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January/February 2004
SAVOIR FAIRE"You had to make do and you coped" Joni Waiser
Between 1922 and 1984, the Ontario Division of the Canadian Red Cross placed nursing stations and small hospitals throughout the rural and remote areas of the province, primarily across the northern districts. At the October Library and Archives Canada (LAC) SAVOIR FAIRE lecture, Jayne Elliott discussed how this program provided a unique opportunity to study the challenges faced by the nurses whom the organization employed to staff these outposts. Over the entire period, the Division administered a total of 44 nursing outposts and hospitals, employed hundreds of workers, and managed millions of dollars from private donations and government grants. Ms. Elliott's research is based on interviews she conducted with nurses involved in the program. The medical outpost program grew out of the Canadian Red Cross’s shift towards peacetime activities following the First World War. Adelaide Plumptre, who served as the first president of the Ontario Division from 1920 to 1930, thought the most important peacetime activity of the Red Cross should be the "popularizing" of health knowledge. She believed these outposts would be useful demonstration projects, teaching both citizens and government officials about the ideals of public health. Thus, in response to a request for a maternity service from Wilberforce, a lumbering village halfway between Haliburton and Bancroft, she dispatched a public health nurse. Her mission was not only to help women at their confinements, but also to initiate a community health program in the district. The Red Cross Society envisioned itself to be on what it termed a "Crusade for Good Health," and the nurses who staffed its outposts became the foot soldiers in this campaign. Nurses were less expensive than doctors, and they often worked in areas where doctors would not. Assumptions of class, race and especially gender reinforced the perception among the social welfare organizations of the time that trained nurses were the ideal recruits for marching the message of good health into the homes and schools of the nation. Their aim was to effectively reach mothers and children, the particular targets of this movement. Who were the 1100 nurses and nursing assistants working in the Ontario Division of the Red Cross during this period? All were female and, based on their last names, the majority were white and English speaking. Most were native-born Canadians, although the Division hired a few nurse-midwives from England before the Second World War and in the 1960s and ’70s, when it experienced a critical shortage of nurses. Of the 400 hired during the interwar years, 85 percent were unmarried. Mirroring social trends around women's work in general and the shortage of nurses after the Second World War in particular, the number of married nurses increased slowly from 1942 on. By the 1960s, married women comprised just over half the total number of nurses and nursing assistants working in the Division. In 1969, they outnumbered the unmarried. Nurses joined the Ontario Division of the Red Cross out of a sense of adventure as well as for a variety of mostly practical reasons. Some sought work close to home, and the nearest hospital happened to be a Red Cross outpost. Some were imbued with a "missionary spirit," a Christian desire to "serve humanity." Others were enticed by bursaries and scholarships to further their nursing education in return for a year of service. Still others were influenced to try rural nursing by a month's exposure to outpost work during their public health nursing course at the University of Toronto. During the economic downturn of the 1930s, outpost work promised a stable salary and free room and board. Exploring new territory and facing the challenges of nursing in an isolated environment likely played a more significant role in the decisions of nurses hired after the Second World War, when opportunities in the urban centres were plentiful. The nursing stations contained private living quarters, shared by a nurse and a housekeeper, as well as institutional space. One room was generally converted into a clinic or office for consultation and treatment, and a few hospital beds were provided, reserved primarily for emergency and obstetrical use. From the Red Cross outposts, the nurses carried out the program’s mandate to bring health services to remote populations who otherwise had little access to medical care. They cared for and organized the treatment of the victims of accidents and other acute illnesses in their lumbering and mining communities. They were available for advice and consultation around the clock to countless numbers of outpatients who knocked on their door. They delivered many of the local babies, both in the outposts and in women's homes, and conducted prenatal visits, well-baby clinics, and home nursing and nutrition courses. They trudged out to poor and isolated homes in all kinds of weather and on all manner of conveyances to render medical assistance and nursing care. They immunized thousands of school children, and organized visiting teams of ophthalmologists, optometrists and dentists to conduct eye and dental exams. In several of the outposts, the nurses arranged and supervised tonsil clinics, gathering patients from far and wide to have their tonsils removed. Outpost nursing work was not only a personal service but also a community service. The nurses were called upon to perform other tasks not normally considered nursing responsibilities. During the winter months, nurses shoved coal and wood into the furnaces to heat the hospital. They melted snow on the back of the stove to obtain water, which had to be strained to remove contaminants. Most of the nurses interviewed confirmed that they were welcomed in their districts. The nurses who were most successful in their assimilation became involved in such gender-appropriate community activities as playing the church organ, attending bridge parties and dances, or holding card parties at the outpost when there were no inpatients. Some, however, had to break through the barriers of reserve in populations that were wary of outsiders and who found health visitors a "somewhat dangerous innovation." Male community members – whose power over the familial resources available for health care and medical treatment could not be ignored – had to be won over. Infrequent nursing supervision and often-distant medical support meant the outpost nurses were required to work independently. Many nurses welcomed the challenges of adapting their urban-based training for practice in isolated communities. Some activities, however, went beyond what nurse educators and the medical profession would have sanctioned in more settled areas. Suturing wounds, dispensing drugs, giving anesthetics, delivering babies and diagnosing patients were all tasks that many nurses had to learn through experience. As one nurse stated emphatically, "you just had to make do and you coped." Many of the Red Cross nurses developed satisfactory relationships with local physicians based on mutual respect and trust. Romance even occasionally blossomed through these friendships. In other cases though, the outpost nurses experienced frustration working with medical men who had not kept pace with new knowledge, who feared competition or who, the nursing supervisors' reports intimated, had problems with alcohol, drugs or mental illness. Some rural physicians required reassurance that, despite the lack of supervision, nurses would not overstep the limits of the hierarchical division of labour. In a version of what has been coined the "doctor-nurse game," nurses sought ways to care for their patients that would appear not to threaten physician authority. Although the supervisors desired that their nurses demonstrate professional respect for physician authority, they expected them to administer the outposts according to Divisional policies and not as a doctor's private hospital. The nurses were thus forced to negotiate the minefield of gender and authority, striking a balance between acquiescing to the demands of local doctors, with whom they often had to work closely, and acknowledging the wishes of their supervisors from head office, who employed them. Outpost nurses were the foot soldiers in the Red Cross campaign to provide remote communities with basic health services. Although some had humanitarian reasons for joining the Ontario Division, the nurses held no romantic notions of themselves as the "angels of the north" portrayed in Red Cross propaganda. One can perhaps understand why they chose to work in these regions, given the potential for financial support in obtaining a nursing education, a chance for some professional autonomy and the opportunity for a little adventure. Following Ms. Elliott's enthralling presentation, a very interesting discussion ensued. It was especially meaningful as two audience members eagerly identified themselves as Red Cross Ontario outpost nurses, and another enthusiastically described his mother's similar experience. Jayne Elliott is a Ph.D. candidate in the Department of History at Queen's University. She is currently completing her dissertation on the Red Cross outpost program in Ontario. A former nurse, her interest in this topic was partially sparked by a month's fieldwork in one of these outposts during her nursing training. Information on up-coming Savoir-Faire presentations: www.nlc-bnc.ca/1/9/index-e.html |
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