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BBC: "The nurse who inspired Live Aid"

July 1, 2005 -- Today the BBC site posted a story by Jane Elliott about Claire Bertschinger, the young U.K. nurse who appeared in an influential 1984 BBC report surrounded by 85,000 starving Ethiopians, and who reportedly inspired Bob Geldof to create the original Band Aid single and Live Aid. Bertschinger has just published an autobiography, "Moving Mountains," about her time in Ethiopia. The BBC piece is a flawed but powerful reminder of the central and extraordinarily difficult roles nurses play in developing world health care, roles that are too often overlooked in media reports.

The piece explains that Bertschinger appeared in an "enduring" image in a BBC report by Michael Buerk that showed starving children, many "within days or hours of death." The BBC report drew massive global attention to the situation in Ethiopia. At the time, Bertschinger worked for the International Committee of the Red Cross at a "feeding centre," where she "had the daily task of deciding which children would be allowed into the feeding station and which were too sick to be saved." Geldof, who evidently saw the report, is quoted as having said at the time that "[i]n her was vested the power of life and death...She had become God-like and that is unbearable for anyone." Needless to say, this power weighed heavily on her. The piece reports that she was so "traumatised" by her work in Ethiopia in 1984 and 1985 that she could not speak about it for 20 years. At the time, she dealt with the situation by cutting herself off from the media reports, and so she had no idea that she was "the catalyst for so much fundraising." The piece quotes her as saying that isolating herself was a way of "shutting out [her] horror." At the same time, she was "engrossed in the feeding station," where she was "so busy [she] would either sink or swim," and where she fought through illness to keep going. Her book includes diary entries that illustrate how difficult the situation became: "There are thousands of people outside...I can only take 60-70 children today, but they all need to come in. Hell, what a job. How can I decide?" The piece also includes a quote, apparently more recent, in which Bertschinger says that she "felt like a Nazi sending people to the death camps...Why was it possible in this time of plenty that some have food and some do not?"

In the piece, Bertschinger also describes taking an anemic baby to a hospital for a blood transfusion: "They had no blood, so I gave him one unit of mine and my diary entry was that 'today I have done something'." In a similar vein, the piece reports that it was not until Bertschinger returned to Ethiopia 18 months ago and met some of the children she had helped to save that she "realised she had actually done some good."

Buerk is quoted as calling Bertschinger's book the story of "one of the true heroines of our times," an "ordinary woman who did extraordinary things and really did move mountains." A caption for a photo of Bertschinger accompanying the piece notes that she won the Florence Nightingale Medal, though it does not explain that this is the International Red Cross' highest distinction for the nursing profession. Bertschinger, who was a guest at the recent Live 8 concert, now teaches at the prestigious London School of Hygiene & Tropical Medicine. There (though the article does not mention it) she is the "Course Organiser" for the Diploma in Tropical Nursing program for nurses who plan to work in developing nations.

The piece is a prominent reminder of the vital work nurses do in developing nations, work that is often undervalued by the media, and even by the organizations for whom the nurses work. Physicians generally receive most of the credit for such work. This piece shows a nurse confronting a situation of great difficulty and saving lives, at a great cost to her mental health. It also at least hints that she is someone with technical knowledge, in noting that she now teaches in London.

Parts of the piece arguably overemphasize the emotional aspects of Bertschinger's experience and underplay her expertise. The piece hits the "power over life and death" angle hard, but it could have emphasized more that she was not simply making arbitrary choices. It rightly notes that she was assessing who was too sick to be saved. But it does not explain to lay readers that this is a difficult nursing task--triage--that requires the exercise of skilled assessments presumably made even more difficult by the mind-boggling consequences of her choices. It is also a terrifying example of care rationing, another task that nurses increasingly confront--thankfully on a far smaller scale--in the managed care era, when short-staffing is common throughout the developed and developing world. In fact, many nurses spend their professional lives trying to provide skilled care while confronting such awful choices, something that the media rarely reports. In addition, we read that Bertschinger is a "hero" who handed out food and by her appearance served as a "catalyst"--things that perhaps many people could have done--but not about the skilled nursing care that she used to save lives. Sadly, Bertschinger's diary itself seems to reinforce this by suggesting that she has only done something good when she donates some of her own blood. Buerk's high praise includes the note that she is an "ordinary" person. That may be so, but we couldn't help wonder if there was an assumption that she was "ordinary" because she was a nurse. Had she been a physician, would we have read instead about how she had devoted her great gifts and skills to the poor? We do get a sense of the strength that must have been required for her to watch so many people die. This is appropriate: nurses are the health care professionals who are most likely to be present for patients' deaths, though again, not usually on this scale.

On balance, we commend the BBC and Ms. Elliott for a helpful piece about the vital work of nurses in one of the world's most desperate care environments.

See Jane Elliott's July 1, 2005 article on the BBC site, "The nurse who inspired Live Aid," about nurse Claire Bertschinger.

We have not reviewed Moving Mountains, but you can find purchasing information here.

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