History of Nursing in Pacific Canada

Public health nurses' bulletin, v.2 no.1 British Columbia. Provincial Board of Health 1933

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PROVINCIAL BOARD
TISH COLUMBIA.
Foreword,    By Mable FpTara^i R. *»* -.-.... ,.*;.,,
pC Harvey,  R.N...
Immunization.    By Mjfry ES^rler^iijj, R*HML ..................
The Importance o|^B^^^fesiff i*^^ CM$e'l of Vaccina*
it ion
OOO  • *O00OQ«0OO
ainst Smaj|p5xl  '^p3v,-A.".^^s,  ^J|.
JgaSf
Pioneering in the ippsice.jyfe^fsjffli^tGlL-KkN.   .
"Eow Far is it Safe for a SdM"th;^^gandfe!;l7ib^feo Undertake
Relief Work?"    By FyvM~Yoitifg7 *"?J.- » r|if|||f!i ...........
A Publicity Campaign.    By CrQTW&±p§^m^^^^^M<>,  and Marion
Page,
2
2
5
7
Car dwell,  R.N  .%■.. •
I
•     ««99«90
.     10
Community Organization in the le3*jeM]p^?fd2( a Health
Unit.    By Kathleen Gordon//
O00C0»0O»»0«*O
..     12
 - 2 -
FOREWORD
To the graduates from the University of British Columbia and from other
Universities who are assisting in the Public Health programme which is being carried
out here and there in the larger centres of population throughout this Province, the
message which I send is one of congratulations upon your accomplishment and the sincere wish that you may have an ever increasing fund of courage and of pertinacity to
continue your good work.
Uppermost in my mind as I try to visualize each nurse at work in her district is the thought of the extreme youth of the majority of the group. Suddenly
throughout the world there was created a demand for which we were not prepared; as a
profession, nursing had failed to sense the meaning of this new era of preventive medi-j
cine upon which we had entered, and there were few who were in any way ready to play
the new role of health teacher. Even as in the Great War, however, the youth of our
profession mobilized to fill the gap, hastily prepared, and with little real leadership from older heads, they have carried on nobly. With a realization of the urgency
of the call they submerged youth* s natural desires for freedom from responsibility and
have successfully carried through the initial stages of the war against disease.
My greatest wish and earnest prayer is that you will ever keep foremost in
your mind the realization that the community's interests and needs are of paramount
importance, and that, conserving your health and your resources, and building upon
your experience of the past few years, you will maintain the high standard which you
have yourselves set; there will then be no failure of the people to recognize the
fundamental nature of your work and to provide for an extension of this health service
to every community.
Mabel F. Gray, R.N.
Assistant Professor of Nursing,
The University of British Columbia,
Vancouver, B.C.
DEPRESSION AND COMMUNITY HEALTH.
In last year's "Bulletin", I wrote on this subject, and now after another
year of stress in the economic world, we find ourselves wondering in what way and how
much community health will be affected.
The Public Health Nurse, who has the interests of the people's health at
heart, is confronted with many new problems. She has had to broaden considerably her
field of work by doing those things which, in ordinary circumstances, would not be included. This is undoubtedly a time when she can prove her value as a helper and adviser, and consequently show that there is a great need for a continuance of her work.
Thus, even with the trend to reduce every unnecessary expenditure, the Public Health
service will stand out as being indispensable.
In Saanich, we are very fortunate in having a health Committee which has
not confined itself solely to the financial situation. To have the Committee realize
that the health of the people comes first is a decided help, and there has been no
question of reducing our staff of a full-time Medical Health Officer, a school dentist
 - 3 -
and four nurses. Consequently, our records show no increase in infectious diseases
and the school attendance up to its usual high mark. Even among the schools in the
poorer districts, the number of underweight children has not increased. In fact, as
long as there is a Public Health service in Saanich — and the same applies to other
places — the health of the people should not be affected to any great extent by this
world-wide crisis. Up to the present, this has been proving itself true, and only the
worry and strain which accompany financial stress, and which have such undermining
effects on the health of the people, have been telling their tale.
Many new problems, which I am sure every Public Health Nurse has been trying!
to solve, have arisen. A large number of defects and deviations from health, which
would be attended to in prosperity, are now neglected. Many of the unemployed men
and women are suffering from badly decayed teeth and uncorrected defects of vision.
Thus the foundation of ill-health, invalidism and a subsequent dependence on society
is being laid. Wherever the School Medical and Dental services are maintained, however, the men and women of tomorrow will not be subject to the disabling conditions
from which their parents suffer today.
It is fortunate that, with the depression, welfare societies, social bureaus
and relief organizations have developed more extensively. Even in prosperity, a large
number of families are on the border-line, and it is often difficult to obtain much
needed aid for them, as people are then less inclined to be charitable. But now the
Nurse, with the help of public funds, is able to attend to many needs which otherwise
would be neglected. The relief system in Saanich allows an extra day of work once a
month to enable families with children or expectant mothers to buy fresh milk. This
is not given unless a slip is signed and renewed each month by one of the Nurses. A
good deal of time is taken to do this, but the Nurse has the advantage of making many
contacts in her investigations. Consequently, the number of prenatals and the number
of visits to them has been steadily increasing for the past three years. At present,
we have the largest number of prenatals which has ever been on our records.
Again, tho people can be instructed in the essentials and non-essentials of
diet and taught that simple, cheaper foods are even better than the more elaborate
and expensive ones. The Public Health Nurse in her home visits has excellent opportunities to teach and establish these and other ideas, the value of which many families have not had to realize before. The necessity of having to accept these ideas
makes the work easier for the Nurse. She can also be most useful in showing how the
family budget should be arranged and how economy can be practised without any harmful
but rather beneficial effects to health. In fact, when the family income is low,
getting back to a simpler way of living is imperative and the people are in consequence benefitted by this knowledge*
Due to financial stress, families do not call a physician unless, in their
opinion, there is an absolute need for him. The chance of a more speedy recovery is
thus lessened, and future trouble is apt to be stored up. In many cases where the
doctor is called, it is most unfair to him as his bill cannot be paid. Besides, the
patient will hesitate before calling him again when there is that barrier of an unpaid bill. As the health of the people is a national concern, and there is no greater
asset than a healthy population, it would be well if the government could provide
means whereby adequate and efficient medical aid would be available to the people at
large. Lack of this provision, especially at this time, contributes largely to the
neglect of tho health question. For example, grocers and other merchants are paid
promptly in most cases, while doctors and dentists, who are subject to the same expenses, are often the last to be remembered.
 \
- 4 -
Thus the present national crisis brings into bold relief as novor before,
the urgent noed for some adequate plan of national health insurance to solve once and
for all the burdens which are now borne by hospitals, municipal governments and tho
individuals who are the least able to pay for medical services.
The crisis has made apparent also that it is high time to deal with that
class which is providing an ever increasing problem, namely, the mentally defective.
It is indeed gratifying to see that this Province has taken the initial step and we
hope that, in the future, moro attention will be paid to this field.
One of the most serious conditions which the present crisis is bringing
forth is a nervous instability and breaking down of the moral fibre of the people.
This worry and uncertainty is gradually undermining their health, and unless there
is an improvement in the economic world, serious consequences may result. Any change
for the better would be quickly reflected in tho general health of tho population,
MYRTLE E. HARVEY, R.N.,
Saanich Health Centre.
IMMONIZATION.        y/
TTo immunize or not to immunize, that is the question; whether it were better
to prevent the dread diseases or to await until the dire plagues are among us and we
have to fight them with insufficient weapons, and have many fallen ill1
The prevention of preventable diseases takes two forms. First, the detection of patients with the malady, and their isolation; the following up and supervision of all contacts, which may be very imperfect through the lack of understanding
and cooperation of the patients and their families. The other method is the giving
of the preventive solutions which Medical science has made available for public use.
The application of either of these practices depends a very great deal upon
the attitude toward them of the public concerned, and especially of those in authority,
who can grant or withhold the financial aid necessary.
Immunization in this district was greatly aided by the incidence of severe
Smallpox in Vancouver 1932. Upon my suggestion to the School Board that it would be
an opportune time to have Vaccination clinics, they appointed a Health Officer for the
town itself, with the result that 89$ of the non-vaccinated were treated at clinics
held in the schools for the pupils. Practically all who received the treatment had
a "take" with no bad results. I then asked if the smaller schools in the district
could have the same privilege. It was granted and received the same response and results.
In May 1952, two months after the above clinics, there were three cases of
Diphtheria and two carriers discovered in the town. The first of June 'Toxoid*
clinics were organized by the Health Officer and myself. The parents were sent "Prevention of Diphtheria" pamphlets, which were supplied by the Health Department in
Victoria, with mimeographed notices of tho clinics, stating that there was no charge,
(as the Health Department supplied the Toxoid and the Doctor presided ^as Health
Officer), also naming the time and place and explaining the number of doses necessary
 - 5 -
They were asked to sign and return the slip to the school if they wished the children
to receive the treatments.    No child was treated without the parent's or guardian's
signature.    63$ availed themselves of the opportunity,  none having any but a normal
reaction,  which being very slight,   caused no discomfort.    The clinics were held in a
classroom at 2 to 4 pm.    There was splendid cooperation of the teaching staff.
At the beginning of the fall term we held further Toxoid clinics for preschool children,  receiving-class and any others who had not been *done' previously,
that then wished to be.    There was a good response,  110 attending for the treatments
with like results.    These clinics were also held in a class-room,  the parents bringing their little children.    Tho homes were circularized as before through the pupils
and the local newspaper*
In addition to the cases of Diphtheria occurring in May there had been cases
previously, but there have been no cases since the giving of the 'Toxoid*.
The first of next month wo are having a clinic at a three-room school,  organized by the Parent-Teachers Association,  the Health Officer,  and me.    45$ of the
children are to be treated,  the handicap there being partly that the parents are asked
to pay 75^ per child.    The Health Officer in that district has a large area and small
pay.    But of course 46 more children protected for life from the ravages of Diphtheria,  as well as the check they will be to the spread of the disease,  is a step forward toward the goal that all should reach eventually.
There seems to be a growing demand for and an interest in Immunization in
different quarters, which I feel sure would be stronger and more persistent granted
the where-with-all to carry it out.    Of course there are always some prejudiced persons such as have flourished since the discovery of serums.    One finds them in the most
surprising places, but "seein* is believin1",  as a mother said whose one child,  Samuel,
an Aunt had signed for the first clinic,  "Sammy seems to be alright, you may do
Gertie".
MARY E,  GRIERSON,  R.N.,
Port Haney, and Mission City.
THE IMPORTANCE OF "FOLLOW-UP"
IN ALL CASES OF VACCINATION AGAINST SMALLPOX.
In two previous papers on Smallpox vaccination,  as conducted at the University Health Service,  we tried to outline our experiences and impressions as they
occurred.    In the first paper wo attempted to convoy our astonishment as the first
hundred unvaccinated,  now presenting themselves for vaccination - unfolded their reasons for the omission.    In the second paper we attempted to describe the volubility of
certain youthful anti-vaccinationists.    No very drastic or new charges were made and,
with one exception,  nothing very arresting.    This student,  however, made the statement that all people submitting themselves to vaccination were insane.
To compare modern anti's with those of Jenner's time is to realize lack of
 - 6 -
originality in the modern specimen of the species, (a) One writer of the ancient
group added to a treatise, chapters upon "Modes of treating the Beastly new disease
produced from Cow-pox" and wrote: "Smallpox is a visitation from God, but the cow-
pox is produced by presumptuous man". Another anti maintained that vaccination had
been discontinued in one part of the country because those inoculated "bellowed like
bulls,| while another quoted a lady saying that "since her daughter was inoculated she
coughed like a cow, and has grown hair all over her body."
In this paper, we are concerned with the failure of the vaccine virus to react on some two dozen persons out of one hundred and twenty, with no history of previous vaccination or Smallpox, although the vaccination was repeated three times over
in eleven of those concerned.
i:(b) When potent vaccine virus is applied to the derma, irrespective of the
method used for penetrating the epidermis, a reaction WILL take place, reaching a
maximum which may be observed in from 1 to 14 days, depending on the degree of immunity of the subject. ABSENCE OF THIS REACTION INDICATES THAT THE VIRUS IS INCAPABLE
OF PROTECTING AGAINST SMALLPOX, AND NOT THAT THE SUBJECT IS BMONE.
If the subject has never been immunized by smallpox or by previous vaccination, the reaction WILL manifest itself as a primary vaccinia - a papule appears at
the inoculation site on the third or fourth day following vaccination, this becomes
vesiculated on the next day being surrounded by a narrow red areola. This vesicle
increases in diameter until the 9th day when the maximum is reached. If the subject
retains some degree of immunity, either through previous vaccination or an attack of
Smallpox, the reaction will be accelerated in development, shortened in time, and decreased in severity. The papule will appear earlier, the vesicle will be smaller, the
area will be less extensive at the maximum of reaction, which may occur any time from
tho fourth to the eighth day. This reaction is called a vaccinoid (accelerated reaction, or secondary vaccinia.) FAILURE TO GET A REACTION INDICATES IMPOTENT VACCINE
VIRUS AND VACCINATION SHOULD BE REPEATED WITH A FRESH LOT."
Hitherto, failure of vaccine virus to produce one of the reactions outlined,
has meant faulty technique or impotent vaccine. According to a Brochure issued by
the Provincial Board of Health the same two reasons are given for this non-reaction.
Embodied in a report on vaccination by the Ministry of Health, London (c) is the following: "It is a simple matter to secure 100 per cent, insertion success, given
potent lymph and proper technique." In our experience there are exceptions to this
rule, wo have found that faultless technique and the most potent of potent vaccine
virus fails to produce any kind of reaction in certain individuals although repeated
three times at two week intervals - and think this point worth stressing, as many
vaccination certificates reach us with a diagnosis of "Insusceptible"; this may mean
insusceptible to smallpox, or, the vaccine virus; in any case it gives a false sense
of security to the individual and his friends, and wo have proof in plenty that such
persons are not in fact immune to smallpox. In a report issued by the United States
Public Health Service (d), we find that out of 1,314 cases of smallpox in California,
(a) A Sketch of Jenner and his work - I.H. Elliot, M.B., Canadian Journal of
Medicine and Surgery, 1920.
(b) Essentials of Smallpox Vaccination - James P. Leake and John N. Force, U.S.A.
Public Health Service.
(c) Report of the Committee on Vaccination, 1928. Page 85. (London)I
(d) Leake, Surgeon F.P., U.S.A. Public Health Reports, 1921.
 ' 1
 - 7 -
1,223 had been at some time unsuccessfully vaccinated - see Table 1, showing the record of four States.
Among the 1,000 cases under survey at the University Health Service, 197
had never previously been successfully vaccinated. Of this group 101 responded with
excellent reaction; the remaining 96 showed no reaction whatever. 71 cases consented
to revaccination with 41 takes and 21 showing no reaction - of 11 cases accepting
vaccination the third time no reaction occurred - the ages range from 6 to 30 years
or age,   - see
i laoxe
m
Table
j 1.
State
Smpx Cases
Unsuccessful
Vaccination
California
Florida
Kansas
Massachusetts
1,314
525
1,798
7
1,223
222
766
6
Table 2.
Vaccination
Vaccinated
within
twenty
years
Vaccinated
within
ten years
Never successfully vaccinated
Of these
revaccinated
twice
Revaccinated
thre e ti me s
197
71
Results
14
Results
Takes
No reaction
1,000
Partial
Takes
135
Immune
reaction
668
101
96
Takes
41
No reaction
26
Takes
3
No reaction
11
If the above outline is clear it will be seen that certain individuals do not
respond to the insertion of potent vaccine virus, irrespective of skilled technique.
It is known such people are not immune from smallpox. In our survey, necessarily
limited, we can only report 11 such cases - but know of many others. We are fairly
certain that a strict "follow-up" of all vaccinated persons would reveal a surprising
number of non-reactionists, and would like to see the word 'WILL' as used in Par. 4
and 5, substituted for the word 'MAY*. We are impressed by the lack of simplicity in
securing a reaction, as given in the Report of the Ministry of Health, Par. 6, of this
paper.
C. A. LUCAS, R.N.,
University of British Columbia,
Vancouver,
PIONEERING IN THE PEACE,
I suppose, that as a rule, pioneering,  if undertaken in the right spirit,
will always bring out the best in people.    It tends to foster such virtues as courage,
endurance,  ingenuity and perseverance,  and a dogged determination to "win out".    And
I think, that the people among whom I work, are no exception to the rule.
Owing to the world depression,   circumstances are much harder for the new
settler than innormal times, but I believe that most of them realize how much better
—
 - 8 -
off they are than if living in a city.
A great many of these new settlers, who are now living under most primitive
conditions, once owned flourishing farms on the Prairies, from which they were driven
by a succession of dry years, and repeated crop failures. Some of them in desperation, just left everything as it stood, shut the door, collected their remaining
stock, and set out for a new land. They arrived in covered wagons, having spent many
months on the journey. The same covered wagons, with perhaps the addition of a tent,
often had to serve as their only home, while they made a clearing in the forest in
which to erect their log cabins. Because they had spent their last dollar on the way,
their main food supply was often wild meat, and wild berries, when in season, and
when ammunition ran out - they would resort to snares.
When times are good, or even moderately good, a Homesteader can, with perseverance and much hard work- soon begin to "feel his feet", and see with satisfaction,
the results of his labours. But under the present circumstances, the hardships are
trebled, even with the help of Government relief, while the immediate future doesn't
look very rosy. It takes a person of wide and courageous outlook to refrain from
grumblings and pessimism. I am proud to say, that it is often the Homesteader's wife,
who chiefly possesses this indomitable spirit, and who refuses to give in, or waste
time on self pity. Indeed, the Homesteader's wife usually has little time to waste
on anything. Her resourcefulness and ingenuity fills me with admiration. Not only do j
they manage somehow, to keep their families fed and clothed on the meagre supplies
available, but make a brave attempt to make the little home attractive. Nevertheless,
housing conditions up here leave very much to be desired, and a terrible overcrowding
is the general rule.
Added to the financial depression, which of course if felt everywhere - the
long hard winter, with its exceptional heavy snowfall, has made the hardships of these
settlers much greater. Thanks to the Canadian Red Cross, the Imperial Order of the
Daughters of the Empire, and other organizations, I have had large quantities of warm
clothing sent in for distribution, which has been greatly appreciated. Owing to the
great distances, the often impassable trails, end the difficulties of the people
getting out because of inadequate clothing - the distribution has not been easy.
The great problem up here now, and one which has persisted for some time -
is the serious shortage of feed. Large numbers of horses have already starved to
death, and unless the snow goes soon, many more will be lost. Inability to feed
the milk cow, has resulted in a sadly diminished milk supply, with the consequent ill
effect on the children.
Nevertheless, in spite of the hard times, the settlers in this northern
part of the Peace Block now have many advantages, unavailable to the settler who came
in a few years ago. Then, all sick people needing hospital care had to undergo a long
and difficult journey by road and river. Now, a resident doctor, and a well equipped
hospital are available to meet the needs of the sick north of the Peace, and serve a
very large area.
Another great convenience to the settler is a grist mill, where he may take
his grain, and have it converted into flour, bran, shorts, etc., and this without the
payment of cash, payment being made by leaving a proportion of the grain.- .-This does
away with that long haul to railhead, which was so expensive and difficult.
I
My work among the settlers, as Public Health Nurse, is very varied and in-
J
 - 9 -
teresting, and the unexpected is always happening. My chief mode of transportation
is horseback, and "Major", an ex-police horse, is my staunch friend and ally. My
"headquarters" is a small Red Cross Outpost, where when necessary I can take a couple
of patients. Since the advent of the Hospital, this has become less necessary, and
the advisability of moving the Outpost further north, or to a more isolated part is
being considered.
M. CLAXTON, R.N..,
Grand Haven.
"HOW FAR IS IT SAFE FOR A HEALTH ORGANIZATION TO UNDERTAKE
RELIEF WORK?"
It is necessary to consider relief work in terms of "safety" in connection
with a Health Organization, because public health is still a growing science. In its
course of development from the filth and lack of care of the middle ages to the present century, progress has been slow, spurred on at intervals by the vision and work
of such men as Jenner and Pasteur who were able to grasp a problem and its significance and apply their solution. The latter port of the 19th and the beginning of the
20th century have "seen the growth of modern Public Health from the limitations of mere
attention to sanitation to a wider field embracing the individual as well as his environment in order to foster good health and to prevent disease.
It has been proved in the examination of large numbers of people, as during
conscription for the World War, that most adults are not in perfect health and that
their imperfections are due either to neglect of the fundamental laws of health on
their part, or to the effects of conditions present in childhood that were preventable.
The constructive programme of public health adopted since the war has been educational
in order to avoid as far as possible these imperfections in the growing generation by
teaching them the value of good health and how to keep it. To tho Public Health Nurse
comes the work of carrying the programme into the home, and with this in view her
training has included, beside the technique of nursing care, instruction in social
and mental hygiene, child welfare and public health. They provide a store of material
that will help to meet most situations that majr arise and that may be an important
point of contact with the family for future work. There must be an clement of confidence present before the average adult will accept the theory of prevention and honestly
try to live the laws of health with the idea of keeping well. That confidence is
almost automatically given to the person who is able to help out in an emergency
whether the cause be mental, financial, or because of illness.
In a generalized public health programme where the nurse has at various
times to do a little of everything, no situation that may have a future significance
is too slight to be considered particularly if it is likely to influence community
opinion. However, she must divide her time according to the relative importance of
the work to be done, especially its relative future importance, placing the emphasis
on the educational side as it affects children, before birth, during infancy, preschool and school ages.
The popular conception of a nurse is of someone who is trained to care for
the sick, to make them comfortable and, if possible, help restore thei^r hoalth. At
first the nurse has the same idea about herself; there is a fascination about actual j
nursing, tho satisfaction of being able to make a patient comfortable - and grateful -
 - 10 -
that, on the district, leads from one visit to another. Done in this way, bedside
nursing in comparison with other branches of district work demands more time than results warrant. A great deal of the nursing care is routine and can be well carried
out by a member of the family, once she has been properly instructed by the nurse,
who can be on call in case of special need, but is free to do other work., Any case
that is too seriously ill to be left in this way requires continual nursing or hospital
care.
At this point one comes to the very present problem of care in sickness of
people living on relief. A class of people, normally self-supporting, has been rendered dependent because of lack of work and is in need of the necessities of life—
food, shelter, and care in sickness. The first two are provided through relief allowances and community help, but the last is a special problem because it requires the
services of trained people. Doctors are doing wonderful work, giving time and services, but they cannot carry on alone. Where must they look for nursing help? Presum- I
ably the situation is a temporary one. These people are potential earners who will
again pay their way when work is available. The established institutions for providing nursing care are best able to give more, now, at less additional cost because they
have the facilities already in use, approximately the same running expenses, and an
opportunity in the future of getting some return.
To the health organization the question becomes one of policy. Cooperation
is everything in carrying on public health work, and any public health nurse gladly
puts her shoulder to the wheel to give an extra turn when it will help. Sho can help
out with home nursing within the limits described above without sacrificing time that
should be used for other work. One questions whether it is worth eliminating any part
of a programme that has been fought for so well and with such good rosults, to solve a
problem that is not permanent, when from a public health viewpoint to do so is a backward stop. Thore are so many more members of a community who are able to nurse than
there aro those who are fitted to teach public health. It is not that the latter arc
attempting to avoid more work in the popular sense of the word, but simply that they
want to make better use of their time and exert a wider influence over the coming
generation, on whom rests the hope of future Public Health.
FYVIE YOUNG, R.N.,
Cowichan Health Centre.
A PUBLICITY CAMPAIGN.
Tho Public Health Nurse is constantly faced with the desire to do something
for her department that will draw more attention to the great piece of work that is
being carried out in the Public Health Field. An ideal way of getting to the fore is
by means of a publicity campaign. This establishes a new and appealing link in reaching the public and creates among the people a "felt need" for Public Health Service.
The slogan "It pays to advertise" is not confined to business alone. Admitting that it pays in health work, the question arises, "Whom does it pay?" It certainly pays the nurse for it brings her in contact with and gains for her the cooperation of a very much larger number of people. It pays the public because, primarily,
it educates the people and secondly it creates new confidences and strengthens old ones.
What do we mean by the term, "Publicity Health Campaign"? It is the serving
 - 11 -
of the health ideas to the citizens in a tempting new way, so that one may break up
any existing inertia and start a movement toward a higher level of healthfulness.
What adult is not influenced by a spectacular and well arranged project and what child
can forgo his own curiosity when it comes to seeing or hearing anything new? How well
each one will remember such health rules J
The principles involved in a Health Campaign plan are, first—to create a
susceptible mood by inspiring each and every individual with health-mindedness. Make
it a personal effort as well as a community effort and instil in each mind a sense of
pride for district healthfulness; secondly, to portray the educational material in an
entertaining manner so that it can readily be absorbed.
HEALTH WEEK: Such a plan was carried out in Chilliwack. Its success was
confirmed by the fact that so many organizations co-operated. The means by which
Health Week was put over were the following: —
1. Poster displays in windows carrying out specific health ideas,
2. Radio talks over the local station for adults and children.
3. Health articles and write-ups in the local paper.
The store windows were really the show windows for the health display.
Every store in town co-operated fully by advertising and displaying some of their own
lines in relation to health. For instance Spencers Ltd. had the best window display
in town. In the first window they had a huge poster in the background showing that
it is necessary to use a handkerchief to protect others from colds, while in the foreground they had children's table and chairs; lamps, umbrellas, etc. docorated or
padded with handkerchiefs in a very clever way, to attract the eyes and draw attention]
to the poster.
In the next window, they had a huge piece of tanned leather in the background with posters illustrating the formation of the foot and the necessity for wearing correct shoes. Grouped in front of this display were different types and sizes
of the ideal footwear*
In an adjoining window they displayed an ideal nursory illustrating the correct furnishing and the necessity for regular habits. Tho latter was portrayed by
the uso of a clock mounted in the background, surrounded by signs, emphasizing regularity in baby's day.
Play and recreation were predominant in the following window. Different
types of children's playthings and sports equipment were attractively and invitingly
shown. This demonstrated that play and recreation were valuable in building up a
healthy allround life.
In the last window of the department store food held a very important place.
Proteins, carbohydrates, fats and oils, vitamlnes and minerals were all there. The
necessity for having the correct proportion in the daily menu was fully illustrated,
by linking colorful illustrative posters with the actual food.
Thus Chilliwack's department store co-operated fully in putting on a most
successful window health display.
 - 12 -
Drugstores, grocery stores, hardware stores, shoe stores, bakery stores,
vegetable stores, cafes, etc. united in displaying health projects. Each display was
linked up by the presence of a sign in each window donated by the Kinsmen Club, the
sign having the slogan "We are co-operating with Chilliwack in her Health Week".
Here, a drug store window with an attractive display of Cod Liver Oil giving its value
as a food to the body rather than a medicine. There, a hardware store with a huge
cardboard lock and key portraying metaphorically the link between play and health
"The Key to Health". Across the street, an attractive meal set up in a cafe window.
A fresh meal appetizingly cocked and served daily, in the background of which were two
huge posters giving the 24-hour correct menu with food values and balance for an adult
and a child.
Another effective medium was the local radio station. We were fortunate in
securing the air for fifteen minutes daily at the supper hour for educational talks.
The latter covered a wide range of health material such as: 1. "The High School Child
and Health", given by the Principal of the High School. 2."The Hygiene of the Mouth",
by a local dentist. 3. "Preventive Tuberculosis Work and the Travelling Tuberculosis
Clinic", by Dr. A.S. Lamb. 4. "Physical Education and Health", by a local physical
education instructress. 5. "Correction of Physical Defects", by a local medical man.
However, the children wore not forgotten, a children's programme was broadcasted three times during the week consisting of interesting health stories, a health
play and health songs rendered by the children from the district.
The housewife, too, was remembered. A neighborly Martha morning programme
revealed the secrets of a balanced diet, the solution of Child's school lunch problem
and appetizing ways of appealing to a jaded milk appetite.
This radio propaganda reached an immediate population of ten thousand people.
The local newspaper was instrumental in preparing the way for our health
work by giving an explanatory account of the prospective health project. It was
followed by narrative descriptions of the complete health campaign. Thus the people
were left with a mental picture of Chilliwack1 s Health Week.
The most searching test of the success of such a project is the amount of
interesting comment aroused in the community. Chilliwack is showing more than more
curiosity in the work we are attempting, as the result of our Health Week.
GERALDINE HOMFRAY, R.N., and
MARION CARDWELL, R.N.,
Chilliwack.
COMMUNITY ORGANIZATION IN THE DEVELOPMENT OF A
HEALTH UNIT.
"Good-will" and "cooperation" were terms used with almost boring frequency
during our courses at University - boring probably because we did not realize at the
time that the good-will of the people and their friendly cooperation are the keynote
to the success of health work in any community. In order to achieve a sympathetic
understanding it is necessary to give honest publicity to the work - not only as the
program is started but also to every new stage in its development.
L/i
 - 13 -
On arriving in Nelson I asked the secretary of the school board to arrange
for a special meeting which gave us an opportunity to outline a tentative plan for our
work. It was not necessary to "sell" to the board members the idea of "Public Health".
They had discussed the subject thoroughly and were prepared to point out little pitfalls along the way. Many of their suggestions have proved helpful.
It was decided that we should confine our activities to school work until we
could gather together sufficient data to present to the rural districts. We corresponded with health units in other parts of the province and collected information
relating to the cost of health work and the benefits accruing from such work. This
information was compiled in mimeographed book forms to be sent to fifteen rural school
boards.
While data wore being collected we used every opportunity to make contact.
During educational week we spoko to parents in three schools on the advantages to
be derived from health work in the schools. We had health literature on vaccine,
toxoid, diet, sex education, care of the teeth and many other subjects displayed in
the medical room. So many parents came to discuss problems that our health literature
was gone on the first day.
The editor of the daily paper has cooperated well and has given generous
publicity to each step in our work.
Around the first week in December our mimeographed forms v/ere sent to the
rural school boards accompanied by letters asking each board to appoint a representative to attend a meeting in Nelson, December 12th, 1932. Because of inclement weather
only six of the boards were represented. However, the tone of the meeting was good
and every ona present was keenly interested in the program which was outlined for them
by members of the council, school board, and the health department.
The secretary of our board arranged for seven meetings. Board members from
two or three small towns met at a central point in each district and were addressed
by the mayor of Nelson; council, school board, and health department members. All
board members realized the value of health work in thoir schools but many of them
thought that it would be difficult to finance a health unit even with the aid of a
government grant at this time. Each board called a ratepayers' meeting but in several
districts tho "unit" was voted down so the whole plan was dropped for the time being.
To any one commencing a campaign I would suggest the advisability of having
the whole rural public circularized through tho children. A brief circular could
present a few salient facts about health work which would enable the ratepayers to
vote more intelligently on this matter. Very sketchy notes were taken at the board
meetings and therefore the subject could not bo presented to the ratepayers in a very
convincing manner. However, we do not feel that our effort to organize the rural
district has been in vain. We think we have sown seed which will some day bloom into
a health unit embracing a large territory contiguous to Nelson.
In the meantime we are carrying on our community work. In February, 1933,
Dr. Simmonds was appointed Medical Health Officer and pathologist for our laboratory.
Dr. Auld had served as health officer gratuitously for a number of months in order
that the salary of the medical health officer might be used as a nucleus for a laboratory.
We were convinced that school nursing was the best phase of work with which
 - 14 -
to begin our health program because it affords entry to so many homes. One probably
receives a much warmer welcome when calling on a sick person, but bedside nursing
does not offer as many opportunities of making contacts and then too there is the
danger that bedside care will gradually encroach on the nurses time until she finds
herself with very little time left for instructional work. We stressed that point very
strongly with the public as we commenced our program.
We have addressed members of the Women's Institute, the I.O.D.E., .and the
Gyro Club, and have found their cooperation most encouraging. The I.O.D.E. has supplied glasses for a number of children and has raised a milk fund in order to supply
milk to over a hundred school children four days a week. The Rotariens have donated
money to the milk fund to supply milk to the same number of children for the remaining
day each week. Both the Rotary Club and tho I.O.D.E. have donated money for cod liver
oil. With this treatment the weight improvement in many of the children is most
gratifying.
The dentists in Nelson are cooperating to the best of their ability. It was
decided at one of their meetings that they would extract teeth without charge for
those children recommended by our department. While this does not begin to accomplish
what we are aiming at it at least removes foci of infection in many cases.
The Women's Institute is cooperating in finding clothing for children for
quite often parents explain the absence of children from school on the score of insufficient clothing.
There are thirteen service clubs in Nelson and at present we are planning a
central committee. Each club is to appoint one representative and there will be representatives from the school board and the health department. It is hoped that by
concentrated efforts we will be able to achieve greater results in the way of correcting defects during the coming year.
During the summer months we intend to link up prenatal, infant and pre-school
work. In the fall we plan to commence Home Nursing classes and Home visiting to tubercular cases.
Our Utopia in Health work at present is a "unit" with a full time health
officer, throe or four nurses and a full time dentist, working a large area surrounding
Nelson, There are times whon our goal' seems a very distant one - in fact there are
times when it almost fades from sight - but we are convinced that by gradually educating the people to the full meaning of Public Health work our Utopia will be realized.
KATHLEEN GORDON, R.N.,
Nelson.

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