal with were harsh working conditions, poor staffing, and low interest in general. This had previously also been the case in Denmark, as the first President of the Danish Nurses’ Organization Charlotte Norrie (1855–1940) described in The American Journal of Nursing in December 1900 [8].²

How will you explain the fact that the nurses have not asked for a school? Well, they are overworked, they have not sufficient brains left to work out plans nor to make a stir in the matter. Their hours on duty are too long: twelve hours night duty, fourteen hours a day, with only time left for meals and one hour during the day for a walk or a rest. And very often, almost every day, the nurse has to do overwork if she will finish what she has been ordered to do …. We must admit that overworked nurses are not able to work out plans for better training, etc., …I think the first thing we must work for is “shorter hours”, hoping that when nurses are no more overworked they will be able to introduce all other necessary reforms themselves.

Other explanations to the slow start could be the need for the daughters to remain in their homes, and by that no interest to move them to Torshavn to begin an education where they would not even receive a salary. Furthermore, a possibility to be trained in nursing was competing with other jobs, especially the rapidly developing fishing industry, offering young women a paid job without shifting hours. With these matters in mind, the objective of this article is, with accounts from some of the very first Faroese women’s nursing training and work abroad and at home, to contribute to the history of Faroese nursing from its early and tiny start in 1910 to the end of the 1930s.

Background

Situated in the middle of the North Atlantic Ocean, the Faroe Islands is today a progressive and self-governing territory of the monarchy of Denmark; it has its own legislative assembly (Lagting) and parliament (Landstýri) [9], an up-to-date infrastructure with tunnels between many islands, a growing population of about 54 000³ and a strong economy. Faroese nursing is since 2008 an academic discipline at University of Faroe Islands, founded in 1965 to foster a scholarly and scientific Faroese community.⁴ The basic nursing education is a four-year bachelor education much like the Icelandic basic nursing education.

The Faroese settlement around 1900 was very different. Then, this most northern county of Denmark had a small population of about 15000 living in scattered farms and hamlets along the seashore, geographically far apart through high mountains and fjords, which had to be transited by foot (there were no roads and no horses) or rowing boats that demanded several rowers when residents needed medical or healthcare assistance. On some of the biggest islands there was a physician, on other sparsely populated and faraway islands there were weeks and up to years between a doctor’s visits [5]. The Faroese men were farmers and fishermen away from home, fishing around Iceland or Greenland for months [10,11]. The Faroese women, as women in other rural areas [12], took care of home and family during sickness and health [5]; the young people could work on other islands, some went to Denmark for advanced education; and seriously ill patients of all ages got hospital care in Denmark, whereto they only could be transported by ship during spring and summer. A journey to Denmark or Norway took several days and could be quite unpleasant, and in wintertime it was too stormy to sail. Thus, the Faroe Islands’ remote geographic site in the North Atlantic produced quite specific life challenges though created a strong, helpful, and religious population [13,14]. For them, men and women, life demanded hard work and frequent sacrifices. Sven Barthel (1903–1991), a Swedish author visiting friends on the small mountain island Skúvoy in the 1930s and Danish Grete Gravesen (1903–1985), who for five years in the beginning of the 1930s lived on Sandoy with her husband, the local doctor, have described the Faroese women as solemn, thoughtful and worried-looking [15,16]. Without doubt, this was due to the women’s hard and serious life at home and their continuous anxiety about their sons and husbands who for months were far away on fishing trails on small ships. Grete Gravesen beautifully stated:

All through wintertime there has been big bustle in the homes. The men have been carding and spinning, the women have been knitting sweaters, socks, and mittens in the hundreds. Now everything is ready, and the day of sorrow is approaching. The fishermen are dragging on Icelandic fishing trails. … The oil clothes and all the good, warm knitted things are collected. The pictures of the loved ones are kept in the ship chests. Hands are awkwardly waving goodbyes. The women, left behind on the beach in close clusters, are crying. They know that very rarely will all return. … It became infinitely empty after their departure. We were missing the many faces we know and love [16].

The women at home knew about the dangers and the accident risks; they had lost friends and family members, and they feared not seeing them again and managing their household without them. Because of these life-threatening challenges, families were used to help and support each other [5], and Christianity had for centuries been significant in Faroese culture and life. The Faroe Islands is described as the most religious country in Europe and the least secular among the Nordic countries [13,14]. The Evangelical Lutheran Church is and was the state church, and in the period in question, it consisted of several independent local congregations, however run in accordance with a common set of rules. The biggest of them were then, and still are, two groupings with different philosophies, The Brethren Community inspired by Scottish Calvinism and the Missionary Community, inspired by Danish Grundtvigianism [17,18]. Thus, both the philosophy of deaconesses and the tradition of strong attachment to Christianity constituted the background for the local young women entering nursing in the beginning of the 1900s.

This study evolved through a longtime interest in nursing history joined with previous research that Faroese nursing is invisible both in the country and abroad [19,20]. We agree with others that seeing the big picture of one’s profession develops professional pride and identity [21–24]. Knowing about nursing history might encourage reflections on beliefs and values among modern nurses [25,26], and we agree with the hermeneutic phenomenological view that the past governs the future and that anecdotes often carry a universal value [27]. Also, we three authors are descendants of caring science scholars [28–31] which influences what we over the years have valued in nursing and nursing history.

The study is the second part of a comprehensive research programme about nursing on the Faroe Islands during the 1900s. In a previous part, we presented accounts about the Danish deaconesses who served in the Faroe Islands from 1897 to 1948, to begin with as hospital and homecare nurses, later also as educators and matrons [32]. The aim of this study is to present accounts from some of the Faroese nurses who trained and worked in the beginning of the 1900s, more precisely from the 1910s to the end of the 1930s. What kind of training did the young women get? How were work and training organised? What did the trainees learn? What did the women do as trainees and after graduation as professional nurses? And what happened if, or when, they married? As far as we know, a story from this time has not been told internationally, and it might join descriptions of nursing development in other countries [33–35]. Even so, as Faroe Islands is a remote, northern, and religious many-islands country, its nursing history is unique and needs to be told. The research thus increases the state-of-art about circumpolar health history and of the history of Faroese nursing.

Method

The study has both historiographical and biographical approaches [36,37]; it is historiographic because it is a study of nursing history; we present, critique and comment on a selection of accounts of primary and secondary nursing history sources in books and texts as we as Nordic nurses ourselves see it. And the study is biographic because we refer to decisive episodes and stories as told in Faroese by nurses and others about nurses’ life, work, and training experiences. One main Faroese source was Wanja Petersen’s Frá Diakonissuni til sjúkrasystrina with the purpose to make visible nursing on the Faroe Islands from its start in the beginning of the 1900s and up through the century [36,38]. Petersen’s book presents interviews in I-form with now deceased nurses about their life and working conditions. Because primary sources are lost, data from this source can, according to the Norwegian historian Knut Kjeldstadli [39:185], serve as primary sources. Another main source was Føroyskir sjúkraarøktarfrødingar 1912–2007, a book based on a structured interview among all women trained as nurses in the Faroe Islands [41]. More than giving personal and family data, often with a photo, this source talked about where and when the nurses were educated and where they had worked or were employed. The source thus was priceless in the beginning of this research. It gave the authors a big picture of Faroese nurses and their work from its early beginning. A third source was Haandbog for Sygeplejersker (Handbook for Nurses). This textbook was written by the two Danish physicians Holger Iacobaeus and Aage Kiaer, who since 1896 had lectured at the community hospital school of nursing in Copenhagen. In 1904, they published their lectures as the first Danish handbook for nurses [42]. The handbook, used for at least the next 25 years, was a small compact textbook (5,1 by 7,8 inches) of almost 300 pages with detailed descriptions about what a nurse should know about the body in health and sickness, how she should follow the doctor’s orders, know about different parts of the sick person’s body, handle threatening conditions, and see to the sickroom. There are chapters about health, diseases, general nursing, nutrition, bandages, first help at life-threatening conditions. The book ends with a short chapter about infant care and a comprehensive word register. A most detailed chapter concerns aseptic and antiseptics, different types of wounds and their care, remedies, and measures to use for infections and wounds to prevent sepsis, tetanus, or childbirth fever. Furthermore, the authors advised about personal hygiene necessary to prevent infection and contamination, asking for the best possible hygienic conditions, for general cleanliness and tidiness, and for healthy and strong nurses.

To foster transparent, trustworthy, and coherent narratives of the past [43,44], our interpretations of the accounts are presented in two periods of time. We present what we call the pioneer time lasting from 1897 when the first deaconess arrived, to the year 1919. At that time, the interest in nursing was, as previously mentioned, poor among the Faroese young women. Although, a few Faroese young women got nursing training at Danish schools of nursing. Also, we describe memorable nursing events from the early 1920s, the first years of organised nursing training in the Faroe Islands. The stories told from these two periods are our interpretations of data from Petersen and others [45–48] and a one-hour telephone interview 7. September 2022 with Majken Hentze, daughter to one of the nurses, Ida Magnussen, about her reminiscence of her mother’s life and work. After writing up Ida’s story, we contacted Majken Hentze, and she approved the sections about her mother.

The early nursing training

In Denmark, Queen Louise (1817–1898) founded the Danish Deaconess Foundation in Copenhagen in 1863 and by that the first school of nursing of the country in a Protestant Lutheran tradition [7]. Some years later, a secular nursing school tradition started. To secure organisation, common standard and development of the profession, Danish nurses established the Danish Nurses´ Organization (DNO) in 1899 [49]. From start, DNO had as one of its main objectives to work for a three-year nurse education with both practical and theoretical contents [46]. This objective was big and difficult to reach, much because women at this time were seen as natural caring creatures which were considered enough to care for sick people. To strengthen its plead for a longer education, DNO, a couple of years later, stated that a three-year hospital education was a demand to achieve trade membership. So, during the first decades of 1900, schools of nursing were established in mainland Denmark.

In the Faroe Islands, the development was slower. In the end of the 19^th century, the Faroe Islands had a handful physicians and some midwives [50], but other trained healthcare providers were almost absent. Care of the sick, the injured and dying traditionally took place at home according to the “family model”. Families and neighbours helped each other at disasters, in sickness, health and death. When needed, they were supported by local people, clergymen, lay healers, and other enlightened people which constituted much of the spiritual and medical care [47].

Trained nursing in the Faroe Islands began when, in the summer of 1897, Danish-trained nurses arrived in the Faroe Islands. One of the first pioneers was Sister Mette-Katrine Thomsen (1870–1959), a deaconess, trained at the Danish Deaconess Foundation in Copenhagen and with several years of service at Danish hospitals [38]. Sister Mette-Katrine served in the Faroe Islands, at the hospital in Torshavn and as the very first public health nurse, for almost two decades. Her letters to the motherhouse showed that working and living conditions were hard and primitive. When she began to work in 1908 as a public health nurse, she reported to her superior in the Danish Motherhouse in Denmark, pastor N.C. Dalhoff (1843–1927).

I’m trying to make it look like parish care in Denmark. The people here are kind to me. The priest has been friendly towards the whole thing. The doctors have been good to call me whenever there are patients. The poor are helped with peat, food, and clothes. I hand out reading stuff, look after the elderly when time permits, sing for one or two for which they are grateful. It is not like at home in Denmark, but when you have been here for 11 years and learned to love everything, you can help to improve conditions.⁵

This excerpt shows that Sister Mette-Katrine was respected by people, doctors, and clergymen; it demonstrates her love, caring and compassion for both country, patients, and staff. The letter further reveals that the weather was windy and rainy, and her oilskin coat was indispensable while walking long distances up and down hills and mountains to see patients and families.

The public health nursing thus was new in the beginning of the 1900s contrasted to the hospital care. The Faroe County hospital situated close to the sea in the capital Torshavn on the island Streamoy was built in 1829 on private initiative [47:143–145] and could at first accommodate nine patients, but after rebuilding and modernising (windows and indoor air toilet conditions) in the 1860s, up to twenty patients. In 1897, the total number of patients were 102 with an average of eight days hospitalisation [47:171]. The patients had many different diseases, but several were admitted with a broken leg or a lost finger [47:174]. A foreman and his wife managed the hospital with the help of both male and female attendants, who continuously were watching over the patients [47:168]. The hospital conditions were quite poor, the walls were thin, dark, and leaking, the doors could break during stormy weather, and at nights rats occupied patient bedtables eating food leftovers. This old hospital in Torshavn was at that time one of three hospitals in the Faroe Islands. The other two were younger, lighter, and modern, one opened in Klaksvik in the north in 1898 and one in Tvøroyri in the south in 1904 with respectively eight and twelve patient beds [48]. In 1908, a sanatorium was opened, because tuberculosis then was a plague. And in 1924 a new bigger hospital, accommodating 52 patients, Queen Alexandrine’s Hospital, was opened in Torshavn [49]. Some years later, a unit for tuberculosis patients was added to the hospital, and in 1933 units for children and epidemiologic patients were opened.

From attendant to trained nurse

A nurse-to-be who began her work life as an attendant at the new Klaksvik hospital was the Faroese young woman Thomasia Arnason (1893–1979). Thomasia was born on the southernmost island, Suderoy, and started to work as an attendant at Klaksvik hospital on the northern island Bordoy at the age of 22 [40]. She lived in a tiny attic chamber at the hospital and was far from her family on Suderoy. Thomasia was one of the hospital staff of four, one physician, one nurse, and two attendants who 24/7 took care of 15–20 patients. Despite poor resources, this small hospital staff cared for the patients and performed major surgery under quite primitive, though creative, conditions. The nurse administered anaesthesia and one of the attendants assisted the surgeon. Interviewed at old age, Thomasia had not forgotten the way things worked in old days.

We used a storm torch and a standard torch in the operation room while the light/lamp in the hospital rooms was a jam glass with rape oil where a piece of cork with a wick was floating [38:68].

Thomasia had varied duties during a workday without day and night shifts. She was responsible for the hospital economics; she bought the food and cooked for the patients, and when critically ill patients were admitted, she was supposed to sleep on the floor besides them. The daily work started at 6 am, and when a patient needed surgery, she first had to serve breakfast to the other patients and give them a bedpan before preparing the patient for surgery. Her work was quite like a housewife’s. She had to keep up the household in general with its multifaceted tasks. On top of that she had to act as an expert nurse and carry out shifting professional demands under poor conditions. This is demonstrated in her statement about handling a critically ill patient.

Dr Heerup went to Torshavn and Jógvan Zachariasen from Fugloy replaced him. He was a patient and meek man. I remember he admitted a boy with a throat inflammation. The nurse was on vacation for a few days, and I was alone. Of course, we operated on the boy immediately and put a tube in his throat (tracheostomy tube).At night, the condition worsened, and I had to call Zachariasen. Back then, there was no phone, so I had to run by feet to him. Zachariasen hurried to put on a pair of trousers and ran the best he could. While we were running, he asked me to grab a feather. I hurried to the basement and grabbed the rooster and jerked off almost his entire tail. I fetched a good feather and hurried to the doctor. I dipped the feather in alcohol and handed it to Zachariasen and he cleaned the tube. It helped and the boy recovered [38:69].

The excerpt gives us an example of the primitive working conditions for both the physician and Thomasia, at that time a nurse attendant; it represents preorganized nursing and conditions that demanded good observations, fast actions, and great ingenuity (the feather) in emergencies. And not to forget, good dynamics between doctor and nurse. No wonder that Thomasia remembered that episode with pride all her life. Her story revealed the harsh working and living conditions of early preorganized nursing not only at the Klaksvik hospital but of the time.

Thomasia served as an attendant at Klaksvik hospital until she in 1924 started as a nurse trainee at the hospital school of nursing at Queen Alexandrine’s Hospital in Torshavn wherefrom she graduated as a nurse in 1927. After graduation, Thomasia wanted to further supplement her training, and for some time she worked at The Christmas Seal Sanatorium (a tuberculosis sanatorium for children) situated by Koldingfjord in Denmark. Back in the Faroe Islands she worked at the hospital in Tvøroyri, at Queen Alexandrine’s hospital in Torshavn and at the sanatorium outside Torshavn; she was also one of the nurses who accompanied mentally ill patients during the sailing to Denmark for their admission to a psychiatric hospital. Thomasia Arnason thus had a broad nursing knowledge. In 1934, Thomasia married Herluf Arnason (1902–1978) a priest in the Ebenezer church in Torshavn, and she stopped working as a paid nurse [38].⁶ Instead, she assisted her husband in his work as a priest. The couple became known for their ease in speaking to people, and they are remembered for singing at the hospitals and at religious meetings. Often, Thomasia was asked to visit dying compatriots; she prayed for them and read from the New Testament that she always brought with her.⁷ Thomasia, thus, is an example of a nurse representing the Deaconess religious tradition that furthered both the Protestant Lutheran Church and the deaconess tradition stressing the importance of spiritual care [7].

Nursing training in Denmark

One of the Faroese young women who got their training at hospital nursing schools in Copenhagen, Denmark, was Petrina Petersen (1893–1990) from Fuglafjordur, the main shipping village on the northern island Eysturoy with about 600–700 inhabitants in the early 1900s [38]. Petrina was one of the oldest of a noticeably big family with 18 children. Her father was a fishing merchant owning several big ships, and thus an important shipping man. In 1914–1917, Petrina trained as a nurse at the Copenhagen municipal hospital. We know that nursing training in Denmark at this time consisted of both theory and patient care as well as training in the laundry and hospital kitchen learning about nutrition and dietary cooking. After graduation Petrina worked abroad for a year, first in England in a recreation home for tuberculosis and later at a charity outpatient clinic at a deaconess hospital in Edinburgh, Scotland. There Petrina participated in all sorts of emergency nursing. “I enjoyed this immensely”, Petrina stated, “… we rinsed and sewed wounds, fixed broken legs and luxation, and lots of other stuff” [38]. When interviewed at an old age, she remembered her work abroad with pleasure. What she learned proved to be quite valuable for her future practical nursing career combined with being a housewife.

Petrina’s stay in Scotland was shorter than planned. The family needed her because of sickness among their members. Shortly after homecoming, Petrina married and ceased working as a paid nurse, but she did not stop being active in taking care of others. There was no local physician in her home village Fuglafjordur at that time, and therefore sick friends, neighbours and foreign sailors came to her for help and support when needed. Then she was called for and she stated:

None of us were asked to take care of people, nor were we employees to do so. It just went without saying that we helped people where we could and guided them as we thought was the right thing to do. If they needed medical attention, we asked them to call the hospital in Klaksvík or we did the call ourselves. The doctor in Klaksvik observed that I could stitch cuts. He provided me all the remedies, and I have indeed sewn and cleaned many wounds by my own. I have also managed to get joint luxations in place [38:39].

For decades, Petrina and another trained married nurse took care of sick and injured family members, neighbours, foreign sailors and compatriots in villages and hamlets around their island. There were no others. The Klaksvik hospital physician supported them with medicine, sewing material for wounds, and whatever they needed of supervision. Petrina e.g. says that she assisted the midwife with anaesthesia, something she also had learnt in Scotland, and she took care of sick and injured people even on Christmas Day.

Nursing training in the Faroe Islands

The year 1920 was a landmark for Faroese nursing. That year a new-established nursing school received its first nurse trainee, in 1921 two more started, and the following years, one to four young women were admitted each year. The first trainee was Sunneva Magnussen (1901–1988) from Husavik on the island Sandoy, and some months later Ida Magnussen (1902–1999) from Saksun on the island Streymoy and Elisabeth Djurhuus (1899–1975) from Fuglafjordur on the northern island Eysturoy began their nursing training. Three Faroese young women from different islands began a three-year nursing training. We cannot but wonder what called them to enter this education. It had not been easy to recruit young Faroese women to nursing. Already in 1904, the chief medical officer tried to get young people from around the farms and hamlets to the hospital but had to give up because of lacking attendance. We also know from Petersen [38] that the parents of Ida Magnussen were influenced by the chief medical officer Hjalmar Heerup (1886–1961), who visited the family at summer times. And we know that two of Ida’s brothers⁸ studied medicine and pharmacology respectively. Nurse training thus might have been a good option for their daughters, considering that when married they had attractive and useful experiences as housewives. It could be that doctor Heerup also visited other families with the same purpose, to inspire parents to let their children get an education, their young daughters for example in nursing; he knew that the need for trained nurses was huge and that it was his responsibility to improve the situation.

Ida Magnussen’s story. Ida Magnussen (1902–1999) was the second of ten siblings, who, from her 6th to 14th year, went to school every fourth week. There was no school or classroom in her home village Saksun. A wandering-teacher came regularly to their home and taught the village children first to write and count, later also to read Faroese. At the age of 18 and for a three-month stay at a folk high school (folkehøjskole), Ida was taught how to write in Faroese. And in the beginning of 1921, she started nursing training at the old Faroe County hospital. At the age of 95 she remembered her training as follows [38:51–52]:

1 February 1921, I went to the hospital and stayed there for two years. It was easy to be accepted, there were no demands. There was only one trainee at the hospital when I came … and after a month another trainee, Elisabeth Djurhuus, came. The trainee-time was mostly work, once a week for one hour we had teaching, by the senior consultant doctor Heerup. It took place at his home. Once a week for two years. … But the ward sister taught us about diseases during working time.

No doubt, the nursing education was a demanding, practical on-the-job training in a strictly hierarchical hospital organisation with the doctor on top. Ida stated that there were no admittance demands to be accepted as a nurse trainee. But later she realised there were plenty of demands – however unspoken! The deaconess nursing school was well-known to be as a strict training school, and working hours were extensive. In Denmark, the most important characteristic to become a good nurse at that time was the trainee’s disposition; she should demonstrate compassion, cleanliness, order, honesty, punctuality, silence, discipline, self-restraint, and politeness [50,51]. However, the young women who chose nursing as their way-of-living were more than trainees; they were first and only, as Ida mentioned, a main and cheap work force doing whatever tasks their senior staff member asked them to do. Working hours were long, often more than 12 hours, and there was little or no time for leisure. Main daily tasks were cleaning, making beds, sorting, and washing patients. When working nights there were duties such as bedside care, cleaning, and sorting, tasks that stretched until late morning. During night shift, the trainees also looked after mentally ill patients in The Cell, a small house specially built for mentally ill persons, while they were awaiting sailing transport to a psychiatric hospital in Denmark. The waiting could be long because for several months during wintertime there were no shipping between Denmark and the Faroe Islands. The weather conditions were too stormy and harsh for sailing. Another night duty was to clean ashes from all the stoves, carry the ashes down to the seashore and throw them in the sea. Teaching was sparse in the nursing training; it took place in the evenings, in their time-off after long working hours. The physician gave lessons in his home using Iacobaeus’ and Kiaer’s Handbook for Nurses. He lectured about anatomy, bacteriology, hygiene, and other medical matters. The matron also used this textbook; she taught about spiritual care, healthy environments, dressing, fundamental patient care, how to manage mouth, eye, and ear care, to give an enema, and different kinds of baths and bandages. The handbook contained detailed descriptions of these and other matters [41].

During the two first years of training at the Faroese hospital school of nursing the trainees were caring for patients in treatment for medical or surgical conditions. The last year was “the supplement year” and took place at hospitals in Denmark. There, the trainees learned about psychiatric, obstetric, and paediatric diseases, treatment and nursing care. The transition to training abroad, to the same country but with quite another culture, made deep impression on the trainee Ida Magnussen. She remembered especially the strict hierarchy among the staff.

In the time we supplemented in Denmark, there was not a single evening that at least one of the young nurse trainees was crying because of hard work and rebukes from older nurses. We did not cry; we had been told not to [38:61–62].

We find this statement to reflect resilience. Ida came from a big family in a small-scale country where “everyone is aware of society’s thousand eyes and ears” [52:58]. Ida seemed to be strong, and she knew that an individual’s action, if considered rude, easily could generate bad reputation with huge consequences. Also, Ida probably was aware that she, being one of the first trained nurses, was needed at home in the Faroe Islands.

After graduated as a nurse in 1923, Ida Magnussen worked, first as a clinical nurse at the hospital in Tvøroyri on Suderø, and then for several years as a ward sister at Queen Alexandrine’s hospital in Torshavn, the new hospital that had opened in February 1924. As ward sister, Ida was obliged to have her residence – to live around the clock – at the hospital. She was off duty half a day each week and every second Sunday. Her hospital work stopped when she in 1932 married and moved to the small island Skúvoy where her husband Johan Hentze lived and where she lived – and worked – the rest of her long life. Skúvoy was a small island with open sea to the physician at the closest island Sandoy. This resulted in restricted sailing in windy and stormy weather. And if, in windy weather, the need for a doctor was necessary, the old men were used as rowers to fetch the Sandoy doctor. The young rowers were too valuable should an accident occur [15].

Ida Magnussen, now Ida Hentze, was the first trained nurse living and working on the small island Skúvoy and thus, we see her as a nurse pioneer. According to her daughter, Ida took the vow of helping her neighbour quite seriously, and cleanliness was for her a big issue, when working professionally as well as a housewife – domestically. Also, Ida was always ready to help whatever she could. For her nursing was a calling. Sometimes too much according to her daughter. Her helpfulness could make her disregard her own children, or in other words, her call as a mother and a wife. The village people had great confidence in her nursing abilities and were much grateful for what she did. And through years of experiences, Ida learnt to recognise symptoms. For example, Ida told her family that she never had made a wrong diagnosis about pneumonia, she recognised the characteristics of these patients.

When needed, Ida and her husband Johan Hentze worked as a team. Ida, the trained experienced nurse, had the knowledge, Johan, a farmer, fisherman and bird catcher on the high mountains, was the practical worker, the handyman. Cleaning the wounds was Ida’s job. When sewing a wound, Ida oversaw the sterilisation and Johan was the one to sew the wound together. There was a medicine chest at the island containing needles and threads but no pliers to hold the needle. Instead, to hold the needle, they used cleaned and boiled beak pincers from Johan’s toolbox. Abscesses and wounds needing treatment were common among the fishermen. For months, the Faroese fishermen lived in small, crowded fishing boats without possibility for taking baths or washing clothes. They brought a medicine chest with them on the ship, but if they got an infected wound or an abscess, they came to Ida when at shore. It was Johan who drained the abscesses with a boiled razorblade, their daughter told. Afterwards, Ida repeatedly cleaned and put a compress in the wound until it started to heal from bottom.

Considering the distribution of tasks in the “wound dynamics” between Ida and her husband Johan, we cannot but wonder. Why this gender division? Why did Ida not do the stiches herself? Was that not part of the nurse training? Probably not, as surgery was a medical doctor’s duty in a Danish and Faroese context. Petrina though, had, as mentioned above, learnt wound care at a Scottish outpatient clinic, and this was a most valuable knowledge that she frequently used and improved considerably by practical training. The national differences in Ida’s and Petrina’s education might provide us with an explanation. The Scottish health care authorities were probably aware that stitching wounds were important due to the many remote places’ nurses were practicing alone [53].⁹ This was probably not the case in the Faroe Islands which mainly took up the Danish model in training nurses and seemingly forgot that the training needed to correspond to the cultural context. Another angle to explore on the question, is to ask if it was common for untrained Faroese men to stitch wounds, and if so, why was it acceptable for them but not for trained nurses? It might be as simple as Johan, being both a fisherman and a bird catcher, was an experienced stitcher by practice. Anyway, Ida was lucky to have him available when no doctor was obtainable. Though, it remains unclear if stitching wounds in this case dealt with gender or solely on practical issues, such as who is the best to do it. Johan might also have been outstanding from other men on the small island, a reason his daughter so clearly remembered these childhood events.

When it came to the spiritual part of nursing, the daughter did not remember that her father Johan participated. Then Ida had a heavy road to go because serious accidents often occurred, and she knew everybody at the island which at this time had about 40 households [14]. Often when someone was dying, Ida would watch at night; she recognised that the nights were the most difficult for dying people. At night, all sorts of thoughts came forward and created uneasiness. We find that Ida’s attitude and actions when a fellow islander was seriously ill and dying, mirrored the deaconess way of thinking that body and spirit formed an entity. Care for body and soul should go together, and nobody should die alone. We also imagine that Ida’s love and care were influenced both by her Faroese religious upbringing and by her years as a ward sister on a medical unit. Her knowing and doing were extensive and so was her responsibility. Because of bad weather, seriously ill patients on this small island could not always get the medical care or hospital treatment they needed. Then Ida had to do the best she could. We would argue, that as the only trained nurse and with no physician on Skúvoy, Ida provided care both dependently, guided by the physician on their neighbour island Sandoy, and independently as a conscientious and responsible professional nurse. It is worth recalling that the first Faroese nurses not only were trained by Lutheran protestant deaconesses but also in the pre-antibiotic period when physicians and surgeons began to ask for a supporting nurse rather than a subservient one. As the New Zealand nurse historian Pamela Wood remarked [54], the physicians needed a conscientious nursing approach rather than just obedience. Ida seemed to have both, obedience, and conscience; she knew that the danger of infection required constant vigilance and scrutiny of hygiene; she knew that loneliness and nights could be troublesome for any dying individual. Thus, we see Ida as an exemplar professional nurse.

Combatting the tuberculosis plague

Through the 1800s and in the beginning of the 1900s, tuberculosis was a plague in many countries, among them the Faroe Islands, killing both children and adults [55–58]. As tuberculosis especially was known to ravage small island groups, there were discussions among medical doctors all over the world about whether the contamination could come through the air with special rain and winds to the islands [59]. Later knowledge was that the contamination was person bound, it went from person to person. In the beginning of the 1900s, research about tuberculosis grew, documenting frequencies among young people living close together, such as soldiers, fishermen and nurse trainees [60–62], and an intense search to find the contaminators, and explain and prevent further spread of tuberculosis contamination took place [63].

In the Faroe Islands, an essential part of the struggle against tuberculosis took place with the help of a team, a medical doctor specialised in tuberculosis and a nurse, with the nickname Pirka. Together this team walked across the islands, up and down the mountains and along the fjords to test the people in villages and hamlets for tuberculosis. The test used was the Pirquet test, a repeated intracutaneous test based on the Austrian paediatrician and scientist Clemens von Pirquet’s (1874–1929) [64]¹⁰ seminal study on one thousand children in Vienna [65]. The nickname Pirka originated from this test and its inventor. The first Pirka in the Faroe Islands was the above-mentioned Elisabeth Djurhuus who, in 1925, shortly after her graduation in nursing was employed by the Faroe Tuberculosis Society. Elisabeth’s work as Pirka was to travel the islands and inform about hygiene and tuberculosis contamination. The objective was to delimit the epidemic by finding the contaminators, who not always were sick, and thereby without their knowing could contaminate others. The tracing took place through finding who had a positive and who had a negative Pirquet test. The negatives were not contaminated but the positives were. The course of action was to drip tuberculin in small skin scratches and after 48 to 72 hours measure the redness around the scratches. The doctor made the scratches, and the nurse dripped the tuberculin, measured the redness, documented, and journaled the results and planned for their trips around the islands. All the Faroese population should take the test, and the team therefore were quite busy travelling back and forth between villages and islands. The planning had to consider when the fishermen were ashore, as they, living close together without possibility to take a bath or change clothes during their months long fishing trails, could be the contaminators; they could spread the tuberculosis to a whole crew and further to the village people when at home.

The Pirka then had a huge responsibility, she not only served as a specialised public health nurse; she sometimes had to stand in for the doctor when he was busy elsewhere or when only one of them could get ashore in bad weather; she was an active planner and organiser; she got known all over the country and her work and assistance was much appreciated [44]. Quite obviously, the Pirka’s responsibility was a big handful, and we compare it with Wood who described the nurses’ job at this time to be nursing the patient, the room and the doctor [66]. Similarly, the Pirka, Elisabeth Djurhuus and those after her, were nursing the patients, they organised time and room for the test, and they were priceless for the doctors.¹¹ And, we would like to say, priceless for the health promotion of the country.

Blurred boundaries between being professional, neighbour and family member

The stories about the Faroese nurses are good examples of blurred boundaries between being a professional and working unemployed following the Faroese family tradition of neighbours helping neighbours, and family members helping and caring for sick, injured and dying at home. The perfect dynamics between the attendant Thomasia and doctor Zachariasen, in an emergency case at Klaksvik hospital, gives us an example that caring, knowing and mutuality are timeless phenomena in good patient care. Thanks to the attendant’s observation and both parties’ ingenuity, the young patient could breathe again. The dynamics between the trained nurse Ida and her husband Johan about wound care is another example. The often-blurred boundaries between the physician and the trained nurse, as shown both in the story about Ida and the story about Elisabeth, are other examples. Similarly, Wood described blurred boundaries between professional and lay home nurses and their practice and knowledge in New Zealand during the first decades of the 1900s [67]. In our study, the Faroe women were not lay home nurses, but quite sure, they knew and collaborated with clergymen, lay healers, other women and compatriots around the islands where they came and were known both as individuals, family members – and trained nurses. Despite the cultural norm that married women ought to stop working and concentrate on family life, both deaconesses and medical officers seemed to acknowledge that trained nurses continued their nursing service after marriage. We assume that they were a great help as a most necessary though informal reserve of nursing labour. In faraway societies and communities, these women, attendants, lay home, and trained nurses were indispensable in the pioneer times, and they might still be. Nordic homecare nursing of today is described to concern family relationships in the primary care of a sick family member [68]. Through a grounded theory study, St-Amant and colleagues found that professional homecare Canadian nursing often was reinforced through familial care [34]. Family members coordinated and couched the home care through consulting and collaborating with professional nurses, who themselves also blended their familial and professional roles. Without doubt, unpaid nurses on the many Faroe Islands made a difference for sick, injured or dying fellow islanders. They were what the Canadian Meg Luxton called a reserve army of labour, they carried an extra ordinary heavy load [33]. One of the Faroese nurses, Petrina Petersen, expressed this a little different. She stated: “… we were as valuable as gold”[38:40].

Conclusion

What are the lessons to be learned from these accounts of Faroese nurses’ training and health-promoting work from 1910 to the end of the 1930s? What are the lessons to be learned from Thomasia’s, Petrina’s, Ida’s and Elisabeth’s stories? Firstly, the stories give a small, though quite important, picture of early 1900s nursing training and working conditions in the many-islands country, the Faroe Islands. The accounts about nursing a century ago are both interesting and of value locally, for Faroese nurses, nurse educators and health managers of today. Our study enriches the local nurses’ understandings but also has limitations; it needs to be critiqued, discussed, and told, again and again. Therefore, we would suggest our study to be included in the history curriculum of the basic nursing study.

The accounts likewise add to the background history for the way nursing as a profession was building on a resilient and proud nursing identity and how a Faroese model for nursing education slowly was established and had indisputable meaning for health and well-being around on the islands. Knowing about old times’ nursing is indispensable for understanding modern nursing, its development, its civic and social importance.

Likewise, the story about the four Faroese nurses has both Nordic, interdisciplinary and global meaning; it demonstrates that the beginning of professional nursing on these remote islands with harsh landscape and a culture marked by family closeness and dangerous fishing traditions, took place in tight dynamics between the medical health officer, Danish deaconesses, and Danish schools of nursing. The deaconesses came to the Faroe Islands and the very first nursing trainees went, or were sent, to Danish schools of nursing.

Furthermore, the accounts show how local nurses followed the Faroese family culture and the strong religiosity. Early local nurses had to cross geographic and professional boundaries and expectations to fulfill their call; they worked according to their training, the doctor’s order and further than so; they also worked independently when no doctor was available, and sick or injured people asked for help and support. Alone and in teams, employed or unemployed, they prevented death, diseases and contamination and cared for sick, wounded and dying fellow islanders at any time of the day and the year. They really promoted health and we ought to be proud of them. Our study thus is an example of nursing as a calling; it enlightens what underlying norms, practices and principles were valid in the beginning of the Faroese nursing tradition both when working in hospital and as a trained nurse – living, working, and promoting health – on some of the many far apart islands.

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Notes

¹ Chief medical officer Carl Strüwing Boeg in the newspaper Dimmalaetting 27. June 1896 (Quotation translated from Faroese)

² Charlotte Norrie attended in 1899 the International Council of Women meeting in London; she was among the nursing delegates founding the International Council of Nurses (ICN) 1899.

³ Hagstova.fo

⁴ setur.fo

⁵ Letter dated 26, June 1908. Archives of the Danish Deaconess Foundation, Frederiksbjerg, Denmark (A-DDF). (Quotation translated from Danish).

⁶ In the Nordic countries, as in other Western countries until the 1960s, the norm was that women could only fullfil one vocation. This meant that a trained nurse had to choose between the professional vocation and the call to be a wife and mother.

⁷ https://evr.fo/herluf-arnason-1902-1975.

⁸ William Magnussen (1904–1989) physician, specially trained in tuberculosis; J.Dávur Magnussen (1912–1975), country pharmacist

⁹ McAlpine has mad a wonderful account about her work as a young nurse at the Scottish / Shetland Island, Fair Isle in the 1960s, and how she dealt with medical issues on her own. The conditions and worries for a nurse were even this much later like the Faroe Islands at the turn of the century.

¹⁰ Clemens Peter Freiherr von Pirquet, a great physician-scientist who described serum sickness and pioneered the understanding of allergy.

¹¹ The most known among the tuberculosis doctors was Wilhelm Magnusson, Ida’s brother. He even got his picture on a stamp when, decades later, the country celebrated his tireless travels around the islands, testing and vaccinating the population. Vilhelm Magnussen also initiated a law demanding regular Pirquet tests for the Faroe young people who wanted to be sailors or nurse trainees. https:dk.stamps.fo/Shop/tem/2008/0/PPA0002008/SETT