AAHN Nursing History
Mission Nursing, Migration, and Mobility in Twentieth-Century Iran

Mission Nursing, Migration, and Mobility in Twentieth-Century Iran

The American Association for the History of Nursing is so pleased to partner with Nursing Clio for this special series, which showcases some of the innovative and diverse work being done by historians of nursing across the world. The AAHN holds its annual meeting this week in Rochester, New York, and these essays are windows into the kind of questions and issues being explored at that meeting, by historians who use nurses as a lens through which to understand the intersection between gender, work, and health. Nursing history did not start with Florence Nightingale, nor is it at an end. As nurses continue to make up the largest health care workforce, practicing their art and science in a variety of settings, communities and political contexts, it is more important than ever that we look to where we have been to learn the lessons we need for the future of increasingly complex healthcare systems. Whenever I talk to students or fellow scholars about the significance of nursing history, especially at the moment, I emphasize the significant social role that nurses have played. Nurses have had to negotiate sexism and racism within society, and within their profession. They have been continually challenged by hierarchies of medicine, power, and authority as they attempted to provide care, as historian Susan Reverby has argued, in a society that does not value caring. And they have not always been angels of selfless good. Yet nursing continues to be the most trusted of all the professions, and that trust is something that has been, and continues to be, earned. These essays from the history of nursing demonstrate the complex ways in which nurses have striven to provide careful, compassionate, patient-centered care, and how they have always been agents of social change.

Dr Kylie M Smith
Assistant Professor
Andrew W Mellon Faculty Fellow for Nursing & the Humanities
Emory University, Atlanta Georgia.
Director and Chair of Communications
American Association for the History of Nursing

When Grace Sayad graduated from Cochran Memorial Training School for Nurses in Urmia, Iran on June 30, 1930, she likely realized the historic significance of the occasion. Grace and her classmate, Anna Lachin, were the first students to graduate from the mission-run nurse training school at a time when there were few trained nurses in the country. Presbyterian missionaries held an elaborate commencement ceremony for the two inaugural graduates. A large platform was erected on the tennis court in the mission compound and decorated with flower arrangements. Persian rugs covered the backstop, and streamers with multi-coloured pennants were strung above the seating area. Grace and Anna delivered papers and were then “pinned” and presented with their diplomas in front of 400 invited guests.1

Copy of a graduation program for Cochran Memorial Hospital
Photo of a program of the Graduating Exercises of the Training School for Nurses at Cochran Memorial Hospital, June 30, 1930. (Presbyterian Historical Society, 91.5.8 | © Family of Rolla Hoffman, used with permission)

Grace was a pioneer nurse in Iran. Until 1936, Presbyterian missionaries from the United States operated the only nursing schools in the country. In the first half of the twentieth century, mission-run nursing schools were one of the only avenues available to women in Iran to further their education.2 Young women like Grace who attended these nursing schools used their nursing training and work to obtain a higher-level of education, enhance their social status, obtain economic independence, migrate from the provinces to big city centers and learn English.

When Reza Shah Pahlavi (1925-1941) came to power, he undertook social, economic and political reforms intended to modernize the nation. These modernization initiatives led to an expansion in the number of hospitals in Iran, and mission-trained nurses like Grace were in high demand.3 They found jobs in private laboratories, public hospitals, and in private duty nursing and were well paid in these positions. Grace, an Assyrian Christian nurse, was employed by the Presbyterian mission hospital in Urmia after she graduated in 1930. She assumed supervisory positions in the hospital and worked there until shortly before she was married in 1934.4

A black-and-white group portrait taken under an arched doorway featuring two men in suits and women in doctor coats
Photo of Cochran Memorial Hospital, Urmia, Iran, around the 1930s. This was one of seven Presbyterian mission-run hospitals in Iran.5 (Presbyterian Historical Society, 91.5.8 | © Family of Rolla Hoffman, used with permission)

Although Grace only worked in Iran as a nurse for three years following her graduation, her training and experience in a mission-run nursing school provided her and her family with the opportunity to leave Iran. Grace’s husband William had dreamt about immigrating to the United States for years. As Assyrian Christians, they occupied a precarious position in Iran. During the First World War, Grace and William had been part of the mass exodus of Armenians and Assyrians who fled the Urmia plain in order to escape the advancing Turkish army. They both lost family members during the exodus, and this tragedy transformed their lives and partially motivated their desire to leave Iran.

They made the strategic decision to send Grace to the United States in 1957. She was sponsored by her stepmother and half-sister, who were already living in the United States, and quickly found work as a nurse’s aide at Augustana Hospital in Chicago. She managed to save $8,000 after working for six months, and her savings and stable income enabled her to sponsor William and Sonia, her daughter, to come to the United States. Two weeks after they arrived in the United States, Grace quit her job at the hospital and moved to California with William and Sonia as their sons were already studying at Cal Poly on student visas.6

It was Grace’s training at a mission-run nursing school that enabled her and her husband to forge a new future for their family. She was fluent in English and had learned nursing skills that were transferable to her new job in Chicago. Her position in the mission hospital, while short lived, had demanded autonomous practice, leadership and a vast skill set. While she was employed as a graduate nurse in the mission hospital, Grace had administered anaesthetics, delivered babies independently and had been in charge of the maternity and pediatric wards. The family’s migration across national borders hinged on Grace’s ability to find work in the United States as a nursing aide. It was Grace’s training in an American mission institution which proved instrumental to her ability to find work in the United States.

Black-and-white group portrait of seven women and girls in doctors uniforms
Photo of a missionary nurse with class of nursing students, Mashhad, 1947.7 (Presbyterian Historical Society, 91.5.8 | © Family of Rolla Hoffman, used with permission)

Mission nursing offered young women like Grace a chance to leave Iran, but it also offered young women who trained as nurses in the United States, like Dorothy Cochran, an opportunity to return to Iran. Dorothy was born in Iran in 1921 to parents who were stationed in the country as missionaries under appointment with the Presbyterian Church in the U.S.A.’s Board of Foreign Missions (BFM). Her father was a well-respected missionary physician who had also been born in Iran, like his father had before him.

As a “mishkid” in Iran, Dorothy grew up in multilingual and multicultural spaces which shaped her unique transcultural identity. As a teeanager, she attended five different schools in four different countries (Iran, Switzerland, the United States, and Lebanon).8 Dorothy and her sister Mary found their time in the United States particularly challenging. Dorothy attended a high school in Minneapolis for a year, but felt “lost” and was “glad” to return to the Middle East where she completed her high school education at a boarding school in Beirut. Although they were citizens of the United States, Mary commented that they didn’t “fit in.”9 These experiences shaped Dorothy’s view of mission work and her desire to return to Iran as an adult.

In June 1945, Dorothy obtained her Bachelor of Science in Nursing from the University of Minnesota and one month later she applied to work as a missionary nurse with the BFM. In her application, she emphasized her desire to return to Iran, with statements like: “I was born in Iran and I would like to return.”11 The BFM Candidate Committee was alarmed by some of her statements and didn’t feel she was evangelically motivated for mission work, but it was also cognizant of her family connection to Iran. And it was missionaries in the country who had specifically “requested her appointment.”12

The BFM felt it could not appoint her as a full term missionary, but it decided to appoint her for a short-term, three-year contract as a missionary nurse. The mission hospitals in Iran were in desperate need of trained nurses at the time. It was Dorothy’s training as a nurse that paved a way for her return to Iran. Missionary service offered her a chance to reunite with her father, a missionary physician who was working at the mission hospital in Tabriz, and to return to the place that “had been [her] home.”13

Her story demonstrates how missionary nursing enabled Dorothy to achieve her dream of returning to Iran. Ten months after she arrived in Iran, Dorothy resigned from the mission to marry Tomic Romson, the Armenian administrator of the mission hospital in Tabriz where she was working. Tomic and Dorothy had been playmates as children and reconnected through their work at the mission hospital.

Transnational nurse migration is a pressing issue in healthcare today. The issue of contemporary nurse migration is often tied to discussions about healthcare economies and world-wide nursing labor shortages. Historian Kathryn McPherson notes that many current studies of nurse migrants across national borders focus on the 1990s onward which suggests that nurse migration is a relatively new phenomenon.14

But transnational nurse migration is not a new development. In the mid-twentieth century, mission nursing offered some women, like Grace, a chance to leave Iran. It also offered other women, like Dorothy, a chance to return to the country. Nurse migration is often analyzed from an economic perspective, but Dorothy and Grace’s experiences reveal that there are many diverse and complex factors that motivate individual nurses to migrate across national borders.


  1. W. P. Ellis to Rev. Benjamin Bush, July 7, 1930, Record Group 91, Box 5, Folder 8 (hereafter cited as 91.5.8), Presbyterian Historical Society (hereafter PHS). Return to text.
  2. Sonia Highfill, “Life History, Grace Asley Sayad Mirza,” March 30, 2008, in Julius W. Mirza, An Assyrian Dream: The Mirza Family Story (Julius Mirza, Xlibris, 2012), 461. Return to text.
  3. “The Tabriz Hospital, 1938-1939” (91.20.9), PHS; “Tabriz Hospital, 1934-5,” (91.20.9), PHS; “Tabriz Hospital, 1933-4,” (91.20.9), PHS; Hilda Lichtwardt, “Personal Report,” 1937, (91.7.4), PHS; “The Colton-Kirkwood-Whipple Hospital, Tabriz Station – West Persia Mission,” (91.20.9), PHS. Return to text.
  4. “Tabriz Hospital, 1934-5,” (91.20.9), PHS; Highfill, “Grace Asley Sayad Mirza,” 462. Return to text.
  5. Rolla Hoffman (1887-1974) Papers, Record Group 231, Series IV: Photograph Albums, c. 1915-1947, PHS. Return to text.
  6. Highfill, “Grace Asley Sayad Mirza,” 472. Return to text.
  7. Rolla Hoffman (1887-1974) Papers, Record Group 231, Series IV: Photograph Albums, c. 1915-1947, PHS. Return to text.
  8. Mary Cochran Moulton, A Mission Child in Iran (Sandy Springs, MD: Moulton Desktop Publishing, 1997), 68. Return to text.
  9. Moulton, Mission Child, 68. Return to text.
  10. “Photograph of Dorothy Cochran” October 1944, RG 360: Dorothy Cochran Romanossian, PHS. Return to text.
  11. Dorothy Cochran, “Personal Information Blank,” August 5, 1945, RG 360: Dorothy Anne Cochran, PHS. Return to text.
  12. PCUSA Board of Foreign Missions, “Cochran, Miss Dorothy Anne,” RG 360: Dorothy Cochran Romanossian, PHS. Return to text.
  13. Cochran, “Life Sketch,” August 5, 1945, RG 360: Dorothy Cochran Romanossian, PHS. Return to text.
  14. Kathryn McPherson, “Learning Across Borders: Education, Practice and Transnational Nurse Migration in the Long-Twentieth Century,” YouTube video, 43:51, UBC Centennial Nursing History Symposium Keynote on November 19, 2015, posted by UBC , November 25, 2015. Return to text.

Lydia Wytenbroek is a PhD candidate at York University in Toronto, Canada, focusing on gender and transnational medicine. Her dissertation, funded by SSHRC, explores the history of mission medicine and the development of the nursing profession in Iran. She is the Past President of the Canadian Association for the History of Nursing and is a practicing registered nurse.