1. Keeling, Arlene W. PhD, RN, FAAN


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For the past few years, the nation's attention has been repeatedly drawn to "the immigration problem" on the southern border of the United States. This past summer, images of babies screaming for their mothers as families were separated, and photos of teens and young children peering through chain-link fences-with foil blankets crumpled in the background-tugged at heartstrings. With recent fearmongering about a caravan of refugees making their way through Mexico toward the United States, the issue is once again taking center stage.


A nation of immigrants. With each image, my thoughts turn to our nation's long history of regulating immigration. After all, we are a nation of immigrants. Many of our ancestors sought religious freedom, freedom from persecution, or economic opportunity in America. That history is replete with conflicting policies: from the exclusion of Chinese, prejudice against those of Irish and Italian descent, and the deportation of those who were seen as "unfit" physically or mentally to enter the country, to decrees from the president that all immigrants be treated with respect.


A history of working with immigrants 'in a middle place.' For over a century, nurses have worked with immigrants in "a middle place"-balancing the needs of newly arrived families with their own public health role as state agents charged with upholding the laws of the land. Nowhere has that role in the "middle" been more troublesome than today. The policies of the current administration-the detaining and/or separation of families-have resulted in ethical dilemmas for anyone working at the border, but particularly for nurses. Responding to the Border Security and Immigration Reform Act, ANA president Pam Cipriano stated: "The American Nurses Association (ANA) is troubled by the Administration's policy of actively separating children from their families as they seek to enter the United States without documentation. The Code of Ethics for Nurses sets the expectation that we must always preserve the human rights of vulnerable groups, such as children, women and refugees. ANA urges everyone involved to protect the mental and physical health of these children who face an uncertain future without their families."


Nurses on Ellis Island over 100 years ago. More than a century ago, in the federal immigration station on Ellis Island, U.S. Public Health Service nurses were essential players in the systematic process of screening and caring for immigrants. In 1913, there were more than 25 nurses, both male and female, employed in the government hospitals on the island. They bathed babies, fed children, hospitalized those who were sick, and comforted little ones whose mothers were quarantined.


It was a huge undertaking: thousands passed through the Great Hall every day. As one immigrant described the scene: "They got off the boat and then they walked[horizontal ellipsis] up those stairs into the building[horizontal ellipsis]. And they looked pretty bad" (Lorie Conway, Forgotten Ellis Island: The Extraordinary Story of America's Immigrant Hospital). Few spoke English. Between 1880 and 1924, 23.5 million immigrants arrived in the United States, largely from countries in southern and eastern Europe but also in smaller numbers from China, Japan, Mexico, and Canada (David Rosner, Hives of Sickness: Public Health and Epidemics in New York City).


'Immigrants shall be treated with kindness and civility.' The immigration station on Ellis Island needed strong leadership, and President Theodore Roosevelt appointed attorney William Williams as commissioner. Williams insisted on compassion and respect, writing in his first directive: "Immigrants shall be treated with kindness and civility by everyone at Ellis Island. Neither harsh language nor rough handling will be tolerated."


On Ellis Island, children with contagious diseases such as measles, scarlet fever, trachoma, ringworm, mumps, or chicken pox encountered nurses in the general hospital. Elizabeth Martin, a Hungarian immigrant, later recalled their interactions: "The nurses, the ladies in white, we used to call them. They were very nice. They talked to the children. They stroked their hair, and they touched their cheeks and held our hands" (Conway, Forgotten Ellis Island).


According to one physician: "There were quite a number of babies involved and one became attached to them even if you couldn't speak their language! It was not necessary[horizontal ellipsis] all that was necessary was gentle and kind treatment" (Dr. Grover Kempf, U.S. Public Health Service, 1912). In 1904, the New York Times reported much the same, noting: "There are usually from six to twelve children in the Ellis Island Hospital. As a rule, they are stunted in growth and bear traces of unwholesome nurture, but they pick up under the skillful treatment of doctors and nurses, and the breezes from a beautiful harbor bring a tinge of color into their wan faces."


Carrying this tradition of compassionate care into the present. While much has changed since the turn of the 20th century, some things remain the same. Most importantly, there is a need for compassionate care for immigrants, especially when they are seeking political asylum or fleeing violence. Examining our past makes it clear that nurses had a critical role to play in the processing of arriving immigrants. Hopefully, this will be the case today, and nurses will make up a significant number of the military personnel being sent to the border.


For more on this topic, see Keeling, Hehman, and Kirchgessner: History of Professional Nursing in the United States: Toward a Culture of Health (Springer, 2018).