A nurse who left school at nine to care for her dying grandmother and went on to get three degrees has been appointed an MBE.
Paulette Bolton, from Sutton Coldfield, emigrated to Britain from Jamaica aged 15 and taught herself to read and write using English dictionaries.
She has been recognised in the Queen's New Year Honours for services to patient care.
The 68-year-old said she was "very surprised".
Ms Bolton said she had been raised from a baby by her grandmother, Matilda Scarlett, who she described as "my whole world".
She cared for her grandmother after she suffered a stroke and, following her death, came to the UK to live with her father.
She said: "I had not had much schooling. It was very hard really.
"There was racism, children weren't used to a black person in the classroom, and at home as well it was difficult.
"But sometimes these things make you stronger in what you want to do."
She began training as a cadet nurse at 17 and has since earned degrees from the universities of Wolverhampton, Birmingham and Sheffield.
Ms Bolton also trained as a midwife, health visitor and mental health nurse while raising her two children as a single parent.
She later became the first Afro-Caribbean nurse to be appointed as a nurse representative on the board of the Ladywood Primary Care Group.
She also became one of the first qualified nurse practitioners, and nurse prescribers, in Birmingham and has campaigned for improved treatment for people with drug addictions, homeless people and those with mental health issues.
Grandmother-of-two Ms Bolton still works full time at Enki Medical Practice, which she helped grow from 200 patients to more than 5,000, and said she still loved her work.
"Our patients are brilliant and I think, when I do these things, my grandma inspired me."
Ms Bolton was nominated by her daughter Tonya.
She said: "Her extraordinary strength of character to survive against enormous odds and her outstanding contributions to drastically advancing patient care within the Birmingham health service deserves to be recognised and celebrated."
Other honours recipients from Birmingham and the Black Country include:
- Mindu Hornick PhD, 90, from Birmingham, who survived the Auschwitz concentration camp is appointed an MBE for services to Holocaust education and commemoration
- Melrose Stewart, 65, a lecturer in physiotherapy at the University of Birmingham, becomes an MBE for services to physiotherapy
- Yvonne Millard, 51, deputy chief nurse in paediatrics at Birmingham Women's and Children's NHS Foundation Trust, is made an MBE for services to paediatric nursing
- Susan Southern, assistant chief constable of West Midlands Police, receives the Queen's Police Medal
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