Nurses Speaking Up, Speaking Out in Tanzania

Zack LangwayBlog, Nursing, Tanzania

As part of our National Nurses’ Week series on nursing and the Sustainable Development Goals, GHSP Volunteer Olivia Kroening-Roche, CNM, interviewed Pauline Mella, a colleague at our partner institution Hubert Kairuki Memorial University, on her life’s work and how nurses can leverage their voices for action in Tanzania.

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“Why I am so proud is I was able to go through that challenge. Oh, rubbish, some people said,” she explained to me as I sat across from her. “Seriously,” I exclaimed my naïveté and incredulity on display at my disbelief that anyone could oppose a degree program for nurses. “Yes,” she responded calmly, an incredible woman who has led her field with competence and confidence to the place it is today. She continued to recount to me how her initial attempts to create a bachelors program in nursing were met with resistance by the medical department.

The gray skies of the rainy season threatened storms all afternoon as I sat opposite Pauline Mella for our interview, petite stature and kind eyes belonging to a woman of wisdom and strength. I had the chance to talk to Professor Mella in our shared office at Hubert Kairuki Memorial University. She taught me about the significant role she played in creating a seat at the table of healthcare for nursing in Tanzania. While unassuming, as you will soon see Pauline Mella is giant in Tanzanian nursing. As she prepares to celebrate her 50th year working as a nurse, she reflects on the achievements in Tanzania towards Sustainable Development Goal four, quality education. Her own career reflects the power of education, both for the individual, the community and the country.

Olivia: Can you briefly explain your history in nursing in Tanzania?

Professor Mella: I acquired my nursing education in the Netherlands and trained in a very modern university hospital. The standards were high and clinical education was emphasized. I came back to work in Tanzania  in 1967 as a registered nurse and the organization that employed me  wanted to establish a nursing school at Mwanza and needed someone to teach. Because of this, I then had the opportunity to go for an advanced nursing degree in Nairobi where I gained experience in teaching, administration and mental health care. Nineteen years later after obtaining my graduate education I became the first Dean of Nursing in Tanzania at the Muhimbili University College of Health Sciences.

Olivia: When you began your career, what were some of the main challenges facing nursing in Tanzania?

Professor Mella: Nurses were not empowered to make decisions or to think independently, they only were able to do exactly what the doctor told them. Even if they knew an order or prescription was wrong, they had no power to challenge this. They were the ‘handmaid’ of the doctor. There was also a low level of education required to become a nurse. There were also no nursing role models to provide education in the clinical setting.

Olivia: How did nurses find their voice to become involved in decision-making?

Professor Mella: Four nurses from Tanzania went to Australia, learned how to be educators and when they returned they began working in nursing schools and formed the Tanzania Registered Nurses Association (TARENA) in 1971, the first nursing association in Tanzania. The aim at that time was to promote professionalism, motivation and compensation among nurses. When I became president of TARENA in 1985 I brought my ideas that the organization should focus on more educational and scientific areas of nursing. We held scientific conferences to discuss research in nursing and promoted the sharing of knowledge. I pioneered the establishment of the first degree program in nursing 1990. Originally it was within the department of medicine but eventually nursing and medicine were recognized as separate professions. Another example is that the Tanzania Nursing and Midwifery Council, the legal organization for nursing in Tanzania, was originally chaired by a medical doctor. Through concerted efforts of nurse leaders, Act no. 12 of 1997, changed the picture when a senior nurse became the chair. The council is able to make changes for nurses, such as advocating for improved hours for nursing working the night shift and proper identification of nurses with different levels of education.

Olivia: When you reflect on your career in nursing in Tanzania, what are you most proud of?

Professor Mella: The graduates of our degree programs have become very successful e.g. some obtained PhDs and hold different positions in local and International organizations and have further helped to advance nursing in this country.  People are hungry for education. We now have good educators, researchers, and role models for our students, which will allow for nursing to continue growing.