Applied Science, Faculty of
Nursing, School of
DSpace
UBCV
White, Alistair
This study explores the development of public health nursing in the Yukon Territory between 1945 and 1967. This period in Yukon history was marked by significant social and political changes, including the rapid increase of the white settler population, the expansion of the modern Canadian welfare state, and the continued colonization of Northern Indigenous communities. Public health nurses played a pivotal role in these processes, but their contributions are underrepresented in the history of nursing. Drawing on archival records, government reports, autobiographies, and oral histories, this study examines the evolution of public health nursing within this historical moment. I argue that public health nurses inhabited a complex position in the development of Yukon health services. Nurses were essential in public health efforts to control communicable diseases and reduce infant mortality, but in doing so contributed to a deepening of colonialism. Public health nurses sought professional independence and autonomy through northern practice yet were heavily scrutinized by their employers who routinely dismissed nurses’ concerns. By situating nurses within the broader context of northern development, this study offers a nuanced understanding of the ambiguities of public health nursing in the Yukon.
NURSING UNDER THE MIDNIGHT SUN: PUBLIC HEALTH NURSES IN THE YUKON, 1945-1967 by: ALISTAIR WHITE BA, University of British Columbia, 2019 BSN, University of British Columbia, 2022 A SPAR PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (School of Nursing) THE UNIVERSITY OF BRITISH COLUMBIA Vancouver April 2025 © Alistair White, 2025i Abstract This study explores the development of public health nursing in the Yukon Territory between 1945 and 1967. This period in Yukon history was marked by significant social and political changes, including the rapid increase of the white settler population, the expansion of the modern Canadian welfare state, and the continued colonization of Northern Indigenous communities. Public health nurses played a pivotal role in these processes, but their contributions are underrepresented in the history of nursing. Drawing on archival records, government reports, autobiographies, and oral histories, this study examines the evolution of public health nursing within this historical moment. I argue that public health nurses inhabited a complex position in the development of Yukon health services. Nurses were essential in public health efforts to control communicable diseases and reduce infant mortality, but in doing so contributed to a deepening of colonialism. Public health nurses sought professional independence and autonomy through northern practice yet were heavily scrutinized by their employers who routinely dismissed nurses’ concerns. By situating nurses within the broader context of northern development, this study offers a nuanced understanding of the ambiguities of public health nursing in the Yukon. ii Preface This SPAR project is the original, unpublished, and independent work of the author, Alistair White. Generative artificial intelligence was not used for any aspects of the work. iii Table of Contents Abstract .......................................................................................................................................................................................... i Preface ........................................................................................................................................................................................... ii Table of Contents ................................................................................................................................................................... iii Abbreviations ........................................................................................................................................................................... iv Acknowledgements ................................................................................................................................................................ v Chapter 1: Contextualizing Public Health Nursing in the Yukon ................................................................. 1 Introduction ............................................................................................................................................................................ 1 Historiography of Rural Public Health and Outpost Nursing ............................................................................ 6 The Yukon in Canadian History ................................................................................................................................... 16 Chapter 2: Nursing On (and off) the Alaska Highway ...................................................................................... 24 The Alaska Highway ......................................................................................................................................................... 26 Indian Health Services Expansion and Public Health Nurses ......................................................................... 30 Chapter 3: Southern Expectations, Northern Realities .................................................................................. 39 Considerations of Nursing in the North ................................................................................................................... 40 Nurses for the Yukon ........................................................................................................................................................ 44 Conclusion ................................................................................................................................................................................ 56 Bibliography ........................................................................................................................................................................... 58 iv Abbreviations DIA- Department of Indian Affairs DNHW-Department of National Health and Welfare IHS- Indian Health Services INHS- Indian and Northern Health Services LAC- Library and Archives Canada MSB- Medical Services Branch TB- Tuberculosis VON- Victorian Order of Nurses YA- Yukon Archives v Acknowledgements I would like to express my deepest thanks to my supervisory committee, Dr. Lydia Wytenbroek, Dr. Geertje Boschma, for endless encouragement and guidance, and whose invaluable time and perspective made this work possible. This work would not have come to fruition without the generous support of the Canadian Association for the History of Nursing through a Vera Roberts Endowment Award and the British Columbia History of Nursing Society through a bursary. I would also like to gratefully acknowledge the financial support of the University of British Columbia Faculty of Applied Sciences. I am also thankful to archivists Lesley Buchan, Caitlin Normandin, and Kira Quinsey of the Yukon Archives, the staff of Library and Archives Canada, those of The University of British Columbia Rare Books and Special Collections, for their dedication and patient assistance. Thanks also to members of the British Columbia History of Nursing Society, for their preservation of the fascinating history of nursing in this province. I thank my wife Charmaine and my children, Lavinia and Lochlan, for their love and support, and for accompanying me up north in the course of this research. Thank you to my parents, Mary and Keith, and my brother Alex. Thanks to my friends and true sourdoughs Kalin and Simon, and also Kurtis. 1 Chapter 1 Contextualizing Public Health Nurses in the Yukon Introduction The years following the end of the Second World War saw a marked shift in the federal government’s approach to public health and healthcare delivery in the north. The Yukon Territory, located in the northwest corner of Canada, had undergone a significant transformation during the war because of massive defence infrastructure projects financed by the United States. The federal Canadian government had a renewed interest in northern development due to population growth and expanded infrastructure, and so began the process of shaping the modern Yukon. In the middle of such rapid change, public health nurses played a pivotal role in establishing and maintaining the healthcare system in the burgeoning territory. Working as they did across a vast and challenging region, public health nurses delivered immunization, communicable disease control, and health education programs to the sparsely populated territory. They provided care in the face of numerous epidemics, including measles, influenza, and polio, and were central in efforts to address the seemingly intractable problem of tuberculosis. Public health nurses delivered babies, pulled teeth, and responded to traumatic injuries from all too frequent motor vehicle accidents. In doing so, these northern nurses built an enduring reputation for service, dedication, and skill.1 Such a reputation, however, did not appear out of nowhere. The Yukon, as with the rest of the Canadian North, has been the home of various Indigenous peoples for thousands of years before the first Europeans stepped foot in the territory. The public health practices of Yukon 1 Barbara Sibbald, “Outpost Nursing: A Legend Comes Alive,” Canadian Nurse, 93, no. 6 (1997): 20. 2 nurses emerged from a thoroughly colonial environment, where settlement was premised on the prospect of exploitation of the land and resource extraction. Yet nurses tried, within their purview, to address the consequences of social and economic dislocation for the Indigenous peoples of the Yukon. Simultaneously, they were integral to and extended the reach of state assimilationist and paternalistic health policies towards Indigenous peoples that disrupted the health and well-being of the very communities they were intended to protect. The following study explores the history of public health services and nursing work in the Yukon from 1945-1967, focusing on nurses' roles and responsibilities, as well as their relationships to the communities they served. Particular attention is given to how public health nursing practice intersects with colonialism, gendered labour, and the history of race and racism in Canadian healthcare. By examining how nurses navigated the challenges of practicing in the Yukon during a period of change and transformation, this work aims to contribute to the growing body of literature on the history of rural public health and outpost nursing. Time Period This SPAR covers the period 1945 to 1967, which was chosen because it offers a unique perspective from which to explore the relationship between nursing, healthcare, and the Canadian state. The study begins in 1945, which saw the creation of the Department of National Health and Welfare (DNHW) and an accompanying investment in health and social services. The contemporary network of nursing stations that form the backbone of remote and northern healthcare was built almost entirely in the post-war period, with the greatest expansion occurring in waves in the early 1950s and mid-1960s. Whereas healthcare delivery below the 60th parallel was the responsibility of the provinces, the Yukon, as a territory, gradually came under the 3 purview of the federal government. During this period, public health nurses were instrumental in the delivery of healthcare, particularly outside the territorial capital of Whitehorse. Thus, this project makes a case for understanding the role of public health nursing in the expanding Canadian welfare state, and of rural public health nursing in the development of a professional nursing identity independent of medicine in Canda. Sources This study draws on a variety of primary sources. The first group or primary sources includes grey literature, such as reports, memos, and other documents produced by the territorial and federal governments. These documents contain communication between government officials and nurses, health reports, descriptions of nursing duties and responsibilities, and documents and statistics related to healthcare administration. Most documents issued by the territorial government were retrieved from the Yukon Archives (YA) housed at Yukon University in Whitehorse. Documents from the DNHW and from Northern Health Services were accessed remotely from Library and Archives Canada. These sources were essential in establishing an understanding of nurses as government employees. The history of modern nursing is bound up with the history of professional nursing. Employers had an interest in observing and directing professional nurses and their activities. Through the communication between nurses, physicians, and administrators, it is possible to see the nursing role within the wider framework of an expanding healthcare service. The second set of primary source documents were obtained from university-based collections of oral histories or were published memoirs. Northern nurses have a rich history of detailing their experiences, and these narratives have proved invaluable for integrating the 4 personal perspectives of northern nurses into this study. Occasionally, accounts from nurses who worked outside the Yukon were useful in contextualizing the nature of outpost work, which was similar in many respects throughout the northern territories. Furthermore, many nurses did not restrict themselves to a single posting or territory. They were almost all employed by federal agencies and often moved between posts. In addition to biographies and autobiographies, the writing of northern nurses was also sourced from two professional journals, Canadian Nurse and The Canadian Journal of Public Health. Lastly, the personal correspondence and oral histories of nurses preserved by the Yukon Archives at Yukon University and the British Columbia History of Nursing Society Archives now located at the University of British Columbia’s Rare Books and Special Collections, were included in order to understand the first-hand experience of nurses. Problem Statement Public health nursing in the Yukon is notably understudied in both nursing history and in more general histories of the Yukon. The literature that currently covers health and nursing history in the Yukon is disproportionately focused on the narrow time period that encompasses the events of the Klondike Gold Rush in 1898 and the building of the Alaska Highway in 1942-43. The period after 1945 has received far less attention from historians, but it is arguably more significant to understanding the state of northern healthcare in the present day. As noted above, the contemporary network of nursing stations that form the backbone of northern rural healthcare were built almost entirely in the postwar period. Furthermore, the role of nurses is almost entirely absent from general and health histories of the Yukon, Nunavut, and the Northwest territories during this period. Yet, nurses in the north were typically the first and frequently the 5 sole point of contact between the Canadian healthcare system and a majority Indigenous population. As such, an analysis of the federal approach to public health and the role and perspective of nurses will yield insights about the relationships between the Canadian state, health, and colonization during this time period. Research Question The role of nurses in the Yukon was multifaceted and complex, and their experiences were shaped by multiple forces and changing circumstances. This study asks the question: what role did public health nurses have in the establishment of public health services in the Yukon? It also analyzes how nurses saw themselves in relation to the populations they served, and how racism and gender shaped their perceptions. These nurses were at the forefront of public health in a period of rapid change, contending with adversity and isolation. This study will thus consider how these factors, central to northern nursing, impacted their experiences and identities both personal and professional. Argument I argue that nurses had an ambiguous relationship with northern nursing and healthcare in the Yukon territory. As key workers in the expansion of the welfare state, nurses provided essential public health care to people in need throughout the Yukon, but in doing so they acted as frontline agents in the deepening of colonial structures. While northern work offered financial and professional opportunities that often exceeded what was available in the south, it was dependent on a level of self-sacrifice from overworked and under-supported nurses that led to consistently high turnover and poor retention. 6 Historiography of Rural Public Health and Outpost Nursing The term ‘outpost nursing’ is generally used in Canada to refer to nurses who practiced in rural and remote parts of the country. The literature details the challenges they faced often as the sole care provider, and with limited supplies or support. Though frequently associated with the northern territories, the primary focus of this essay, outpost nurses have worked in every part of the country, including the Maritime islands, the prairies, the West Coast, as well as in Inuit and First Nations communities in the subarctic and Arctic North. These nurses have been called many names, including District Nurses, Visiting Nurses, Station Nurses, Public Health Nurses, Community Health Nurses, and most recently Primary Health Care nurses. While variation in their roles existed in different regions and across time, the nature of their work in geographically, professionally, and socially isolated conditions has enough commonalities that the term ‘outpost nurse’ can be seen as common to many nurses who have worked in these remote areas. However, in the Yukon territory in the mid-twentieth century, the term Public Health Nurse was applied to those in isolated outposts as well as those engaged in more recognizable public health work in the main settlements of Dawson City and Whitehorse. Thus, Yukon public health nurses fit well within the history of outpost nursing due to the conditions of the communities they practiced in that shaped the character of their work. Outpost nursing as a subset of Canadian nursing history is one that had, until the last two decades, received relatively little attention from historians. Most often, it was included as an interesting subsection in professional or organizational histories whose primary purpose was to consolidate and transmit a professional identity, celebrate the achievements of organizations, and record the efforts of prominent figures. Whether religious or secular, the portrayal of such nurses 7 was intended to be celebratory, focused on the positive personal attributes of these nurses and their contributions to a greater purpose. For example, missionary nurses who worked under the Church Missionary Society of the Anglican Church or the Grey Nuns of Montreal played a prominent role in the establishment of frontier hospitals in the Northwest Territories during the nineteenth and early twentieth century.2 As missionaries, they often saw their healing work as secondary to or in service of their efforts to convert the Indigenous population to their denomination of Christianity.3 Rural and remote nurses that belonged to secular organizations, such as the Victorian Order of Nurses (VON), the Red Cross, and provincial Public Health Services, also had their work documented in official and unofficial histories.4 These nurses were also understood in some sense as engaged in an evangelical effort, but for modern science and the health of the nation, not the church. This approach is summarized well by John Murry Gibbon and Mary S. Mathewson, who in their milestone work Three Centuries of Canadian Nursing wrote that: “It is all the more interesting to find Red Cross Outpost Hospitals today established in remote districts of northern Canada staffed by plucky women who have faced hardship and danger in order to bring healing and the gospel of sanitation to isolated communities.”5 2 Brett, H.B. “A Synopsis of Northern Medical History,” Canadian Medical Association Journal 100, no. 11 (1969): 523, https://pmc.ncbi.nlm.nih.gov/articles/PMC1945783. 3 Barbara Kelcey, Alone in Silence: European Women in the Canadian North before World War II (McGill-Queen’s University Press, 2001), 112. 4 Rev. Father P. Duchaussois, The Grey Nuns in the Far North (McClelland & Stewart: 1919); Monica Green, Through the Years with Public Health Nursing: A History of Public Health Nursing in the Provincial Government Jurisdiction British Columbia (Canadian Public Health Association, 1984); Irene Stewart, These Were Our Yesterdays: A history of district nursing in Alberta (self-pub, 1979). 5 John M. Gibbon and Mary S. Mathewson, Three Centuries of Canadian Nursing (MacMillan Co. ltd., 1947),138. 8 The early historiography of outpost nurses was thus incorporated into the larger story of Canadian nursing by framing their contributions as those of ‘pioneers’ for both the profession and the nation.6 As nursing history moved from traditional histories into the academy, outpost nursing was viewed as an extension of public health nursing. Nursing historical scholarship since the 1990s has been greatly influenced by what Veronica Strong-Boag referred to as revisionist nursing history.7 Historians such as Barbara Melosh, Susan Reverby, and Kathryn McPherson began to challenge and critique such histories which privileged the lives and experiences of elite nursing leaders.8 Instead, they sought to include the experiences, challenges, and achievements of the vast majority of ‘rank-and-file’ nurses. They drew on other bodies of scholarship such as women’s, labour, and educational history in order to understand how nursing and nurses were shaped by social forces such as gender, class, and race. Though nursing offered an independent income for young women with limited career opportunities, the characterization of nursing as women’s work contributed to a subordinated position in relation to majority male doctors in the patriarchal hierarchy of the scientific hospital. At the same time, the ideals of Victorian middle-class bourgeois femininity inculcated by the apprenticeship process allowed nurses to garner positions of prestige and power in relation to lay providers without formal training.9 Furthermore, racial discrimination in education and 6 Kathryn McPherson and Meryn Stuart, “Writing Nursing History in Canada: Issues and Approaches,” Canadian Bulletin of Medical History 11, no.1 (1994): 5, https://doi.org/10.3138/cbmh.11.1.3. 7 Veronica Strong-Boag, “Making a Difference: The History of Canada’s Nurses” Canadian Bulletin of Medical History 8, no.2 (1991): 232, https://doi.org/10.3138/cbmh.8.2.231. 8 Barbara Melosh, The Physician’s Hand: Work Culture and Conflict in American Nursing (Temple University Press, 1983); Susan Reverby, Ordered to Care: The Dilemma of American Nursing, 1850-1945 (Cambridge University Press, 1987.); Kathryn McPherson, Bedside Matters: The Transformation of Canadian Nursing, 1900-1990 (University of Toronto Press, 2003). 9 McPherson, Bedside Matters, 39. 9 employment meant that the profession was associated with whiteness, which invisibilized the presence and contributions of racialized nurses in nursing history.10 Rather than tracing a teleological course to modern professional Canadian nursing from its twin origins in French religious orders and the English apprenticeship systems, these revisionist scholars sought to expand the story of nursing beyond a limited focus on professionalization and education.11 However, these historians remained focused on the two dominant practice areas of 20th century nursing: hospital nursing and private duty nursing. These areas shared significant structural similarities, both being based around the concept of direct, bedside care provided within the dyad of the nurse-patient relationship. This conceptual similarity facilitated historical analyses of a coherent and unified subject of the nurse as the professional caregiver. Public Health Nursing, on the other hand, was distinct from these areas in terms of the required training, working environment, day-to-day responsibilities, and even uniforms and appearance. Public Health Nurses often had further education in the form of a post-graduate diploma or certificate, and were thus able to attain higher pay, status, and greater independence than their bedside colleagues.12 These nurses were not perceived to have the ‘hands-on’ skills and expertise of hospital nurses, and their work in health inspection, education, and surveillance meant they did not align with a focus on labour; they were “practitioners, not proletarian.”13 The emphasis on their education and professional status also associated them with the laudatory histories of nursing leaders that more recent histories were reacting against. These distinctions, as Susan 10 McPherson, Bedside Matters, 17. 11 Strong-Boag, “Making a Difference,” 238. 12 McPherson, Bedside Matters, 21. 13 Susan Riddel, “Curing Society’s Ills: Public Health Nurses and Public Health Nursing in Rural British Columbia, 1919-1946,” (master’s thesis, Simon Fraser University, 1991), 13. 10 Riddell has argued, meant that public health nursing has suffered from a definitional problem that initially limited its productive inclusion in the new nursing history.14 Despite these differences, historians found that like their counterparts in hospitals, public health nurses also experienced contradictions between the expectations of their positions and the reality that they entailed. Scholars located public health nursing within the wider public health movement. The early 20th century reform movement that sought to address the crises of health that were attributed to changes brought about by urbanization and industrialization. Whereas improvements in sanitation had made inroads into the prevention of epidemics, reformers turned their attention to issues such as malnutrition and infant mortality. These issues were particularly salient after the First World War, as leaders of the public health movement believed that the strength of the nation and its preparedness for war would depend on the number of healthy babies born. Nurses, educated in the techniques of modern hygiene and promoting the ideals of scientific motherhood, were recruited by public health departments for the surveillance of child and maternal health to produce healthy future soldiers.15 Meryn Stuart’s study of public health nursing in interwar Ontario revealed the misguidedness of some of these efforts, for while officials believed that education would be sufficient to improve the health of rural mothers, the poverty these nurses encountered was often overwhelming. Contrary to officials’ expectations, nurses were not always welcomed nor their advice well received, and the nurses could see that plain demonstrations were not enough to “erase the effects of poverty nor replace the lack of expert care in the treatment of morbidity and the prevention of mortality.”16 Looking at public 14 Riddel, “Curing Society’s Ills,” 11. 15 Cynthia Abeele, “’The Infant Soldier’: The Great War and the Medical Campaign for Child Welfare,” Canadian Bulletin of Medical History 5, no. 2 (1988): 100, https://doi.org/10.3138/cbmh.5.2.99. 16 Meryn Stuart, “Ideology and Experience: Public Health Nursing and the Ontario Rural Child Welfare Project, 1920-25,” Canadian Bulletin of Medical History 6, no.2 (1989): 126, https://doi.org/10.3138/cbmh.6.2.111. 11 health nurses in rural British Columbia, Riddell argued that despite the chance for autonomy and professional satisfaction for public health nurses working in rural areas of British Columbia, the poverty they encountered and limited resources they had to work with left many of these nurses disillusioned.17 Kari Dehli also argued that the gendered expectations of professionalism, such as their uniforms and the preoccupation with maternal-child health education, functioned to discipline these women towards the priorities of public health departments.18 Public health practice was deeply embedded within the nationalist socio-political contexts of its time, and nurses also had to navigate the oppressive nature of their work being tied to expectations of class, gender, and respectability. More recent historiography has recognized the importance of place for nursing history. It is difficult to overstate the importance of place for a study of outpost nursing for, along with isolation, it is a key factor in distinguishing the outpost nurse as a subject of study.19 Elliot, Dodd, and Rousseau have argued that the various outpost nursing associations founded in the interwar period, such as the Alberta District Nursing Service, the Newfoundland Outport Nursing and Industrial Association, and Quebec’s Medical Service to Settlers, opened up large sections of the country for settlement by providing essential medical care.20 For these communities, often very poor and composed of recent immigrants, recruiting physicians who would travel to these areas was nearly impossible as they knew very few members of the population would be willing or able to pay their fees. However, public health nurses, whose income was provided by a third-party or through very limited fees, were vital to delivering health care. As long as 17 Riddel, “Curing Society’s Ills,” 64. 18 Kari Dehli, “‘Health Scouts’ for the State? School and Public Health Nurses in early twentieth-century Toronto,” Historical Studies in Education 2, no.2 (1990): 256, https://doi.org/10.32316/hse/rhe.v2i2.1316. 19 Jayne Elliott et al., Place and Practice in Canadian Nursing History (UBC Pres, 2009). 20 Christina Bates et al., “Outpost Nursing in Canada,” in On All Frontiers: Four Centuries of Canadian Nursing, ed. Christina Bates et al., (University of Ottawa Press, 2005), 151. 12 accommodation could be provided, a community would be able to secure a trained practitioner for the area even if that training did not cover the full scope of the nurse’s eventual responsibilities.21 In particular, nurses who provided obstetrical care were permitted to act as midwives in areas that did not have a physician available. This was an essential service for many young mothers who had limited support on isolated homesteads. In areas with high rates of immigration, government health officials hoped that nurses would able to gain the trust of such mothers by virtue of their shared gender, and would also aid the process of assimilating them into the cultures and values of Anglo-Canadian society.22 Johanne Daigle has also argued that the nurses of the Medical Service to Settlers in northern Quebec took on an ideological importance in supporting mothers to reproduce the French-Canadian ‘race’ in the isolated frontier.23 Through their willingness to go beyond the circumscribed nursing role due to the necessity borne of remote practice, public health nurses were instrumental in supporting projects of settlement. In a similar vein, scholars have also drawn attention to how services provided by nurses to Indigenous peoples were shaped by the dynamics of colonialism in Canada. This is a point of particular importance in the study of northern and rural nursing. While the independent outpost nursing services were eventually incorporated into governmental bureaucracies helmed by physicians, it was nurses, missionaries, and lay dispensers who were the most prominent and visible representatives of Western medicine in many Indigenous communities. Historian Mary- Ellen Kelm demonstrated how Western medicine and discourses on Indigenous health “functioned as a legitimizer of colonial relations” that facilitated the dispossession and 21 Bates et al., “Outpost Nursing,” 144. 22 Dehli, “’Health Scouts’” 250.; Ina Bramadat, “WHMS Nurses in ‘Foreign Settlements: The Ethelbert Mission” in On All Frontiers, 136. 23 Johanne Daigle, “The Call of the North: Settlement Nurses in the Remote Areas of Quebec, 1932-72,” in Place and Practice in Canadian Nursing History, ed. Jayne Elliott et al. (UBC Press, 2008), 115. 13 displacement of First Nations in British Columbia.24 The women employed by the Department of Indian Affairs (DIA) as field matrons, who performed nursing as well as social work-like tasks, were often guided by an agenda of assimilation and at the forefront of policy implementation.25 In addition, Kathryn McPherson examined how federal nurses in Manitoba were ‘on-the-ground’ representatives. Thus they were implicated in a system of colonial medicine that, while required to attend to local needs in order to be functional, remained characterized by underfunding and a refusal to acknowledge traditional Indigenous medical practices or any formal responsibility for Indigenous health.26 Helen Gilbert and Judith Zelmanovitz have both suggested that the expanded scope of practice granted by northern nursing, though providing much needed and sought out care to communities, contributed to the suppression of traditional health practices and the imposition of Euro-Canadian cultural values.27 Indigenous midwifery in particular underwent rapid change in the post-war period, with the transition from majority of births taking place at home to blanket policy of evacuation occurring within a single generation.28 Though embedded within and representative of a health system that mirrored the colonial relationship between Indigenous peoples and the federal governments, scholars have noted that that the frontline nature of nursing work afforded some agency in how nurses navigated relationships with their employers and communities. The resident nature of nurses in such communities, compared to the infrequent visits of physicians, means that a focus on nurses offers 24 Mary-Ellen Kelm, Colonizing Bodies: Aboriginal Health and Healing in British Columbia, 1900-50 (UBC Press, 1998), 127. 25 Kelm, Colonizing Bodies, 149. 26 Kathryn McPherson, “Nursing and Colonization: The Work of Indian Health Service Nurses in Manitoba, 1945-1970,” In Women, Health, and Nation: Canada and the United States since 1945 ed. Georgina Feldberg et al., (McGill-Queen’s University Press, 2003), 226. 27 Helen Gilbert, “Great Adventures in Nursing: Colonial Discourse and Health Care Delivery in Canada’s North” Jouvert 7, no.2 (2003): 25; Judith B. Zelmanovitz, “‘Midwife Preferred’: Maternity Care in Outpost Nursing Stations in Northern Canada, 1945-1988,” in Feldberg et al., Women, Health, and Nation, 162. 28 Zelmanovits, “‘Midwife Preferred,’” 178. 14 a unique perspective that should be considered in its own right, not just as an extension of a monolithic healthcare system.29 As Maureen Lux and Mary Jane McCallum, among others, have shown, federal policy was shaped by discursive practices in regards to disease that rendered Indigenous peoples as both inherently vulnerable targets and dangerous vectors of transmission.30 At the level of the individual encounters, such policies were not hegemonic or uniformly applied and differed based on the discretion of some practitioners. In their study of northern Saskatchewan nursing stations, Laurie Meijer Drees and Lesley McBain have argued that while nurses at these stations were materially constrained, the specific care they provided did not deviate significantly from standard nursing care.31 Historian Myra Rutherdale also wrote extensively on the experiences of nurses and other professionals in the north, emphasizing how the personalities, backgrounds, and motivations of nurses in the arctic varied considerably and shaped their approach to unfamiliar circumstances.32 Rutherdale argued that despite their official positions, nurses and doctors often felt vulnerable in relation to Indigenous community members as they relied on them for translation and basic necessities like food, transportation, and shelter. Such an approach resists what she appears to see as a reductive impulse to either condemn or redeem every aspect of northern healthcare, or as she states: 29 Lesley McBain, “Jurisdictional Boundaries and the Challenges of Providing Health Care in a Northern Landscape,” Nursing History Review 21 (2013): 82, http://dx.doi.org/10.1891/1062-8061.21.80 30 Maureen Lux, Separate Beds: A History of Indian Hospitals in Canada, 1920s-1980s, University of Toronto Press, 2016), 139.; Mary Jane McCallum, “This Last Frontier: Isolation and Aboriginal Health,” Canadian Bulletin of Medical History 22, no.1, (2005): 104, https://doi.org/10.3138/cbmh.22.1.103. 31 Laurie Meijer Drees and Lesley McBain, “Nursing and Native Peoples in Northern Saskatchewan: 1930s-1950s,” Canadian Bulletin of Medical History 18, no. 1. (2001): 55, https://doi.org/10.3138/cbmh.18.1.43. 32 Myra Rutherdale, “Alaska Highway Nurses and DEW Line Doctors: Medical Encounters in Northern Canadian Indigenous Communities,” in Roots of Entanglement: Essays in the History of Native-Newcomer Relations eds. Myra Rutherdale et al. (University of Toronto Press, 2018), 176. 15 “They were not all colonizers bent on re-shaping Aboriginal lives. Some were. They were not all post-colonialists conscious of the hegemonic health care enterprise. Some were.”33 The history of outpost and public health nursing is a growing field of study with wide-ranging implications for Canadian healthcare and its history, not just the history of nursing. Recent research on military nurses at the Fort Churchill military hospital in northern Manitoba by Matthew Wiseman demonstrates a number of parallels between their experiences and those of civilian outpost nurses.34 Furthermore, McCallum, Vandenberg, and Penz have used historical inquiry to address the ongoing crisis in recruitment and retention affecting rural communities, where high turnover and burnout remain persistent problems. For example, the current strategy of offering financial incentives for return of service and recruiting internationally trained nurses has been attempted in the north previously with mixed results, suggesting that there is still a need for further research and dissemination of the findings of historians studying this subject.35 As the following work will be situated within this body of scholarship, it will seek to make a small contribution to understanding these issues and provide support for future research. The Yukon in Canadian History Although its current territorial borders were established in 1898 with the passing of the Yukon Act as a result of the Klondike Gold Rush, the area now known as the Yukon territory encompasses and intersects with the traditional and ancestral territory of a number of Indigenous 33 Myra Rutherdale, “Cleansers, Cautious Caregivers, and Optimistic Adventurers: A Proposed Typology of Arctic Canadian Nurses, 1945-70,” in Elliott et al., Place and Practice, 69. 34 Matthew Wiseman, “Ottawa’s Burden: Fort Churchill and Military Nursing in Northern Canada, 1945-1975,” Canadian Journal of Health History 41, no.2 (2024): 187. https://doi.org/10.3138/cjhh.662-072023. 35 Amanda M, McCallum, et al., “Help Wanted, Experience Preferred, Stamina a Must: A narrative review of the contextual factors influencing nursing recruitment and retention in rural and remote Western Canada from the early twentieth century to 2023,” Canadian Journal of Nursing Research 56, no.2 (2024): 141, https://doi.org/10.1177/08445621231204962. 16 groups who have continuously inhabited the area for several thousands of years.36 There are 14 Yukon First Nations as well as 8 transboundary Indigenous groups who have called this area home, living on and stewarding the land into the present day.37 The diversity of language and ways of life between Yukon First Nations and other Indigenous groups is a topic that falls outside the scope of this study, but there were some common patterns that are helpful in understanding pre-contact patterns of economic and cultural activity. Most First Nations in the Yukon sustained themselves primarily through a combination of hunting, trapping, fishing, and making use of the region’s flora and fauna. Due to its northerly position, the resultant cold winters and short summers of the Yukon meant that many groups maintained a semi-nomadic pattern to meet their needs. In general, this entailed making use of traditional hunting and fishing areas in the summer and fall and returning to reliable winter camps each season.38 European entrance into the territory began in the 1800s with the arrival of fur traders working for the Hudson’s Bay Company. This later date for European contact has contributed to perceptions of the Yukon as an isolated part of the far north, but in fact the presence of outsiders in the Yukon was felt long before Europeans themselves were. Yukon First Nations were connected to both over-land trade networks across the North American continent, coastal trade with the British and Americans, and trans-Pacific trade through contact with the Russian Empire in Alaska. These networks facilitated the exchange of useful European-made goods, including firearms, for access to the abundance of furs that First Nations were able to harvest. As historian Ken Coates has noted, fur traders attempted to control the market through monopolistic 36 Ken S. Coates, Best Left as Indians: Native-White Relations in the Yukon Territory, 1850-1973 (McGill-Queen’s University Press, 1993), 3. 37 “First Nations Traditional Territories,” Yukon Government, accessed Jan 12, 2025, https://open.yukon.ca/information/publications/first-nations-traditional-territories. 38 Coates, Best Left as Indians, 6. 17 practices, and First Nations groups also attempted to retain exclusive access to traders by discouraging further exploration.39 Early contact in the context of the fur trade was characterized by this dynamic, with very limited numbers of European and American traders transactionally engaging with Indigenous groups whose traditional knowledge was instrumental to the continuance of the fur trade. The second half of the 19th century also saw increased numbers of non-Indigenous persons come to the Yukon primarily for the purposes of resource extraction, most notably prospectors and whalers. The nature of such extractivist work meant that outsiders who came to the territory were mostly transient males, and few settled in the territory long-term. Marriage and relationships between non-Indigenous men and Indigenous women were common, and early northern contact history does not demonstrate the systematic attempts at social, cultural, economic reform of First nations peoples that would characterize later periods.40 An exception to this general pattern can be seen among Christian missionaries who first came to the territory in the 1860s. The two groups most active in proselytizing to the First Nations and Inuit were the Anglican Church Missionary Society (CMS) and the Catholic Missionary Oblates of Mary Immaculate.41 The goal of these missionaries was first and foremost to spread their belief to the Indigenous peoples, gaining converts and for their respective denominations. The first Anglican to enter the Yukon was Reverend Kirby in 1861, who set out hoping to establish a mission at Fort Yukon at the confluence of the Yukon and Porcupine rivers.42 Though Kirby chose not to return to Fort Yukon, a mission was established by Robert 39 Coates, Best Left as Indians, 22. 40 Coates, Best Left as Indians, 209. 41 William R. Morrison, True North: The Yukon and Northwest Territories (Oxford University Press, 1998), 55. 42 “William West Kirby,” Diocese of Yukon, Anglican Church of Canada. Accessed Jan 10th, 2025, https://anglican.yukon.net/kirby.html. 18 MacDonald the following year, and more missions would be created over the next several decades.43 Given its sheer distance from the urban centers of southern Canada and its comparatively harsh climate, the Canadian north was not a particularly prestigious post for missionaries. The nature of transport and communication at this time meant that the missionaries only contact with the outside would be through mail delivered on an annual basis. Conversion efforts in the north were, from the ecclesiastic perspective, remarkably successful as it was claimed that nearly the entire Indigenous population had been converted through a series of mass conversion events.44 However, in many cases these conversions resulted in few demonstrative changes in Indigenous spiritual practices, and the incompatibility of regular attendance of mass with a seasonal, semi-nomadic lifestyle frustrated some missionaries. The extent to which missionaries tried to impose western cultural norms and economic patterns during this period varied from site to site, as their express goal was to win and minister to converts.45 This is significant for nursing history as missionaries were the first representatives of Western medicine and nursing to Indigenous peoples. Success in the treatment of illness and disease among the Indigenous population, then, was seen as an opportunity to demonstrate the virtue of Christian belief, indicating that western medical care in the north has been bound up with evangelism from its introduction.46 These patterns of interaction would remain stable with relatively few changes until 1896, when the discovery of gold on a small tributary creek of the Yukon River set the Klondike Gold 43 Morrsion, True North, 56. 44 Walter Vanast, “The Bad Side to the Good Story: Vilhjalmur Stefansson and Christian Conversion in the Mackenzie Delta 1906-1925,” Religious Studies and Theology 26, no. 1 (2007): 82. 45 Coates, Best Left as Indians, 117. 46 Walter J. Vanast, “Arctic Bodies, Frontier Souls: Missionaries and Medical Care in the Canadian North, 1896-1926,” (Ph. D diss., University of Wisconsin-Madison, 1996), 44. 19 Rush in motion. Despite its marginal position in the northwestern corner of North America, the Yukon has at several points been at the center of questions of Canadian sovereignty, with the most famous of these being the Klondike Gold Rush. The original discovery of gold on Bonanza creek was made by three men, a Tagish man named Keish, also known as James ‘Skookum Jim’ Mason, his nephew Kaa Goox Charles, also known as ‘Dawson Charlie,’ Henderson, and Keish's white American brother-in-law George Carmack.47 In the few years after their discovery, nearly 100,000 people would make their way to the Yukon. The boom town of Dawson City would reach a peak of over 30,000 people, a number that the territory itself would not reach again for nearly 100 years, and the equivalent of one billion dollars of gold would eventually be pulled from the Klondike.48 The issue for the Canadian Government, however, was that the vast majority of gold-seekers were Americans, and this influx was the latest event in a pattern of expansion and encroachment that left the young Dominion concerned for its territorial integrity. The United States finalized the purchase of Alaska from the Russian Empire in 1867, the same year as Canadian confederation. American merchants and traders from Alaska enthusiastically and aggressively entered the Yukon pursuing commercial activity, disrupting the HBC’s monopoly on the fur trade. Furthermore, Americans were willing to trade alcohol and ammunition in contravention of the Indian Act, and were often viewed by the Canadian authorities and missionaries as a pernicious influence on First Nations who were not yet ready to join ‘white civilization.’49 By 1894, Herschel Island off the Yukon’s Arctic coastline had become a major 47 Pierre Berton, Klondike: The Last Great Gold Rush, 1896-1899 (Anchor Canada, 2001), 57. 48 Berton, 382. 49 Ken S. Coates and William R. Morrsion, Land of the Midnight Sun: A History of the Yukon, 3rd ed. (McGill-Queen’s University Press, 2017), 55. 20 hub for American whaling ships, and with a population numbering 1500 people, it was at this point the largest settlement in the Yukon, challenging the ability of the Northwest Mounted police to maintain order.50 Therefore, the prospect of tens of thousands of American prospectors flooding across the border made the Canadian government concerned it could lose the territory. This fear was not unfounded, as American territorial expansion across the continent had continued nearly unabated since the country’s founding. Furthermore, the north-western border between Alaska and Canada was the subject of an ongoing territorial dispute, and the discovery of gold in the Klondike prompted the Americans to undertake increased efforts in the area to secure the route from the coast to the gold fields.51 In response, the Canadian government took several measures to assert sovereignty and maintain control of the impending rush. Headed by Commissioner Sam Steele, a detachment of the NWMP set up a short-lived border crossing and customs office at the townsite of Skagway, Alaska, though they were eventually expelled and the customs office moved further inland.52 The NWMP also implemented a supply requirement at the border, refusing any would-be who could not prove they had at least one-ton of provisions per person to sustain themselves. Their approach to crime and punishment was marked by adopting a low threshold for the informal deportation of those who were accused of crimes or appeared to be likely to cause trouble. While both of these measures were technically illegal, Steele received the full support of the government in these actions as it allayed fears of unrest or American annexation.53 Further to this 50 “Herschel Island- Qiqiktaruk: A Guide to the Historic Resources” Yukon Government, Accessed December 18th, 2024, https://yukon.ca/sites/default/files/tc/tc-herschel-island-qikiqtaruk-guide.pdf.; William R. Morrison, Showing the Flag: The Mounted Police and Canadian Sovereignty in the North, 1894-1925 (UBC Press, 1985), 74. 51 Coates and Morrison, Land of the Midnight Sun, 93. 52 Morrison, Showing the Flag, 63. 53 Coates and Morrison, Land of the Midnight Sun, 100. 21 point, Canada also sent a 203-person detachment of the army that became known as the Yukon Field Force to be stationed at the central settlement of Fort Selkirk, who would be ready to “keep the peace” if necessary.54 This was a significant effort as the Yukon Field Force comprised a quarter of the entire army at the time, and given that they could not enter US territory without permission, they arrived by a longer all-Canadian overland route.55 The strict and sometimes extra-legal practices of the Canadian authorities in the Yukon contributed to the reputation of the Klondike gold rush as the most orderly in history, especially when compared to the image of lawlessness held by the Alaskan boomtowns of Skagway and Dyea.56 The Yukon, like the North in general, has served as a contested site for the assertion of Canadian sovereignty. The population of Dawson would reach its zenith of approximately 40,000 in the spring of 1898, though it would decrease precipitously over the next decade as the claims of individual miners were sold and consolidated under corporate gold-mining conglomerates. The civic and social institutions that were created to manage the needs of the settler population would survive into the interwar period, albeit in a reduced capacity and geared towards facilitating ongoing dredge mining operations. The elected council would be reduced from 9 seats to 3, and the territory would be governed by the federally appointed commissioner.57 St Mary’s Hospital in 54 Bereton Greenhaus, Guarding the Goldfields: The Story of the Yukon Field Force (Dundurn Press, 1987), 15. The Yukon Field Force would be accompanied by four nurses of the VON: Georgina Powell, Rachel Hanna, Amy Scott, and Margaret Payton. These four were selected to accompany the force by Lady Aberdeen, founder of the VON and wife of the governor general, to address health crises among the miners in Dawson, including typhoid epidemic. It is notable that these women were all trained nurses, as the VON at this time was primarily composed of nurses without formal qualifications. See Lynda Orr, “Ministering Angels: The Victorian Order of Nurses and the Klondike Gold Rush,” B.C. Historical News 33, no.4 (2000): 18. 55 Greenhaus, Guarding the Goldfields, 22-23. 56 Morrison, Showing the Flag, 35. 57 The Yukon’s Constitutional Foundations, ed. Kirk Cameron, Steven Smyth, and Graham Gomme, vol. 1, Steven Smyth, The Yukon Chronology, 1897-1999, (Clairedge Press, 1999), 11. 22 Dawson, established by the Sisters of St. Ann in 1897, would stay open to serve the small population of labourers, and hospitals at Whitehorse and Mayo would also remain in operation. For many Yukon First Nations, the impact of the gold rush on their traditional patterns of economic and cultural life was relatively unaffected compared to settler incursions of similar scale. The Moosehide reservation was created 3 miles down river from Dawson. While the Anglican church continued to operate a number of day schools, the number of schools open and students in attendance varied significantly.58 The Chooutla residential school in Carcross was opened in 1903 under Bishop William Bompas after moving the mission and its students from Forty Mile, partly to shield them from what he viewed as the corrupting influence of white society.59 Another residential school at Shingle Point in the north was established in 1926 for Inuit from the western Arctic, but was closed shortly afterwards and the students sent to Aklavik in the northwest territories.60 By the end of the First World War, Dawson was essentially a company town and the Yukon, in the view of the federal government, was a mining colony that had limited prospects for any further significant non-indigenous settlement. Chapter Outlines The onset of the Second World War, and the subsequent building of the Alaska Highway starting in 1942 in particular, there was a distinct change that marked the beginning of a transformation of the federal approach to territorial governance. As such, it is a useful starting point for this study. Chapter Two will focus on the role of public health nurses in health 58 Truth and Reconciliation Commission of Canada, Canada’s Residential Schools: The Inuit and Northern Experience, The Final Report of the Truth and Reconciliation Commission of Canada Vol. 2, (McGill-Queen’s University Press, 2015), 59. 59 Coates and Morrsion, Land of the Midnight Sun, 71. 60 TRC, Inuit and Northern Experience, 21. 23 programs for Indigenous peoples delivered by the federal government in the post-Second World War era. It draws on government reports to examine why public health nurses were sought out for this work, in relation to the priorities of government health policy. I argue that nurses' work was embedded within a colonial framework of health surveillance and reform, and was made possible by involvement with state institutions, such as the RCMP and the Canadian Armed Forces (CAF). Chapter Three will draw on literature written by nurses, and oral histories, to focus on the experiences of nurses in the Yukon. It will begin with a discussion about the ideals and imagery of northern outpost nursing, and the expectations that nurses had about working in the north, in particular the opportunities for adventure, autonomy, and expanded scope practice. It will primarily examine the literature written by northern nurses themselves, as well as oral histories. I suggest that the government depended upon public health nurses to address the difficulties of healthcare delivery that resulted from the territorial government’s fiscal constraints. Nurses were dedicated and cost-effective compared to physician services, but the limited resources and apathetic stance of the government exacted a significant toll on the nurses themselves. 24 Chapter 2 Nursing On (and off) the Alaska Highway “Along the whole Alaska Highway from Dawson Creek to Whitehorse, the only official representative of the Indian Affairs Branch was Nurse Hackett.”61 When Nurse Minnie Hackett arrived in the Yukon in 1944 as a public health nurse, she had twenty years of nursing experience and advanced training in public health nursing. Originally from England, she graduated from St. Boniface School of Nursing in Winnipeg in 1925 and began working at the Anglican hospital in Aklavik, NWT in 1926. She spent four years in the north - three at Aklavik and one in Hay River - after which she spent six years at the Six Nations reserve in Ontario. Hackett went on to complete a public health diploma in 1936, after which she was recruited by the IHS to address an ongoing crisis of severe epidemic diseases affecting First Nations people in the southwest Yukon along the path of the newly built Alaska Highway.62 The initial pioneer road had been completed by 1942, but work remained ongoing as the corduroy road was replaced by gravel and asphalt and errors in the route from the initial construction blitz were corrected. As a result, Indigenous people along the highway’s path through the Southwestern mountains were experiencing high rates of disease brought on by increased contact with both American servicemen and civilian contractors. Considering her 61 “Extract from Report on Trip to Yukon and Northwest Territories,” W. L. Falconer, July 1945, Department of Indian Affairs and Northern Development Fonds, RG85-D-1-A, volume 1872, file 550-1 part 3, Library and Archives Canada [hereafter LAC]. 62 Minnie Hackett, interview by Dianna Ritchie, 8 January 1992, cassette recording, British Columbia History of Nursing Society, Oral History Files, RBSC-ARC-1831-008-06-SPC-OH-073, box 119, University of British Columbia Rare Books and Special Collections, Vancouver, BC [hereafter: Hackett, interview]. 25 extensive experience in public health techniques and work with Indigenous people, Nurse Minnie Hackett appeared to be qualified for the task at hand. However, this was not the first time that Yukon First Nations had been impacted by diseases brought from outside the territory. As early as 1851, Hudson’s Bay Company fur trader Robert Campbell estimated that a third of the Indigenous population in the local area had died from an outbreak of mumps, and an 1861 epidemic of scarlet-fever brought by HBC traders killed nearly half of the total population of a band near the trading post of Lapierre’s House.63 The Klondike Gold Rush brought influenza, typhoid, and an increase in tuberculosis to the Han people that led to a 20-25% decline in their population from 1899-1906.64 While the impacts of such disease were significant and cannot be measured in vital statistics alone, settlement after the gold rush remained largely confined to the narrow corridor between Dawson City and Whitehorse, and therefore many Yukon Indigenous peoples tended to maintain traditional patterns of social and economic life in the 1920s and 1930s.65 The Yukon was also a racially segregated society. While medical treatment itself constituted a regular point of contact between cultures, public health measures such as quarantine were used to protect white settlements from the perceived threat of Indigenous peoples as disease vectors.66 The Alaska Highway would re-shape the territory and provide the impetus for greater government intervention into public health, one which would not only seek to limit the threat of diseases that were perceived to transmit from Indigenous persons, but to actively address and 63 Coates, Best Left as Indians, 38. 64 Bruce Lloyd Willis. "The Environmental Effects of the Yukon Gold Rush, 1896-1906: Alterations to Land, Destruction of Wildlife, and Disease,” (master’s thesis, University of Western Ontario, 1997), 68. 65 Coates, Best Left as Indians, 68. 66 Liza Piper, “Diphtheria Antitoxin and Tales of Mercy in Northern Health Care,” Canadian Bulletin of Medical History 38, no. 2 (2021): 288, https://doi.org/10.3138/cbmh.491-112020. 26 improve the ‘problem’ of their health. While historians have written extensively on the role of medicine and public health in Canadian colonialism in the north, fewer have focused on the role played by public health nurses.67 This is particularly significant for studies of northern healthcare, as it was nurses more often than physicians who were the face of Canadian medicine for Indigenous populations. This chapter will examine some of the public health nurses at work in the Yukon in the post-war period to 1957, when responsibility for most territorial health services was transferred to the federal government.68 I argue that public health nurses were instrumental to the expansion of the welfare state and the intensification of colonization in the Yukon that occurred after World War Two. Public health nurses acted as frontline agents in the implementation of an often-paternalistic health policy that was guided by assumptions of Indigenous peoples as inherently diseased or unhygienic. I locate nursing within this colonizing process and within the context of the expanding health infrastructure in the post-war north as they functioned as emissaries of public health. Nurses thus played an integral part in the organization of the modern Yukon during a period of rapid social, cultural, and economic change. The Alaska Highway The construction of the Alaska Highway is a somewhat mythologized event in Yukon history, much like the gold rush, and is seen as causing the territory’s second ‘boom’. The Alcan highway, as it was known, was one of three wartime construction projects that contributed to the 67 McPherson, “Nursing and Colonization,” in Feldberg et al., Women, Health and Nation; Meier Drees and McBain, “Nursing and Native Peoples”; Rutherdale, “Alaska Highway Nurses and DEW Line Doctors,” in Rutherdale, Roots of Entanglement; Zelmanovits, “Midwife Preferred,” in Feldberg et al., Women, Health, and Nation. 68 Smyth, “The Yukon Chronology,” 18. 27 physical and demographic reshaping of the Yukon territory.69 Since the United States financed the construction of the road, the formation of the road was shaped primarily by American, not Canadian, concerns. Dawson City, the Yukon’s capital, was completely bypassed by the highway. Instead, the transport hub of Whitehorse was transformed almost overnight into a city with tens of thousands of occupants.70 The 30,000 American and Canadian service members and contractors who came to the Yukon for these projects was an immense population for the territory to accommodate given that the entire estimated population of the Yukon was just above 3,000 in 1939. Thus, the increase in workers primarily from the United States was likened to a ‘friendly invasion’ of their Canadian neighbour.71 The ‘invasion’ also brought about an increase in contact between Yukon First Nations and non-Indigenous outsiders. Communities that were located along the construction routes of the Highway and the Canol road were exposed to the influx of outsiders, and to the diseases that they brought with them. The military and civil authorities sought to limit contact by placing certain communities off-limits to highway personnel, but it was impossible to completely prevent interaction, and severe and extensive outbreaks quickly sprung up throughout the territory.72 The year 1942 was a record high for Indigenous deaths in the territory, but in terms of strict 69 In addition to the Highway, Second World War defence projects in the Yukon included the Northwest Staging route, a series of airstrips extending to deliver materiel to the Soviet Union, and the Canadian Oil (Canol) pipeline to deliver oil from Norman Wells, NWT to a proposed refinery in Whitehorse. While the airstrips and airports were converted to civilian use, the Canol Pipeline was decommissioned a year after its completion. Like the Alaska Highway, both projects were marked by environmental and social disruption for Indigenous communities along the paths of development. See Kenneth S. Coates and William R. Morrison, The Alaska Highway in World War II: The U.S. Army of Occupation in Canada’s Northwest. (University of Oklahoma Press, 1992); P. Whitney Lackenbauer, “Race, Gender, and International ‘Relations’: African Americans and Aboriginal People on the Margins in Canada’s North, 1942-1948,” in Dominion of Race: Rethinking Canada’s International History, ed. Laura Madokoro et al., (UBC Press, 2017), 118. 70 Richard Stuart, “The Impact of the Alaska Highway on Dawson City,” in The Alaska Highway: Papers of the 40th Anniversary Symposium, ed. Kenneth Coates (UBC Press, 1985), 194. 71 Stuart, “The Impact of the Alaska Highway,” 192. 72 Julie Cruikshank, “The Gravel Magnet: Some Social Impacts of the Alaska Highway on Yukon Indians,” in Coates, The Alaska Highway, 182. 28 demography the Indigenous population recovered and stabilized within a few years.73 However, the social and cultural impact of such deaths, which disproportionately affected both the very young and the very old, left a lasting legacy for Yukon First Nations communities. Years later, in the 1970s, during the Mackenzie Valley Pipeline inquiry, Yukon representatives argued against the pipeline project citing their experience of death and loss during the highway years.74 Thus Yukon citizens recalled the highway construction as one that devastated their community. The loss of elders, especially for a people that relied on oral transmission of history and cultural knowledge, was devastating beyond the direct loss of life. The arrival of the highway itself did not fundamentally alter the traditional patterns of life for most Indigenous communities because the wartime construction projects, like the gold rush before them, were confined to narrow corridors of activity that could be avoided.75 Rather it was, as historian Paul Kelton has called it, the second-wave effects of “conflict, captivity, displacement, and destruction of Indigenous means of subsistence” that had a greater impact as the highway provided the impetus for the extension of state institutions.76 Highway workers and soldiers were granted special hunting permits leading to overuse, and the RCMP relocated its territorial headquarters from Dawson City to Whitehorse. This latter move resulted in a marked increase in arrests, particularly those related to alcohol. For Indigenous people, even simple possession of alcohol was a crime.77 As well, venereal disease reached almost epidemic proportions in 1943 due to contact between Indigenous women and girls and the majority male 73 Coates, Best left as Indians, 101. 74 Cruikshank, “The Gravel Magnet,” 185. 75 Coates, Best Left as Indians, 14. 76 Paul Kelton et al, “Introduction,” in Beyond Germs: Native Depopulation in North America, ed. Alan C. Swedlund et al. (University of Arizona Press, 2015), 7. 77 Kenneth Coates, “The Alaska Highway and the Indians of the Southern Yukon, 1942-1950: A Study of Native Adaptation to Northern Development,” in Coates. The Alaska Highway, 163. 29 newcomers. Still, blame was placed upon women with regard to this epidemic. Seven Indigenous women were arrested for forced treatment to contain the disease.78 Furthermore, residential and day schools were often unable to enforce attendance as seasonal trapping took priority, but the implementation of the Family Allowance Act in 1944 made qualification dependent on children's school attendance.79 New reservations were established, pushing many people into hastily built overcrowded log cabins that had never been intended for permanent occupation, and added to poor health conditions of Indigenous peoples in the area.80 The war years had exposed the inadequacies of the DIA's general inattention towards the health of Indigenous communities. Prior to 1945, responsibility for healthcare provided to Indigenous peoples in the north had generally been left to a patchwork system of contracted physicians, lay dispensers, and mission hospitals.81 The DIA had begun to take a more active role in direct healthcare provision in the 1920s and 1930s, but it was content to leave northern healthcare firmly in the hands of missionary societies. Outside observers were appalled by the conditions they saw among Yukon Indigenous communities. While epidemic diseases would be a recurrent issue, it was tuberculosis (TB) in particular that was seen as the most intractable problem.82 TB had been endemic among Indigenous groups in the Yukon since before the gold rush, but the primacy of wartime concerns meant that any kind of preventative efforts, meagre as 78 Coates, “The Alaska Highway,” 163. 79 Coates, Best Left as Indians, 141. 80 R. J. Meek, A Survey of Conditions of the Indians of Northern B.C. and the Yukon Territory (University of British Columbia, 1955), 9. 81 Vanast, “Arctic Bodies,” 157. 82 A letter written by the Bishop of Whitehorse J. L. Coudert was published in the Edmonton Journal after a member of the US army medical staff at Watson Lake heard about its internal circulation among the local missionaries. The letter states that during a meeting with C.W. Jackson of the DIA to secure funding for a Yukon-based sanatorium, Coudert had been forced “to wait and bear with more humiliating remarks on the part of many strangers witnessing the plight” of First Nations along the Highway. J. L Coudert to P. E. Moore, 21 June 1945, Yukon, Records Office fonds, Series 1 Commissioner, Gov 2206, file 7, Yukon Archives [hereafter YA], Whitehorse, YT. 30 they may have been, had fallen completely by the wayside. In 1944, Physician A.C. Duncan wrote in a report sent to Dawson City Indian Agent J. Gibbon: “I have visited villages with children dying in convulsions from meningeal tuberculosis. In the same cabin would be found almost invariably an adult in an advanced and active stage of the disease… I could have saved many lives by prevention that cannot be cured after they have sustained a massive infection.”83 Duncan goes on to say that no one in these communities were “immunized against smallpox and diphtheria except in the towns.” Duncan noted also noted a critical lack of health information, suggesting that the IHS undertake an urgent survey to ascertain the full extent of the disease.84 Thus, while the changes were not immediate, the highway had provided impetus for the construction of a regulatory framework that enabled a greater level of intervention into Indigenous peoples lives. IHS Expansion and Public Health Nurses It was within this context of greater surveillance and the expansion of state institutions that IHS began to turn its attention northward with renewed energy. The role of the public health nurse in this expansion was to extend the influence of the IHS’ civilizing program to the most remote and isolated populations, farthest away from urban centers. Historian Mary Jane McCallum has shown how the discourse of isolation constructed Indigenous people in the north as particularly susceptible to disease, requiring the benevolent guidance and protection of the state.85 The farther from ‘civilization’, the greater the need for education and intervention. As the DNHW described, it was the willingness of the field nurse to venture into the frontier north by 83 A.C. Duncan to J. Gibbon, 26 May 1944, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 84 A.C. Duncan to J. Gibbon, 26 May 1944, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 85 McCallum, “This Last Frontier,” 105. 31 “primitive conveyance” such as dog sleds and canoes that she acted as the “front line in the struggle” to combat tuberculosis and other threats to the health of northern peoples.86 The persistence of nomadic and semi-nomadic patterns posed a particular problem for the conduct of a traditional public health program. Northern geography, whether due to its cold, ruggedness, barrenness, or simply its size, was an inescapable problem for healthcare delivery. Generally, this was not because it would prove impossible to locate a particular community, as there was a seasonal regularity to the patterns of land use. Rather, paternalistic attitudes towards Indigenous people were common among northern administrators and IHS personnel, who viewed them as incapable of self-government and dependent on government assistance.87 IHS staff did not trust Indigenous patients to follow IHS precepts without observation, making it necessary to “pursue the program as well as its beneficiaries… since the degree of self-discipline demanded by modern medical care is unfamiliar to the nomad.”88 Given their isolated positions, nurses were expected to respond to emergencies and provide medical care when needed. However, the IHS viewed this as a secondary concern to their primary public health work of vaccination, health teaching, and the control of communicable diseases. The nurse's role was to impart messages of sanitation and encourage the adoption of habits and customs that were superior not because of culture or religion, but because of their basis in scientific rationality. To accomplish their work, nurses worked closely with the existing institutions and networks of state surveillance, such as the RCMP, the military, and mission schools. When Minnie Hackett first arrived in the Yukon in 1944, the Alaska Highway was technically complete 86 Department of National Health and Welfare [hereafter DNHW] Annual Report, Indian Health Services, 1951/52, 51. 87 Fred Fraser to R. A. Gibson, 4 July 1949, DIAND Fonds, RG85-D-1-A, volume 1872, file 550-1 part 3, LAC. 88 DNHW, Annual Report, Indian Health Services, 1949/50, 80. 32 but was still undergoing frequent revision and maintenance and was closed to civilian traffic. She would travel by plane to reach outlying communities or by boat along the rivers and lakes of the southern Yukon to try and find people “wherever they happened to be travelling to look for their food.” 89 On one occasion, she enlisted another nurse who was married to an American doctor to come with her on a small RCMP boat to “all the little places the steam boat didn’t stop,” alternating between tuberculin testing and vaccinations between communities, working past midnight for days at a time.90 Similarly, nurse Amy Wilson, who succeeded Hackett’s position in 1949, frequently found herself travelling by plane, dogsled, or with military escort. She took advantage of regular predictable gatherings to carry out her programs.91 This kind of travel was hazardous in Yukon conditions - summer or winter – and was complicated by the nurse’s need to transport not only herself but supplies and medical equipment. For example, Wilson and public health nurse Aileen Bond had responded to an outbreak of diphtheria at Halfway River in December of 1949, and proceeded to spend several weeks immunizing whoever they could find along the highway. The glass vials that contained the toxoid were sensitive to temperature and prone to breakage, and any damaged supplies could not be replaced easily. As Wilson described: “that toxoid was the bane of our existence for the next few weeks” and “we cared for that box as though it contained a premature baby.”92 In cases where the population could not be pursued, the centralization of services in settler institutions was the most reliable means of ensuring compliance. A nurse named Helen Larkin was posted to Carmacks in 1947 and she noted that the 89 Hackett, interview. 90 Hackett, interview. 91 Amy V. Wilson, When Days Are Long: Nurse in the North (Caitlin Press, 2019). 84. 92 Wilson, When Days Are Long, 57. 33 mission day school provided a convenient place to centralize her work, as both parents and children could be seen regularly.93 Nurses were thus frequently seen with and accompanied by representatives of the state, like the RCMP and Indian Agents, who had a much longer history of intervention. In a colonial context established upon a racial hierarchy, there is often little difference seen between encounters with various colonizers. It is possible that the populations that they served viewed nurses themselves as representatives of settler authority and as contiguous with other agents of state power. It is important to note that nurses’ close association with the coercive powers of the state was a result of the way the HIS, and nurses themselves, framed their accomplishments as victories of persuasion. Modern public health practitioners have often focused on changing the behaviour of their targets, which has always involved elements of bother persuasion and coercion, often resulting in resistance. The nurse's job was to gain the trust of a community by demonstrating the effectiveness of her methods. The point was to perpetuate the program of public health surveillance and teaching itself, as the nurse who visited homes and cared for minor ailments could become “known, trusted and accepted” for her advice on postnatal care, sanitation, and the need for hospital treatment to be heeded.94 It was thought that nurses, as women, would be more successful in reforming the habits of Indigenous women and girls as part of maternal-child health programs. A 1945 report on conditions at the village of Teslin noted that Hackett’s health education consisted of “giving the girls talks about hygiene, sanitation, care of babies, etc.”95 93 Helen Larkin to J. E. Gibben, Commissioner, 17 April 1950, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 94 W.J. Wood and Anna M. Swail, “Outpost Nursing Station,” Canadian Nurse Vol. 59, no. 5. (1963): 446. 95 “Extract from Report on Trip to Yukon and Northwest Territories,” W. L. Falconer, July 1945, Department of Indian Affairs and Northern Development Fonds, RG85-D-1-A, volume 1872, file 550-1 part 3, LAC. 34 Wilson herself, who otherwise readily acknowledged the effectiveness of traditional medicines and practices, also seemed to have held a certain level of ambivalence about Indigenous women’s health knowledge. For example, Wilson noted that very few Indigenous women died during childbirth despite Wilson’s own perception that the level of sanitation and hygiene in their the birth environment was subpar.96 However, Wilson also suggested that the high infant mortality rate seen among Indigenous Yukon communities was due to Indigenous mother’s tendency to cut umbilical cords over long and improperly tie the cords after birth, with the subsequent bleeding leading to the newborns death.97 As Patricia Jasen has pointed out, infant mortality had become representative of population health as a whole, and high rates among Indigenous populations were attributed to the continuing influence of traditional practices during childbirth.98 In equating assimilation with sanitation and medical cooperation, public health nurses often reproduced and endorsed the colonialist logic of the IHS, a dynamic that was in sharp contrast to any efforts to establish trust. The pervasiveness of paternalistic attitudes meant that public health nurses often perceived Indigenous people as being unable to manage their own health concerns. This was especially evident in the case of tuberculosis control. TB was referred to as ‘the white plague’ because it was perceived as a thoroughly European disease, unlike other diseases which were thought to have foreign origins. In the colonial health discourse, TB was considered a disease of “civilization” to which “primitive” peoples were susceptible to and unable to resist.99 The discovery of Mycobacterium tuberculosis, the bacterial pathogen which causes TB, established 96 Wilson, When Days are Long, 70. 97 Wilson, When Days are Long, 71. 98 Patricia Jasen, “Race, Culture, and the Colonization of Childbirth in Northern Canada,” Social History of Medicine 10, no. 3 (1997): 395. https://doi.org/10.1093/shm/10.3.383. 99 Randall M. Packard, White Plague, Black Labor: Tuberculosis and the Political Economy of Health and Disease in South Africa (University of California Press, 1989), 241. 35 that TB was as a communicable disease that could be transmitted through contact with infected persons. As Alison Bashford notes, this contributed to constructing the image of the dangerous consumptive who, if undisciplined in self-hygienic practices, posed a danger to the public at large.100 Prior to the development of effective chemotherapy, the primary means of treatment for TB consisted of “rest, good nutrition, and fresh air” within the institution of the sanatorium.101 Sanatoria beds that could serve the dual purpose of both treating tuberculous patients and isolating them from society were in great demand. Funding from the federal government and anti-tuberculosis leagues led to the expansion of sanatoriums during the interwar period.102 The paradox of the sanatorium was that it was an institution premised upon strict discipline and routine. Public health officials understood that the “responsible” (white, middle-class) consumptive patient would freely isolate himself within.103 On the other hand, the Indigenous patient with TB was perceived as a danger to settler society. White folks believed that Indigenous peoples' reasons for avoiding prolonged treatment were fundamentally irrational. White communities construed stereotypes of Indigenous people as ignorant of basic hygiene, “racially careless.”104 “tuberculosis-soaked,”105 and “reservoirs of disease.”106 Thus, Indigenous people’s mere proximity to white was construed as a threat to a “vulnerable” white population. Historian Maureen Lux has argued that Indian Hospitals, as total institutions aimed at the 100 Alison Bashford, Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public Health (Palgrave Macmillan, 2004), 66. 101 Katherine McCuaig, The Weariness, the Fever, and the Fret: The Campaign against Tuberculosis in Canada, 1900-1950 (McGill-Queen’s University Press, 1999), 4. 102 McCuaig, The Weariness, 94. 103 Bashford, Imperial Hygiene, 69. 104 Maureen K. Lux, “Care for the ‘Racially Careless’: Indian Hospitals in the Canadian West, 1920–1950s,” Canadian Historical Review 91, no. 3 (2010): 409, https://doi.org/10.3138/chr.91.3.407. 105 David A. Stewart, “The Red Man and the White Plague,” Canadian Medical Association Journal 35, no. 6 (1936): 674. 106 Megan Vaughan, Curing Their Ills: Colonial Power and African Illness (Polity Press, 1991), 39. 36 isolation and reform of “dangerous” Indigenous bodies, emerged in tandem with conceptions of Canadian citizenship as white, healthy, and self-disciplined.107 As the IHS began to put “more and more emphasis on health services to remote areas” to demonstrate its efficacy in the improvement of health status, northern tuberculous patients were increasingly viewed as threats who had to be removed from their own communities.108 We can see the role of the public health nurses in persuading Indigenous patients during X-ray surveys. Advances in portable x-ray technology had enabled the IHS to use mobile screening units to identify patients with TB who were recommended for hospital treatment. The opening of the Charles Camsell Indian Hospital, as well as the addition of eighteen segregated beds in the Whitehorse hospital basement, had increased capacity. However, public health officials had not yet devised a strategy to fill them. The X-Ray survey became an important method in extending the screening of patients in more remote or mobile populations. However, Indigenous people avoided screenings because they understood that a positive reading could result in their removal from home and family for many years, if they returned at all. Many of those sent out for treatment died in hospital.109 In order to screen as many people as possible, the public health nurse would, along with the RCMP, send advance notice of the coming X-ray survey, and then carry out follow-up notifications. Elva Taylor, who was Director of Nursing at Camsell Hospital for 23 years, emphasized the importance of persuading voluntary treatment: “Now as much as possible this was a voluntary thing. The nurse or the Indian agent would try to persuade them to come in for their treatment. Having any kind of an order to have anyone brought to hospital was a last resort, because that isn’t the way to get cooperation.” 110 107 Lux, “Care for the ‘Racially Careless,’” 411. 108 “Minutes of Special Meeting of Northwest Territories Council held in Senate Committee Room 368” 24 March 1949, DIAND Fonds, RG85-D-1-A, volume 1872, file 550-1 part 3, LAC. 109 Lux, Separate Beds, 121. 110 Nancy Gibson, “Northern Medicine in Transition,” in Health Care Issues in the Canadian North, ed. David E. Young (Boreal Institute for Northern Studies, 1988), 113. 37 Wilson, as a frontline public health nurse, also greatly believed in gaining people’s trust: “It meant so much to get the people to want to go out for treatment of tuberculosis. As they came back cured, others would go out more readily.”111 She viewed people’s concerns of dying during treatment as something that only affected far-advanced cases, but that it was “a setback for our work.”112 She leveraged both family connections and resources to make her case. In one instance, Wilson convinced a young mother to send her child to the hospital by noting that the baby’s grandmother was on the notification list as well. As such, Wilson suggested that the baby and its grandmother could go to the hospital together, which would enable the mother to stay and care for the grandmother’s other children. Wilson concluded with a bribe: “the Indian agent would give good rations to anyone who would help look after them.”113 Historian Myra Rutherdale argues that the relationship between medical providers and Indigenous communities should not be seen as one of uncomplicated domination and colonization, as the isolated conditions necessitated a level of negotiation and compromise with communities and leaders to accomplish their goals.114 While Wilson does not report any forcible confinement, she was aware of and used her association with agents of state control. Nurses like Minnie Hackett and Amy Wilson played a crucial role in the expansion of the IHS in the Yukon, but their work was deeply entwined with the colonialist policies of the Canadian government. This is not to dismiss their efforts and personal sacrifices, as they provided much-needed medical care and had a desire to protect and promote the health of 111 Wilson, When Days are Long, 125. 112 Wilson, When Days are Long, 110. 113 Wilson, When Days are Long, 124. 114 Rutherdale, “Alaska Highway Nurses and DEW Line Doctors,” 250. 38 Indigenous peoples. However, they also acted as agents of surveillance and assimilation, enforcing state policies that often undermined Indigenous autonomy and traditional ways of life. Their efforts, particularly in TB control, were framed as benevolent, yet they reinforced paternalistic assumptions about Indigenous people’s ability to care for themselves. The Alaska Highway and its aftermath provided the impetus for and accelerated these interventions, reshaping Yukon society and Indigenous communities in ways that extended far beyond immediate health concerns. The work of public health nurses was not just about nursing, it was a critical part of the larger process of colonization, reflecting the complex nature of public health practice within an unequal colonial context. 39 Chapter 3 Southern Expectations, Northern Realities In July of 1952, Joyce I. Driver was hired as the first public health nurse for a new service created by the Yukon Territorial government. Driver was an experienced nurse from Kamloops, British Columbia, and the Yukon territorial government hired her as part of a several years long effort to establish a public health program in the isolated and sparsely populated region. As I noted in Chapter 2, Driver was not the first public health nurse to work in the Yukon. The IHS has employed nurses in the area since 1944. The construction of the Alaska Highway had led to the expansion of IHS services into the Yukon. The apparent necessity of a territorial public health nursing service arose because of the dramatic demographic brought on by the post-war boom. While the population would drop from its wartime peak of approximately 30,000, the total population of 8,588 in the territory in 1950 was 8,588. Of that population, 4,000 individuals were located in Whitehorse.115 The government sought out public health nurses as part of the growing demand for health and social services on the part of the steadily increasing non-Indigenous population. Nurses like Driver came north for a variety of reasons, both personal and professional, including higher pay, greater autonomy, and the prospect of adventure. However, what these nurses often found was that the reality of northern nursing practice was demanding and isolating, placing immense pressure on nurses to work beyond their training, often with little support. Limited funding meant that staff turnover and burnout was an ever- 115 P.E. Moore to Justice C. H. Locke, 25 April 1950.Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 40 present problem, which took its toll on those who remained. I argue that nurses had an ambiguous relationship with northern practice. While the financial and professional opportunities for nurses often exceeded what was available in the south, practice in the north also came with a personal cost and an often-unsustainable level of pressure. Nurses formed the backbone of northern healthcare in the post-war period, though often at a significant personal cast, because of their willingness to take on challenging work and because it was cost effective to hire nurses over physicians. Considerations of Nursing in the North Despite comprising a relatively small proportion of nurses, northern nurses have managed to cultivate a high level of professional clout within the contemporary culture of Canadian nursing. Northern nursing is broadly associated with independent, autonomous, and highly skilled practice. And nurses who work in remote areas are perceived to have gained a level of competence that puts them above many other nurses.116 This is in contrast to medicine where, as John D. O’Neill notes, one’s professional prestige has always been dependent on one’s place within the hierarchy of university-based hospital’s proximity to the development of scientific advances; for physicians, rural and remote practice was the domain of immigrants, outliers, and other outsiders.117 On the other hand, due to nursing’s subordinated role within the modern hospital, remote practice conferred a certain amount of respect and achievement precisely because of its independent nature. For Canadian nursing in particular, the centrality of 116 Brenda Canitz, “Nursing in the North: Challenge and Isolation,” in Gossip: A Spoken History of Women in the North, ed. Mary Crnkovich (Canadian Arctic Resources Committee, 1990), 208. 117 John D. O’Neil, “Self-Determination, Medical Ideology and Health Services in Inuit Communities” in Northern Communities: The Prospects for Empowerment, ed. Gurston Dacks and Ken Coates (Boreal Institute for Northern Studies, 1988), 43. 41 northernness and northern experience to national identity served to elevate northern practice into an ideal of nursing. Helen Gilbert has argued that the transgression of the boundary between nurse and physician, occasioned by the liminal event of the medical emergency, represented the ultimate expression of nurse independence.118 The hard-scrabble northern nurse, the substitute doctor for the places doctors wouldn’t go, became an important symbol for nurses who were seeking greater recognition and autonomy for the profession, culminating in the role of the nurse practitioner.119 The appeal of the north could often attract nurses, but considering the significant demand that was placed on individual nurses, it was difficult to ensure that they would stay. Nurses were able to have a prominent role in northern healthcare because they were viewed as a financially feasible option for healthcare delivery in sparsely populated regions. Physicians were difficult to recruit to remote or under-resourced areas as there was little ability for them to make a significant income, but nurses from organizations such as the Victorian Order of Nurses (VON) and the Red Cross could be secured for comparatively little.120 Nursing education was geared towards preparing nurses for private general duty rather than specialized hospital work, and many nurses were sufficiently prepared to handle a good majority of health concerns that presented in rural areas.121 Most nurses in the Yukon and Northwest Territories before 1945 had come as missionaries. The first nursing station was established by the Grey Nuns at Fort Providence in 1867.122 The DIA especially valued mission nurses as its main priority was to keep expenditures 118 Gilbert, “Great Adventures in Nursing,” 4. 119 Anne Wieler, “Physician’s Substitute — the Role of the Nurse in the North,” Canadian Journal of Public Health / Revue Canadienne de Santé Publique 62, no. 4 (1971): 333. 120 Bates et al., “Outpost Nursing in Canada,” in Bates et al., On all Frontiers, 144. 121 Daigle, “The Call of the North.” 115. 122 Brett, “A Synopsis of Northern Medical History,” 523. 42 related to healthcare for Indigenous populations to a minimum. Although mission health services required initial grants for the construction of nursing stations and hospitals, missionary nurses provided in effect free or very low-cost labour.123 The Grey Nuns did not receive salaries. Neither did the wives of Anglican priests who took on nursing duties. While hired Anglican nurses were paid a small stipend as employees, this was often not paid to the nurses directly but deposited in an account that they would receive at the end of their postings.124 Much like their secular counterparts, these nurses were expected to make do with what they had, and the level of support they received could vary significantly. In a 1949 report written by IHS physician H.A. Procter regarding health facilities at Hay River, NWT, he described the conditions of the area where the district nurse (Neville) practiced, in this way: “Miss Neville is about through physically. She must be about 60 and has put in many hard years. For most of these she can have had practically no active support from her church. I am informed that at times she has had to beg or borrow from the Company sufficient food for her station. Anything she receives in the form of cash goes to the church.”125 Dr. Proctor, the report’s author, notes that aside from being evacuated for an illness 11 years prior to his visit, Neville had not left Hay River since she arrived “on the same boat as the material for the nursing station 18 years ago.”126 It was generally considered by CMS leaders that because of the strain of northern work that nurses, especially unmarried nurses, should not be posted for longer than 5 years.127 Northern practice was considered inherently demanding and required nurses to possess significant motivation and willingness to endure hardship. 123 Vanast, “Arctic Bodies,” 286. 124 Kelcey, Alone in Silence, 110. 125 H. A. Procter to P. E. Moore, 6 February 1949, DIAND Fonds, RG85-D-1-A, volume 1872, file 550-1 part 3, LAC. 126 H. A. Procter to P. E. Moore, 6 February 1949, DIAND Fonds, RG85-D-1-A, volume 1872, file 550-1 part 3, LAC. 127 Kelcey, Alone in Silence, 109. 43 The fiscal advantage of employing nurses over physicians was important for the Yukon, as its territorial status meant that it faced significant financial constraints in funding its own services. The Yukon remained highly dependent on grants and funding from the federal government. The position for a public health nurse at Dawson City was made possible through joint funding with the department of National Health and Welfare (DNHW) on the conditions that the nurse would serve the whole population.128 Yukon Commissioner A.H. Gibson noted the nurse for this position should be “capable of formulating a plan to improve the present low standard of cleanliness and sanitation” that he perceived to exist among the local Indigenous community.129 Appealing to the federal government’s responsibility towards Indigenous health was not an uncommon strategy to secure funding for health and hospital services in more remote areas. What little money the IHS had was used to fund the construction of a common hospital. However, most hospitals would segregate Indigenous patients into crowded and inadequately maintained segregated wards, essentially diverting these reserved funds to the white population.130 Although Gibson justified this reallocation of funds, the newly appointed Chief Sanitary Inspector noted that Indigenous people “along the river seemed to take much better care of their home and surroundings than many along the highway and in the town of Whitehorse.”131 Similarly, Procter’s 1949 report also mentioned that homes at the Moosehide reservation were kept “in good order.”132 On his own visit to Dawson, E. L. Stone, a physician employed by the 128 A. H. Gibson to I. Broadfoot, 26 October 1950, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 129 A. H. Gibson to I. Broadfoot, 26 October 1950, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 130 Kelm, Colonizing Bodies, 140. 131 H, J. Locke to J.E. Gibben, 26 September 1949, Records of the Yukon Government, YRG 1, Series 2, Central Registry Files, GOV 1886, file 369496, YA. 132 “Medical Arrangements - Dawson, Y.T.,” H. A. Procter, 14 March 1949, DIAND Fonds, RG85-D-1-A, volume 1872, file 550-1 part 3, LAC. 44 HIS, also remarked that “a nurse could afford very useful service” not only to the Indigenous families in the district, but to the “average white residents.”133 This is not to say that there were no health or sanitation issues in Indigenous Yukon communities, but it is likely that the difference between the Indigenous population and the white population was likely not as great as Gibson had implied. By pointing to the apparent ill-health of the Indigenous population, the territorial government makes up for its small local tax base to access such funding to meet the needs of the white population. Nurses for the Yukon The issues of northern nursing were made readily apparent to the Yukon territorial government as it attempted to establish its own public health nursing service. The first target of recruitment was Aileen Bond, the BC Public Health Nurse who had worked closely with Amy Wilson. Most notably, Bond and Wilson had received medals of commendation from the BC government after their mass immunization efforts in southern Yukon following the diphtheria outbreak at Halfway River, covering a distance of 1,000 miles in under ten days in 1949.134 As an experienced public health nurse intimately familiar with northern conditions, Bond made an ideal candidate for the Yukon and was well-equipped to undertake the significant responsibilities of public health work for the growing territory. After Bond declined the position, the Yukon Commissioner also reached out to the Red Cross, but he was unable to attract a viable candidate. Great emphasis was placed on the nurse’s need for self-reliance and ability to work independently, as the nurse would be “responsible for all public health matters within the 133 J.E. Gibben to R.A Gibson, 8 May 1950, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 134 Myra Rutherdale, “Nursing in the North and Writing for the South: The Work and Travels of Amy Wilson,” in Caregiving on the Periphery: Historical Perspectives on Nursing and Midwifery in Canada, ed. Myra Rutherdale (McGill-Queen’s University Press, 2010), 170. 45 Dawson District” and should be “competent to formulate policies and implement them.”135 Despite the extensive search, Yukon commissioner A.H. Gibson wrote to Indian Agent R. J. Meek that “Exhaustive inquiry has unearthed nobody willing and capable to take this position,” suggesting both that the staff shortages following World War Two had not yet been resolved, and that the salary offered at this point was not significantly better than those offered in less trying environments.136 In April of 1952, the new commissioner Fred Fraser stated in a letter to the chief superintendent of the VON that “there is not, at present any organized Health and Welfare Department in the Government of the Yukon” and that securing a public health nurse now based out of the soon-to-be capital city of Whitehorse would be “a first step.”137 They were finally successful in this effort when Joyce Driver applied for the position in June and began working in Whitehorse that September. Like Aileen Bond, Driver was a former public health nurse in British Columbia and had likely undertaken postgraduate training in public health. As Susan Riddell notes, BC public health nurses were generally regarded as highly skilled and formally educated.138 Since public health nursing in the Yukon had previously been provided by organizations like IHS or missionary societies, the Yukon’s public health nurse would in effect be initiating such a service and thus necessitated a nurse with “sufficient experience in Public Health Nursing, and with experience in administration work.”139 Driver was expected to spend 135 A. H. Gibson to I. Broadfoot, 16 November 1950, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 136 A. H. Gibson to R. J. Meek, 24 October 1950, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 137 F. Fraser to C. Livingston, 18 April 1952, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 138 Riddel, “Curing Society’s Ills,” 39. 139 F. Fraser to the Secretary, the Board of Trade, 16 July 1952, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 46 the month of September in Edmonton studying the Alberta public health service to copy their methods and documentation, as well as to pick up the vehicle and required supplies. She was offered a starting salary of $3,600 per year and the provision of accommodations, as well as being given an advance of $300, an Imperial Oil Credit Card, and a travel expense account.140 While this was likely an attractive offer given that the starting salary was about 20% above advertised public health nurse postings, she was warned that the work “will be no sinecure,” and that there would be a “good deal of hard work until you get things organized.”141 Although she accepted the position, Driver must have quickly realized, like other northern nurses, that the work in the area that she had taken on was nearly impossible for a single person. Furthermore, she was constantly reminded by her new employer that the financial limitations of the territory’s government meant that she would be expected to make do with what she had, even if it was inadequate. In her first few weeks, Driver contacted the commissioner at least five times in regards to maintaining adequate supplies, particularly for “medical supplies that are absolutely necessary here at this time” stating that “there [were] none at [her] disposal.”142 The temporary accommodation provided for her in 1952 was located in a former school and was unheated with no place for a fire, putting the perishable medications that were stored in that same building at risk for damage in the cold Yukon winter.143 Historian Lesley McBain has examined how nurses in northern Saskatchewan nursing stations faced similar 140 F. Fraser to J. Driver, 4 July 1952, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA; F. Fraser to J. Driver. 2 September 1952, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 141 “Positions Vacant” The Canadian Nurse 48, no. 7 (1952): 602-603; F. Fraser to J. Driver, 4 July 1952, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 142 J. Driver to F. Fraser, 30 September 1952, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 143 J. Driver to F. Fraser, 29 September 1952 Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 47 scrutiny and pressure to limit their expenses, being told to communicate only by telegram as phone calls were too costly.144 Whereas nurses in Saskatchewan resorted to telegrams as a cost-cutting measure, Driver was informed that even telegrams were too great a cost to communicate with the commissioner located 500 kilometers away in Dawson City.145 All communication, except for emergencies, was to occur via correspondence. When Driver insisted that at least a second nurse be hired, she was told by Fraser that: “Exclusive of natives, the total population of the Yukon is less than ten thousand, which is the population of a small city. I cannot, therefore, justify the employment of more than one Public Health Nurse. If in your opinion, there is more work than can be done by one nurse, it will be necessary to limit your services to the most essential items only, particularly during the coming year.”146 Driver had ostensibly been sought out specifically for her experience and education, but there was little interest or ability on the part of the government bureaucracy to respond to her input or provide the necessary resources for her to carry out her work. It was not just Driver’s requests that were dismissed. The community of Haines Junction had also petitioned the territorial government for the placement of a public health nurse due to the increasing number of motor vehicle deaths from the highway, arguing that in one instance “the life of a child could have been saved had there been a nurse available in this district.”147 The people of Haines Junction were told that if a nurse was placed there, the government would be obligated to provide a similar 144 Lesley McBain, “Pulling up Their Sleeves and Getting on with It: Providing Health Care in a Northern Remote Region,” Canadian Bulletin of Medical History 29, no. 2 (2012): 317, https://doi.org/10.3138/cbmh.29.2.309 145 F. Fraser to J. Driver, 14 October 1952, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 146 F. Fraser to J. Driver, 14 October 1952, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 147 W. L. Thurber to W. G. Brown, 24 January 1955, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 48 service to all communities with similar situations, and the territorial government was therefore “not yet in a position to undertake financing such an admirable public service.”148 Although they had little in the way of material support, nurses were frequently praised for their ability to endure trying situations. Epidemic conditions in particular placed considerable strain on nurses, who essentially composed the entire public health infrastructure in the northern territory. In 1951, a district nurse identified as H. Seaholm responded to an influenza epidemic in Mayo. The epidemic initially began at the Keno Hill Silver mine with over one hundred cases reported, spreading quickly to the Indigenous community in Mayo as well. Constable R. Johnson of the RCMP described Seaholm’s actions in his patrol report: “During the epidemic in Mayo District Nurse SEAHOLM was called upon twenty-four hours per day and spent an average of over twelve hours per day visiting patients… though Nurse SEAHOLM contacted the Flu herself as a result of her work, she refused to confine herself to bed and continued giving the necessary relief to those already suffering”149. In this case, it was necessary for Johnson to detail Seaholm’s actions to justify her payment, as epidemics were the only time that district nurses received a supplement to their limited pay.150 The salaried government nurses received similar treatment, but with no additional compensation. An outbreak of poliomyelitis in 1953 led to the imposition of limited quarantine, banning all indoor public gatherings as well as closing the schools and pool.151 At the time, Driver was one of two public health nurses headquartered in Whitehorse, along with Aline Moen of the IHS who worked with her sister Nora, a nursing aid. These women provided care to those confined to home in line with public health ordinance, and they moved quickly to administer gamma 148 W. G. Brown to W. L. Thurber, 5 March, 1955, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 149“Special Patrol- Influenza Epidemic- Mayo, Y.T.” 24 February 1951, DIAND fonds, RG85-D-1-A, volume 1102, file 550-2, part 2, LAC. 150 J. L Coudert to T. A. Crerar, 10 October 1944, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 151 “REGULATIONS UNDER THE YUKON HEALTH ORDINANCE.” 5 June 1953, DIAND fonds, RG85-D-1-A, volume 1102, file 550-2, part 2, LAC. 49 globulin injections to outlying communities, as well as to transport more severe cases to hospital. “These three girls have been on the go the whole time” wrote Dr. E.H. Lossing, “and have responded very well to a difficult situation.”152 Words of thanks were likely worth little considering the demands of the position, and high turnover among the limited number of qualified applicants would remain a perpetual problem. The territorial government faced constant budgetary shortfalls in funding health services, which were somewhat relieved in 1956 when the territorial council agreed to transfer primary responsibility for most health services provided to northern residents to the federal government through the Indian and Northern Health Services.153 The Yukon Health Plan provided for the employment of five additional public health nurses, as well as a territorial medical officer with training in public health. The territorial government also agreed to a cost-sharing arrangement, with costs split proportional to the population of status Indians in the territory, resulting in a territorial-federal ratio of approximately 70:30.154 Furthermore, the Diefenbaker administration’s Road to Resources campaign resulted in millions of dollars being put into major infrastructure investments throughout the Yukon, improving existing road conditions and opening up transport communities, although this was primarily undertaken to enable further mining activity.155 There was little relief for nurses though, for along with these improvements in communication and transportation came an expansion of their responsibilities to address new concerns. Infant mortality and infectious diseases were still disproportionately large concerns 152 E.H. Lossing to A.F.W. Peart, 23 June 1953, DIAND fonds, RG85-D-1-A, volume 1102, file 550-2, part 2, LAC. 153 “Health Services Plan, Yukon Territories, 1962-1967,” 1962, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 6, YA. 154 “Health Services Plan, Yukon Territories, 1962-1967,” 1962, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 6, YA. 155 Coates and Morrison, Land of the Midnight Sun, 282. 50 across the north, but both had been showing a downward trend. Instead, there was an increase of ‘social’ diseases that were attributed to widespread alcohol abuse, poverty, and inadequate and unsanitary housing.156 For example, in 1962 deaths from accidents comprised 25% of all deaths in the Yukon compared to the Canadian average of 7.8%, with the territory also having the highest rate of venereal disease in the country.157 Accounting for the comparatively high rate of infant mortality rate of 30%, traumatic deaths from accidents were in fact responsible for 55% of all causes of mortality over the age of 12 months in that same year.158 Across the north, nurses also began to attend a greater number of births, sometimes acting as sole birth attendants, but on occasion working with lay midwives and community members.159 Public health efforts and education were still purported to be the primary activities of nurses, but in reality the need and demand for acute treatment that nurses had always provided often precluded the ability to devote significant time to preventative care and teaching.160 Marny Ryder was one such nurse who came to the Yukon in 1959. Although nurses went north for many reasons, Ryder’s self-professed primary motivation was to make as much money as possible since Northern Health Services “gave the best money you could find in Canada.”161 She initially worked as a public health nurse in Maskwacis, Alberta,162 before transferring to the Whitehorse hospital, though she would occasionally accompany other public health nurses as 156 “Health Services Plan, Yukon Territories, 1962-1967,” 1962, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 6, YA. 157 “Health Services Plan, Yukon Territories, 1962-1967,” 1962, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 6, YA. 158 DNHW, Annual Report, Indian Health Services, 1962/63, 81. 159 J. D. O’Neil, “The Politics of Health in the Fourth World: A Northern Canadian Example,” Human Organization 45, no. 2 (1986): 123, https://doi.org/10.17730/humo.45.2.q34m761r857km8lh. 160 Judith Zelmanovits, “Baby Rats and Canada’s Food Rules: Nurses as Educators in Northern Communities” in Rutherdale, Caregiving on the Periphery, 315. 161 Marny Rider, interview by Michael Gates, 25 November 2019, Whitehorse, YT, audio recording, Michael Gates Personal Collection, YA [hereafter: Ryder, interview]. 162 Formerly Hobbema. 51 they attended to outlying communities. According to Ryder, Dr. Otto Schaefer asked her to head to Watson Lake as the sole nurse present there was overworked, and the local doctor was a “bit of a drunkard.”163 Ryder’s impression was that the nurse had been depressed for quite some time but had been continuing to work anyway to the detriment of her own mental health. As this nurse had midwifery training, she frequently attended births for the local First Nations population. Ryder accompanied her for a number of these, including the delivery of one baby in a tent during the winter by candlelight. “I was scared to death,” Ryder said, “but we got it out, and I was very grateful I hadn’t been sent alone.”164 At the time, Watson Lake possessed only an emergency treatment center that was unintended for inpatient treatment.165 Given its location along the highway, accidents were not an infrequent occurrence. In one instance, Ryder had to extract a man from the cab of a semi-truck collision by herself because she “was the only small one that could do it” only to discover that the man had already passed.166 Though her posting was only supposed to last a month, Ryder returned to Watson Lake almost immediately when the nurse already stationed there called Dr. Schaefer stating that she would quit if she had no further relief. Ryder filled in, and stayed in Watson Lake for several more months, even attending to births by herself with telephone support. But the work took its toll on her as well. She told her supervisor: “I need more help, and I need more training.”167 She also threatened to leave if there was no relief available. When her 163 Ryder, interview. 164 Ryder, interview. 165 “Watson Lake Emergency Treatment Centre Meeting,” 17 August 1962, Records of the Yukon Government, YRG 1, Series 12 Territorial Treasurer Records, GOV 1418, file 12, YA. 166 Ryder, interview. 167 Ryder, interview. 52 supervisor tried to convince Ryder to stay, as there was no other help available due to a staff shortage lasting for over a year, she responded: “You've done that before and I’m not doing it again… You’ve got to get a nurse down here just the way you did me. Get a nurse down here and that’s it.”168 Just as Driver had discovered, Ryder likewise realized that the fiscal advantages of northern nursing did not always make up for the increased demands and absence of supports. Following the further consolidation of health services under the Medical Services Branch of the Department of National Health and Welfare in 1962, the concept of the nursing station – which had proven useful in the Northwest Territories - was taken up in the Yukon as well. The key quality of a nursing station was that it could accommodate several beds for short-term inpatient stays, rather than first aid alone. In addition, the nursing station also served as the nurse’s residence, as compared to health centers which the nurses would visit on regular schedules. The first nursing station was established in the most northerly Yukon community of Old Crow, with subsequent stations first being built at Watson Lake and Dawson in the 1960s.169 Additional stations were built at Faro and Ross River in the 1970s, and by the end of that decade most communities had at least a nursing or health station present.170 The nursing station was envisioned as “more than a mere refuge for the sick who cannot be treated in their home,” but rather as a comprehensive “base of operations” for nurses who comprised the “key worker[s] in the Public Health Campaign.”171 Most stations except for the most remote would ideally have a 168 Ryder, Interview. 169 “Health Services Plan, Yukon Territories, 1962-1967,” 1962, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 6, YA. 170 DNHW Medical Services Branch, Annual Report-Yukon Region, 1979, 36. 171 “Health Services Plan, Yukon Territories, 1962-1967,” 1962, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 6, YA. 53 complement of two nurses, but once again limited staff meant that many operated as solo positions.172 Nurses were supposed to work regular hours engaged in both public health and clinic work during the day, being available outside these times for emergencies only. However, given the prevalence of accidents, substance use, and community members differing definitions of what was considered ‘emergency’ compared to the nurses, it was a rare occasion that they would not be called on during any given night. Nurse Joan Penney-Flynn noted that during her time at Old Crow that “out of five months, there have been exactly two days where I haven’t done any work at all.”173 There was a growing recognition on the part of MSB administrators that the burnout of nurses and frequent turnover caused by an unmanageable workload was a key hindrance to an effective public health program. The MSB took several steps to mitigate them, though these were limited, such as offering educational leave for advanced training and increasing the number of two-nurse stations.174 The pay scale for public health nurses also increased during this period with a high-end salary of $4,560 in 1962, but qualified nurses could make nearly twice that amount working in Alaska and were occasionally lured away.175 The issues that nurses faced in regard to the high workload and the indifference of bureaucratic superiors cannot be separated from consideration of gender. Historians of the north have noted that the isolated conditions faced by women nurses and missionaries were difficult, but also provided opportunities for alternate modes of femininity and independence not afforded 172 Zelmanovits, “Baby Rats and Canada’s Food Rules,” 320. 173 Joan Penney-Flynn and Pamela Taylor, Edge of the Wilderness: The Old Crow Village (Janus Publishing, 2001), 83. 174 “Health Services Plan Yukon Territory, 1967-1972,” 1966, Yukon Records Office Fonds, Series 10 Administration, GOV 2322, file 4, YA. 175“Health Services Plan, Yukon Territories, 1962-1967,” 1962, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 6, YA; Zone Superintendent Yukon Zone to W. Roscoe, 8 January 1962, Yukon Records Office fonds, Series 1 Commissioner, GOV 2206, file 7, YA. 54 to southern women.176 Given that the vast majority of nurses were women, and were located in professionally subordinate positions to mostly male physicians, government health services tended to recreate a patriarchal hierarchy within their organizations.177 For example, it was recommended that a local woman could be employed as a housemaid at a nursing station, but if this was not possible the expectation was that nurses would undertake domestic duties, such as preparing meals for patients or visiting physicians. It was also assumed that married women’s domestic labour would be freely available. A housemaid was only required at a clinic “if the doctor is single.”178 As Jayne Elliott has shown, the blurring of the boundary between the nurse’s personal and professional space brought about by their dual role within the nursing station made nurses, already natural outsiders, hyper visible within these communities and subject to increased scrutiny.179 On the other hand, even in the face of the often strenuous workload and professional isolation, a number of nurses enjoyed and thrived in the northern environment. As the sole nurse at Old Crow for a period of two years, Penny-Flynn – who treated children attacked by dogs and sutured drunken combative patients by herself - remarked that she understood “why it’s so difficult to get nurses to these isolated outposts and difficult to get them to stay.”180 Old Crow also offered respite for Latvian-born nurse Herta Richter, who worked as a Yellowknife public health nurse in the 1970s. After some disagreements with her immediate supervisors, Richter 176 Myra Rutherdale, Women and the White Man’s God: Gender and Race in the Canadian Mission Field (UBC Press, 2002), 64. 177 Kathryn McPherson, “Nursing and Colonization,” 229. 178 “Health Services Plan, Yukon Territories, 1962-1967” 1962, Yukon, Records Office fonds, Series 1 Commissioner, GOV 2206, file 6, YA. 179 Jayne Elliott, “Blurring the Boundaries of Space: Shaping Nursing Lives at the Red Cross Outposts in Ontario, 1922–1945,” Canadian Bulletin of Medical History 21, no. 2 (2004): 317, https://doi.org/10.3138/cbmh.21.2.303. 180 Penney-Flynn & Taylor, Edge of the Wilderness, 93. 55 asked to be transferred to Old Crow where she stayed for a period of five years, providing regular coverage and continuity for the distant community.181 After her rocky start, Ryder returned to the Yukon in 1963 and spent her life since then in the territory, becoming the chair of the Yukon Hospital Corporation from 2006-2010.182 Nurses’ recollections of experiences in isolated outposts are often framed much more positively than the contemporary correspondence they produced suggests, but the autonomy and sense of adventure that nurses experienced, as well as increasing opportunities for expanding scopes of practice, appeared to be worth the hardship.183 Even as technological advances in air travel and the expanded highway system eased some of the logistical issues that had seemed to be inherent to delivering northern healthcare services, Yukon nurses continued to play an indispensable role in extending essential health services to rural and remote communities.184 181 “Interim Employee Performance Review and Evaluation Report,” 4 February 1974. Herta Richter Fonds, MSS 394, file 82, YA. 182 Peter Jickling, “A Lifetime of Caring,” Yukon Events Magazine (blog), November 21, 2012, https://www.whatsupyukon.com/yukon/yukoners/a-lifetime-of-caring/. 183 McBain, “Pulling Up Their Sleeves,” 312.; Judith Zelmanovitz, “‘Midwife Preferred,’” 162. 184 Brigitta Arnoti, “Yukon Medicine: The Vital Role of Public Health Nurses,” Canadian Medical Association Journal, 130, no. 4 (1984): 496, https://pmc.ncbi.nlm.nih.gov/articles/PMC1876082/ 56 Conclusion The varied stories and experiences of the public health nurses who worked in the Yukon during the post-war years of 1945-1967 are representative of the social and cultural shifts of the time. Nurses like Amy Wilson and Minnie Hackett have been celebrated for their adventurous spirits and commitment to the nursing profession. Though the dedication of nurses - like Wilson and Hackett - in harsh circumstances is indeed impressive, at the same time, their supposedly good intentions were integral to a federal health policy that furthered the colonial dispossession of Indigenous peoples. Yukon nurses’ willingness to work beyond their scope and training meant that they were subject to, and able to be exploited by, indifferent government officials who were unwilling and unable to provide key support. Even though nurses were often required to make significant sacrifices, it is partly because they endured such conditions that public health nursing developed such a strong and persistent role in the identity of contemporary Canadian nursing. Public health nurses like Joyce Driver and Marny Ryder contended equally with epidemic diseases and apathetic bureaucrats to care for the health and well-being of Yukon communities. Personal qualities of resilience and adaptability emerge from the evidence examined here, but so too does a fragile and unsustainable public health system that depended on the self-sacrifice and nigh exploitation of its supposedly key personnel. Records of nurses enduring difficult circumstances are not difficult to find in northern Canadian nursing history. The commitment of individual nurses to their patients and professional responsibilities often compensated for the lack of organizational or material support.185 Previous accounts of public health nursing history had bordered on the hagiographic in their emphasis on the heroic self-sacrifice of nurses. This project was guided by the approach of contemporary 185 McCallum et al., “Help Wanted, Experience Preferred,” 141. 57 historians of nursing who have situated nurses within their sociopolitical contexts, and in doing so have brought greater nuance and deeper understanding of the nursing experience. Public health nursing practice in the Yukon was as much shaped nurses’ motivations for autonomy and adventure as it was by colonialism, gender, and modernization. Historian Kathryn McPherson has noted that public health nurses are overrepresented in the history of nursing, compared to their actual numbers.186 However, there is still a need for further research into rural public health and outpost nursing, especially in the regions of Canada located above the 60th parallel. While this study has focused on the difference between missionary and secular public health nursing, there were as many continuities between these modes of organization as there were differences. As nursing organizations in Canada are taking efforts to address Indigenous-specific racism in the healthcare system, greater consideration of the historical influence of colonialism within nursing could lead to valuable insights.187 Finally, a historical study is first and foremost dependent on its sources. The outpost nurses who worked in Inuit and other northern Indigenous communities have produced a substantial body of autobiographies, anthologies, and articles that deserve scholarly attention.188 A consistent problem I encountered during the research for this project was that nurses would be discussed in archival material, but there were few records written by nurses. It is critical for the future of nursing history that the lives, perspectives, and stories of nurses are preserved and made accessible to future historians of nursing. 186 McPherson, Bedside Matters, 21. 187 “Nursing Declaration Against Anti-Indigenous Racism in Nursing and Health Care,” Canadian Nurses Association, accessed April 16, 2025, https://www.cna-aiic.ca/en/policy-advocacy/advocacy-priorities/racism-in-health-care. 188 Karen J. Scott & Joan E. Kiser, eds. Northern Nurses: Ture Nursing Adventures from Canada’s North (Kokum Publications, 2002). 58 Bibliography Abeele, Cynthia R. “‘The Infant Soldier’: The Great War and the Medical Campaign for Child Welfare.” Canadian Bulletin of Medical History 5, no. 2 (1988): 99–119. https://doi.org/10.3138/cbmh.5.2.99. Arnoti, B. “Yukon Medicine: The Vital Role of Public Health Nurses.” Canadian Medical Association Journal 130, no. 4 (1984): 492–96. Bashford, Alison. Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public Health. Palgrave Macmillan, 2004. Bates, Christina, Jayne Elliott, and Nicole Rousseau. “Outpost Nursing in Canada.” In On All Frontiers: Four Centuries of Canadian Nursing, edited by Christina Bates, Dianne Dodd, and Nicole Rousseau. University of Ottawa Press, 2005. https://coilink.org/20.500.12592/bkrcxz Berton, Pierre. Klondike: The Last Great Gold Rush, 1896-1899. Anchor Canada, 2001. Brett, H. B. “A Synopsis of Northern Medical History.” Canadian Medical Association Journal 100, no. 11 (1969): 521–25. Canitz, Brenda. “Nursing in the North: Challenge and Isolation.” In Gossip: A Spoken History of Women in the North, edited by Mary Crnkovic. Canadian Arctic Resources Committee, 1990. Coates, Kenneth. Best Left as Indians: Native-White Relations in the Yukon Territory, 1840-1973. McGill-Queen’s University Press, 1993. Coates, Kenneth. “The Alaska Highway and the Indians of the Southern Yukon, 1942-1950: A Study of Native Adaptation to Northern Development.” In The Alaska Highway: Papers of the 40th Anniversary Symposium, edited by Kenneth Coates. UBC Press, 1985. Coates, Kenneth, and William R. Morrison. Land of the Midnight Sun: A History of the Yukon. 3rd edition. McGill-Queen’s University Press, 2017. Coates, Kenneth, and William R. Morrison. The Alaska Highway in World War II: The U.S. Army of Occupation in Canada’s Northwest. University of Oklahoma Press, 1992. Cruikshank, Julie. “The Gravel Magnet: Some Social Impacts of the Alaska Highway on Yukon Indians.” In The Alaska Highway: Papers of the 40th Anniversary Symposium, edited by Kenneth Coates. UBC Press, 1985. Daigle, Johanne. “The Call of the North: Settlement Nurses in the Remote Areas of Quebec, 1932-72.” In Place and Practice in Canadian Nursing History, edited by Jayne Elliott, Meryn Stuart, and Cynthia Toman. UBC Press, 2008. 59 Dehli, Kari. “‘Health Scouts for the State? School and Public Health Nurses in Early Twentieth-Century Toronto.” Historical Studies in Education / Revue d’histoire de l’éducation 2, no. 2 (1990): 247-64. https://doi.org/10.32316/hse/rhe.v2i2.1316. Drees, Laurie Meijer, and Lesley McBain. “Nursing and Native Peoples in Northern Saskatchewan: 1930s–1950s.” Canadian Bulletin of Medical History 18, no. 1 (2001): 43–65. https://doi.org/10.3138/cbmh.18.1.43. Duchaussois, Rev. Father P. O.M.I., The Grey Nuns in the Far North. McClelland & Stewart, 1919. https://www.chac.ca/documents/743/Grey_Nuns_In_The_Far_North_1919.pdf Elliott, Jayne. “Blurring the Boundaries of Space: Shaping Nursing Lives at the Red Cross Outposts in Ontario, 1922–1945.” Canadian Bulletin of Medical History 21, no. 2 (2004): 303–25. https://doi.org/10.3138/cbmh.21.2.303. Gibbon, John M., and Mary S. Mathewson, Three Centuries of Canadian Nursing. MacMillan Co. ltd., 1947. Gibson, Nancy. “Northern Medicine in Transition.” In Health Care Issues in the Canadian North, edited by David E. Young. Boreal Institute for Northern Studies, 1988. 108-118. Gilbert, Helen. “Great Adventures in Nursing: Colonial Discourse and Health Care Delivery in Canada’s North.” Jouvert 7, no.2 (2003). Green, Monica M. Through the Years with Public Health Nursing: A History of Public Health Nursing in the Provincial Government Jurisdiction British Columbia. Canadian Public Health Association, 1984. Greenhaus, Bereton. Guarding the Goldfields: The Story of the Yukon Field Force. Dundurn Press, 1987. Jasen, Patricia. “Race, Culture, and the Colonization of Childbirth in Northern Canada.” Social History of Medicine 10, n. 3 (1997): 383-400. https://doi.org/10.1093/shm/10.3.383. Jickling, Peter. “A Lifetime of Caring.” Yukon Events Magazine (blog), November 21, 2012. https://www.whatsupyukon.com/yukon/yukoners/a-lifetime-of-caring/. Kelcey, Barbara. Alone in Silence: European Women in the Canadian North before World War II McGill-Queen’s University Press, 2001. Kelm, Mary Ellen. Colonizing Bodies: Aboriginal Health and Healing in British Columbia 1900-1950. UBC Press, 1998. Lackenbauer, P. Whitney. “Race, Gender, and International ‘Relations’: African Americans and Aboriginal People on the Margins in Canada’s North, 1942-1948.” In Dominion of Race: 60 Rethinking Canada’s International History, edited by Laura Madokoro, Francine McKenzie, and David Meren. UBC Press, 2017. Lux, Maureen K. “Care for the ‘Racially Careless’: Indian Hospitals in the Canadian West, 1920–1950s.” Canadian Historical Review 91, no. 3 (2010): 407–34. https://doi.org/10.3138/chr.91.3.407. Lux, Maureen K. Separate Beds: A History of Indian Hospitals in Canada, 1920s-1980s. University of Toronto Press, 2016. Marchand, John F. “Tribal Epidemics in the Yukon.” Journal of the American Medical Association 123, no. 16 (1943): 1019–20. https://doi.org/10.1001/jama.1943.02840510013002. McBain, Lesley. “Jurisdictional Boundaries and the Challenges of Providing Health Care in a Northern Landscape.” Nursing History Review 21 (2013): 80-88. http://doi.org/10.1891/1062-8061.21.80 McBain, Lesley. “Pulling up Their Sleeves and Getting on with It: Providing Health Care in a Northern Remote Region.” Canadian Bulletin of Medical History 29, no. 2 (2012): 309–29. McCallum, Amanda M., Helen E. R. Vandenberg, and Kelly L. Penz. “Help Wanted, Experience Preferred, Stamina a Must: A narrative review of the contextual factors influencing nursing recruitment and retention in rural and remote Western Canada from the early twentieth century to 2023.” Canadian Journal of Nursing Research 56, no.2 (2024): 134-150. McCallum, Mary Jane. “This Last Frontier: Isolation and Aboriginal Health.” Canadian Bulletin of Medical History 22, no. 1 (2005): 103–20. https://doi.org/10.3138/cbmh.22.1.103. McCuaig, Katherine. The Weariness, the Fever, and the Fret: The Campaign against Tuberculosis in Canada, 1900-1950. McGill-Queen’s University Press, 1999. McPherson, Kathryn. Bedside Matters: The Transformation of Canadian Nursing, 1900-1990. University of Toronto Press, 2003. McPherson, Kathryn. “Nursing and Colonization: The Work of Indian Health Service Nurses in Manitoba, 1945-1970.” In Women, Health, and Nation: Canada and the United States since 1945, edited by Georgina Feldberg, Molly Ladd-Taylor, Alison Li, and Kathryn McPherson. McGill-Queen’s University Press, 2003. McPherson Kathryn, and Meryn Stuart, “Writing Nursing History in Canada: Issues and Approaches.” Canadian Bulletin of Medical History 11 (1994): 3-22. Meek, R. J. A Survey of Conditions of the Indians of Northern B.C. and the Yukon Territory. University of British Columbia, 1955. 61 Melosh, Barbara. The Physician’s Hand: Work Culture and Conflict in American Nursing. Temple University Press, 1983. Morrison, William R. Showing the Flag: The Mounted Police and Canadian Sovereignty in the North, 1894-1925. UBC Press, 1985. Morrison, William R. True North: The Yukon and Northwest Territories. Oxford University Press, 1998. O’Neil, John D. “Self-Determination, Medical Ideology, and Health Services in Inuit Communities.” In Northern Communities: Prospects for Empowerment, edited by Gurston Dacks and Kenneth Coates. Boreal Institute for Northern Studies, 1988 O’Neil, John D. “The Politics of Health in the Fourth World: A Northern Canadian Example.” Human Organization 45, no. 2 (1986). https://doi.org/10.17730/humo.45.2.q34m761r857km8lh. Orr, Lynda. “Ministering Angels: The Victorian Order of Nurses and the Klondike Gold Rush,” B.C. Historical News 33, no.4 (2000).18-21. https://www.library.ubc.ca/archives/pdfs/bchf/bchn_2000_fall.pdf Packard, Randall M. White Plague, Black Labor: Tuberculosis and the Political Economy of Health and Disease in South Africa. University of California Press, 1989. Penney-Flynn, Joan, and Pamela Taylor. Edge of the Wilderness: The Old Crow Village. Janus Publishing, 2001. Piper, Liza. “Diphtheria Antitoxin and Tales of Mercy in Northern Health Care.” Canadian Bulletin of Medical History 38, no. 2 (2021): 285–319. https://doi.org/10.3138/cbmh.491-112020. Reverby, Susan. Ordered to Care: The Dilemma of American Nursing, 1850-1945. Cambridge University Press, 1987. Riddell, Susan Elizabeth. “Curing Society’s Ills: Public Health Nurses and Public Health Nursing in Rural British Columbia, 1919-1946.” Master’s thesis, Simon Fraser University, 1991. ProQuest (303986397). Rutherdale, Myra. “Alaska Highway Nurses and DEW Line Doctors: Medical Encounters in Northern Canadian Indigenous Communities.” In Roots of Entanglement: Essays in the History of Native-Newcomer Relations, edited by Myra Rutherdale, Kerry Margaret Abel, and P. Whitney Lackenbauer. University of Toronto Press, 2018. Rutherdale, Myra. “Nursing for the North and Writing for the South: The Work and Travels of Nurse Amy Wilson.” In Caregiving on the Periphery: Historical Perspectives on Nursing and Midwifery in Canada, edited by Myra Rutherdale. McGill-Queen’s University Press, 2010. 62 Rutherdale, Myra. “Cleansers, Cautious Caregivers, and Optimistic Adventurers: A Proposed Typology of Arctic Canadian Nurses, 1945-70.” In Place and Practice in Canadian Nursing History, edited by Jayne Elliott, Meryn Stuart, and Cynthia Toman. UBC Press, 2008. Rutherdale, Myra. Women and the White Man’s God: Gender and Race in the Canadian Mission Field. UBC Press, 2002. Scott, Karen J. & Joan E. Kieser, eds. Northern Nurses: True Nursing Adventures from Canada’s North. Kokum Publications, 2002. Sibbald, Barbara. “Outpost Nursing: A Legend Comes Alive.” Canadian Nurse, 93, no. 6 (1997): 20. Smyth, Steven. The Yukon Chronology, 1897-1999. Vol. 1 of The Yukon’s Constitutional Foundations, Edited by Steven Smyth, Kirk Cameron, and Graham Gomme. Clairedge Press, 1999. Stewart, David A. “The Red Man and the White Plague.” Canadian Medical Association Journal 35, no. 6 (1936): 674–76. Stewart, Irene. These were our Yesterdays: A History of District Nursing in Alberta. Self-published, 1979. Strong-Boag, Veronica. “Making a Difference: The History of Canada’s Nurses.” Canadian Bulletin of Medical History 8, no 2 (1991). 231-48. https://doi.org/10.3138/cbmh.8.2.231 Stuart, Meryn. “Ideology and Experience: Public Health Nursing and the Ontario Rural Child Welfare Project, 1920–25.” Canadian Bulletin of Medical History 6, no. 2 (1989): 111–31. https://doi.org/10.3138/cbmh.6.2.111. Stuart, Richard. “The Impact of the Alaska Highway on Dawson City” In The Alaska Highway: Papers of the 40th Anniversary Symposium, edited by Kenneth Coates. UBC Press, 1985 Swedlund, Alan C., Paul Kelton, and Catherine M. Cameron. Beyond Germs: Native Depopulation in North America. University of Arizona Press, 2015. Truth and Reconciliation Commission of Canada. Canada’s Residential Schools: The Inuit and Northern Experience. Vol. 2 of The Final Report of the Truth and Reconciliation Commission of Canada. McGill-Queen’s University Press, 2015. Vanast, Walter J. “Arctic Bodies, Frontier Souls: Missionaries and Medical Care in the Canadian North, 1896-1926.” Ph.D. diss., The University of Wisconsin-Madison, 1996. ProQuest 304292588 63 Vanast, Walter J. “The Bad Side to the Good Story: Vilhjalmur Stefansson and Christian Conversion in the Mackenzie Delta 1906-1925.” Religious Studies and Theology 26, no. 1 (2007): 77–116. https://doi.org/10.1558/rsth.v26i1.77. Vaughan, Megan. Curing Their Ills: Colonial Power and African Illness. Polity Press, 1991. Wieler, Anne. “Physician’s Substitute — the Role of the Nurse in the North.” Canadian Journal of Public Health / Revue Canadienne de Santé Publique 62, no. 4 (1971): 333–36. Willis, Bruce Lloyd. "The Environmental Effects of the Yukon Gold Rush, 1896-1906: Alterations to Land, Destruction of Wildlife, and Disease." Master’s thesis, University of Western Ontario, 1997. ProQuest 304411527. Wilson, Amy V. When Days Are Long: Nurse in the North. Caitlin Press, 2019. Wiseman, Matthew. “Ottawa’s Burden: Fort Churchill and Military Nursing in Northern Canada, 1945-1975.” Canadian Journal of Health History 41, no.2 (2024): 185-218. Wood, W.J. and Anna M. Swail. “Outpost Nursing Station.” Canadian Nurse 59, no. 5 (1963): 445-447. Zelmanovits, Judith. “Baby Rats and Canada’s Food Rules: Nurses as Educators in Northern Communities.” In Caregiving on the Periphery: Historical Perspectives on Nursing and Midwifery in Canada, edited by Myra Rutherdale. McGill-Queen’s University Press, 2010. Zelmanovits, Judith. “‘Midwife Preferred: Maternity Care in Outpost Nursing Stations in Northern Canada, 1945-1988.” In Women, Health, and Nation: Canada and the United States since 1945, edited by Georgina Feldberg, Molly Ladd-Taylor, Alison Li, and Kathryn McPherson. McGill-Queen’s University Press, 2003.
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Nursing Under the Midnight Sun : Public Health Nurses in the Yukon, 1945-1967
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