Outposts of Mercy

The story of the Red Cross’s frontier war against suffering and disease

JOSEPH LISTER RUTLEDGE June 1 1927

Outposts of Mercy

The story of the Red Cross’s frontier war against suffering and disease

JOSEPH LISTER RUTLEDGE June 1 1927

Outposts of Mercy

The story of the Red Cross’s frontier war against suffering and disease

JOSEPH LISTER RUTLEDGE

STRAIGHT away from Edmonton, that last city outpost in Northern Alberta, long, long days of travel—nearly five hundred miles— and you come to Pouce Coupe.

Never heard of it?

Most probably not, few people have. It does not bulk large in the world of newsdoes not bulk large any way you look at it—just a huddle of houses, a bare twenty of them; but it is all that a scattered people, in a territory wide as some provinces, know of urban life. To them, Pouce Coupe stands for comfort and convenience and safety, the things we city dwellers consider as our natural rights, our undeniable necessities.

There is a doctor here, with the ink not so long dry on that document with its stately Latin phrases:

‘Testamur Senatum Universitatis—’, and

the red seal in the corner. Nothing so wonderful in that, to us who can call a doctor from an adjoining block, at a moment’s need. But think of hundreds of square miles, and this the only doctor, and the nearest city almost five hundred miles away.

It is a rugged parish, where roads are few, and the windblown drifts lie deep in the winter, and where a ninetymile drive is all in the day’s work, and hardly worth recording. But the doctor is cheerful and confident, despite the fact that the homes of his parish are mainly of one room, sleeping quarters and living room and kitchen combined, certainly no place for a patient who is critically ill. “Take him to the hospital,” he says. Hospital? Five hundred miles from the nearest place of consequence. Yes, a hospital at Pouce Coupe, with its tiny operating room supplied with every equipment that human skill can devise and, over them, their presiding genius, a Red Cross nurse. There are two small wards, four beds in each. But if you were to ask the matron how many patients they could care for, she would answer promptly,

“Eight to eighteen.” For, in the Outpost Hospital, they don’t measure service in terms of equipment, but by the urgency of the need.

Here is a man burning out with pneumonia, up on Nelson River, five days travel by sleigh from even Pouce Coupe—five days of bitter cold, and only one stopping place en route. Think of a patient kept warm through that desperate trip, wrapped round by heavy chains, heated in the camp fire, and then the peace and succour of that tiny hospital at Pouce Coupe.

That is the Red Cross—the Red Cross with the trappings off.

No martial music, no tramp of uniformed men, just a clapboard house, and a white uniformed nurse, and a sobbing mother standing in the doorway, bearing her only child, and whispering through her tears:

“Take him, nurse. I’ve done all I can.”

These things are the stuff of life. They happen. They happen every day in one or other of these far-flung outposts, though hands are too busy to chronicle the stories. They afford one of the outstanding justifications for the new peace-time program of the Red Cross.

This new program grew out of an imperative challenge, that touched the conscience of the nations, just as the appalling horrors of war had urged them to bring this great organization into being.

Startling and stark this challenge stared out from the cold and unimaginative pages of official reports. In the last year of war, out of every nine men called to the

colors in Great Bri-tain, only three were fit to serve. Of the rest, two were infirm in health, three were ■ physical wrecks, and one a chronic invalid. with a slim hold on life.

It might be urged that in our newer civilization, with its more open life, and healthier conditions, such things could not be. Fortunately in Canada although not ~ as bad, they are striking enough to challenge a sober reflection. For, almost to a fraction, of the men called up under the Military Service Act, one half were found unfit; out of the pickedyears of human.life, only a bare half fully vigorous.

What then of those not-so-vigorous years, and what of the women and children? That was the challenge that faced the nations after armistice, the challenge of a waste beside which even the appalling waste of war becomes insignificant. Half the world unfit!

To meet such a challenge some agency was needed, and there stood the Red Cross, ready to be demobilized. Yet here was an organization staffed and equipped and trained in the hard school of war. Certainly there was no other organization that could face this challenge with the same hope of a successful outcome, for no other agency held so large a share of public sympathy and appreciation. And that, after all, was the crux of the situation, for the challenge could be met only by an awakened public conscience, and such an awakening could not come by legislation or by coercive measures.

So, in the early months of 1919 the Red Cross took up the challenge. Canada was among the first to signify her acceptance of this new campaign that now comprises: fifty-six nations dedicated to a noble and inspiring ideal:

‘In times of peace orwar to carry on and assist the work for the improvement of health, the prevention of disease and the mitigation of suffering throughout the world.’

In undertaking this campaign the society has given up nothing of its former character or aims: ‘The relief of sick and wounded of armed forces in the time of war.’-—It has only assumed a wider obligation.

Canada has conditions that are peculiarly its own, and even in Canada they are only partially understood. It is difficult for those of us who live in centres of population, surrounded by every convenience and comfort and safeguard, to realize that there are tens of thousands of Canadians who know nothing of these things. They face life with naked hands.

It is not easy for sheltered folk to visualize these things. Yet, no longer ago than 1917, of 5,400 births outside the cities of Alberta, 4,492 mothers and

children received no medical or other trained attention. There is no reason to think harshly of Alberta because of that. Varying only slightly, such figures could apply to a score of sections. Surely it is not difficult to see how much these cold figures could mean in human suffering and death, and in the wastage of frail and twisted bodies.

Yet, all the while we are telling one another: “What we need is more people. Give us more citizens, and our problems will be solved.”

We are ready to develop large schemes, and to spend great sums of money to bring new people to our doors, while betterpotential citizens than they could ever be, are shattered in health or dying, because of lack of knowledge, lack of care, or the facilities for that care.

This is part of the obligation assumed by the Red Cross. Who else, for instance, is to look after Meadow Lake. Here it is, 120 miles north of North Battleford, Saskatchewan, eighty miles from the nearest railway. But there are 130 families in the town, and in the surrounding territory some 1,600 people, English, French, Americans, and Canadians from the older provinces, drawn there by the splendid ranching facilities of the section; and to serve this territory— hundreds of square miles of it—one doctor and one nurse. Think of driving a patient on 120 miles of almost impassable roads to the nearest centre. The doctor shakes his head: “No use. Couldn’t live half the distance.” What then is the answer? The answer is an attractive log cottage, with the red cross on the wall by the door, and a white-garbed nurse, and a small boy in a comfortable cot. He has fallen into some farm machinery, and has been cut and torn almost beyond belief. Not much chance—none at all in the old days, before the Red Cross came; not the shadow of a chance. Not much chance either for that young lad in the adjoining cot. He has been pitched on his head, and has lain unconscious day after day. You can’t expect miracles of healing in a crowded single room. But, to-day, these two lads are growing up into the sort of citizens that Canada is calling for, because of that outpost hospital at Meadow Lake.

There is no paternalism about this service. Where these outpost hospitals or nursing services are placed, there are people eager and waiting for them, and ready to give of their small means for their support, and steadily, one by one, they are being turned over to the community, as it becomes able to assume the entire support.

Resources Pitifully Limited

■^TOT every section, even where the need is urgent, or where a measure of support is assured, can have these services. Resources are pitifully limited in the face of the great obligations and only a part can be used for this phase of the work.

For it is to be remembered that the Red Cross is a purely voluntary society; a few small grants are all the official support it receives. Its real resources are drawn from voluntary gifts, and from the membership fees of the Society that are only a dollar for the senior Red Cross, and twenty-five cents for the junior. It is obvious that even with its fifty odd thousand senior members and one hundred and twenty-five thousand juniors, the revenue from this source could not go very far.

Fortunately the

Canadian Red Cross started its peace-time program with substantial funds at its disposal. During the war years, everyone could understand and sympathize with the work of the Red Cross, and because of that the public was ready to give generously.

About one half of the funds available at the close of the war, and the funds received since, have been devoted to the needs of disabled soldiers. The balance has carried on the peace time program. In round figures these services have called for the distribution of some seven million since the armistice. Last year the demands upon the society totalled virtually a million dollars. All these funds, apart from some relatively small governmental grants, have come from the voluntary contributions of people who have been able to visualize the work and its great need.

The extent of this work is limited only by the finances available.

There are scores of places crying out for an outpost service. But

before one cf them is placed, its need is demonstrated beyond any shadow of question. Sometimes this proof comes in tragic fashion, as when it was shown that out of eight expectant mothers in one section, two had died while being conveyed on the harrowing trip to the nearest hospital.

Not so long ago, a mother, being brought to the settlement for confinement, gave birth to her child a mile and a half away on a rough road, with the temperature standing at twenty below zero. That was at Carragana in Northern Saskatchewan, where the government opened a settlement for returned men. It is twenty miles to Prairie River, the nearest settlement with telegraph, and the nearest doctor is at Tisdale, forty-five miles farther on. Is there need for a hospital there? Ask that woman who, just two weeks later, looks back for a last glimpse at the white flag with its red cross fluttering from the staff, and beyond it the little log cabin set in a wilderness of brush She’ll tell you, as she hugs her baby to her, that she’s not a bit the worse. But what if there had been no Outpost—if there had been no nurse?

There are thirty-nine of these outpost hospitals or nursing stations located in the different provinces of Canada. Alberta has three, Saskatchewan eleven, Manitoba five, Ontario nineteen, and, just recently one has been opened in New Brunswick. They are placed as the provincial headquarters deems the need sufficiently urgent. They are, in every case, partially financed by the community served. The hosPital building is so provided, while the staff and equipment, the nurse’s salary, and a considerable portion of the running expenses are borne by the Red Cross.

In the nature of things these hospitals are not and cannot hope to be self-supporting; their capacity is too small to make such a thing possible. During the past year 2,138 patients spent 24,404 hospital days under the Red Cross flag, and 541 new citizens were born under the same kindly shelter, In every instance these hospitals are located far away from any other similar accommodation, in pioneer sections, where conditions are rigorous, and the quality of service offered by these Red Cross nurses must be beyond the average. There is the Wood Mountain Outpost, with the nearest doctor at Limerick, thirty-five miles away. Is it surprising that in the routine of her regular reports there should appear this line? ‘The most welcome sight I have ever seen is the headlights of the doctor’s car at two a.m.’

They are not overly imaginative women certainly, these graduates of a hospital ward. Most of them were trained as well in the hardschool of war. But it takes a different type of courage to stand by alone, with a weak voice asking: “Oh,

nurse, nothing will

Continued on page 77

Continued from page 13

happen, will it? You know I have three at home. They’re babies yet. I just can’t leave them.” Is it any wonder that the nurse writes? ‘Combined with the textbook of procedures, I find myself taking much comfort from, ‘Oh God our help in ages past.’

At Fisher Branch, in Northern Manitoba, there is no regular hospital, but there is a visiting Red Cross nurse. For those who think it is an easy service, the following extracts from the nurse’s routine reports are presented: ‘Went to visit a patient, nineteen miles away, who was very ill with pneumonia. The roads were very bad and I had to change horses twice, and it took sixteen hours to make the trip. Took patient, who had fractured his skull to Winnipeg. No train for two days, so improvised a bed on a motor the sectionmen use for their work. Patient unconscious all the wjay.’

Heroic Exploits

'T'HEN there was the case of Clarence Helgorson, nineteen years old. He was sick, very sick, and Nurse Litton knew it. Appendicitis it was, and in malignant form. That was Saturday night, and there wouldn’t be a train out of Fisher Branch before Tuesday morning, and by Tuesday morning there wouldn’t have been any further need to worry about Clarence Helgorson. He had to go to Winnipeg, that much Nurse Litton knew, and he must go at once, if he was to have a chance, and the only possible way was by the gas jigger in the section house. Winnipeg was 100 miles away. Think of an open gas jigger with the wind racing across the prairies, and the thermometer at twenty below, and a boy slowly dying. Four miles out of Inwood, the gas container sprang a leak. For that four miles, the nurse, and the one section hand who accompanied her, pushed that useless jigger with its suffering freight. Then the station house at Inwood, and tea and food, and another jigger, and Winnipeg in the early dawn of Sunday morning.

“Undoubtedly,” say the hospital authorities—who are not given to eulogies— “the patient owes his life to the devotion of Nurse Litton.”

And the nurse, back in the little house at Fisher Branch makes out her official report. ‘Took patient on jigger to Winnipeg. Returned to outpost.’

It may, perhaps, be asked, why, with so urgent a need, this service should be left to a private organization, why it should not be a direct and imperative charge on the gpvernment? That is a logical question, and yet it can be simply answered. Such an undertaking can only be successfully accomplished by voluntary effort, and the intervention of governments would defeat the object.

The Red Cross can and does work in

harmony and co-operation with the' governmental agencies that are devoted to a similar end, notably the Provincial Health departments. It stands ready to assist both in effort and money with any activities of these departments. But it has to be remembered that the Provincial Health departments have their own specific work to do, sanitary measures, the prevention of outbreak of communicable disease, and similar activities. Theirs is primarily a legislative and administrative function.

Take the instance of the outpost hospital. It is beyond any question that, were the needs fully met, the number of these would not be thirty-nine but rather be numbered in the hundreds. Why then does not the government supply the need? Because, of course, it would open an unbelievable field of expenditure. If it were a government undertaking, every community would have an equal right. If ■óne community has an outpost hospital, why not another community close at hand? And if the government undertook tke financing of these needy undertakings out of the public funds, would not other communities, which are themselves financing such undertakings at a considerable sacrifice, feel that they also were entitled to governmental aid? No, the cost would be too colossal, and it would lead to a system of paternalism that would defeat the one great object of the campaign, to awaken public conscience. Causes makes governments, not governments causes. To pin the badge of officialdom on this undertaking would be to rob it of its greatest asset, its disinterested standpoint. Because of that the Red Cross makes no appeal for governmental support. A few small grants are made, definitely docketed for specific uses. Undoubtedly the governments would be ready to give more. It isn’t conceivable that the Province of Ontario sets the value of the service offered by the Red Cross in that province at $15,000. Yet that is what it grants, arjd it is not asked for more.

The Red Cross looks to the public for the financial munitions to carry on this great work. For, every dollar subscribed means someone definitely interested in its campaign, and its aim is broader than the relief of present suffering. Its aim is to see that such suffering need not be, that an aroused and educated public may see their own needs and provide their own protection, through a better understanding of physical laws, better sanitation, better living conditions, and a knowledge of the care and feeding of children.

The Red Cross carries on this great work with a comparatively small staff. Roughly, its standing organization is about as follows: seventy-two Red Cross nurses, ten junior organizers, nine home nursing class organizers, two seaport

nurses, and various officials and assistants in the national headquarters and provincial branches, to a total of about fifty. Not a large staff, certainly, for the work undertaken; but it is safe to say that for about every one of these officials there are five hundred to a thousand voluntary workers, who are giving of their time and enthusiasm in promoting the aims of the society.

The Red Cross Outpost, while it presents one of the most dramatic and appealing of the activities of the Red Cross, is far from being its only sphere of action.

Further Activities

ipVERY year thousands of new citizens ^ come to our shores. They are destined to become either an asset or a liability in our national life. Scattered here and there, they will be difficult to find; perhaps impossible to reach. So, as in wartime . it met the returning soldier, the Red Cross now meets these new citizens at the door. Seaport nurseries are maintained at Halifax the year round, and at Quebec and St. John during the shipping season. These nurseries are under the supervision of a registered nurse, with a small staff of volunteer helpers to assist her.

They meet all ships and, as soon as thenewcomers leave the inspection officials, they are conducted to the nursery, where children and mothers are provided with milk and food; the children, perhaps bathed and put to bed, in the attractive ward with its row of white cots. It is easy to realize how much this attention means to the stranger. If a child is sick it receives attention, and the follow-up card is addressed to the headquarters in the province where they will reside, that will assure the attention of a Public Health nurse.

In two days following the opening of the Quebec nursery last year, nine hundred and twenty-seven children and their mothers were given a friendly welcome and attention. There is enough in that work to call out anyone’s sympathy. Here is a young Irish girl, only twentythree, going out with her four children to meet her husband in Manitoba. When it was explained to her that it would be necessary to provide food for the journey, she looked up shyly and said she guessed she wouldn’t be able to get any, as she had only one pound left. Think of that little family of five starting out without food, and without anyone to help them. But you see there was the Red Cross, so they went, provided with ample food, and with additional clothing to meet the needs of their new life.

Perhaps these Red Cross workers, being human, sometimes wonder if all this trouble is worth while. There are those routine cards to be completed, after a long day’s work. Tired, yes, this nurse was more than tired after eight hours of uninterrupted duty, yet she wrote her report.

“Mrs. V . . . and child, proceeding to her husband in Sydney, N.S., with her daughter Margaret aged five years, Halifax, March 13th, 1926.”

She wrote it, perhaps, with an inward feeling that it was just another bit of red tape. But when the Provincial Headquarters received the card and started checking up, they found that Mrs. V. had deserted her child, leaving that little child in a place that was far from respectable, where she was discovered and rescued. But if it hadn’t been for that bit of red tape, that child might have become one of the debit items in our national life.

It is not difficult to imagine the wealth of incident that might be drawn from the stories of those 66,000 mothers and children, who have passed through those nurseries in the last five years. There is no imagination required to estimate the value to those 12,000 families for whom definite follow-up work has been done. There are 12,000 new citizengroups, which will be a focus for health in their commun-

ities. Striking and poignantly arresting as is the record of the immediate personal touch between the Red Cross and these needy people, it is, and of necessity must be, pitifully inadequate to meet that pressing necessity of bringing health and happiness to the great body of citizenship. No one can question that it is worth doing, but the great aim and end of fighting disease and death cannot be achieved by that alone. After all, the fundamental strategy in this campaign to combat disease and suffering is to arm the whole people with the weapon of sound knowledge.

It is this idea that is behind the development of the Junior Red Cross, to enlist the enthusiasm of youth in this great campaign. Over one hundred and thirty thousand children in more than five thousand classrooms, are banded in this league of youth, for a healthier and a happier world. These children join an organization of their own, whose avowed purpose is to observe the rules of health. Think how that leavening can work through all the families directly interested; think, too, how that training will reflect in the well-being of the future citizens of this country.

Back of this Junior Red Cross is the idea and ideal of service. Not all children come into the world with the child’s full heritage of a sound and healthy body. Obeying the rules of health cannot straighten a twisted leg. So the children step in to aid in giving the less fortunate a chance. Saskatchewan has its Junior Red Cross Hospital at Regina, and in that province alone 700 children owe their ability to walk and see and work, to the efforts of the Junior Red Cross. In Alberta there are other hundreds, and the Junior Red Cross Hospital in Calgary, with its forty little white beds that are always occupied, also stands as a living monument to this great crusade of the children.

All the receipts from this branch of the society go immediately and entirely to the Children’s Fund, and, since its inception five thousand crippled and suffering children have been started on the road to health.

Home nursing classes have been one of the more recent developments. Thousands of women have seized this opportunity, gladly, so that they might fit themselves to be better citizens and mothers.

Think of that group of Finnish women up in Quibell, Ontario. Not one of them knew enough of the language to understand an English teacher, but they were pitifully eager for this assistance, so eager that they found a young student of their race who could understand, and through this interpreter, the lessons were secured.

It is no small enthusiasm that would make a teacher brave the bitter cold of a Northern Alberta winter. Yet one of these teachers had to drive eight miles each lesson a day, in temperatures from forty to fifty below zero, and with snow lying five and six feet deep on the level.

Every mother that goes out from one of these home nursing classes carries with her a new understanding, that disease is not a necessity but a wilful waste. Every one with whom the Outpost or Public Health nurse comes in contact, is also taught this lesson. In many other ways as well this new and potent gospel is being preached. As an instance, here was a Nova Scotia health caravan sponsored by the Red Cross. The caravan consisted of four ambulances and cars to convey four doctors and three public health nurses. In the two months of its service, one hundred and thirty-five meetings were held, attended by 50,000 people. On the practical side there were thirty-five clinics with over 4,000 patients attending, with 1,822 dental cases treated, 360 chest examinations made, and 380 operations under anaesthesia. Educational public health films were carried, dealing with child welfare, medical inspection of school children, tuberculosis and rural hygiene.

These results were a matter of congratulation in themselves, but, if there were only these actual results to be considered the task would appear to be endless. But they are only striking milestones on the way to better health conditions. It is the general appreciation, the contacts with their far-reaching influence, and the public acceptance of the general principle that diseases are not the unavoidable portion of humanity, that has made this work so eminently worth while. As a direct result of this one campaign eleven counties asked for the services of a public health nurse. That, surely, is an evidence of an aroused people, themselves asking for better facilities for health protection, and eager to make the most of them.

OF COURSE, too, the Red Cross still carries its old-time burden of responsibilities. The Great War is receding farther and farther into the past, but its aftermath remains, and there can be no discharge for the Red Cross. Every agency that is operating for the benefit of the returned man, whether it is the soldier settlers, soldiers’ dependents, or hospital patients, is still assisted, and in part financed by the Red Cross. This work includes, assistance for needy cases under the Soldiers Settlement Board, recreation huts and comforts for soldiers in hospital, convalescent lodges, where sick and injured soldiers can have a change and outdoor treatment, care of soldiers’ dependent children, short courses for soldiers’ wives to fit them better for their work, and workshops for the crippled. Perhaps there is nothing very dramatic in this work of sympathy and understanding, but it stands as a tribute of remembrance, a reminder that the Red Cross, which stood by in the agony of war, has not forgotten, but is still behind them, bringing what compensations it can to the men whose sufferings have not ended with the war.

It is in times of catastrophe, too, that eyes instinctively turn to this organization. When Florida was laid waste, the Canadian Red Cross was one of the first agencies to offer assistance. It has always been so. When, a few years ago, there flashed on the wires the news that fire was sweeping across Northern Ontario, wiping out towns and villages in its path, and leaving desolation and agony in its wake, people were stunned with horror, and exalted by stories of sacrifice and heroism almost too tragic to be borne. But, almost before the first message had ticked out its grim story, the Red Cross was moving. Doctors and nurses were racing toward the stricken zone, and car after car was loading with every imaginable need, for it is difficult to appreciate the complete destitution of burnt-out people. So without noise or tumult the Society went about its work

That, among other things, is its business, to meet the emergency as it arises, promptly, adequately and efficiently. Sometimes it is cyclone relief, as happened, not so long ago in Saskatchewan. Sometimes it is a crop failure over a wide area, that leaves the settler desolate and destitute, with a lifetime’s work gone for nothing. Sometimes the occurrence has not the dramatic quality of a great calamity. It may be fire, or sickness, or loss, happenings in themselves too small to make any great impression on the public mind. But they are still the errand of the Red Cross.

‘The prevention of disease and the mitigation of suffering.’

Surely this is a high enough ideal to catch at the heartstrings. It is a challenge to enlist in a war against ignorance that breeds disease, torture for little children, and for men and women who, through it, are hampered and handicapped and suffering through a long lifetime. And as the symbol of this warfare, pointing the way, appealing for assistance, for help and interest-and co-operation,'stands the red pmblerh of a skilled and unselfish service.