“THIS is how you should hold the baby. Make sure the milk is of the right temperature before you start feeding,” the nurse instructs the nervous young mother. My wife and I had just arrived at the home of a distant relative who’d just had her first child.
We join the group of well-wishers, craning our necks to get a good look at the ongoing demonstration. The nurse’s presentation quickly brings back a flood of memories. My wife and I call to mind the time when we were once first-time parents. Just like our young and inexperienced relative, we were thankful for the excellent post-natal assistance extended by the trained nurses from the Health Services Department several decades ago.
RUDIMENTARY BEGINNINGS
Health services began taking root in Malaya during the turn of the 19th century when a military hospital was established by the British East India Com¬pany for its troops stationed in Penang. The task of tending to the sick and wounded soldiers was given to the Catholic nuns attached to the garrison church.
Members of the public only had access to health services after Mun Ah Foo, a leader of the Ghee Hin Society, started the Pauper’s Hospital to provide basic healthcare for the poor and needy in Penang. Apart from that, the hospital staff also attempted to rehabilitate opium addicts.
Later, upon Mun’s demise, the administration of the hospital was passed to a committee, headed by Governor Archibald Anson, comprising representatives from various Chinese clan associations, guilds and other pillars of 19th century Penang society.
As British influence spread along the coast to the other Straits colonies and the inland Malay States, quality healthcare soon followed suit. Prior to the Second World War, things were done in a rather rudimentary manner where a large proportion of local nurses only started receiving training on their first day of work.
Apart from on the job training, these nurses attended sporadic lectures, both theory and practical, conducted by their immediate superiors who comprised mainly European sisters, matrons and doctors. The emphasis of nursing practice back then was on the curative aspects of patient care.
During those early years, trainee nurses merely sat for their respective state examina¬tions which had varying standards. Upon the completion of their train¬ing, these caregivers were promoted to staff nurses and over time, if con¬sidered suitable, became senior staff nurses.
SIGNIFICANT ROLE OF THE ‘BIDAN’
Traditional midwives, however, remained largely independent of leg¬islation until 1923 when the control of the midwife practice and specific train¬ing programmes were established for the first time in the Straits Settlement and the Malay states.
Midwives were the essential link between the trained nurses in hospitals and expecting mothers living in far flung reaches of the country. These women didn’t have the funds or means to com-mute regularly to government hospitals in larger towns.
As a matter of fact, midwives have exist¬ed long before the medical profession ever showed concern for childbirth and treated it as a special discipline. Known generally as bidan among the local Malay community, these highly respected elderly women were vastly experienced in matters concerning pregnancy and childbirth.
The bidan’s expansive knowledge in the use of traditional medicines enabled her to call upon her large arsenal of traditional herbs to safeguard the growing foetus in the womb and, when the time came, facili¬tate its birth.
According to Perak tradition, the task of inviting the village bidan falls on the hus¬band of the pregnant woman who, upon acceptance of his request, would pay the bidan her fee upfront and present a gift in the form a tray filled with lime powder, sliced areca nut and betel leaves. These were necessary items for chewing betel nut, a mild narcotic popular in the past.
The bidan would move in with the family from the seventh month of pregnancy onwards and left only after both mother and baby were out of harm’s way. Her arrival at the house would be marked by a special ceremony called lenggang perut (rocking the abdomen).
During this observance, the midwife would spread out seven sarongs of differ¬ent colours for the pregnant woman to lie on. She’d then proceed to massage the pregnant woman’s abdomen with oil before rolling a de-husked coconut slowly down the woman’s abdomen seven times. At the end of the penultimate round, the midwife would release the coconut and allow it to roll onto the floor.
The coconut would be inspected once it came to a complete stop. The ‘eyes’ of the coconut pointing upwards essentially signified the birth of a baby boy. At the end on the ceremony, the midwife would lift the sarongs and gently cradle the pregnant woman, rocking her for a while. She does this in the belief that it would ensure a safe and easy delivery.
SHARED BELIEFS
Feeling thirsty, I head to the kitchen only to find a group of elderly women in deep conversation around the dining table. It seems they’re sharing experiences and opinions about pregnancies in the past. Listening intently to their chatter, I gather that some of the pre-natal precautions practiced today are based on hearsay and vaguely understood beliefs inherited from our ancestors.
It seems that one of the common fears during pregnancies is the possible effects of one’s actions on the unborn child. The Malays call this effect tertekan. They believe that the growing foetus is undergoing formation during the first four months of pregnancy and would be vulnerable to the actions of the parents, to whom it’s inextricably linked as a product of their union.
During this sensitive period, Malay parents would abstain from fishing for it’s believed that if their fishhook were to tear the mouth of the fish, then their child may be born with a cleft lip. Chopping off the legs or pincers of a crab is believed to deform the child’s limbs; meanwhile, if the father uses a hammer, then the child would be born deaf.
Also, in general, the expecting mother would be encouraged to look at pleasant things and utter positive words lest the child is born ugly. The pregnant woman would also avoid sitting on doorways to prevent the obstruction of her birth canal. Society frowns upon the father placing towels or other pieces of cloth around his neck as it’s believed that this may cause the umbilical cord to wrap around the baby’s neck at birth.
While sharing similar ideas with the Malays, the Chinese also believe that Tai Shen, the ‘placenta god’ that animates the foetus’ soul, moves around precariously during the first four months of pregnancy, a period before the soul firmly attaches to the body. During this sensitive period, it’s con¬sidered dangerous to move large house¬hold items like furniture for fear that the pregnant woman may suffer a miscarriage.
Meanwhile, around the seventh month, Indian Hindus observe a tradition where the pregnant woman returns to her own parents’ home for a ceremony. All married relatives would usually turn up for this cer¬emony as a show of support.
Held at dawn, the woman would sit on the floor lined with banana leaves and face the rising sun. Nine different kinds of veg¬etarian food and three types of rice would be placed on the leaves. The Indians believe that the early part of the morning symbol¬ises the beginning of life.
Married female relatives would then place coloured bangles on the pregnant woman’s arms to protect her against evil spirits. The expecting mother would then be asked to choose between three different packets of rice where only one would be sweetened. Choosing the sweet rice would signify that the unborn child is a boy. Before the end of the ceremony, the woman would break open a coconut. A pure white interior is believed to foretell an easy and unevent¬ful delivery.
“The nurse is going back. It’s only polite if you join us in front to bid her farewell,” my wife’s whisper catches me by surprise. I’d been so caught up in the conversation that I’d lost all track of time. We reach the hall just in time to say goodbye to the dedicated nurse. Then, one by one, the guests start to disperse. As we’re among the last to arrive, it’s common courtesy to stay a little longer to chat. By this time, I notice that the young mother is much more confident in handling her baby. The nurse’s house call has defi¬nitely made a world of difference.
MAJOR MILESTONES
Eventually, the conversation skews to the advancement of health services in this country. Everyone present concurs that much of the risks concerning childbirth has been minimised following ground breaking medical advancements and improved legislations following the years leading up to Merdeka.
In 1950, the Nursing Board came into existence when the Nurses Act was passed. The board had power over the training and registration of nurses as well as deter¬mined the issuance of the all-important registration certificate and badge.
The next milestone occurred in 1959 when health services became the responsibility of the central government which then delegated service delivery through the various state and district health administrations. As a result of this move, the maternal and child health services were given an expanded role in the National Rural Health Development programme. This move led to a significant shortage of nurses.
With the three government-funded schools of nursing in Johor Baru, Penang and Kuala Lumpur running at capacity, a decision was made in 1961 to establish Malaya’s first private nursing school at Assunta Hospital to cope with the sudden increase in demand. The school, subjected to the 1950 Nurses Act regulations and pro¬cedures, was named the Tun Tan Cheng Lock College of Nursing, in recognition of the statesman’s strong belief in education.
The midwife profession was finally brought in line with the other health services when the Midwifery Board was formed following the establishment of the Midwives Act in 1966. With it came the mandatory requirement for all midwives in the country to be registered and regulated. In order to enhance their skills and knowledge, many nurses were sent for courses in Great Britain, Australia and New Zealand.
By the time we finally decide to leave, someone in the group suddenly reminds us that her daughter, who’s now an advanced practice nurse in Kuching, belonged to the pioneer group of students who graduated from University Malaya in 1996. They were the first batch to sign up for the three year tertiary education course.
Her words hit a chord with me. Despite the great progress made by nurses today, they still share something in common with their predecessors — the relentless pursuit to provide the best care for their patients. For that, our nation owes all nurses a great debt of gratitude in recognition of their tireless service and selfless sacrifice in providing quality healthcare to everyone, regardless of gender, race, colour or creed.