e-ISSN: 2386-4540

https://doi.org/10.14201/reb20231021

Nurses in the “good neighbourhood”: the

Special Public Health Service (SESP) and
the creation of the Nursing School of the
Federal University of Bahia (EEUFBA)
Enfermeras de la «buena vecindad»: el Servicio Especial de Salud Pública (SESP) y la
creación de la Escuela de Enfermería de la Universidade Federal da Bahia

Enfermeiras na “boa vizinhança”: o Serviço Especial de Saúde Pública (SESP) e a

criação da Escola de Enfermagem da Universidade Federal da Bahia

AUTORES
ABSTRACT:
Ricardo dos This article analyzes the role of the Special Public Health Service (SESP), which operated
Santos Batista* between 1942 and 1960 as a bilateral Brazil/United States agency, in the creation of the
kadobatista@hotmail. School of Nursing at the Federal University of Bahia (EEUFBA). SESP reports, collected at Casa
com de Oswaldo Cruz (Fiocruz, RJ) Documentation Center, interviews, legislation and newspaper
news are used as sources, analyzed as bearers of interests of the institutions and individuals
José Lúcio Costa who built them. It is understood that SESP offered technical and financial assistance for the
Ramos** creation of EEUFBA and that the proposal presented the hospital as a central element in
[email protected] nursing teaching activities. Although there were international guidelines to be followed, the
project encountered complications in its implementation, especially due to the difficulty of
maintaining a stable faculty and interference from local dynamics.
* PhD in History from
the Federal University
of Bahia. Professor RESUMEN:
in the Postgraduate Este artículo analiza el papel del Servicio Especial de Salud Pública (SESP), que actuó entre 1942 y 1960 como
Programme in Teaching,
una agencia bilateral Brasil/Estados Unidos, en la creación de la Escuela de Enfermería de la Universidade
Philosophy and
History of Science at Federal da Bahia (EEUFBA). Se utiliza como fuente los informes de la SESP, recopilados en el Centro de
Universidade Federal da Documentación de la Casa de Oswaldo Cruz (Fiocruz, RJ), las entrevistas, la legislación y las noticias de
Bahia (UFBA, Brazil).
los periódicos, que se analizan como portadores de los intereses de las instituciones e individuos que los
** PhD in Public Health. elaboraron. Se entiende que la SESP ofreció asistencia técnica y financiera para la creación de la EEUFBA
Professor at the Nursing y que la propuesta presentaba al hospital como un elemento central de las actividades de enseñanza de
School at Universidade
enfermería. Aunque hubiera directrices internacionales que seguir, el proyecto encontró complicaciones
Federal da Bahia (UFBA,
Brazil). en su implementación, especialmente por la dificultad de mantener un cuerpo docente estable y por la
interferencia de las dinámicas locales.

RESUMO:
Este artigo analisa o papel do Serviço Especial de Saúde Pública (SESP), que funcionou entre 1942 e 1960
como uma agência bilateral Brasil/Estados Unidos, na criação da Escola de Enfermagem da Universidade
Federal da Bahia (EEUFBA). São utilizados como fontes relatórios do SESP, coletados no centro de
Documentação da Casa de Oswaldo Cruz (Fiocruz,RJ), entrevistas, legislação e notícias de jornal, analisados
como portadores de interesses das instituições e dos indivíduos que os construíram. Compreende-se
que o SESP ofereceu auxílio técnico e financeiro para a criação da EEUFBA e que a proposta apresentou

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 o hospital como elemento central nas atividades de ensino em enfermagem. Embora houvesse diretrizes
internacionais a serem seguidas, o projeto encontrou impasses na sua implementação especialmente pela
dificuldade de manter um corpo docente estável e por interferências das dinâmicas locais.

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 KEYWORDS
1. Introduction History of
Sciences; Nursing;
This article analyses the part played by the Special Public Health Service (SESP), a Brazil/ Federal University
United States bilateral agency created in July 1942, in the emergence of the Nursing School of Bahia.
of the Federal University of Bahia (EEUFBA)1. It also reviews the postulates involved in the
planning and functioning of the EEUFBA up to 1960. The following are documents used as PALABRAS CLAVE
research sources: SESP reports, interviews, laws, and newspaper articles. The analysis of these Historia de
documents considers them to be productions of institutions and social players. For this reason, las Ciencias;
such productions disseminate these actors’ interests, as Jacques Le Goff (1990) indicated in his Enfermería;
analysis of documents/monuments. Universidade
Federal da Bahia.
The 1930s and 1940s strengthened relations between the United States and Latin American
countries. In the context of the so-called “Politics of Good Neighbourhood”, the idea of inter- PALAVRAS-CHAVE
American cooperation circulated recurrently in the United States political discourse (Campos, História das
2006, 2008; Andrade, 2019; Tota, 2020). Brazil was one of the countries that had established Ciências;
lasting relations with Americans, primarily through the work of the Office of the Coordinator Enfermagem;
of Inter-American Affairs (OCIAA), created by Franklin Roosevelt and directed by Nelson Universidade
Rockefeller in 1940, and initially referred to as the Office for Coordination of Commercial and Federal da Bahia.
Cultural Relations between the Americas. In 1941 the agency became known as OCIAA, and
in 1944 it was entitled as the Office of Inter-American Affairs (Tota, 2020). More than this, the
Institute of Inter-American Affairs (IIAA) proposed a health cooperation policy (Campos, 2008). Recibido:
21/11/2022
The SESP planned and executed the OCIAA’s health and sanitation projects. The organisation of Aceptado:
the agency followed the recommendations of the Third Meeting of Ministers of Foreign Affairs of 06/07/2023
the American Republics, held in Rio de Janeiro, in response to the attack on the United States
Naval Base at Pearl Harbor. As a result of the meeting, it was recommended that the countries
of the hemisphere would raise resources for the war, break off relations with Germany, and
implement public health policies in bilateral agreements (Campos, 2008).

The agreement that created the SESP established the Amazonian sanitation plan and the training
of health professionals as part of its functions, especially doctors, nurses, and engineers. The
agency set up a network of health units and other equipment and built and managed nursing
schools, hospitals, and health centres. Moreover, it assisted in the expansion of bureaucracy
and public health, in line with the Brazilian public health agenda as determined by the Estado
Novo2, which lasted through the 1950s (Campos, 2006).

Although American standards had inspired the SESP health administration model, the health
policies it put into practice were not unilateral. Conflicts, negotiations, and adaptations marked
these policies (Campos, 2006). The guidelines for health reforms sponsored by the Minister of
Education and Public Health (MESP) Gustavo Capanema indicated the nationalisation of public
health in the process of bureaucratisation of the Brazilian State promoted by Getúlio Vargas
(Campos, 2008). Therefore, the SESP Nursing Programme was also in line with the national
health project.

Considering the relationship between the SESP and the Brazilian government as a result of
interactions contributes to questioning interpretations of science developed in a specific
centre, namely the Global North. Supposedly, this science met passive reception among the
countries in which it was applied. The analysis observes how local contexts and the actions of
specific individuals interfered with expectations about the implementation of the SESP Nursing
Programme in Bahia, for instance. The thoughts of Kapil Raj (2007) have been central to a

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 NURSES IN THE “GOOD NEIGHBOURHOOD”:
THE SPECIAL PUBLIC HEALTH SERVICE (SESP) AND THE CREATION OF THE NURSING SCHOOL OF THE FEDERAL UNIVERSITY OF BAHIA (EEUFBA)
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reflection on how specific national agents interpret, re-elaborate conceptions, and construct knowledge
based on local assumptions of experience. By demonstrating how the creation of modern science has been
historically attributed to Western Europe and has disregarded contributions from other people—such as
the Chinese, the author highlights the role played by “intermediary” individuals who act in the circulation of
knowledge in “contact zones”. Based on Raj’s reflections, authors such as Batista and Porto (2021) have
also highlighted the importance of the concept of circulation for deconstructing centre-periphery binarism.
This pair was at the centre of analyses focused on the emission and reception of actions, practices, and
health knowledge in Brazil.

2. The SESP and nursing in Brazil

When the bilateral agreement between the IIAA and the SESP was signed, there was evidence that the lack of
professional nurses impeded the “modernisation” of the health systems in Latin America. Thus, the unification
of nursing standards in the Western Hemisphere was an aim to be ensured. The SESP Nursing Programme
was officially initiated in August 1942, when the IIAA approved the project “Mais Enfermeiras para a Saúde
Pública no Brasil” [More nurses for Public Health in Brazil]. The Catholic Hospital Association of the United
States, the Kellogg Foundation, and the Rockefeller Foundation supported the project (Campos, 2008).
The report conducted by nurse and Rockefeller Foundation’s3 International Council representative Elizabeth
Tennant suggested that the Ministry of Education and Health supervise the nursing schools to be created
throughout the country. In that regard, the SESP would be responsible for organising the establishment of the
first four schools: “in Rio de Janeiro, Salvador [emphasis added], São Paulo, and Belém” (Campos, 2008).

The main objectives of the Nursing Programme were, firstly, the sending of nurses to Brazil by the IIAA to
reorganize the schools already in existence. Secondly, the creation of schools to train professional nurses
by the SESP, with support from the Rockefeller Foundation. Thirdly, the provision of Kellogg Foundation
scholarships for Brazilian nurses to study in postgraduate programmes in the United States, as well as
SESP scholarships for training in national nursing schools. And lastly, the creation of short courses for nurse
practitioners and health visitors (Campos, 2008).

Fifteen years after the emergence of the school, nurse Ermengarda de Faria Alvim brought forward an
organisation chart of the agency structure (Figure 1).

The chart pointed to a Nursing Division and a Nursing Section within the Technical Guidance Division.
Respectively, the first division was responsible for orienting schools and nursing auxiliaries and collaborating
with other organisations. Moreover, the second was responsible for guiding all SESP services in the hospital
sector and public health (Alvim, 1958).

Domestic reasons for the Brazilian nursing field also influenced the creation of SESP-supported Schools in
the country. The National Public Health Department School was created in 1923 in Rio de Janeiro. In 1926
it was named Anna Nery (EEAN). Furthermore, it emerged from the so-called Parsons Mission, a technical
cooperation assignment through which the Rockefeller Foundation sent nurse Ethel Parsons to Brazil to
establish a professional nursing standard. Thus, this model came to be followed by other Brazilian schools.
Nonetheless, throughout the 1930s, the conflicts between the American nurses and the so-called “native
nurses”—who had been trained at Anna Nery’s (Barreira, 1999)—contributed both to the withdrawal of the
international philanthropic agency from the Rio de Janeiro centre and to the rapprochement of the project
created by the Brazil/USA bilateral agency.

Regarding this incident, the first director of the EEAN nurse Claire Louise Kieninger, was designated as the
interlocutor between the Brazilian nurses and the SESP. However, Kieninger’s mission was unsuccessful due
to the resistance of the EEAN director Laís Netto dos Reys, who prevented the interference of the American
nurse in her management. In 1943 Kieninger returned to the United States, replaced by Gertrude Hodgman,
which caused the end of a period of academic confrontations for the power to lay down the new directions for

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 NURSES IN THE “GOOD NEIGHBOURHOOD”:
THE SPECIAL PUBLIC HEALTH SERVICE (SESP) AND THE CREATION OF THE NURSING SCHOOL OF THE FEDERAL UNIVERSITY OF BAHIA (EEUFBA)
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Figure 1. Special Public Health Service (SESP) organisation chart, 1958. Source: Alvim (1958).

Brazilian nursing. Resultantly, this situation established a spirit of antagonism between the EEAN and the SESP,
generated by a small group of female instructors and the director herself (Renovato & Bagnato, 2008, p. 912).

Although the historiography of the first nursing school ever to be created with the support of the SESP in
Brazil is extensive (Bonini, 2014; Campos & Oguisso, 2013; Campos, Carrijo & Campoi, 2020)—i.e., the
School of Nursing of the University of São Paulo (EEUSP)—, little is known about how the bilateral agency
worked on creating other nursing education institutions such as the EEUFBA. In addition to the Salvador and
São Paulo schools, in 1948, the SESP aided the Rio de Janeiro State Nursing School, created in 1944; the
Manaus Nursing School, created in 1946; the Recife Nursing School, created in 1949; and the Porto Alegre
Nursing School, created in 1950 (Alvim, 1958, p. 434).

Furthermore, regarding the São Paulo and Salvador schools, it is worth mentioning that, on the one hand,
the EEUSP received scholarship holders from different states of the federation to expand the number of
nurses in the country. On the other hand, the EEUFBA had technical and financial support from the SESP
and granted scholarships for students from Bahia to study in São Paulo.

3. The SESP and the Nursing School of the Federal University of Bahia: hospital
as the central axis of learning

Since 1943, when there was an intention to create a Nursing School in Bahia, the Medicine Faculty of
Bahia director Edgard Santos went on to discuss plans with the SESP regarding the project implementation
(Background..., 11 Feb. 1952). On 17 June 1944, Beatrice Lennington—born in Curitiba but a daughter
of American parents—reported on the visit made to Dr. Hanley, a staff member of the bilateral agency.
According to Lennington, Dr. Hanley showed great interest in the opening of the new school and seemed
keen to use his best efforts to participate in its construction (Report..., 1944).

Hanley was acquainted with influential physicians from Bahia. Some of them had been on special assignments in
the United States and regretted the situation of nursing in Brazil, a state of affairs that could facilitate international

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 NURSES IN THE “GOOD NEIGHBOURHOOD”:
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cooperation. The establishment of relations between professionals from the Medicine Faculty of Bahia (FMB)
and American physicians began in the 1920s when the Rockefeller Foundation granted scholarships to Octavio
Torres, Eduardo Araújo, and Enoch Torres to study overseas (Batista, 2020). Later on, between 1928 and 1934,
the yellow fever laboratory of the Rockefeller Foundation also operated in Bahia, promoting contact between
American and Brazilian doctors. The Rockefeller Foundation turned to field and laboratory research responding
to the defeat of the key focus theory. As per this theory, to eradicate yellow fever, reducing the larvae of Aedes
aegypti mosquitoes to the rate of 5% in large coastal cities would have sufficed. Consequently, doctors
from different countries transited through that scientific production space based in Salvador (Batista, 2022).
Therefore, it could be argued that the international relations between Brazilians and members of international
health agencies such as the Rockefeller Foundation were consolidated in the 1940s.

Before the foundation of the new SESP school in Brazil, letters were sent to Bahia with the expected guidelines
to develop in that institution. In a letter issued by the SESP staff in Rio de Janeiro on 20 September 1944,
it was argued that “modern nursing can only be taught where it is practiced” (Experiência..., 20 Sep. 1944).
It was not under consideration the possibility of training nurses who did not experience the environment in
which they would work—i.e., the hospital. Consequently, there was advocacy for the existence of a hospital
run by the Nursing School. In addition, there should be a reasonable number of certified nurses “with
expertise and good credentials” always on duty in several hospital sectors (Experiência...., 20 Sep. 1944, p.
1). The service was to operate 24 hours a day, every day of the year. As there were not many graduate nurses
available for hospital and school services, it was considered necessary that the Bahia Clinical Hospital
ensured hiring the highest number of these professionals when its wards were inaugurated.

Another critical aspect of the foundation of the EEUFBA was the students’ residence. It was advised that
the facilities should have an attractive appearance as “a means of improving the reputation of the nursing
profession in the public eye and of attracting young and educated women to the profession” (A residência...,
20 Sep. 1944). The emphasis was on establishing a quiet and private ambiance and, at the same time,
enabling social gatherings as if the students were in their homes. Dormitories should be single or shared,
with a maximum of three students. Each student should have a desk, a dressing table, and an individual
locker. The students were not expected to live in their own homes for the first three months of the course as
this would not allow the inspection of their hygiene.

The third recommendation concerning the practices adopted by the future EEUFBA referred to the
organisation of the study space. It was argued that only one classroom would be sufficient to accommodate
all the students during the first year, but later two classrooms would be needed. One classroom devoted to
the “art of nursing” course and set up with nursing techniques demonstration materials should be equivalent
to one ward unit with six beds. Also, a dietetic laboratory with 8 or 16 separate units would be needed for
cooking practice, as well as chemistry and microbiology (anatomy and physiology) laboratories. If the FMB
laboratories were used, their cost would be relatively low. However, by creating its laboratories, the EEUFBA
would incur relatively large expenses (Salas de..., 20 Sep. 1944).

With evidence that a nursing school was to be created in Salvador, the local press started to report on
this. For instance, the newspaper Cidade do Salvador of 19 May 1944 announced that the Pan-American
clipper had arrived in the city with the American hospital technician Felix Lamela. Lamela came from Rio de
Janeiro, where he had been working for the Office of the Coordination of Inter-American Affairs at the request
of the Brazilian government (Uma escola..., 20 May 1944). Lamela was also the Inter-American Hospital
Association director and consultant with the Pan-American Sanitary Office in Washington.

Invited by Public Service Administrative Department of Brazil (DASP) director Luís Simões Lopes, Felix
Lamela had been in Brazil for two months. The DASP was a public body created by Decree-Law No. 579 of
30 June 1938. It was configured as an administrative department, linked to the Presidency of the Republic,
and responsible for conducting a detailed study of public agencies (Oliveira, 2012). Lamela had guided the
construction of a sizeable DASP hospital in Rio and, at the time, was in dialogue with Edgard Santos about
the Bahia Clinical Hospital and the implementation of the Nursing School of the Federal University of Bahia.

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 NURSES IN THE “GOOD NEIGHBOURHOOD”:
THE SPECIAL PUBLIC HEALTH SERVICE (SESP) AND THE CREATION OF THE NURSING SCHOOL OF THE FEDERAL UNIVERSITY OF BAHIA (EEUFBA)
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When the newspaper interviewed Lamela, he said that the Washington Pan-American Sanitary Office would
directly or indirectly assist the school. One aim of the Office was to contribute to the solution of all public
health problems in several countries across the Americas, especially in the hospital sector. The institution
would also guide the construction of “ultramodern hospitals or even provide material help, wherever it was
needed” (Uma escola...., 20 May 1944, p. 1).

As in the letters sent from Rio de Janeiro to Bahia, the technician reaffirmed that the hospital gained centrality
in the activities to be carried out by the EEUFBA:

Our work consists of planning hospitals and guiding their construction, equipment, and installations.
Likewise, our work guides how to organise the various hospital departments and their personnel, and
establish all the regulations for its functioning in collaboration with the local technicians, not only by
giving but also by receiving suggestions. All this is being carried out by the [Pan-American Sanitary]
Office, which sends its representatives to all the Americas to organise studies of large Hospital Centres.

Although the Americans technically guided the hospital’s construction, local technicians’ suggestions were
accepted. In order to continue and conclude the work on the Bahia Clinical Hospital, the Brazilian Ministry of
Education and Health opened a special credit facility through Decree-Law No. 6.125 of 18 December 1943
(Brasil, 1943).

The influence of the SESP on the EEUFBA was not restricted to guidance on technical issues. Due to the
centrality of the EEUSP at that time, Edgard Santos consulted with its director Edith Fraenkel about the best
person to direct the EEUFBA. Fraenkel recommended that he contact nurse Haydée Guanais Dourado, an
instructor at the EEUSP who had had her training in the United States focused on creating the São Paulo
school (Memorandum, 1946)4. Guanais Dourado was from Bahia, born in Morro do Chapéu, and graduated
in nursing from the EEAN. During her administration, she guaranteed important aspects recommended by
the SESP in the EEUFBA, such as the number of nurses per room—which she managed to reduce to two—
and the decision to use the FMB laboratories. In her international training, she frequented laboratories used
by professionals from various areas (Guanais Dourado, 1993a).

Before the creation of the EEUFBA, still as a professor at the EEUSP, Haydée Guanais Dourado promoted
the Nursing profession when she visited different Brazilian states. American nurse Gertrude Hodgman, who
idealized the SESP Nursing Programme, accompanied her. In a passage through Bahia, she stated the following:

Miss Hodgman’s interest in visiting Bahia is part of the SESP [Nursing] Programme’s intention to
contribute to the improvement of the population’s health and, in particular, to the development of the
project, which aims to extend the facilities for teaching modern nursing in the country.

On my behalf, (…) I come on a mission from the São Paulo Nursing School [EEUSP] to interview
applicants for enrolment at that institution (Para o desenvolvimento..., s.d. p. 1).

Haydée also stated that the São Paulo [Nursing] School had recently been created and attached to
the Medicine Faculty of São Paulo. Moreover, she said the young women interviewed in Salvador were
candidates for four SESP-funded scholarships for the state of Bahia. These women were to undertake the
regular nursing course, which was three years long and would start in March 1944. This measure of the SESP
aimed to ensure the training of an initial cadre of professors when the EEUFBA was inaugurated (Figure 1).

In May 1946, then director of the Nursing Division Clara Curtis visited Salvador to learn about the health
services in that city, especially the plans and prospects for the operation of the Nursing School and the
Clinical Hospital. The SESP Nursing Division offered advisory services for the initial planning of the EEUFBA.
Moreover, the division was several times called upon and helped the institution, mainly to ensure the formation
of a team of nurses (Background..., 11 Feb. 1952, p. 2).

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 NURSES IN THE “GOOD NEIGHBOURHOOD”:
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RICARDO DOS SANTOS BATISTA - JOSÉ LÚCIO COSTA RAMOS

Image 1. Design of the Nursing School of the Federal University of Bahia (1939). Source: Memoranda (1939).

4. The EEUFBA begins its operations:

faculty difficulties and local/national conflicts

The EEUFBA was created in Salvador on January 22, 1946, by Decree-Law No. 8.779 (Brasil, 1946). As
previously stated, its creation marked a confluence of the interests of Rector Edgard Santos—who intended
to form a body of nurses for the University’s Clinical Hospital, whose construction had already started in
1938—and the SESP Nursing Programme. The school emerged at a time that stimulated the creation of
other Nursing Schools in Brazil in the post-World War II (1939–1945). It was a time of urbanisation and
industrialisation in Brazil, in which the public power reported that society needed more nurses and more
qualified professionals to work in hospitals, the public health sector, and the armed forces (Passos, 2012).

The arrival of nurse Haydée Guanais Dourado was influential in the organisation of the course since her
professional and academic experiences served as a base for the political pedagogical project (PPP) designed
for the school, especially on the PPP proposed by the SESP at that time. Her professional improvement was
obtained mainly in the Anna Nery Nursing School, in Canada, the United States, and the EEUSP, and affected
the model implemented in the EEUFBA. Haydée promoted the values of these institutions, adapting them to
the cultural reality of Bahia (Oliveira et al., 2016).

Guanais Dourado took recently-graduate nurses from the EEUSP to Bahia to implement the Nursing School,
as Olga Verderese, born in Piracicaba, São Paulo, where she graduated in 1947. In addition to collaborating
with the organisation of the first Nursing School in Bahia, where she stood out as a professor and held the
position of vice-director, Verderese assumed the Nursing Directorate of the Clinical Hospital, which came
to be a future field of internships for the new course students (Mancia, Salles, & Padilha, 2008). However,
occupying this position did not come naturally. On the contrary, it resulted from previous negotiations
between Haydée Guanais Dourado and Edgard Santos. The UFBA’s Rector had already in mind the name of
a professional to occupy that position. Nonetheless, director Guanais Dourado (1993a, p. 3) reiterated that
only a full professor at the school could supervise nursing in the hospital.

The difficulty in forming a staff team of permanent professors was one of the issues the EEUFBA had faced
since the beginning of its operations. The SESP even contributed both technically and financially to guide
the school’s operation, but that was not enough. In 1949, for example, two SESP nurses were put at the
disposal of the school to serve as faculty members. They did so through a project named “BA-SAL-14”,
an aid granted to the EEUFBA between March 1949 and December 1951. However, the EEUFBA received
books on nursing and scholarships aimed at several students (Termo de..., 11 April 1960, pp. 1-2). Technical

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 NURSES IN THE “GOOD NEIGHBOURHOOD”:
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and financial assistance continued in subsequent years, including hiring IIAA Public Health consultant Mabel
Johnson, who trained the students on public health. On 31 December 1957, on the one hand, the BA-SAL-14
project expired, and, on the other hand, the EEUFBA received only technical assistance whenever it was
requested (Termo de..., 11 April 1960, pp. 2-3).

As long as Haydée Guanais Dourado held the position of director of the EEUFBA, she used her social capital
to get nurses for the school. She visited the EEUSP and the EEAN, talked to their respective directors, and
asked them to transfer some experienced professionals to her team temporarily. Guanais Dourado (1993a, p.
11) told them that “one cannot open a new School with newly trained nurses only, so lend me an experience
one to commission there for a couple of years”. On the one hand, EEUSP director Edith Fraenkel did not fail
to help her, but the nurse on loan Lúcia Jardim could not take the teaching post in Bahia because her mother
fell ill. On the other hand, the EEUFBA director wished to receive from the EAAN her sister, also born in Bahia,
nurse Radcliff Guanais Dourado. However, the EEAN director Laís Netto dos Reys insisted to the rector of
her institution that Radcliff remained in Rio de Janeiro. Reys would have described Radcliff as “one of the
professors I rely on the most in here; she belongs to my team” (Guanais Dourado, 1993a, p. 11).

Although Reys was linked to the Vargas government through the minister Gustavo Capanema (Barreira,
1999) and the end of the Vargas government in 1945 may have placed her in a delicate situation to obtain
professors for the EEAN in the case of Radcliff’s transfer, the use of the term “my team” in the interview given
by Haydée Guanais Dourado reinforces the existence of a division in Brazilian nursing. As mentioned earlier,
conflicts between EEAN projects, on the one hand, and those of the Rockefeller Foundation and the SESP,
on the other, caused this division.

Apparently, Haydée Guanais Dourado used the advantages of running a school supported by the SESP to
“lure” the EEAN rector and obtain the cession of her sister. In a letter sent to the institution, Guanais Dourado
said she could send her sister from Bahia to a specialisation in another country. In considering the possibility
of one of his professors having post-graduate training overseas, the rector was in favour of her transfer:

Laís, you cannot say no… Ah, I wish we had scholarships here for all the faculties of my university.
Yes, I would send her. The education on their account, the travel, everything. You must let her go. She
will be one more professor from Brazil to be well prepared. This is interesting for the School (Guanais
Dourado, 1993a, p. 11).

Classes at the EEUFBA began on 12 March 1947, just over a year after the publication of the Decree-Law
that created the nursing course. As the EEUFBA did not yet have its facilities, the classes of the first group
of students took place at the FMB, in Terreiro de Jesus, in the historic centre of Salvador. The first curriculum
of the EEUFBA, which lasted four years, was divided into core and professionalising disciplines (Chart 1).

Chart 1. Disciplines of the EEUFBA’s first curriculum

CORE DISCIPLINES

Chemistry of nutrition, physiological chemistry; Biological sciences: Anatomy, Physiology, Biochemistry, Microbiology,
Parasitology, Pathology and Pharmacology; Social Sciences Applied to Nursing, Psychology and Sociology, and Social Work.

CORE DISCIPLINES

Medical-Surgical Area
Medical-surgical nursing I and II, Otolaryngology, Ophthalmology, Neurology, Orthopaedics, Emergency Room, Operating Room

Intermediate Area
Ethics, History of Nursing

Public Health Area

Sanitation and Community Study, Public Health Nursing I and II, Nursing in Communicable Diseases

Source: Museu da EEUFBA Prof.ª Haydée Guanais Dourado, 1947.

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The basic disciplines involved curricular components of Exact and Human Sciences. Recognised at the time
as non-exclusive disciplines, they were taught by the FMB’s full professors or assistants. Furthermore, they
did so by using the faculty laboratory resources already in existence. The professionalising disciplines’ axis
was subdivided into Medico-Surgical, Intermediate, and Public Health.

A Nursing School Board selected professors to teach the first courses of the EEUFBA. Rector Edgard Santos
created this body because the Nursing School neither participated in the University Board at the time nor had
its Congregation, as it was an annex to the Medicine Faculty of Bahia. In addition to the Rector, the Medicine
Faculty director, Professor José Olímpio da Silva, and the Nursing School director, Professor Haydée
Guanais Dourado, were also part of the Nursing Board. Afterward, the EEUFBA vice-director, Professor Olga
Verderese, joined the board (Fernandes, 2001).

In the first year of the EEUFBA, faculty physicians or professors with other training, i.e., distinctive from Nursing,
taught the theoretical approaches of the disciplines. The few female nurse professors who worked at the
school were in charge of demonstrative practical activities and patient care. Whenever possible, the nurse
professors attended the classes of these other professors with a two-fold objective: to orient them regarding
the school’s philosophy and, at the same time, to broaden their own knowledge. The intention was to replace
faculty physicians with nurses gradually. However, the initiatives to modify the programmes occurred only
starting from the late 1950s when the nurses began to intervene in the teaching curriculum (Fernandes, 2001).

If, on the one hand, the presence of Haydée Guanais Dourado as a director coming from the EEUSP favoured
the development of the SESP Nursing Project; on the other hand, the constant conflicts for autonomy with
Edgard Santos made coexistence increasingly difficult. In many excerpts of her interviews, it is possible to
notice the disputes between Haydée Guanais Dourado and the UFBA’s Rector: “it could be that the rector
himself thought I was a bit too ambitious” (Guanais Dourado, 1993b), or even “that I administrated without
consulting him, and I did not realise that. It could also be my fault, but I did not realise it because I was quite
imbued that I was the one who knew [how to run] my teaching staff that, at that time, was bigger” (Guanais
Dourado, 1993c, p. 7). On one occasion, the rector complained that she “needled” him publicly (Guanais
Dourado, 1993c, p. 7).

The conflicts between Haydée Guanais Dourado and Edgard Santos are an example of how doctors felt
threatened by the arrival of qualified nurses with degrees in a “territory” that they considered theirs, which
can also be observed in other nursing schools linked to Faculties of Medicine in the country. The troubled
relationship between the rector and the director—as well as the conflicts arising from the hierarchy established
between doctors and nurses—influenced the conduct of the EEUFBA and caused Guanais Dourado to
resign in mid-1949. At that point, the nurse who started implementing the SESP Nursing Project in Bahia had
to return to the EEUSP. From there, in 1950, she also followed the EEUFBA students who needed to do part
of their courses in São Paulo (Guanais Dourado, 1993b, p. 8). Due to the difficulties in finding clinical practice
settings in Salvador, the first two classes did their final year of nursing in São Paulo (1950 and 1951), taking
advantage of a partnership between the Universities of Bahia and São Paulo prevailing at the time. In São
Paulo, the students completed internships in Urban and Rural Public Health, Communicable Diseases, and
Psychiatry, as well as in other hospital-based disciplines of their interest (Fernandes, 2001).

A graduate in Nursing from the EEUSP, Jandyra Alves Coelho took over the direction of the EEUFBA between
1950 and 1951. She was followed by vice-director and graduated from the EEUSP Anayde Correa de
Carvalho, born in Ribeirão Preto, São Paulo, and went to Bahia in 1950 (Ramos, 2017). Concurrently with
difficulty in finding a stable and well-qualified cadre of instructors, the SESP observed that the constant
change of directors influenced the development of the school. Nevertheless, the agency stated that in just
a few years of its existence, the EEUFBA had already gained recognition for maintaining good standards of
nursing education and practice (Background..., 11 Feb. 1952, p. 1).

The school building was inaugurated in 1950 in the Canela neighbourhood of Salvador. Besides the administrative
facilities and classrooms, the building served as a residence for teachers and students from the countryside

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or other states. It could house about 80 students and 20 professors. The on-campus residence for nursing
students came from an Anglo-American tradition. Following a regulation required by the specific legislation
on nursing education, i.e., Law No. 775 (Brasil, 1949), the EEAN and the EEUSP absorbed such a tradition.
The boarding school system lasted from the 1950s to the mid-1970s. It was propagated as a necessity for the
training of nurses by facilitating the daily routine of practical and theoretical classes and internships.

The on-campus residence aroused the interest of course applicants, thus becoming one of the motivating
elements of their choice for Nursing. The residence met the needs of students from lower socio-economic
backgrounds and offered advantages to those from higher social backgrounds, which accommodated the
desires of their families. “The distinctiveness of the building and the comfort that the school provided were a
way of drawing them into a secluded life” (Passos, 2012, p. 98).

The SESP considered an asset of the EEUFBA its ability to attract an “exceptionally good group of students”.
Seven students in the first class were “young women from prominent families in Bahia, and this set a standard
for future enrolments” (Background..., 11 Feb. 1952, p. 1). The graduates of the first and second classes
attained positions at the EEUFBA, the Clinical Hospital, the Santa Terezinha anti-tuberculosis sanatorium,
and the Public Health Secretariat. They were as follows (Chart 2).

Chart 2. Students from the first two EEUFBA classes

1950

Leônia Melro de Freitas, Maria Helena Resende Ribeiro, Maria Ivete Ribeiro de Oliveira, Maria José de Oliveira, Maria Juliêta
Calmon Villas-Bôas, Nilza Marques Maurício Garcia e Stela Alves dos Santos

1951

Alba Gueudeville, Arlinda de Azevedo Barreto, Dulce Ferraro de Mello, Edla Dalva Moreira, Iracy Silva Costa, Iraides Teixeira
de Carvalho, Joêta Guerra de Macêdo, Junia Nogueira Brandão, Lenisia Costa Santos, Maria Carmelita Hegoonet, Maria dos
Reis Lopes, Mª José de Carvalho Florence, Maria José Magalhães de Jesus, Maria Lisete de Oliveira Mendonça, Marizete
Borja Lima, Nildes Corbiniana dos Anjos, Nilza Cardoso Barreto, Zilda Cotrim Fernandes e Zuleika de Sena Actis

Source: Fernandes (2001).

During the 1950s, the EEUFBA underwent several curricular changes, including introducing the teaching of
Nursing Service Management related to the hospital environment and public health. Starting in 1952, during
the directorship of nurse Nilza Garcia at the EEUFBA, the clinical practice settings were expanded. They had
the collaboration of the institution’s graduates, who started working in state and federal public hospitals. The
University started operating extramurally, both in teaching and extension activities. In the public health field,
the EEUFBA contributed to the organisation of Nursing Services at Health Centres, thus strengthening the
relationship with the Bahia State Health Secretariat. This relationship favoured the insertion of the students
from the third class onwards into urban and rural public health services. Such a partnership ended the
internship that was carried out in São Paulo at the end of the course (Fernandes, 2001).

5. Concluding remarks

The development of the SESP Nursing Project positively contributed to expanding the number of nurses
graduating from the schools it helped create in Brazil. The complex relationships at the Federal University of
Bahia encountered obstacles in training nurses. These obstacles started with the conflicts between director
Haydée Guanais Dourado and Rector Edgard Santos. However, they also extended to the maintenance of
teaching staff and subsequent changes of directors.

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This example shows the difficulties of implementing projects in the international health field, constantly
pressured by local issues, professional disputes, and the personal characteristics of the individuals
responsible for their operation. Nurse Haydée Guanais Dourado was the first director of the EEUFBA and,
according to Kapil Raj (2007), can be analysed as a mediator of the contact zone between the science
practised in the United States and Brazil. Trained at the EEAN, she incorporated elements of the SESP
proposal when she graduated to work at the EEUSP. Subsequently, she was assigned to the EEUFBA.
Although she enabled the interlocution between the different knowledge constructed and learned throughout
her career, she did not lack professional aspirations. However, her professionalism was marked by the desire
for autonomy in the nursing field.

The EEUFBA needed to find other ways to consolidate itself as an educational institution, which occurred with
an expansion of mediating individuals. After graduating, the Rockefeller Foundation granted scholarships to
students from the first classes who returned to teach at the Bahia School. This subject needs to be studied
in depth because the context in question was no longer the same in which Haydée trained overseas. New
national and international priorities were at issue in nursing in the 1960s, and they certainly influenced the
paths these women took and their professional practice.

This research is supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil, process:
150221/2022-3.

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NOTES
1 The Nursing and Social Services School of Bahia was
created by Decree-Law No. 8.779 of 22 January 1946
(Brasil, 1946), and it was annexed to the Medicine Faculty
of Bahia. The Federal University of Bahia (UFBA) was
only created by Decree-law No. 9.155 of 5 April 1946.

2Dictatorial regime established in a coup d’état by

Getúlio Vargas.

3 The Rockefeller Foundation is an international

philanthropic agency established in 1913. Since the
beginning of its operations, the agency members
have followed the philanthropic principles of John D.
Rockefeller. Rockefeller was a North American millionaire
who invested in the international agency with the money
generated by exploiting, refining, and trading petroleum.
He believed that philanthropy could not be mistaken for
charity. He also advocated that philanthropy should be
seen as an investment offered to government agencies,
not individuals. Beyond that, it should be limited in
duration so as not to become dependent. It should be
destined for organizations committed to continuing
their work when the aid eventually ends. On the one
hand, the philanthropic agency worked with the idea
of demonstration effect, which offered funding for a
certain period to the institutions. On the other hand, the
leaders of the recipient country should be subsequently
responsible for maintaining their institutions. Confer
Farley (2004).

4 Haydée Guanais Dourado graduated in nursing from

the Anna Nery Nursing School in Rio de Janeiro in 1935.
She became director of the EEUFBA on 26 June 1946
and left the position on 22 October 1949.

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SOURCES:
Para o desenvolvimento do ensino de enfermagem.
A residência de uma escola de enfermagem. (1944) Fundo Fundo FSESP. Centro de Documentação da Casa
FSESP. Centro de Documentação da Casa de Oswaldo de Oswaldo Cruz. BR/Fiocruz/COC/FSESP/AMS/00/
Cruz. BR/Fiocruz/COC/FSESP/AMS/00/US/00/100. US/00/100. s./d.

Alvim, E. de F. (1958). Quinze anos de enfermagem no Report from Beatrice L. Lenington. (1944) Fundo FSESP.
SESP. Revista Brasileira de Enfermagem, 12(2). Rio de Centro de Documentação da Casa de Oswaldo Cruz.
Janeiro: Associação Brasileira de Enfemagem. BR/Fiocruz/COC/FSESP/AMS/00/US/00/100.

Background information on the Bahia School of Nursing Salas de aulas, laboratórios, bibliotecas e escritórios.
(1952). Fundo FSESP. Centro de Documentação da Casa (1944) Fundo FSESP. Centro de Documentação da Casa
de Oswaldo Cruz. BR/Fiocruz/COC/FSESP/AMS/00/ de Oswaldo Cruz. BR/Fiocruz/COC/FSESP/AMS/00/
US/00/100. US/00/100.

Decreto-Lei nº 8.779 de 22 de janeiro de 1946 (1946). Termo de encerramento e sumário final do projeto SU-
Cria, anexa à Faculdade de Medicina da Bahia, a SAL-14. (1960) Fundo FSESP. Centro de Documentação
Escola de Enfermagem e Serviços Sociais, e dá outras da Casa de Oswaldo Cruz. BR/Fiocruz/COC/FSESP/
providências. Câmara dos Deputados, Centro de AMS/00/US/00/94.
Documentação e Informação, Rio de Janeiro, Brasil.
Uma escola de enfermagem será instalada na Bahia.
Decreto-Lei nº 6.125 de 18 de dezembro de 1943 (1943). Cidade do Salvador. (1944). Fundo FSESP. Centro de
Abre ao Ministério da Educação e Saúde o crédito Documentação da Casa de Oswaldo Cruz. BR/Fiocruz/
especial de Cr$ 14.688.698,00, para prosseguimento COC/FSESP/AMS/00/US/00/100.
e conclusão de obras. Diário Oficial da União. Rio de
Janeiro, Brasil.

Lei nº 775, de 6 de agosto de 1949 (1949). Dispõe sobre o

ensino de enfermagem no País e dá outras providências.
Presidência da República, Casa Civil, Rio de Janeiro,
Brasil.

Experiência prática em enfermagem para uma escola

de enfermagem (1944). Fundo FSESP. Centro de
Documentação da Casa de Oswaldo Cruz. BR/Fiocruz/
COC/FSESP/AMS/00/US/00/100.

Guanais Dourado, H. (1993a). Entrevista realizada por

Therezinha Vieira em 8 de setembro de 1993. Museu
da Escola de Enfermagem da Universidade Federal da
Bahia.

Guanais Dourado, H. (1993b). Entrevista realizada por

Therezinha Vieira em 25 de setembro de 1993. Museu
da Escola de Enfermagem da Universidade Federal da
Bahia.

Guanais Dourado, H. (1993c) Entrevista realizada por

Therezinha Vieira em 27 de setembro de 1993. Museu
da Escola de Enfermagem da Universidade Federal da
Bahia.

Memoranda (1939). On requerements for the School of

nursing in Bahia. Fundo FSESP. Centro de Documentação
da Casa de Oswaldo Cruz. BR/Fiocruz/COC/FSESP/
AMS/00/US/00/100.

Memorandum (1946). Fundo FSESP. Centro de

Documentação da Casa de Oswaldo Cruz. BR/Fiocruz/
COC/FSESP/AMS/00/US/00/100.

Museu da EEUFBA Prof.ª Haydée Guanais Dourado

(1947). Disciplinas do primeiro currículo da EEUFBA.
Salvador: Escola de Enfermagem da UFBA.

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