Brazilian nurses in air transport of wounded during World War IIABSTRACT
Objective: to analyze the preparation of nurses from the Brazilian Expeditionary Force to work in the air transport of wounded people during World War II.
Method: historical-social study, of a qualitative nature, based on the work entitled “Nurses with the FAB on the Italian front: 1944-1945”, written by nurse Izaura Barbosa Lima. The data results from a bibliographic survey, the use of documentary sources and database consultations, with the material being treated using Thematic Content Analysis.
Results: the following categories emerged: Professional trajectory of Nurse Izaura; Commuting between the United States and Italy; and the Nursing Air Evacuation Course.
Conclusion: the study highlights the pioneering role of nurses in the Brazilian troops sent to Italy, the necessary preparation and completion of the course to join the air transport service for the wounded. Its achievement assumes relevance for contributing new elements to the History of Brazilian Nursing, particularly regarding the establishment of the foundations of Brazilian female military nursing.
Descriptors: Biography; Military Nursing; Nursing; World War II; History
RESUMEN
Objetivo: analizar la preparación de enfermeros de la Fuerza Expedicionaria Brasileña para actuar en el transporte aéreo de heridos durante la Segunda Guerra Mundial.
Método: estudio histórico-social, de carácter cualitativo, a partir del ejemplar titulado “Enfermeras con la FAB en el frente italiano: 1944-1945”, escrito por la enfermera Izaura Barbosa Lima. Los datos resultan de un levantamiento bibliográfico, el uso de fuentes documentales y consultas de bases de datos, siendo el material tratado mediante Análisis de Contenido Temático.
Resultados: surgieron las siguientes categorías: Trayectoria profesional de la Enfermera Izaura; Idas y vueltas entre Estados Unidos e Italia; y, el Curso de Evacuación Aérea de Enfermería.
Conclusión: el estudio destaca el papel pionero de los enfermeros en las tropas brasileñas enviadas a Italia, la preparación necesaria y la realización del curso para incorporarse al servicio de transporte aéreo de heridos. Su realización asume relevancia porque aporta nuevos elementos a la Historia de la Enfermería brasileña, especialmente en la construcción de las bases de la enfermería militar femenina brasileña.
Descriptores: Biografía; Enfermería Militar; Enfermeras; Segunda Guerra Mundial; Historia
RESUMO
Objetivo: analisar a preparação das enfermeiras da Força Expedicionária Brasileira para atuação no transporte aéreo de feridos, durante a II Guerra Mundial.
Método: estudo histórico-social, de natureza qualitativa, elaborado a partir do exemplar intitulado “Enfermeiras com a FAB na frente italiana: 1944-1945”, de autoria da enfermeira Izaura Barbosa Lima. Os dados resultam do levantamento bibliográfico, da utilização de fontes documentais e de consultas às bases de dados, sendo o material tratado pela Análise de Conteúdo Temática.
Resultados: emergiram as seguintes categorias: Trajetória profissional da Enfermeira Izaura; Idas e vindas entre os Estados Unidos e Itália; e, o Curso Nursing Air Evacuation.
Conclusão: o estudo destaca o pioneirismo da inserção das enfermeiras brasileiras junto às tropas militares enviadas à Itália, a preparação necessária e a realização do curso para integrarem o serviço do transporte aéreo de feridos. Sua realização assume relevância ao contribuir com novos elementos à História da Enfermagem brasileira, em especial, sobre a construção dos alicerces da Enfermagem militar feminina brasileira.
Descritores: Biografia; Enfermagem Militar; Enfermeiras; II Guerra Mundial; História
INTRODUCTION
World War II (1939-1945) was the largest conflict in history ever experienced by humanity. This global conflict, motivated by different political and ideological issues, lasted six years and involved 72 countries from four continents. During the war, the countries formed two major military alliances: the Axis (Germany, Italy and Japan) and the Allies (France, England and the Soviet Union, initially, and the United States after the Japanese attack on the US base at Pearl Harbor)1.
The realization of Brazil’s participation in World War II can be attributed to the Potengi Conference2, when in Natal, capital of Rio Grande do Norte, on January 28, 1943, Getúlio Dornelles Vargas and Franklin Delano Roosevelt, presidents of Brazil and the United States, respectively, signed a bilateral cooperation agreement. Among other agreements, they dealt with the transfer of military bases along the Brazilian coast, the transfer of technology, training of military personnel and the installation of the US Navy's IV Fleet in Recife/Pernambuco and the construction of airstrips3.
As part of the necessary actions for participation in the war, on August 9, 1943, the Brazilian Expeditionary Force (Força Expedicionária Brasileira - FEB)4, was created, responsible for mobilizing and sending the military delegation to Europe. Its leadership was entrusted to General João Batista de Mascarenhas de Moraes, responsible for the 1st Expeditionary Infantry Division and non-divisional units. In this context, on December 13, 1943, the Army Reserve Nurses Corps was created5. This allowed for the deployment of 73 volunteer nurses4,6-9 divided into two groups: 67 in the Army Medical Service and six in the Wounded Air Transport Service.
Thus, the preparation and participation of nurses in World War II, especially those in the Air Transport of Wounded Service, although it corresponds to an unfolding of government actions, is relevant due to the unprecedented inclusion of women in the Brazilian military. This event can be understood as contributing to the professionalization of Brazilian women and the visibility of the nursing profession.
Therefore, it is worth noting that this study corresponds to part of World History and is justified by providing elements to the History of Brazilian Nursing, focusing on its qualifications, practice and professional identity. Therefore, it can be seen as an opportunity for professional development through the acquisition of new knowledge resulting from military training, international exchange and care experiences in a wartime scenario. Thus, the objective was to analyze the preparation of nurses in the Brazilian Expeditionary Force for their role in air transport of the wounded during World War II.
METHOD
This is a historical-social study of a qualitative nature, prepared according to the Consolidated Criteria for Reporting Qualitative Research (COREQ)10, with the purpose of certifying the absence of conflicts and guarantee quality and reliability11. Structured based on the copy entitled “Nurses with the FAB on the Italian front: 1944-1945”, written by nurse Izaura Barbosa Lima, published in 1952. This book, published by the Health Organization Division of the National Department of Public Health, of the Ministry of Education and Health, is indexed in the library of the Historical-Cultural Institute of the Air Force, in the city of Rio de Janeiro, under code FSNC0699.
Data collection was carried out between January and April 2023. It results from a bibliographic survey, consultations of documentary sources12, databases - Regional Portal of the Virtual Health Library (BVS) and Scientific Electronic Library Online (SciELO) - and websites such as: Hemeroteca Digital da Fundação Biblioteca Nacional; Biblioteca Digital da Câmara dos Deputados; Revista Verde-Oliva Digital; Arquimedes: Difusão da Memória da Justiça Militar da União; Biblioteca do Exército Digital; Associação dos Expedicionários Campineiros. To this end, a combination of “keywords” (Brazilian expeditionary force and nurse) was used for the websites and “descriptors” (nurses, World War II and military nursing) for the Databases and the Boolean operator “AND” was used in search syntax formulation.
Out of the total of 265 productions located, only 37 met the inclusion criteria, firstly, because they were relevant to the objective of this article, and secondly, because the texts were fully available, written in Portuguese, English or Spanish. In turn, all those that did not specifically address Nursing were excluded. This stage of the research was developed by two different authors, independently and, if necessary, with the participation of a third author.
The data was analyzed according to the Thematic Content Analysis13, complying with the phases of pre-analysis, material exploration and result treatment and data interpretation. This activity allowed to order the events chronologically, to interpret the events in detail and to systematize the elements essential to the reconstruction of this story. Thus, for a better understanding, the results were systematized into three categories: Professional trajectory of Nurse Izaura; Commuting between the United States and Italy; and the Nursing Air Evacuation Course.
Ethical aspects of research were considered in accordance with Resolutions No. 466/2012 and No. 510/2016 from the National Health Council. The research project was submitted to Plataforma Brasil and approved by the Research Ethics Committee of the Hospital Universitário Onofre Lopes of the Universidade Federal do Rio Grande do Norte under CAAE No. 64740017.0.0000.5292, Opinion No. 1,946,320.
RESULTS
The analysis of the book “Nurses with the FAB on the Italian Front: 1944-1945” resulted in three categories: Professional trajectory of Nurse Izaura; Commuting between the United States and Italy; and the Nursing Air Evacuation Course. Therefore, this section initially includes information about the professional career of nurse Izaura Barbosa Lima, and then discusses the preparation of nurses for air transport of wounded people, as detailed in the publication of her authorship, which is the subject of this manuscript.
Professional trajectory of Nurse Izaura
Born on May 13, 1897, in the city of Rio de Janeiro, she is the daughter of Francisco Barbosa de Lima and Eliza Barbosa de Lima and graduated from the first class (1925) of the Anna Nery School of Nursing9,14. On August 12, 1926, with seven other nurses, they founded the National Association of Graduate Nurses, which later became the National Association of Brazilian Graduate Nurses (1928) and, since 1954, has been the Brazilian Nursing Association (Associação Brasileira de Enfermagem - ABEn)15. Its first Board of Directors operated provisionally for a period of one year, with Rimídia Bandeira de Souza Gayoso, Isolina Saldanha Lossio, and Izaura Barbosa Lima in the positions of President, Secretary and Treasurer, respectively.
Regarding her involvement in the association14-16, Izaura Barbosa Lima remained very engaged and, on several occasions, was part of the Board of Directors, in positions such as: representative of nursing in the states (1945-48), President of the Education Division (1948-52) and on the Fiscal Council (1952-56, 1958-1960, 1962-64, 1966-70). At times, she combined roles as President of the Nursing Assistants Commission (1951-1960) and during the Nursing Census Survey (1950), carried out in partnership with the National Department of Public Health. Equally relevant were her contributions to the Brazilian Journal of Nursing (Revista Brasileira de Enfermagem - REBEn), published since 1932.
As a nurse, she was a federal public employee located in the National Department of Public Health, of the Ministry of Education and Health, where she held the position of Chief of the Nursing Section, in the Division of Sanitary Organization17. She made notable contributions to public health in combating epidemics of smallpox (1925), yellow fever (1928), and typhoid fever (1928 and 1933)14. She contributed to the nursing service in public health, in maternal and child care and with the creation of the course for Sanitary Visitors14,18, both in Rio Grande do Sul (1938-43). She was in the city of Trinidad, in Bolivia (1947), as a participant in the Brazilian humanitarian aid to flood victims16. She worked inspecting nursing and nursing assistant schools, issuing operational and recognition certificates14.
Izaura Barbosa Lima, Judith Arêas, Ocimara Moura Ribeiro, Maria Diva Campos, Regina Cerdeira Bordallo and Antonina de Hollanda Martins - all graduates of the Anna Nery School of Nursing - participated in World War II, as part of the Brazilian Expeditionary Force, in the Air Transport Service for the wounded19, affiliated to the 1st Fighter Group of the Brazilian Air Force20. Together, they took the Nursing Air Evacuation course at Micthel Field Air Base in New York, United States6, in preparation for their deployment to Italy.
During her professional career, Izaura Barbosa Lima received the following awards: the War Medal; Ministry of Health Medal for services rendered (1963); Izaura Barbosa Lima Scholarship established by ABEn for nurses in Medical-Surgical Nursing (1970); title of Honorary Member of ABEn awarded at the 28th Brazilian Nursing Congress, held in Rio de Janeiro (1976)15. Also in recognition of her legacy, ABEn sponsors the Izaura Barbosa Lima Award for active members who present the best work on Public Health at the Brazilian Nursing Congresses21. On February 25, 1987, at the age of 89, Izaura Barbosa Lima passed away in Porto Alegre, Rio Grande do Sul.
Commuting between the United States and Italy
Among the preparations necessary for the training process of nurses for the Air Transport of Wounded Service in the United States, it was necessary to undergo a rigorous health inspection and immunization schedule (yellow fever, tetanus, typhus and smallpox). In that country, the Brazilians completed a preparatory program to work in the American field hospitals in Italy22.
Thus, on June 12, 1944, they left Santos Dumont Airport in Rio de Janeiro for Salvador (Bahia), then headed to Recife (Pernambuco) and Natal (Rio Grande do Norte), where they spent the night. The next day, they left for Belém (Pará), Georgetown (Guyana) and San Juan (Puerto Rico), with one more stop. On June 14, they continued to Miami (United States), from where they traveled to New York by train the following day. Their final destination was the Mitchell Air Force Base22.
As part of this training, they made technical visits to hospitals - civilian and military, of different sizes and specialties - scheduled by Nurse Lieutenant Joelma Wallace. In this way, they visited the nursing services at the Station Hospital for Women, Old Canton-Men Hospital and New Canton-Men Hospital, in the state of New York, and Halloran General Hospital, in New Jersey. They also visited the Nursing School, attached to Bowman Field Air Force Base, in the state of Kentucky, an institution that is a reference in the preparation of nurses for the air transport of wounded. They experienced the ceremony of awarding certificates to 200 nurses and received theoretical and practical instructions, inside a training aircraft, given by Nurse Majors Juanita Pearsons and Mary Leontina22.
They also visited: the Center Convalescent Hospital, in the city of Pawling, in New York, specialized in the rehabilitation of war amputees; Walter Reed General Hospital, in Washington, an important Army hospital; the School of Nursing at the Catholic University, under the administration of Sister M. Olivia; the American Red Cross, with nurse Virgínia Dumbar; the School of Nursing at New York Hospital, whose students interested in military service received housing, meals and scholarships; and the School of Nurses at Lincoln Hospital, exclusively for the training of black nurses22.
In Washington, DC, at the Surgeon General Office Wartime Bladf, they met with nurse Colonel Florence Aby Blanchefield, superintendent of the Army Nurse Corps, who explained the context of the war, the number of nurses and the commitment to keep exclusively qualified professionals in the field hospitals. Finally, they had an audience with Brazilian Ambassador Carlos Pereira Martins, at the Brazilian Embassy22.
As part of the protocol before boarding for Italy, on August 29, 1944, the Brazilian nurses underwent a new series of health exams, blood tests and personal identification. On September 5, they left Mitchel Air Force Base in New York, bound for Camp Patrick Henry, Virginia, where they joined the 1st Fighter Group of the Brazilian Air Force. On September 19, they boarded the French-flagged ship Columbia in Newport News, bound for Europe. This trip followed the following routine: strict compliance with the regulations; two meals a day (8:30 a.m. and 7:00 p.m.); three liters of water for personal needs; remaining calm during alert calls until arriving at the port of Livorno, Italy. On October 6, 1944, after disembarking, the nurses went to the 154th Station Hospital in the city of Civitavecchia, and the members of the 1st Fighter Group of the Brazilian Air Force went to the city of Tarquina22.
In this hospital, with a capacity for 115 beds, these Brazilian nurses stayed from October 7 to December 12, under the same rules and routines as the 13 American nurses already there, regarding work schedules, days off (half a day per week and a full day every two weeks) and vacations (according to service needs). One of these nurses was responsible for assisting the Brazilians and all were assisted by sergeants, corporals, soldiers and, in some cases, even by less severe patients who were able to move around22.
After this period, the Brazilian nurses were transferred to the 12th General Hospital in Livorno, where they stayed from December 12, 1944, to June 19, 1945. Three wards were created then to serve the 1st Fighter Group of the Brazilian Air Force, which was camped in Pisa. This hospital, with a capacity for three thousand beds, was intended to assist clinical and surgical cases. It employed 1,500 professionals, of whom 150 were nurses22.
It is important to inform about the operation of the Rest Houses organized by representatives of the American nursing and social services to serve those who worked for more than 90 days in hotels located in safe cities away from the hospital environment. These houses were set up separately, by rank, but with similar structure and comfort (living rooms, clubs, public phones, post office, bars, libraries, laundries, leisure activities, shows, tourist programs, etc.). Additionally, these environments had signs indicating streets, neighborhood directions, and locations for food, restaurants, stores, and public restrooms22.
On June 19, 1945, these Brazilian nurses ended their activities, by the end of the war, leaving the 12th General Hospital the following morning, leaving Livorno to Naples. On June 26, at 12:30 p.m., they flew to Casablanca, Morocco, where they stayed until the 30th, when they boarded for Brazil. They arrived in Natal, Rio Grande do Norte, on August 1 and proceeded to the Rio de Janeiro on August 3, 194522.
The Nursing Air Evacuation Course
This course, whose schedule is presented in Chart 122, was structured over six weeks (July 21 to August 26, 1944) and was held at the Field Canton-Men Hospital, Mitchel Air Force Base, in the town of Santini, with Major-Nurse Mahoney as the general head of the Nursing service. The Brazilian nurses attended theoretical and practical classes and completed internships in the orthopedic wards and in surgical rooms. They also received materials (gas masks, steel helmets, boots, socks, overalls and hats) to use during military instructions given by Sergeants Teodoro Fernandes - a Portuguese naturalized American - and Luiz Fernando, a Brazilian22.
Based on the above, the results were prepared to support the reconstruction of the trajectory of nurse Izaura Barbosa Lima, highlighting her professional training, her career as a public servant and her political and social engagement. Additionally, the displacement of Brazilian nurses to the United States/Italy and the detailed preparation of this group for work in the air transport of wounded during World War II were highlighted. Finally, the organizational aspects and execution of the Nursing Air Evacuation preparatory course were summarized.
DISCUSSION
In Brazil, the context of participation in World War II became an opportunity for women to join the military service. This pioneering work is due to the inclusion of nurses from the Brazilian Expeditionary Force (FEB), in the Army Medical Service and in the Air Transport Service for the Wounded, to work in the American field hospitals set up in Italy.
For information purposes, the geographical area in which the Brazilians operated was structured into four types of hospitals, based on the location of the troops on the front line, in the following order: First Aid, Field Hospital, Station Hospital and General Hospital. The First Aid unit was mobile, organized in tents to be able to accompany the movement of the troops and its purpose was to provide first aid. There, the wounded were triaged and, as their health condition stabilized, they could be transferred to the Field Station, from there to the Station Hospital, and finally to the General Hospital. In this same order, there was an increase in the number of healthcare professionals, inpatient beds, and specialized care. A hospital classified as a General Hospital could have up to three thousand beds and, once recovered the patient, they could probably be transported back to their home country22.
Regarding the involvement of Brazilian women in World War II, it is worth noting another aspect of female participation in auxiliary war groups - the Women’s Auxiliary War Organization (Santos and São Paulo) and the Volunteer Corps for Passive Defense (Rio de Janeiro) - as a result of the creation of the Anti-Aircraft Passive Defense Service23, after the establishment of the Ministry of Aeronautics24, in 1941. These emergency courses were created to train agents to deal with potential situations such as: protection against gases, public sanitation, removal of intoxicated people, first aid, air surveillance, fire prevention and extinguishing, policing and supervision in the execution of orders, construction of trenches and emergency shelters, among others25.
Certainly, these occupations - military nurse and war auxiliaries - can be seen as examples of the search for non-traditional spaces by these Brazilian women. It can be assumed that this availability and commitment aligns with the global rise of the feminist movement1 in an effort to break social, political and economic paradigms, in which, for women have traditionally reserved roles as motherhood, domestic chores and the teaching profession.
Regarding the women’s struggle, it is worth noting that the early decades of the 20th century saw the suffragist movement26. In this regard, it is worth highlighting the efforts of Brazilian biologist and politician Bertha Lutz, daughter of a nurse, in the fight against the social invisibility of women. Due to her activism, she represented Brazil at the San Francisco Conference in the United States in 1945. As an activist, she gained prominence in the fight for women’s access to education, paid work and participation in elections27.
In our reality, the right to vote for women was guaranteed by the 1934 Constitution, voluntarily and with the husband's authorization, except for widows and single women who could prove their income. Political rights were equalized with the enactment of the Electoral Code in 1965, which universalized registration and voting for those over 18 years old28. However, the state of Rio Grande do Norte recorded two previous events: in 1927, women were allowed to vote, with teacher Celina Guimarães Viana being the first to register and vote in Latin America; and in 1928, Alzira Soriano Teixeira was elected the first female mayor, also in Latin America, in the city of Lages, with 60% of the votes29.
Returning to the training of FEB nurses, all of them complied with the requirement of completing the Emergency Course for Army Reserve Nurses, lasting six weeks, taught by the Army Health Directorate, with an emphasis on physical conditioning, specific knowledge and military instructions8. Those candidates that passed the test became part of the Army Nurse Reserve and, when called up, were promoted to active duty19.
In turn, the nurses of the Air Transport of Wounded Service complemented their qualifications by taking the Nursing Air Evacuation Course in the United States. This was, therefore, yet another partnership recorded in the History of Brazilian Nursing within a representative number of international cooperation aimed at exchanging expertise, bringing peoples and cultures closer and expanding the provision of health care30-31. On this occasion, the participation of nurses in the FEB occurred within the context of the good neighbor policy32 implemented by the United States for Latin America and was probably designed to avoid overload of US field hospitals in providing care to troops sent to Italy6,19.
This additional training lasted 96 days and included technical visits to different health institutions, with the aim of observing the dynamics of providing care and facilitating adaptation to field hospitals. It also involved visits to military bases and institutions that train nurses; to military and diplomatic authorities; and the Nursing Air Evacuation course, structured essentially with military instructions and held at the Mitchell Air Force Base in New York22.
Regarding air medical evacuation, it is worth mentioning that the first experiences date back to the Franco-Prussian War in 1870, when balloons were used to transport wounded soldiers to safe locations where care could be provided. Decades later, the advent of the airplane brought about a new reality when, especially during World War II, it was widely used for military purposes and to transport of victims. From this perspective, the aerial transfer of wounded people can be considered a global milestone for nursing, as it enabled the emergence of flight nurses, nurses specialized in this service33.
Therefore, Izaura Barbosa Lima, Judith Arêas, Ocimara Moura Ribeiro, Maria Diva Campos, Regina Cerdeira Bordallo and Antonina de Hollanda Martins can be credited with two pioneering roles: joining the Brazilian military and transporting wounded by air. They were diploma nurses, a term used at the time for graduates from schools recognized by the Federal Government. This homogeneous group shares the same educational background, which probably facilitated teamwork, the acquisition of new knowledge and the development of new care practices in Brazilian nursing.
Regarding information about Izaura Barbosa Lima, it was not intended to elaborate on her biography. The data presented here is part of a collection of publicly available information, much of which is content from nursing magazines. Even so, it adds necessary contributions to the knowledge of the profession, to the understanding of events and highlights the achievements of individuals in their historical context34.
When related to Nursing and its processes, historical studies and their various methods can contribute with specific knowledge necessary for understanding professionalization, establishing professional identity, to unveil events and the analysis of the health-disease-care process35-36. Although they may be specific, life stories are of vital importance to review interpretations, valuing achievements and constructions made by characters that may be forgotten. This perspective aims to revisit, redoing, signifying, deconstructing discourses and developing new concepts37, thus expanding the discussion on the political, cultural, social and historical spaces of Nursing38 and its actors.
Finally, conducting historical research requires the development of skills to overcome limitations regarding the location, conservation and access of sources, which can limit the development and discussion of results. The analysis of this important episode corresponds, therefore, to the appreciation of a historical snapshot and does not intend to exhaust studies on the participation of nurses in World War II. Therefore, further investigations are recommended to reconstruct the history of Brazilian nursing.
CONCLUSIONS
The historical and social event analyzed here deals with a challenging and innovative context for Brazilian nurses during World War II. Its record contributes with elements to the understanding of the nursing history, the construction of identity and professional visibility, especially concerning the pioneering work of these nurses who built the foundations of Brazilian female military nursing.
This study presents, as an analysis, individuals, innovations and organizations in the nurses' work process, highlighting the establishment of international partnerships, the acquisition of knowledge and the development of care practices. Understanding these elements contributes to the acquisition and expansion of new knowledge, especially for the development of a new area of practice and the advancement of scientific research in Brazil on this thematic area - female military nursing, with a focus on the air transport of wounded.
Acknowledgments
To the Hospital Universitário Onofre Lopes (HUOL) and the Universidade Federal do Rio Grande do Norte (UFRN) for granting permission to carry out the Post-Doctoral program at the Escola Superior de Enfermagem de Coimbra (ESEnfC), in 2023, in collaboration with the Unidade de Investigação em Ciências da Saúde: Enfermagem (UICISA: E), in accordance with UFRN Ordinance No. 365, March 1, 2023.
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Publication Dates
-
Publication in this collection
25 Nov 2024 -
Date of issue
2024
History
-
Received
22 Dec 2023 -
Accepted
14 Mar 2024
