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Der Spiegel: "From Johns to Geriatrics"

March 14, 2006 - Today the leading German news magazine Der Spiegel posted an article by Guido Kleinhubbert about a new government program to train prostitutes to become "care workers for the elderly," apparently including nurses. "Prostitute Retraining Program: From Johns to Geriatrics" suggests that some of the skills gained in prostitution are quite transferable to elder care. It also suggests that the training program is a timely idea, as Germany has a glut of prostitutes and a desperate need for nursing home workers, especially as its population ages. We have no problem with the training program itself. But the piece makes lighthearted comparisons of prostitution and health care, and it fails to define precisely what jobs the sex workers are training for, or to note that professional nursing requires years of college-level science training. These elements may reinforce harmful "naughty nurse" and handmaiden imagery. More broadly, we remain uncomfortable with the continuing suggestions that the developed world nursing shortage can be resolved by recruiting new nurses from groups who are presented as having few good options, rather than with better workplace conditions and adequate clinical and educational resources.

The piece describes the training program, which is financed by the state of North Rhine-Westphalia and the European Union , as "teaching prostitutes a wholly new bedside manner." It tells how one sex worker made the transition even without the new program: "Angie, the whore, became Angelika the care worker for the elderly," trading her "stilettos for sensible shoes" as she "helps her customers bathe and change their bandages." Rita Kühn of Diakone Westfalen, a large nursing home company that is reportedly "organizing the project," says that "prostitutes have 'good people skills,' aren't easily disgusted and have 'zero fear of contact.'" The piece say Kühn believes these traits set the prostitutes apart from "trainee nurses and future care workers." Her program offers the new trainees "two years of courses and vocational training."

The piece explains how well the program matches supply with demand. In Germany, there is "bad news from the red light milieu," with a surge of sex workers not only from "economically depressed Eastern Europe," but also "plenty of mothers simply trying to make ends meet, academics who can't find other work, or even schoolgirls trying to make some extra pocket money." "[F]ormer star dominatrix" Gisela Zohren, who now works at a busy "prostitute help center" in Dortmund and is a local coordinator for the new project, says the job situation is "miserable." When Zohren herself made the transition to nursing home work in the late 1990's, she "found the wishes of many of her former customers weren't so different from her nursing home work with bedpans and washcloths. She often used to play the role of nanny -- albeit with a whip." Zohren stresses that she had learned to "listen and to convey a feeling of safety."

On the other side of the equation, the piece explains that there are "few sectors that so desperately need new workers like nursing homes and social services." And the nation's population is quickly aging, so the demand will likely grow even more.

The piece briefly discusses the mechanics of getting the new program off the ground. Zohren and other city coordinators plan a "road show" to convince people around the state that "prostitution can offer true qualifications."   Kühn is hoping for "absolute discretion from nursing managers to avoid elderly men demanding erotic services from their new nurses."

The piece closes with an ironic note comparing how prostitution and health care are valued in today's society. Angelika notes that she is happy in her new job--even though she earns less than half of what she did as a prostitute, and "due to cutbacks in healthcare, she doesn't have as much time for her customers as she once did." One implication (at least to us) is that if nurses really did provide sexual services to their patients, as the naughty nurse stereotype suggests, they might enjoy better pay and safe staffing.

It's not clear to us exactly what jobs the prostitutes are training to do. The piece at one point does say that they will become "new nurses." At another point it compares the prostitutes to "trainee nurses and future care workers." And at another point it says the new trainees will get two years of courses. But the nature of the training is unclear, as are the current educational qualifications of the trainees, and for the most part the piece simply suggests that the prostitutes will be providing nursing home care. So it's really not clear whether they will become professional nurses, or whether the article is assigning the label "nurse" to anyone who provides custodial care, which is itself a problem, as it understates the training and skill required to be a nurse. Of course, nursing was associated with prostitution in the early days, and reviving that association will not help the profession overcome its current crisis. Even so, we're pleased to see a program that seems to be matching real needs, and we wish the participants well.

The article's jokey comparisons of nursing care and sex, while hardly surprising, tend to reinforce the naughty nurse imagery that has helped to hold the profession back. The article does suggest that nursing requires good interpersonal skills and a tolerance for bodily functions. But that's hardly news, and it's not likely to do much to persuade decision-makers or society as a whole that nursing deserves more clinical and educational resources. And the piece fails to discuss why there is a shortage of elder care workers in the first place.

We're also uncomfortable with the number of initiatives and press pieces in recent years that seem to suggest the solution to the developed world nursing shortage is to find nurses from the ranks of those who are presented as having few good options: sex workers, those on public assistance, desperate nurses from poor nations, foreign physicians who can't pass their physician licensing exams. Excellent nurses may come from any of the above categories. But the sense we get from many of these press stories is that nursing is a good choice for those with nowhere else to turn, because, after all, it doesn't require much critical thinking, knowledge or skill. That, of course, is not the case. And simply finding new groups of people to plug the gaping holes in the nursing workforce does nothing to fix why those holes exist in the first place, which include poor workplace conditions, inadequate clinical and educational resources, and a lack of real understanding and respect.

Consider the reaction if similar strategies were applied to other critical shortages of workers who hold lives in their hands. Would a Western government announce it planned to address shortages of intelligence analysts or Arabic translators by training prostitutes to do the job?

Click here to see the article: "Prostitute retraining program: From Johns to Geriatrics" by Guido Kleinhubbert in the March 14 edition of der Spiegel.


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