Aurora de Afonso Costa Nursing School: from its creation to its inauguration (1943-1945)

Maria da Graça Moreira Moscoso Marques1, Kyvia Rayssa Bezerra Teixeira2, Pacita Geovana Gama de Sousa Aperibense2, Antonio José de Almeida Filho2, Maria Angélica de Almeida Peres2, Tânia Cristina Franco Santos2

1 Fluminense Federal University, RJ, Brazil

2 Federal University of Rio de Janeiro, RJ, Brazil

ABSTRACT:

Objective: To analyze the creation process of the Rio de Janeiro State Nursing School (Escola de Enfermagem do Estado do Rio de Janeiro, EEERJ), currently the Aurora de Afonso Costa Nursing School (Escola de Enfermagem Aurora de Afonso Costa, EEAAC/UFF). Method: A historical study with a qualitative approach. Sources: reports, minutes, legislation, news from newspapers of the collections of the EEAAC/UFF, of the Anna Nery Nursing School/UFRJ, and of the Casa de Oswaldo Cruz/Fiocruz. Triangulation analysis of the sources. Results: Created on 04/19/1944 and inaugurated on 02/01/1945, the creation strategies were the following: choosing the city of Niterói; structuring equivalent to the Official Standard School, appointment of a former student and former professor as principal; authorities at official ceremonies. Discussion: The insufficiency of professionals; the quality of teaching; the strict discipline and political influence of Alzira Vargas contributed to the implementation in a very short time and to take advantage of symbolic gains. Conclusion: Its creation contributed to the professional and social recognition arising from the participation in a project that would collaborate for the development of the country.

Keywords: Nursing; Nursing History; Nursing Schools.

INTRODUCTION

The object of study is the creation and implementation of the Nursing School of the State of Rio de Janeiro (EEERJ), currently called Aurora de Afonso Costa Nursing School of the Fluminense Federal University (Escola de Enfermagem Aurora de Afonso Costa da Universidade Federal Fluminense, EEAAC-UFF). The time frame comprises the period from 1943 to 1945, marked by the year in which a group of North American nurses from the Nursing Division of the Special Public Health Service (SPHS) completed the report on the evaluation of health conditions in the cities belonging to the state of Rio de Janeiro: Niterói, Campos dos Goytacazes, and Petrópolis, with a view to selecting the location for the installation of a nursing school (the city of Niterói, then federal district and capital of the state of Rio de Janeiro being indicated); and the year corresponds to the inaugural class of EEERJ, on February 1st, 1945.

The political context includes the dictatorial regime of the New State (1937-1945) implemented by President Getúlio Vargas. At the international level, the entry of the USA into the World War II in 1941 contributed to increase the importance of Brazil as an ally due to its geographical position, providing naval and air bases for the supply of American planes and anti-submarine naval base(1).

In exchange, agreements were signed between these two nations, culminating in the creation of the Special Public Health Service (SESP), on July 17th,1942, which had technical and financial support from the Rockefeller Foundation and from the Institute of Inter-American Affairs (IIAA). It was up to the SESP to guarantee sanitary conditions in Amazonas, and later in Vale do Rio Doce, to expand the production of raw materials for military purposes, such as rubber and minerals. In addition, the preparation of professionals for public health work and collaboration with the National Leprosy Service(2).

Regarding the training of professionals, in October 1942, nurse Mary Elizabeth Tennant, from the Rockfeller Foundation, came to Brazil to carry out a reconnaissance on Brazilian nursing, with a view to analyzing the value of the education imparted in the existing Nursing schools and of the number of nurses who could be trained. The report identified approximately 400 nurses working in the country, an insufficient number to meet the needs of the health services at the time(3).

The report adds that this project also aimed to “choose the institutions that offered the greatest advantages for the development of new sources of nurse training”(4).

In addition to the need to create a body in the Ministry of Education and Health responsible for the guidelines and structuring of nursing education, the recommendations emphasized the construction of at least another four schools in Rio de Janeiro, São Paulo, Bahia, and Pará (3).

Also due to the report, in December 1942, the SESP created the structuring program for the SESP Nursing Division (initially called the Nursing Training Section) which, under the command of American nurse Clara Louise Kienninger, had the objective of developing and improving the function of Nursing in Brazil, which represented mutual assistance through cooperation, training, encouragement, and interest in the country's basic problems. It was an administrative structure in charge of contributing with Nursing services, so that they could be executed under the direct responsibility of the programs. These programs were responsible for the execution of the work plans approved by the superintendency, which functioned fundamentally in delegation of authority; and they should collaborate with official and private institutions to raise the level of the Nursing services in Brazil(5).

Thus, with the contribution of the SESP, the EEERJ was created through the Decree 1,130, on April 19th, 1944, the tenth in Brazil and the sixth in the Southeast region. On January 27th, 1947, it was assimilated to the Anna Nery Nursing School (Escola de Enfermagem Anna Nery, EEAN), remaining in this condition until 1949, when it was recognized by the Ministry of Education by Law No. 775(6).

It should also be noted that the state of Rio de Janeiro was governed by Ernani do Amaral Peixoto, married to Alzira Vargas, daughter of the then President of the Republic, Getúlio Vargas. This is because the 1937 Constitution expanded the presidential powers, allowing him to appoint state governors called interveners(1).

In view of the concerns regarding the historical situation presented, the following objective was defined: to analyze the process of creation and implementation of the EEERJ.

The contribution of this study, in relation to those already published on the subject, is evidenced by the deepening of the discussion on the expansion of nursing education in Brazil, highlighting the participation of American nurses, once again demarcating their influence on the training of nurses in the country(7,8). Furthermore, with regard to the studies on the history of the profession, an understanding of past historical facts can also prove to be an opportunity to reflect on the present.

METHOD

A historical documentary study with a qualitative approach. The documentary corpus, consisting of written documents, was located in the collections of EEAAC-UFF, EEAN-UFRJ and the Casa de Oswaldo Cruz of the Oswaldo Cruz Foundation. After identification, organization, and classification of this corpus, the “adequacy analysis” was applied, evaluating the quality and relevance of the information found to identify its veracity(9).

Subjected to external and internal criticism, which is mandatory in historical research, the historical evidence on which this research is based to interpret or prove our hypotheses were determined(10).

The chronology and historical context of the facts of the studied section were also considered. The reliability of the results was ensured by the valuation of the documentary set that includes reports; minutes books; clipping book; laws; and decree-laws that are presented in the figure below.

Figure 1 - Direct sources that supported the research presented in chronological order

Source: Elaborated by the authors.

The Clipping Book, belonging to the collection of the EEAAC Memory Center, has two hundred (200) pages containing newspaper clippings from 1943 to 1966 recording events related to the school. It was organized by Aurora de Afonso Costa, during her entire administration. From this source, 3 reports, items 8, 9, and 10 from Figure 1 were used.

Two categories of analysis emerged from the sources: 1) The planning of a Nursing school for Niterói; 2) The implementation of the EEERJ.

With regard to the ethical aspects, this study did not need to be appreciated by the Research Ethics Committee, as it is a study that uses only public documents and of free access, as supported by item III, sole paragraph of Article 1, Resolution No. 510, of April 7th, 2016, of the National Health Council, Ministry of Health.

RESULTS

After the issuance of a favorable opinion on the creation of the school in Niterói by the North American nurses of the SPHS Nursing Division, Gertrudes Hodgman and Lottie Chaikin Plaut, the measures for its effective creation were outlined. One of them was holding a meeting between the aforementioned nurses and the principal of the Public Health Department, Adelmo de Mendonça, on August 10th, 1943, with a view to starting the school planning, even reinforced by the donation of four hundred contos de réis, in cash.

The report prepared by the American nurses on the selection of the city that would host the school also pointed out that the nurses' salaries were low and that the quantity very small. Thus, there was a suggestion to expand the number of nurses in the states and increase the weekly workload of public health nurses, with consistent remuneration and a higher framework for those who taught and supervised in schools, in relation to the staff of assistant nurses.

On January 7th, 1944, through Decree-Law No. 1057, the state of Rio de Janeiro's intervener began the school planning process, creating the Nursing School Administration Commission (Comissão de Administração da Escola de Enfermagem, CAEE) whose purpose was to undertake the strategies necessary for the implementation and operation of the future school, according to the teaching standards of the EEAN.

The minutes book shows that the CAEE was chaired by Adelmo de Mendonça, representing the governor of the state of Rio de Janeiro; Gertrudes Hodgman, member of the SPHS and responsible for the organization of the preliminary project for the creation of the school; Dolizete Cabral, representative of the Brazilian Association of Registered Nurses (Associação Brasileira de Enfermeiras Diplomadas, ABED), who assumed as treasurer of the committee and executive principal of the school, until the appointment of the future principal; Maria Pinheiro (secretary), representing the Brazilian Legion of Assistance (Legião Brasileira da Assistência, LBA) and; Paulo Pimentel, also treasurer and representative of the Fluminense Medical School.

Likewise, the minutes also register the extinction of the Commission on April 19th, 1944, on the occasion of the signing of the school creation decree. On that same date, another commission was created, called “Nursing School Administrative Commission”, with the same members and attributions. Its purpose was to manage the school and to provide the preparations for its inauguration. Therefore, the commission was responsible for signing contracts and agreements with public and private institutions, preparing and approving the school budget, admitting technical and administrative personnel, setting salaries, as well as choosing the location for the school and boarding school for the students, in addition to negotiating with a hospital where the practical teaching would be developed.

The records in the minutes book allow us to assert that these commissions worked in a short period of time, promoting weekly meetings, at the headquarters of the Health Department of the state of Rio de Janeiro, in Niterói. 26 meetings were held, from February 11th, 1944 to January 25th, 1945, always with the presence of all the members. It is noteworthy that the EEERJ received financial assistance to reform the school's headquarters, which was located at the Azevedo Lima Boarding School, in addition to the purchase of equipment and to the payment of the professors’ salaries.

Opened on October 18th, 1944, the EEERJ had the boarding school installed on the 7th and 8th floors of the Azevedo Lima Boarding School. This hospital opened two months earlier, on August 19th, 1944. The eight-story establishment had a 320 bed capacity. According to the minutes of the twenty-third meeting of the Administrative Commission, held on September 27th, 1944, although the area destined for the boarding school provides comfort for the students, both nurse Getrudes Hodgmam (SPHS) and Aurora de Afonso Costa (principal recently designated for the school), expressed their concerns about the inadequacy of the space in terms of safety, since it was a space for the treatment of patients with pulmonary tuberculosis.

These minutes record the arguments about the urgent need to build a proper building for the students' boarding school. However, despite the donation of land for the construction of the school's own headquarters in October 1945, the school remained at the Azevedo Lima Boarding School until July 1947 when it was transferred to its second provisional headquarters, located at Preventório Paula Cândido, in Jurujuba/Niterói, remaining there until 1966.

It is worth mentioning that the visit to the school's future facilities by the Administration Commission on August 4th, 1944 was reported in the “Diário da Noite” newspaper on August 5th, with the title of “The development of hospital care in the State of Rio de Janeiro”; and this report was stored in the Clipping Book. This visit highlights the presence of Alzira Vargas, president of the LBA; Clara Curtis, representing the SPHS; and Marcolino Candau, a sanitary doctor with a scholarship at the Public Health School of the John Hopkins University - USA.

Two months after the visit, on October 18th, 1944, the school opened on the 7th floor of the Azevedo Lima Boarding School; however, yet with no operations. The booklet published by the Press Service of the Federal University of Rio de Janeiro in collaboration with the Nursing School authored by Professor Fernandes Clea Alves de Figueiredo Fernandes once again describes the authorities present at the ceremony: Ernani do Amaral Peixoto, Alzira Vargas, Gustavo Capanema (then Minister of Education and Health, also representing President Getúlio Vargas), Monsignor João de Barros Uchoa (representative of the diocesan bishop of Niterói), Einor Christopherson (head of the IIAA technical mission), Lais Netto dos Reys (principal of the EEAN), members of the EEERJ Administration Committee, as well as representatives of the medical staff of Rio de Janeiro and Niterói, especially those from the Fluminense Medical School.

In the Clipping Book it is possible to identify the event being reported in the Vanguarda newspaper, with the title of “The fight for health in the State of Rio”, on October 19th, 1944, publishing the speech of Minister Gustavo Capanema:  

Setting up schools, graduating more and more new teams of nurses. It is the only and the right solution. Thus, the need becomes clear for a campaign to establish a network of Nursing schools across the country.

In addition to the strategies for making the school's operation feasible in relation to the acquisition of financial resources and space for the implementation of the school, measures were also taken to comply with Decree No. 20,109, which “regulated the exercise of Nursing and set the conditions for the equivalence of the Nursing schools”. The administrative committee worked weekly on the organization of the school, both in the administrative and academic aspects.

The careful selection of students, through the requirement of a “normal” or “junior” high school diploma; the high level of the course program; the academic quality of the professors and the boarding school system for standardizing behaviors and maintaining constant vigilance over the students ensured compliance with Article 7 of Decree No. 20,109/31, with regard to the basic requirements for equalizing the Nursing schools. In addition, to facilitate the conditions of equivalence of the future school, the name of Aurora de Afonso Costa, a former student who worked as a professor at this school at the time, was appointed by the EEAN Principal to head the EERJ.

The school effectively started its operation on February 1st, 1945, with the inaugural class given by the sanitary doctor Marcolino Candau; its registration in the clipping book allows us to identify that it was entitled “History and Purpose of Nursing”, and highlighted the participation of the government and the contribution of North American nursing in the organization in the project to create a Nursing school in Niterói successfully concluded.

The president of the CAEE, Adelmo de Mendonça, also spoke. In a record in the clipping book, the conveniences of creating a school in Niterói stand out from his speech, which was in accordance with the achievements of the intervener of the state of Rio de Janeiro, Amaral Peixoto, as well as the possibility of future insertion of the school at the University of the State of Rio, currently Fluminense Federal University. The event was also attended by civil and military authorities.

DISCUSSION

The dictatorship of the New State, together with Brazil's alliance with the USA in World War II, reflected on the importance that Brazilian Nursing gained in the scenario of promoting the health of the urban and rural working population. Through financial investment, the government expanded diverse State apparatus to more inland regions of the country and guaranteed sanitary conditions in these regions to expand the raw materials needed by the military(11).

Thus, in November 1942, the IIAA sent nurse Clara Louise Kienninger (1s principal of the EEAN–1923-1925 period) to Rio de Janeiro, with the task of implementing the SPHS in Amazon and Vale do Rio Doce, and of developing technical and financial cooperation activities with Nursing schools and services, resuming leadership in the field of Nursing education and contributing to legitimize the foreign presence within the State apparatus(12-14).

In this context, the movement to expand Nursing schools was strongly influenced by the SPHS, as several schools were created and some others which already existed received various kinds of assistance.

In the excerpts of the analyzed documents, the school's administrative commission undertook strategies to disseminate the Nursing teaching standard in force by appointing a former student and former EEAN professor as principal. These attributes gave Aurora de Afonso Costa the credentials to occupy such an important position in the field of education in Nursing in Rio de Janeiro. Contemplating systematic and quality theoretical and practical knowledge, they guaranteed the group's expertise and, consequently, its professional and social recognition(15,16).

In this context, the Boarding School was an object of concern and operated as a valuable instrument of control of the group. There was also a prediction (which became a reality) that the instructor nurses and the school principal would also reside in the boarding school. Thus, the close and continuous coexistence ensured full-time orientation of the desired behavior for the future nurse. In an interview for the “Folha Carioca” newspaper, the principal commented on the contribution of the boarding school to the standardization of decent attitudes and gestures. She stated that the routine at the boarding school would be rigorous, so that the students could be ready for the challenges of the profession, exercising it with discipline and good moral conduct.

This rigor in the principal's perception, while ensuring respectability and the good concept of the school, also contributed to the construction of a professional identity compatible with the morality of the time, based on socialization among members of the same group(16,17). Also, the daily contact of the professor and the principal with the students demanded not only the fulfillment of all the determinations but, above all, to act as an example.

Due to her distinction, as a valuable instrument of group control, the Principal was concerned about the inadequacy in terms of safety, since it was a space for the treatment of patients with pulmonary tuberculosis. It must be remembered that it was a deadly and highly contagious disease, stigmatizing because it represents a disagreement with socially permissible standards, perpetuating to this day prejudices and attitudes of segregation with people affected by the disease(18).  

The opening conference given by the Minister of Education and Health praising the nurse's importance had the effect of being called out, as it was an authority expressing the nurse's value to society. It is noteworthy that the presence of several authorities from different spheres of society at the inauguration rite of the EEERJ had the function of transmitting the image of greatness of the event as well as projecting important personalities of the profession. These presences gave visibility to the event, highlighting the importance of the future school.

This strategy, which can be observed since the composition of the commission for the creation of the school, as it was made up of prestigious figures in the field of Health and Nursing education, aimed at giving visibility to the school to be implemented in the capital of the state of Rio de Janeiro, which was governed by the president's son-in-law. Underlying these measures, the process of showing Vargas' image as a creative leader of a new nation project becomes clear.

In charge of the New State, Getúlio's personal power represented the decisive instance in political resolutions. Furthermore, this power was also expressed and consolidated through strategies aimed at personifying the myth. Parades, demonstrations, and radio programs were organized with a view to praising his personal qualities and to ensuring the social dissemination of a favorable image of the dictator, through symbolic strategies of inculcation and coercion, which contributed to society identifying the president as an authorized spokesman to speak and act on their behalf(19).

In the wake of these strategies, the date of publication of the decree creating the EEERJ, on April 19th, 1944, Getúlio Vargas' birthday, contributed to the uplifting of the mythical figure of the president, effecting in history the relationship of his government with the expansion of Nursing schools in Brazil.

In addition, in the New State, the commemorative celebrations of national dates and the achievements of President Vargas had maximum ideological use, gathering crowds, with wide dissemination in the media. These measures were also evidenced, in this study in three important moments of the school: visit to the boarding school, inauguration and opening of the course, with the inaugural class. In these three moments, civil, military and ecclesiastical authorities were present, and they even gave speeches.  

The illustrious presence shows the recognition of the authorities of the newly created school to these personalities, at the same time that these participations in the event enunciate the importance of the school for the development of the country. The event also symbolized the crowning of a successful project.

In addition, these presences at the time when they were important to give visibility to the newly created school that aspired to social recognition, also reasserted the power of the authorities present or represented, in the midst of the New State dictatorship. This is because the symbolic effectiveness of institutional rites is exercised to the extent that the target audience recognizes those who perform it as being able to exercise it rightfully. This condition reflects the recognition extorted by violence as invisible as it is silent, in which the presence of one is enough to impose on the other, without ordering, the behavior consistent with their position in that space. This is because “symbolic violence may, in some ways, be gentler than physical violence, but it is no less real. Suffering is the result of both forms of violence”, whose social origins are mostly unnoticed and internalized, contributing to the perpetuation of symbolic systems of domination(19).

With regard to the EEERJ, its implementation in strict compliance with the precepts of the standard school, as well as the appointment of a nurse to be the principal, graduated from that school as a former student and professor, in addition to formal recognition, also symbolized a fight strategy to give visibility to the future school, ensuring prestigious positions in the training of nurses in Rio de Janeiro. This is because in this time frame the diploma formally ensured nurses a competence that really guaranteed the possession of capital, considered as much broad and extensive as more prestigious was the document. Thus, the diploma produces “a difference of essence between those who have their knowledge recognized and those who do not”(20). Therefore, the greater the recognition of the competencies assessed by the school system and the more educational the techniques used to evaluate them, the stronger the relation between performance and diploma.

In this way, the high level of expectations in relation to holders of diplomas from prestigious institutions can be understood, which reflect the recognition of social positions. This is because having a diploma implies greater or lesser possibilities for social capital(20). These possibilities that are not only granted and recognized as rights or privileges, but also attributed and imposed as duties and through efforts, represent incessant encouragements to order.

It can be said that the strategies for the creation and implementation of a school in the capital of the state of Rio de Janeiro were effective, since the school started to function on February 1st, 1945 and, after graduating the first class, obtained the equivalence to the official school, remaining in this position until 1949, because, on August 6th, it became a recognized course category through Law No. 775/49, of August 6th, 1949, which provided for “Nursing education in the country and other measures”.

In addition, the need for Nursing care in the city; the quality of the standard education imparted and the political influence of Alzira Vargas, daughter of the president and wife of the State intervener, certainly contributed to the implementation of a Nursing school in a short time and with maximum use of the symbolic gains of creating a new space for the training of high-level nurses.

CONCLUSION

The strategies undertaken by the holders of power in favor of the creation of the EEERJ in Niterói reflect the conjuncture and derive from the international and national conjuncture, since the school was implemented in the midst of World War II, which had significant repercussions in the country that, under the dictatorship of the New State, fought allied with the United States against the Axis countries (Germany, Japan, and Italy). In this context, the growing industrialization and the consequent increase in urbanization and in the modernization of the hospitals demanded the need to increase the number of nurses in the country.

The analysis of the findings allowed for the reconstruction of a historical version of the process of creation and implementation of the EEERJ, involving government, education, and health authorities, especially in Nursing, which, underlying the objective of creating the school, sought professional and social recognition arising from participation in a project that would contribute to the country's development.

The principal of the Aurora de Afonso Costa school and the instructor nurses, all certified by the Anna Nery standard school, endeavored to transmit knowledge and codes of behavior, ensuring the dissemination of a model of a nurse which, ultimately, also contributed to the recognition of the importance of nurses for society. In addition, the appointment of Aurora de Afonso Costa as the school's principal represented a symbolic gain for the EEERJ, as the success of this challenge was also linked to the fact that the principal had been trained at the standard official school and, therefore, served as a professor there, owner of the legitimate discourse to lead the training of future nurses in that space.  

Finally, it can be said that the objectives of the study were achieved by reconstructing part of the process of creating and implementing the EEERJ, contributing to the preservation of the institutional memory of the school and also to the recognition of the role of nurses, especially those involved with teaching and school administration, for the development of the profession. Further studies on the daily lives of these students are still necessary, as well as on strategies for obtaining equivalence to the official standard school, under the decree.

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Received: 04/27/2020

Revised: 05/15/2020

Approved: 05/15/2020