Fadwa Affara

Fadwa Affara retired to Edinburgh following an international career in nursing education regulation and advance practice, but that hasn't stopped her from supporting healthcare professionals fighting the Covid-19 pandemic.

At the moment

I have retired to my home in Edinburgh after spending the last 31 years working abroad, first in Bahrain, then with international bodies such as the World Health Organization and the International Council of Nurses, or directly with governments or national nursing organisations as a consultant on nursing education and regulation policy.

Your time at the University

I was born in Aden, at the time a British colony. At the age of 11, I was sent to Edinburgh to be educated as suitable education for girls past the primary level was not available. My father was a Church of Scotland medical missionary and a graduate in Medicine from Edinburgh University.

My enduring memories of my university education was that of being the focus of critical and somewhat sceptical scrutiny from both the academic and nursing authorities. I was part of a second group of students undertaking an MA while concurrently pursuing a Registered Nurse qualification. In the early 1960s nursing was significantly hostile of what they called ‘academic’ nurses arising from doubts that nursing care needed the intellectual and scientific rigour as well as critical thinking and decision-making skills developed through academic study, and the University was not yet prepared to recognise nursing at a degree level subject.

The university years left little time for much beyond study as I had to meet the demands of both programmes, including spending eight weeks of the summer breaks on the wards of Edinburgh Royal Infirmary learning the caring role. After obtaining the MA I had two more years of nursing study and practice experience as a student to qualify as a registered general nurse. Three years later, I qualified as a state-certified midwife. However, I do recall with pleasure two holidays arranged through student services to Denmark and Positano, Italy, as well as a stimulating week acting as a rapporteur at my first international nursing conference in Athens.

Nearly 10 years later, I returned to Edinburgh University to be in the first group to complete an MSc in nursing education and to find that nursing was no longer just an add-on programme but a recognised and growing field of academic study and research.

Your experiences since leaving the University

I spent the first 15 years of my professional career in clinical nursing and midwifery in Edinburgh, Glasgow, and as a volunteer at the French Hospital in Nazareth. There I practiced as a midwife as well as teaching in a newly established nursing school. It was a challenge as the language of instruction was French and teaching followed the experiential rather than didactic teacher-led model. It was daunting having had no teaching experience, and struggling to do so in a language I had last studied at school.

After completing the MSc, I took up a lecturing position in Dundee teaching the first group in the newly launched BSc in Nursing. In Dundee I came in contact with healthcare professionals on World Health Organization (WHO) fellowships, which directly resulted in a decision to work internationally, taking me first to Bahrain as Chairperson of the Nursing Division at the College of Health Sciences, then to Geneva as consultant with the International Council of Nurses (ICN), a federation of over 120 national nurses associations. At ICN my first responsibility was directing and implementing a project involving 87 countries across five world regions designed to assist countries in achieving a necessary reform of nursing professional regulation.

What I learned was that nurses across the globe faced many similar challenges. These only differed in intensity, the political and social contexts and the degree of control nurses had over their own destiny.

I worked internationally for the last 31 years, first with ICN and latterly as an independent consultant, participating at the international and country levels in a variety of activities, particularly in the education regulation and advanced practice fields. Activities included assisting countries review and develop proposals for regulatory reform; working with WHO on developing regional nursing education standards; establishing a mobile library of current nursing and health sciences knowledge housed in a tin trunk for nurses working in areas where access to current information was poor; collaborating with the other international experts on ICN publications; setting up networks with international colleagues to support ICN members in areas such as regulation, and advanced practice; and managing the development of the ‘Classification for Nursing Practice’, now available in 18 languages.

What I learned was that nurses across the globe faced many similar challenges. These only differed in intensity, the political and social contexts and the degree of control nurses had over their own destiny. Although there has been significant improvement to date, too often nurses were and are in some cases excluded from participation in the decision and policy making processes that directly affected their work. A challenging part of my role at ICN and later was to help nurses develop skills and strategies to become recognised, legitimate participants in those processes that directly affect their work life, education and status.

Life during Covid-19

I assisted three international colleagues to establish 'The Covid-19 Africa Action Network for Nurses & Nurse-Midwives' and the 'Protect Nurses. Save Lives' campaign. We were all living in countries with functioning and well-resourced healthcare systems while our contacts in low-resource settings in eastern and southern Africa reported that nurses and nurse-midwives on the front lines were too often working without personal protective equipment (PPE), greatly risking themselves and families to infection and physical and psychological violence. We set up a crowdfunding site and began to raise funds from other donors to provide identified country partners with modest grants for projects for the procurement, local production, and provision of PPE.

Several other initiatives were launched, including establishing evidence-based specifications for artisanal reusable PPE; live, online Q&A sessions linking doctors in China, who were first responders during the Wuhan stage of the pandemic, to healthcare professionals in Eswatini, Kenya, Lesotho, Malawi, Tanzania and Uganda. Also working with the World Continuing Education Alliance, the network promoted free access to Covid-19 education through mobile technology so the mobile phone becomes the platform for learning in the absence of Wi-Fi services.

Alumni wisdom

Regard what was learned and experienced at University as being only the basic tools which need to be added to and honed for a lifetime of growth, both personal and professional. Do not be afraid to take risks using judgement and a critical regard, and explore opportunities to innovate and create a better reality.

Related links

Read more alumni profiles of 1960s graduates

Nursing Studies at Edinburgh