What happens in those places that are apart from the big cities and major hospitals when health care is needed? Who attends a labouring mother involved in a high-risk delivery or a critically ill newborn when a medical evacuation flight is delayed by bad weather or distance?
Those questions and more are at the heart of Caregiving on the Periphery: Historical Perspectives on Nursing and Midwifery in Canada, a new collection of essays edited by York history Professor Myra Rutherdale published this spring by McGill-Queen’s University Press.
The book examines the crucial role women have played in health and medicine as nurses and midwives, particularly in the remote geographical areas that dominate Canada’s landscape. As the book's editor, Rutherdale assembled a national contingent of scholars from nursing, women’s studies, geography, native studies and history to supply the essays and anecdotes that are contained within its pages. The result is a comprehensive volume that provides insight and understanding into the two centuries of history and courage of the women working on the front lines of health care and medicine in Canada’s remote communities.
"I was inspired to gather these works together into one collection because I was made aware that there were many scholars working on the history of outpost nursing and midwivery in rural Canada," says Rutherdale. "It struck me that there would be common themes across the country and across the two centuries explored in this book. Most particularly I thought that the perspective of ‘the periphery’ would be useful to explore."
"Were these women, especially the trained nurses, acting as agents of the state or in the best interests of agencies like the Red Cross? To what extent were they actually autonomous?" asks Rutherdale. "And, were they merely reinforcing the sometimes racist and social inequities that seemed to be part of many of the federal government schemes?"
Left: Myra Rutherdale
"Did they, for example, work with midwives from northern communities, and how did they respond to medical traditions which were already established in the communities before their arrival? What motivated these women nurses and midwives to take up their work in the first place?" notes Rutherdale. "Were they just looking for adventure or were they women who wanted to advance in their chosen careers?"
The essays contained in the book also explore themes of religion, colonialism, social divisions and native-newcomer relations. Special attention is paid by Rutherdale to nursing in Aboriginal communities and the relations of race to medical work, particularly in connection to ideas of British ethnicity and conceptualized meanings of whiteness.
Rutherdale looks at the experience of nurses in Newfoundland and Labrador, northern Saskatchewan, northern British Columbia and the Arctic. The book features essays on topics such as Mennonite midwives in Western Canada, missionary nurses and Aboriginal nursing assistants in the Yukon.
"There were many interesting submissions and several fascinating stories. The Mennonite midwives explored [in an essay] by University of Waterloo history Professor Marlene Epp were especially interesting since they were so integral to the communities in which they worked. Not only were they midwives but they also worked as undertakers and arranged bodies for funeral rites," says Rutherdale.
Right: A nursing station in Iqaluit
What she discovered in compiling the book was that creativity was a key attribute for the women profiled within Caregiving on the Periphery. "The midwives and nurses who worked on the periphery had to work often alone, or sometimes with just one partner, and they had to work quickly to ensure the survival of their patients," says Rutherdale. "They did not necessarily have the opportunity to consult doctors or to speak with teams. They had to do their best under some harsh circumstances. They had to be skilled and confident in themselves. Nurses were trained ‘not to diagnose,’ but they often found themselves having to do just that, and quickly. They were tested in these communities and had to work hard."
That quality of creativity was also a key element for some of the research that went into the book, says Rutherdale, as there were challenges associated with the fact that some of the nurses, midwives and patients did not leave detailed primary source material. "As is evident from this collection, there are some very innovative ways to get around this frustrating lack of evidence," says Rutherdale. She cites an article by Judith Young, professor emerita of nursing at the University of Toronto. "One example of this is the excellent article by Judith Young who researched midwives in 19th-century Toronto. She used directories and land purchase records as well as other official documents to trace the existence of these fascinating midwives – records that might not be turned to for the questions which she ultimately answered. Sometimes one has to be innovative and creative to find traces of the human past."
Rutherdale also drew on the creativity of her 19-year-old son when she was seeking an appropriate title for the book. "I always find titles rather challenging. I had several titles, most of which were not favoured by family, colleagues or publishers," says Rutherdale. "Finally, I hashed it out with my son who has two parents who are historians so he has heard his fair share about Canadian history throughout his life. He thought Caregiving on the Periphery made a lot of sense given what the authors were trying to highlight in their collective works. And how does one disagree with an opinionated 19-year-old?"
Above: Donalda McKillop Copeland with her interpreter and his friends, Southampton Island, early 1950s. Rutherdale is researching the experiences of McKillop Copeland.
Rutherdale teaches Canadian history, with a special focus on 20th-century Canada and native-newcomer relations in the Department of History in York's Faculty of Liberal Arts & Professional Studies. She also teaches courses on the history of the body and Canadian women's history.
Her current research project is on the history of the introduction of westernized medicine into northern Aboriginal communities. "I look at the history of traditional medicine and ask what changes took place when doctors and nurses moved to northern communities to establish nursing stations and small hospitals," she says. "Northern Canada is still woefully under-served in terms of access to health care and there are many inequities that still exist in northern communities. The infant mortality rate is high, and women are still being sent to the south to deliver their children. This is ridiculous in 2010."
By Jenny Pitt-Clark, YFile editor