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The Director of Nursing kept her word and assisted me with my visa application to America. I was granted a working visa for a year and was granted an exemption for the TOEFL test. This is an English test which assessed speaking and understanding of the English language. The immigration department had faith in my speaking and written English having done my nursing training in Australia and working in England. I was excited to go to America for some nursing experiences. Not many nurses had the opportunity to go. I was looking for greater nursing experiences and adventure in another new country. I never thought I would have so much opportunity for travel before I took up nursing.
When I arrived at Kennedy Airport, there was a car to pick me up. I was driven straight to the hospital. As the car drove past New York City, I was intrigued by the skyscrapers and the hustle and bustle of the place. I kept wondering whether I really was on another continent. I was excited and kept the feelings to myself. I was driven straight to Beth Israel Medical Centre in Newark, New Jersey. Newark as compared to New York was not as exciting and tidy. The staff apartments were an extension of the hospital compound. The surroundings of the hospital looked old, gloomy and dark. I was told the area was once a Jewish area, but as black people moved into the areas, the Jews had moved out. I could see that the area was once a tidy nice residential area. There were maple trees planted along the walk way on each side of the streets. During autumn the colourful leaves brightened the streets and when there was a harsh winter, the empty branches would be covered with snow which beautified the streets in a different way.
The cities in America seem to be divided by economic status. The poor congregated into one area of the city and the rich another. We were advised to go out as a group. It was believed that "black" areas were not safe to walk around alone. At the time, segregation of the whites and blacks was prevalent in American cities. I remember when I was invited to a ball at Newark Town Hall by one of my black American nurses, I was surrounded by black people. There were only two or three non-black people at the ball. I was one of them and I had to ask myself whether I truly was in America.
Top: Lai Fun at Liberty Island looking towards the World Trade Center, New York City (February 1973, archive ref. S30/006). Bottom: 42nd St near Broadway, Manhattan (March 1973, archive ref S27a/003)
Photo: Lai Fun with her new colour TV and a note written to her parents on the back of a print of the same photo (4 February 1973, archive refs. S27a/010 and A04/021b)
Since the staff residence was connected to the hospital through a walkway, we were not required to walk out of the building for work. Each resident had a key to access the staff residence and the front entrance to the apartment block. Each unit was connected to the intercom at the front entrance. I was given a studio apartment. At night my living room was converted into my bedroom. There was a neat little kitchen at the corner of the apartment with a small dinner table with two chairs. There was a bathroom and a laundry attached. I found the apartment comfortable compared to the room I was used to throughout my nursing trainee days and the early period as a registered nurse. I enjoyed the freedom and privacy. Since the apartment building entrance was connected to each apartment via intercom, it was quite secure. We checked out the caller before we allowed anybody into the building. I had a phone connected to my apartment. I also treated myself to a nice coloured television, record player and radio to while off my many lonely hours. It was quite fun to be able to shop around for items for the apartment. I found electronic equipment was so much cheaper than in Malaysia or England. I was introduced to a Malaysian nurse who worked in the neonatal unit and we became friends. She introduced me to many shopping areas for my shopping for the apartment. We developed a friendship and went to quite a number of places around the United States during our holidays.
The hospital was huge with a cardiac unit and a transplant unit. Dr. Zucker made the hospital famous with his invention of the Zucker pacemaker wires. I was asked to work in a General ward when I first started work at the hospital. The ward layout was quite different from the open ward which had two rows of beds on each side and extra beds in the balcony or in special unit. The ward area was huge with bed units on either sides of the ward. Each side of the ward could be occupied by over twenty patients and each unit had either a single bed, two beds, or four beds. The patients who were in a four bed unit paid less than a single or a two bed unit. Most hospitals in the States were private with a number of public beds. There was a receptionist on each floor who looked after the costing of any items used for the patients. Every single drug, band-aid or gauge used for dressing a wound was being charged to the patient's account. When there was no clerical assistance, the nurse had to make sure the costs were entered.
As a registered nurse on the ward, one had great responsibilities. There were only two registered nurses on duty, one on each side of the ward. During the morning shifts, there might be a Graduate Nurse and a Practical Nurse working with a registered nurse who was responsible to the assigned side of the ward. The registered nurse was responsible for all medication of the patients and the smooth running of the ward. A Head-nurse assigned the duties of the shift to each nurse and oversaw both sides of the ward. Each nurse was assigned to a number of patients for the shift. The average number of patients to each registered nurse was around eight to ten patients. The Head-nurse answered to the nursing administration and queries of the doctors. When there were changes to orders, the patient's chart was placed in a basket with a red window turned on and when there was no change, the blue window was turned on. The doctors did the rounds of their patients by themselves; seldom was a nurse required to follow a doctor around. The nurses followed the doctors around only if they were required. The doctors helped themselves with the necessary supplies for any simple procedures they wished to perform and cleaned up after themselves. However, when there were any important changes to the patient's orders, the Head-nurse or the registered nurse would be notified. I found this system much better than the system where a nurse had to follow the doctor in all their rounds. I did not believe nurses were the doctors' 'handmaidens'. The time of the nursing staff spent with the doctors' rounds could then be concentrated on the nursing duties and patients. Moreover, when the rounds with the doctors were over, the doctors were not there to assist the nurses with their duties; the precious time spent with doctors on their rounds would be wasted nursing time.
Photo: Lai Fun with colleagues at ICU nurses station at Beth Israel Medical Centre, New Jersey (1974, archive refs A04/022a-b)
Photo: Lai Fun with colleagues at Mountainside Hospital, Montclair, New Jersey (1975, archive refs A04/019a-b)
Working in the wards in an American hospital was physically tiring, as each side of the ward was long, and patients were nursed in units. It could be a single, two or a four bedroom unit. The cost of stay in the hospital depended on the type of unit they requested to be in. A patient would make a request through the intercom at the front desk and one had to walk from one side of the ward to the other to attend to the patient's requests. An assistant nurse might need some assistance in the other end of the ward and one had to quicken the duties and run to their calls. At the end of the day, I found my legs were tired. I often said I needed rollerskates to work in the wards. If one was not quick in attending to the patients, there would be buzzing on the intercom or the receptionist calling and yelling for the nurses. When the ward was busy and things had to be done immediately, one could easily get frustrated.
I was working as a graduate nurse then as I had not obtained my American Nursing Registration. I had to take a high school equivalent test before I was allowed to sit for my New Jersey Nursing Registration Board Examination. I was lucky I passed both the examinations within the six month period given to nurses to obtain their nursing qualifications in America. As a graduate nurse, my role was very much the same as a registered nurse. I was paid as a graduate nurse but worked and held responsibilities as a registered nurse. I felt quite resentful for being made use of in this way and thus I was eager to be registered as an American nurse quickly.
Image: Lai Fun's US General Educational Development (GED) results, a high-school equivalent degree required to be completed for registration as a nurse in the US (June 26 1973, archive ref. P7/24)
Photo: ICU bed at Mountainside Hospital, Montclair, New Jersey (1975, archive refs A04/020a-b)
After three months of working in the ward, I requested to be transferred to the Adult Intensive Care unit. My experiences at the St George Hospital gave me the confidence to work at the intensive care unit. There were ten beds in the Adult Intensive Care Unit. Next to the unit was the Cardiac Unit which specialised in open heart surgery. The Adult Intensive Care unit took care of the major surgeries like kidney transplants and reconstructive surgeries that required ventilation after surgery. After recovery from their surgery and when their general condition was stable, the patient was then transferred to the ward for recuperation before being discharged home. I found working in the unit more satisfying than working in the ward because each patient was given total care by the nurse and was responsible to those patients who were under the nurse's care for that shift. There was minimum walking unlike the ward where I had to walk from one end of the ward to another numerous times till my legs were tired at the end of the day. The primary care given in the intensive care unit was better carried out than in the ward as all the nurses were registered nurses and they could carry out all nursing duties required by the patients. However, there were times when the registered nurse was assigned to overlook an assistant nurse; the registered nurse on all accounts would be looking after more than one or two intensive care patients. The assistant nurses who worked in the intensive care unit were especially trained to work in the area. The assistant nurse only attended to the basic nursing care of the patient like the patient's personal hygiene, cleaning ventilation apparatus and assisting the registered nurses whenever required within the assistant nurse's abilities. The patients who were under the assistant nurses care had to be those patients who were convalescing and waiting to be transferred to the ward without any ventilating assistance. When the intensive care unit was adequately staffed, the assistance nurse duties were that of cleaning around the unit and assisting registered nurses whenever possible like turning a patient or running errands for the registered nurse.
Another satisfaction in working in the intensive care unit was that one was not asked to work or assist in another ward. I found working in another ward not satisfactory because one's heart was not in the work. When a nurse was not happy in working in an area, the nurse would not be able to give their best to the patients. Morale could be low when nurses resented going in for work and constantly complained about working conditions. There were also more in-services in the intensive care unit. We were often updated to changes in the unit and constantly reminded to attend in-services offered by the hospital. Besides, the Head Nurse was very keen that the intensive care nurses were working as a team. Her nursing management and administration was highly commended. She did not show favouritism among her staff. The unit was staffed mainly with Filipino nurses with only two white American nurses. She treated every nurse as an individual often encouraging the nurses to work with one another and appreciated their contributions to the unit. Thanks and praises for her nurses were very freely given when they were deserved. Now and then, she would bring in morning teas for the nurses and every Christmas she invited the nurses who were not on duty to her place for a Christmas dinner. A Christmas present for every staff member was a must with a little note. She knew how to manage people and had the resources to do so. She showed her appreciation in the work you gave to the unit. I enjoyed working with her and really felt I had learned a lot working in the unit under her direction.
Photo: With a colleague at Mountainside Hospital (archive ref. S51/001)
I worked in New Jersey for about three years. I worked in the semi-public hospital for two years and one year in a private hospital. One thing I noticed between the private and public hospitals was that the staff in the public hospitals was mainly overseas, from countries like the Philippines, England, Ireland and a few nurses like me from Malaysia, whereas private hospitals were staffed mainly by American white nurses. The Black American Nurses were generally working in the public hospitals. Newark Beth Israel Medical Centre had many Black nurses working for them and they held nursing positions like nursing supervisors. I also noticed there were many Black Practical Nurses working at the public hospital. It appears that the nurses isolated themselves voluntarily; there must have been a comfort zone they liked to seek out.
Photo: Nurse's pin issued by Newark Beth Israel Medical Center ICU (archive ref. Z25/03)
I found working with the American nurses very satisfying as one knew where one stood with them. They were very truthful about how and what they felt about you. They called black, "black" and white, "white" unlike the English nurses who were very cynical. "Dears" and "thank you" came out of the English nurses mouth freely but they could mean differently. I remembered a nurse in England who complained about my work to the authorities, but she was so nice and helpful to me on the wards I thought she was my friend till she bad mouthed me. I found one could not know where one stood with English and Australian nurses as they talked gossiped behind each other backs, but had no guts to confront you with the truth. Was I right in saying they acted more like hypocrites?
After working three years in America, I felt I had to move on as I did not feel I could live in America even though I had a Green card. I found the cities were inflicted with violence and I did not feel safe walking around the streets. One of my girlfriends was cut in the mouth from left to right with a pen knife by a sixteen year old boy when she screamed and refused to surrender her handbag during her shopping at six o'clock in the evening after work. I was told that Filipino nurses were raped in elevators. Many of my girlfriends who had served their contract with the hospital had moved on to a "better" white area to work or live and I had to ask myself what I wanted to do with myself. I was alone with no relatives living around me. The thought of going to California to work was on my mind as my Malaysian friend was going there. I was told it was a better state to work in and live. I went for a visit to San Francisco and I quite liked the city; it was cleaner and a tidier city. Moreover it was also populated with many Chinese unlike other American cities which were populated with lower income Blacks. I applied for my Californian Nursing Registration and I was successful. There were no hassles as my New Jersey Nursing Board Examination scores were adequate for Californian nursing registration.
Photo: Golden Gate Bridge, San Francisco (July 1975, archive ref. S32/026)
At that time nursing registration was changing too. We were required to do so many hours of in-service a year before we could be re-registered for work. The hospital was changing the format of their nursing care-plans. The Kardex system was used. Nursing pay increases were awarded according to peer review. The many changes at that time caused me to think whether I needed all the stresses of nursing. I saw lots of friction and conflicts among nurses with peer review. Peer reviews were very subjective and personal. If one could not get along or had a personal conflict with one of the senior nurses on the peer review committee, one would fail as the senior nurse's opinion stood and not yours. The pressure of attending an in-service was high as one had to be registered every year and without the required hours, one would not be registered. When one had to attend and sit on a lecture which was not of ones' interests or a poorly conducted lecture it could be torture. It would be a waste of time and money to attend something one did not like and had to sleep through just to get the hours clocked for the sake of satisfying the registration authorities.
Image carousel: Nurse registration papers for New Jersey (11 April 1974, archive ref. P7/30a) and California (31 May 1974, archive ref. P7/31)
Many thoughts came into my mind as to where I should go and what to do. I liked the challenges of nursing in America. The many in-services I attended gave me knowledge which I was not given during my hospital training programmes and my medical knowledge was updated all the time. We only mastered the basic nursing skills during our hospital nursing training. There was no teaching on the electrocardiogram readings and the use of ventilators, etc. I believed I had gained more nursing knowledge in working in the English and American hospitals. I enjoyed myself working with the American nurses. I got along with them very well and made many good friends. I remember travelling around America with my nursing friends. We drove cross-country together and shared many happy moments. The nursing pay in America was good. I could save enough money for my many travels and even support two of my younger brothers in their college education in England. My parents loved mah-jong which is a Chinese game played with "bricks". I did not like my hard earned money lost to their friends in gambling, so I chose to send money to my brothers for their education as part of my contribution to the family. It was easy to get more work in America. I often worked at another Nursing Home for more pocket money when I required more money to spend. I liked travelling ever since I was given a chance after my secondary schooling. We had two days off weekly and I took the opportunity of combining two days sick leave with my two days off and drove off with my girlfriend to see America. Those were my many happy days in America. However, when my girlfriend moved to Chicago, and another friend moved to California, I thought I should go home to Malaysia for my father's 60th birthday and decided then what I should do. One girlfriend asked me to join her at Colombia University in New York for our nursing degree. I always liked to prove to myself that I could get a degree of some kind if I was given a chance when I was young. The suggestion was tempting, but the contract I had to sign with the university was not attractive. Five years was a long time to be tied down at any place. I had been tied with the Malaysian Government before, so I was not attracted to the move to New York City with her.
Photo: Kok Pah Lee's 60th birthday in Ipoh (Dec 1974, archive ref. A03/075)
Photo: Lai Fun with sisters Lai Ching and Lai Kheng (archive ref. A03/083)
Photo: Lai Fun's parents in front of mahjong table (archive ref. A03/080)
When I was home with my sister in Malaysia, she suggested that we move to Australia since my elder brother had moved to Darwin, Australia with his family. The Malaysian Government who favoured the Malays in all aspects of life had drove many non-Malays away from the country. Every four vacancies at the Malaysian University would be given to Malays and one to non-Malays. The Malay language had then become a national language in place of English. Malay had to be the medium of education in schools and government offices had to use the Malay language in all official communications. It was difficult to take such a quick drastic move all of a sudden when our generation was educated in English at home and overseas. Those parents who wanted their children to be English educated and were professional moved overseas. They had higher dreams and wished to give more opportunities in life for their children. The Chinese value education highly and often see education as a great investment in their children. Chinese parents would willingly pawn their valuables or borrow money to ensure that their children had a good education. Moreover the Chinese population appeared to hold the financial economy of the country, so many wealthy educated Chinese packed their bags and moved out of Malaysia. There was than a great influx of professionals to countries like Singapore, Australia, Canada, United States, and England. There was a "brain drain" out of Malaysia. I thought going back to Australia to settle was neat since I had family members there already. When I returned to Montclair, New Jersey, I applied for my Australian Nursing registration in Perth. My sister suggested Perth for us to settle. I had not been to Perth so it was a good idea. I loved seeing new places and worked at different hospitals and gained a variety of nursing experiences. I realised then one had to have a variety of nursing experiences to be versatile in nursing. My intensive care nursing in England had been an asset to me in America; thus it would also be in Australia.
I applied to go to Australia and within six months I was successful in gaining my Australian Residency visa to Australia. I had no difficulty in getting registered in Perth, Western Australia as nursing as a profession was my passport to many countries. Many countries were short of nurses and Australia was willing to accept nursing as one of the skills in gaining a visa entry to Australia. Their White Australian Policy was abolished by the Whitlam Government in the 1970s. I had never thought I would return to Australia after my nursing training. I liked Australia when I was a student. I met many nice Australian people during my early days in Australia. I had no bad memories of the country. Why not make Australia my home.
Image: Australian permanent residency visa granted 9 April 1975 (archive ref. P1/MY/29)
Image: Nurse registration in Western Australia (7 November 1974, archive ref. P7/33)
My sister and I were to meet in Sydney as she already got a nursing job at one of the Sydney hospitals. Her nursing training from England was recognised in Australia. The Australian nursing syllabus was based on the English nursing syllabus as the country was under the English influence. The nursing texts were also English so she had no difficulties in getting a job or being registered. She worked at St George Hospital, Kogarah, New South Wales and stayed at the hospital nursing quarters. I was put up at the quarters for a couple of weeks before I got a job at the Prince of Wales Hospital, Randwick, New South Wales. I liked action more in the city and did not like to be too far away from the city of Sydney. I got the job at the hospital easily with my Intensive Care Nursing experiences. Intensive Care Nursing was in great demand than. There was no contract to sign and I could start work the next week after the interview. I was glad I got the job so easily as I was running out of money after my move from the States. After leaving the States I did not work for two months and travelled from New York to Hawaii, Brazil, Argentina, Peru and Fiji before reaching Sydney, Australia. I had a great time travelling during the two months, but was glad to be in Australia knowing that it would be my last time for a while not having to pack and unpack again. Besides giving me a job at the hospital, I could also move into the Staff Residence Quarters the next week. It worked out fine for me as I did not need to stay with my sister any longer and risk being caught by the Home Supervisor for staying in the residence illegally. My sister was not supposed to put anybody up without the consent of the Home Supervisor. Since it was unlikely that the supervisor would allow me to stay with my sister, she thought she would risk putting me up without permission.
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