MARCH 2010 • NURSE TO KNOW

Angela Cooper Brathwaite’s mother, a midwife and community health nurse in Trinidad, loved telling her young daughter about her work. Some of the more vivid tales lingered in Brathwaite’s mind for decades. One story delved into the horrors of smallpox. At the time, there was no vaccine to prevent the deadly disease. “They’d put the sickest people on trucks to go to isolated places to die,” says Brathwaite. “Healthy people would go along to care for them, knowing they’d die as well.”

Another concerned a pregnant woman, beside herself with labour pain, who was trying to deliver a breech baby. Brathwaite’s mother helped the woman move into a better position, then reached inside to carefully turn the baby.

“I didn’t fully appreciate the complexity of what she did in that situation until I became a midwife myself,” says Brathwaite.

Like her mother, Brathwaite chose to become a midwife and public health nurse; the desire to help others seems to have been a genetic trait. Not long after she began her career in Trinidad, she made the decision to move to Canada. She arrived in Newfoundland on Thanksgiving Day 1975, unaccustomed to the chill in the air but ready to jump into her first job. (Most of her training had been in the British system, so she didn’t have to do extra schooling to start practising in her new country.)

St. Anthony is a tiny community just below the northernmost tip of Newfoundland. A serious nursing shortage in the town’s hospital meant that Brathwaite was the only RN on duty at night on the obstetrics ward. She had support from two licensed practical nurses, but the nights were long, she says.

Next, Brathwaite went to central Labrador, where she worked with an aboriginal community in North West River. (It was connected to the nearest hospital by a suspended pedestrian bridge. Today a solid bridge means ambulances can get across the river.) She returned to Newfoundland six months later, setting up in Roddickton as the regional nurse manager for primary care and community health at the local health centre. It served seven semi-isolated communities and was the site of a well women’s clinic Brathwaite established.

The isolation allowed her to work fairly independently — something she had missed. “In Trinidad, midwives could prescribe medication to clients. We did our own episiotomies and sutured them. And we taught medical residents how to deliver breech babies. The only thing we didn’t do was forceps deliveries,” she says. Now, she was using a larger range of her skills again, and calling for a physician only when she needed an extra pair of hands during a birth.

Brathwaite spent most of the ’80s in Winnipeg, teaching and working in maternity wards before moving to Ontario to do mental health nursing in Whitby and obstetrics in Ajax. She took positions directing several programs at the Lakeridge Health Oshawa General Hospital in the ’90s.

Today, Brathwaite’s focus is injury prevention and substance “misuse” as a public health nursing and nutrition program manager in Durham Region’s health department. The region has large rural and urban areas so her public education programs target the use of farming equipment and all-terrain vehicles in addition to motor vehicles. (She is advocating for amendments to the Off-Road Vehicles Act that will keep children off ATVs.) She has embraced modern tools like YouTube videos to spread messages about healthier choices to counter the effects of the growing misuse of drugs among urban youth.

Sixteen public health nurses report to her, and she can rattle off their achievements with ease. They advocated for two provincial bills, both of which were passed in 2009: Bill 118 bans drivers from using hand-held devices with display screens while operating a vehicle on the road. Bill 126 ― the Road Safety Act — goes after drivers with blood alcohol levels between 0.05 and 0.08 (the “warning” range), as well as those with suspended licenses, whose vehicles can be impounded for a week if they’re caught driving.

Back in 2006, a similar advocacy campaign inspired a “long overdue” Ontario law mandating a seatbelt for every person in a vehicle. The legislation was put in place just months after the crash of an overcrowded minivan killed four people northwest of Toronto.

The rash of pedestrian injuries and deaths in Toronto in recent months is on her mind. Brathwaite views these tragedies as predictable and preventable. Some motorists aren’t obeying the rules of the road and allow themselves to be distracted by others in the car, she says. She wants the pedestrians who are jaywalking or focused on their cellphones and MP3 players to pay more attention as well.

“They ought to cross the road as if their life depends on it, because a motor vehicle is a lethal weapon,” she says.

By calling these collisions “accidents,” we are allowing pedestrians and drivers to shirk their responsibilities, says Brathwaite. She would like to see the media take part in launching an education campaign to remind everyone of the basics of driving carefully and crossing the street with eyes and ears open.

The high numbers of children, elderly and disabled people who had had serious hot water burns was the motivation for yet another of her group’s initiatives. The eventual outcome was an amendment to the provincial building code requiring that hot water temperatures in new residential buildings not exceed 49 C. (Third-degree burns take five seconds or less to occur at 60 C. Scald injuries make up 70 per cent of burn hospitalizations in Canada, and 45 per cent of burn-related emergency department visits.)

With these successes, it’s almost hard to believe that Brathwaite has spent just a decade in public health. Aside from the fact it has been a good career fit for her, it has also allowed her the time to pursue a doctorate in nursing at the University of Toronto.

“I like the adrenaline rush of policy development and advocacy work,” she says. “I get to use my knowledge, experience and skills as RNAO’s member-at-large for socio-political affairs and in my PhD program.“

Brathwaite has had her fair share of intense experiences working in infection control. More than 10,000 people in her health region were quarantined during the SARS outbreak in 2003. She supported and counselled some of them, assisted staff in problem solving and provided leadership to a team of health-care professionals. “The working environment was relatively calm,” she says. “SARS was nothing, compared to the H1N1 pandemic. The crowds have been much larger; demand for service and resources has been greater.”

Last fall, Brathwaite worked for a month straight as part of the first public health unit in the Greater Toronto Area to offer vaccinations against H1N1. (Some 70,000 people were vaccinated between Oct. 26 and Nov. 30 in Durham Region.) “The clinics were loud, and many children were very vocal when they were getting vaccinated,” she says. “During the first two weeks, public health nursing and nutrition managers worked 12- to 14-hour days. It was hard to fall asleep when you got home after something like that.”

Brathwaite dealt with some anxious and even angry people. She managed the lines, answered questions about what was in the vaccine and clarified which of those in line were actually on the priority list. It reminded her of the time in the early ‘70s when she handed out oral vaccine during an outbreak of polio in Trinidad. “We had hundreds of people getting vaccinated, and polio victims took up two floors of a 600-bed hospital,” she remembers.

The intensity of those lineups is worlds away from the quiet classroom environment at the University of Toronto. Brathwaite is a part-time assistant professor, teaching master’s students how to develop research proposals, identify problems that arise in clinical practice and implement their research findings. Teaching helps to sharpen my critical thinking and research methodology skills,” she says. Mentoring students and passing on her knowledge to the next generation is a particular passion. She and another U of T professor will be in Ethiopia in April, working with students and professors there to strengthen a master’s program in nursing.

After investing more than 36 years in her profession, Brathwaite expects to retire soon, but she wants to carry on with her studies and teach part time while continuing to volunteer with her church, with RNAO and as a reviewer for several journals. “My mother always told me that I could do anything if I set my mind to it,” she says. “I think she would be proud of what I’ve accomplished so far.”