Caravans of Health
In Alberta the pioneer no longer has to seek out the surgery, for the travelling clinic is bringing surgery to the pioneer
H. F. MULLETT
TWO hundred miles to the nearest city. Four children whose condition imperatively demands the removal of tonsils and adenoids as the price of health—of life, even.
And the lowest possible cost for the four, including fares to and from the nearest city where skilled treatment is available, living expenses, hospital charges, and the surgeon’s fee, is around four hundred dollars.
A struggling pioneer farmer and his wife, fighting hard to overcome the handicaps of those first few difficult years,—and four children sickening daily before their eyes.
No possible hope of having the children attended to this year. There’s just a chance, maybe, if everything turns out well, that ten-year-old Mary, who seems to sulfer more than the others, may be taken to Calgary or to Saskatoon this winter; but there’s so many things to buy with the little money that can come in even under the best circumstances, that even Mary’s chance is very doubtful, so far as this is concerned for this year at least.
But Mary, her sister and her two brothers, were given the necessary skilled surgical treatment right at home —within an hour’s buggy ride of home, anyway—and the total cost was just sixty dollars.
“Worst diseased tonsils I’.ve ever set eyes on,” commented the surgeon.
“Mightygood thing you got ’em done.”
A miracle! Mahomet, unable through force of circumstances to get to the mountain, finds that the mountain has come to him.
Alberta’s travelling clinic—the most advanced piece of public health service anywhere in Canada.
And the above n no hypothetical case; it is one of many, taken from actual records in the files of the public health department of the Province of Alberta; it is one of over seven hundred such cases actually de..It with by the travelling clinic in 1928; and there will be even more of them for 1929.
What is a travelling clinic? How is it organized? How does it operate? How does a district secure thervices of the clinic? What does it cost? What do the doctors say about it? Always to the fore in service to the pioneer within her borders, Alberta long ago commenced the practice of sending out district nurses into those distant settlements remote from railways, where it was impossible to secure medical attention.
The practice was commended during the regime of the late Hon. A. G. Mackay, former minister of health in the old Sifton government of Alberta.
The nurses visited mothers and expectant mothers. They gave advice to the expectant mothers on pre-natal care; they frequently stood between the young mother and death, when child-birth far from medical aid presented problems more than ordinarily difficult.
They taught these pioneer mothers how to care for their babes; how to clothe them, howto feed them, how to keep them clean; how to guard them from the many dangers that lurk for the tiny child.
Then, as the little ones grew older, the district nurses watched closely for physical defects—diseased tonsils, troublesome adenoids, defective teeth, and the like, There were, too, many observations made in more serious cases, requiring at all costs early medical or surgical attention.
And out of this wat.hful care given by the district nurses, there evolved one clear, definite need; a need for a central service of some description, that would provide the children of the pioneer with surgical, medical and dental treatment, at the lowest possible cost consistent with adequate service.
Thus evolved the germ out of which was developed Alberta’s successful travelling clinic of today.
In its original state, the idea involved merely the establishing of a sort of medical club, grouping a number of cases at some central point, and then inviting a doctor to attend and to give such service as was needed, at a low, club rate.
Originating, as they did, out of a definite, proven need, these precursors of the present travelling clinic were at once successful.
Aimed to bring to those unable to pay for it a necessary public health service, the original experiments were made at the expense of the province, but speedily there grew up a new demand—for-an organized travelling clinic, operated as a public health service by the government, and made, by the charging of minimum fees, as nearly self-supporting as possible.
“We want the service—but we don’t want charity,” said the pioneers. “Let us pay, all of us who are able to do so, but do not withhold the service to those unalle to pay, or who will be able to pay in the fu ure.”
So, in 1924, the first public health travelling clinic was organized and commenced to operate. It made its first “stands” in the northern part of the province, where settlers lived long distances from the railway, and where there was but a twice-a-week train into Edmonton.
In that first year, the clinic visited six centres. In 1928, more than eighty clinics were held in 480 school districts, covering every section of the province.
A Health-bringing “Circus”
T E T us, for a moment, visualize an actual clinic in operation.
It is a gloriously sunny day in early autumn, a day of that real Indian summer which comes to Alberta when the heat of July and August are passed, and the land is full of the mystic haze of a still September day.
Within the two-roomed school in which the clinic is to operate, all is spotless as strong soap and lots of hot water, plus hours of elbowgrease, can make it. The women of the district, formed into a willing committee of unpaid workers, have pursued the elusive germ with mop and pail, until that dirt-loving protozoon has curled up its tail and died miserably in a spray of hot suds.
Desks, pictures, and all the other impedimenta of school, are piled out in the yard under the poplars, and the bare walls shine with much cleaning.
And now the children and their parents commence to arrive.
Ancient buggies and democrats, drawn by fat and sweating teams, wheel in to the school yard and draw up in the shade. Laughing children shout and wave greetings as they tumble forth. Picnic baskets are stowed beneath the wagons, ready for the healthy appetites that even the clinic cannot altogether stay.
It is nine o’clock in the morning, and the clinic was expected earlier than that. It is on the way, for Jim Smith, down at the Corners, ten miles to the south, received a telephone message from the exchange saying, that the caravan, held up by a heavy rain-storm, was digging itself out and would be at the school “round about nine.”
Eager eyes scan the dipping road by which the clinic will come.
A cloud of dust over a distant hill—a cloud that resolves itself into four distinct and separate bodies of dust, with a larger body in the rear.
“It’s coming, mother! the clinic is coming!”
There is a rush of children out into the road beyond the school gate, and in a few minutes the cavalcade wheels into the yard—several big autos, and behind, a big truck, a brown canvas cover securely lashed tightly over its contents.
Autos and truck are caked in mud, dry now, with the white dust of the later roads over all. Out step the two doctors, the dentist, the nurses, and the “handy men” whose duty it is to drive the cars, pack the baggage, make camp, cook, and in general look after the comfort of these busy professional folk, whose whole summer and fall is spent in a fight against child disease and the hurrying onset of winter.
“Some trip,” grins the clinic’s surgeon, as he draws off his dusty gauntlets and greets the members of the little executive committee. “Ran into a bad storm south, and had to dig ourselves out, or we’d have been here two hours ago.”
The women serve breakfast from an improvised camp kitchen ih the shade of the poplars, while indoors the two bare rooms are rapidly converted into operating rooms, wards, and the like.
Almost magical is the manner in which the big truck disgorges cots, chairs, an operating table, dental equipment, and all the paraphernalia of a real hospital.
And in half an hour the surgeon, clad in his white jacket, is hard at work, while white-robed nurses move silently and efficiently around him.
All the children here today are operating cases for the surgeon, or require dental extractions and fillings. An examining team took care of the minor cases yesterday.
Rapidly the two nurses undress and prepare the patients for their brief ordeal, aided by anxious mothers, and by the ex-scrubbing squad, now clad in white aprons, and working under the direction of the nurses.
Cot after cot is wheeled into the operating room, and so expert is the surgeon—so skilled the anaesthetist—so efficient the nurses—that only a few minutes are required before the little patient is wheeled back to the ward, where she is received by thankful parents and that little working squad of willing helpers.
A few hours rest, and—so resilient is youth—the children are in most cases fit to be taken home. Others remain in the temporary ward all night, watched over by the parents and volunteer nurses, while the surgical and dental staff take a few hours of needed sleep in their tents beneath the poplar trees.
And by the morning, the little school that but yesterday was a hospital, is once more a thing of desks, and blackboards, and maps on the walls. Only the heavy odor of iodoform hangs thick in the air, and cots and chairs are piled up, waiting their turn to be loaded on to the big truck.
The last ancient democrat has jogged its way through the schoolyard, its little patient waving a weak good-by to the kindly doctor and the smiling nurses. The tents of the clinic are struck, the brown canvas cover is lashed over the top of the big truck, and the little cavalcade sweeps out into the sunshine, strikes the north road, and is soon a moving column of dust that rises and dips into the distance, to drop finally over the last rise into a new valley and toward another centre. The dinic has come and gone. The swift, merciful work has been completed in that area.
As preliminary to the visit of the clinic to any area, much necessary ground-work has to be done. School districts are circularized with a preliminary announcement, very early in the year, outlining the aims and objects of the clinic, the cost, and the method of organization. Usually the districts are grouped in fours. A local committee is then brought into being, usually consisting of one representative from each school district, with representatives from other interested bodies such as the local municipalities, the United Farmers of Alberta, the United Farm Women of Alberta, Women’s Institutions, and the like. It is this committee which makes the preliminary arrangements necessary before the clinic’s visit.
But the organization, like the area, is developed along sufficiently elastic lines to permit of considerable variation in the method whereby the clinic is secured for any given district.
Take, for example, the clinic which operated in the case of the four children mentioned at the beginning of this article. That clinic owed its visit to but one thing—the determination of the mother of those four ailing children, that there should be a clinic held in her district.
The mother, distracted at the problem that faced her, with four children needing surgical treatment for which it was quite impossible to find the money, heard by chance of the travelling clinic.
“The clinic shall come to our district,” she decided, and at once she went to work. she tried first to interest the adjoining school districts, but it had been a dry year; crops were not good in that particular area, and the school trustees did not feel that it was wise to go ahead just then.
So the mother hitched up a horse to the family’s tumbledown buggy, and day after day, week after week, in all weathers and through all manner of roads, she went from farm to farm, from homestead to homestead, preaching the gospel of the travelling clinic.
And she got her reward in the bringing of the needed surgical service to her own four children, and incidentally to the other children of the district, too.
That is the spirit behind the travelling clinic—the absolute conviction on the part of pioneer mothers, that it brings to their children the safeguard of expert examination and of expert surgical and dental attention—service of the very highest quality—at fees which even the struggling pioneer homesteader can meet.
Prior to the arrival of the clinic a public health nurse visits each of the four school districts and gives every child a thorough physical examination. The youngsters are weighed, and their height and chest measurements recorded; teeth are examined; the nose, throat and ears are carefully inspected; the eyes are tested for gross defects of vision.
Where remediable defects are noted, a card detailing these, is sent or given to the parent of the child. This work alone has been found to be of inestimable value, pointing out as it does harmful defects of which the parents may not have been aware, though they may have been conscious of the fact that the child was not developing as it should, either physically or mentally.
Then comes the great day, the arrival of the clinic.
The first day is examination day, when the preliminary diagnosis made by the nurse is carefully checked up by the doctor, the surgeon or the dentist.
Then follows operation day already described, with as much more time as is needed for cleaning up all the work in sight, and allowing the patients to recover sufficiently to be moved.
Although fees are charged for all work done, the service is not entirely selfsupporting. In 1928, for instance, the total cost of the clinics ran in the neighborhood of $32,000, of which amount some $22,000 was paid in fees. Thus, the province had to meet a deficit of $10,000. Deficit is scarcely the right word, however. Rather say that the province spent $10,000 to ensure the examination of more than 5,000 children and the treatment by way of operations of more than 1,600.
Most of the clinic’s personnel is drawn from the University of Alberta. All the field work comes under the direct supervision of Dr. R. T. Washburn, formerly superintendent of the University of Alberta Hospital.
What the Parents Think
AND what of the results? What the effect on the children—what the opinion of the parents? What, most important of all, the effect in the awakening of a new consciousness of the value of good health?
To thosé who know the effects of diseased tonsils and of adenoids on the mental and physical development of the child, the actual results of these operations are a foregone conclusion.
They are embodied in the returns made by parents to a follow-up questionnaire sent out a few weeks after the visit of the clinic. A few extracts from actual returns as they appear on the files of the department, will suffice.
“Is growing much stronger and better in every way,” reads one. “Gained
eleven pounds; eyesight has improved visibly; unable to see the blackboard from a short distance, but seeing O.K. now,” says another.
“Temperament has changed for the better; very much easier to get along with; gained thirteen pounds,” one report says. “Much brighter; rests better at nights, and is filling out splendidly,” yet another report reads. “A great improvement in this child. Is better-natured, and does not get nervous when going to school,” still another exults.
“Both boys *doing better in every way. No rheumatism now, and one boy’s ear has given no more trouble.” “Hasn’t had a single cold all last winter.” “In perfect condition.” “Great gain in weight.”
One could enumerate similar reports by the hundred. And letters from parents tell a similar story.
“I think the operation saved our boy’s life,” writes one parent. “He is doing extra well since, and has grown three inches since the operation. I do not know how to thank you for your good work.”
“This is one of the best things the department could have taken up, and we certainly appreciate it.”
“If it was not for the clinic, I could not have been able to afford these operations. The staff of the clinic are the finest people I ever met.”
“We thank you very much for the help of the clinic. The same work in town would have cost us $115 to $160, so you can see we have every reason to be pleased. The children are back at school again, and are fine.”
THERE is yet another aspect of the clinic, that of its success in the discovery of disease. Dozens of cases, too complicated for treatment by a travelling clinic, have been referred to resident physicians and dentists, and in some cases, immediate action has saved lives.
A boy was found by the examining team with mastoids in so advanced a stage that only a prompt operation could save his life. He was rushed by auto to the nearest railway station, and in a few hours was successfully operated on. He would have been dead in two or three days, had not the clinic seen him in time.
Another child, a little Russian boy brought to Canada by poor immigrants, and placed out to work on a farm operated by a slave-driving and ignorant fellow-countryman, was found in a pitiable state of emaciation from over-work and under-feeding. His case, was at once referred to the provincial department of neglected children, who took charge of the child.
A girl, being examined by the doctor, burst into tears and sobbed out her pitiful tale of being always tired—always ailing, and her parents would not believe her, insisting that she was lazy. This child’s heart-beat was discovered to be on the right side instead of the left, and only careful regulation of her life would have saved her. The girl was described as one of the brightest patients, mentally, ever examined by the clinic.
The Lighter Side
X_TUMOR, too, is infused into the day’s L work, grim though it is at times. There is, for instance, the case of the old ex-Kansas farmer, in a pitiable condition of exhaustion from asthma, who begged the clinic to examine him, though he knew that the clinic was only for children.
Common humanity could not do less. The doctor went over the old man with minute care, then—
“I believe it’s your teeth,” he said. “They should all come out.”
Still in his work-stained overalls, the
feeble old farmer climbed into the dentist’s chair.
“Ef you-all says so, I guess thar’s nothin’ else to do,” and in less time than it takes to tell, almost the rotting stumps from the old mouth had all of them gone for good.
Toothless, his thin lips drawn in over lacerated gums, the sufferer was game.
“I’m childless, doctor,” he lisped in his quaint Kansas drawl, “an’ ef these-yer teeth was the cause of my bein’ so ill, I’ll leave you my farm when I die,” and, getting into his weather-beaten buggy, he jogged down the road to his lonely farmstead.
Two months later, the clinic, beating its way across country in the teeth of a rain-storm, paused for direction at a crossroads, one arm of which pointed the way to the district in which the old Kansan lived.
Down the road chugged a little tractor, a quaint old figure perched on the driver’s seat. Rain streamed from the battered felt hat of the apparition, and soaked into the ragged coat that covered him, but the driver, whistling a gay tune, seemed to mind the rain not at all.
“Aye, sure I’ll put you-all on the right road,” he grinned, showing twin rows of gleaming white dentures, and swinging his rain-sodden hat high in the air. Then he peered out of his old eyes into the leading car of the column.
“Why, dang my eyes, ef it ain’t the clinic!” he shouted, and nothing would do but the tired travellers must come up to his house, get dried out, and rest for awhile.
“And how’s the asthma?” they asked him.
“Gone—every last bit of it,” whooped the ex-Kansan. “Cain’t seem to be able to stay indoors any more, these days, ’spite the rain. Dassen’t go outside ef a spit o’ rain fell, afore you-all took them ’ar teeth out,” he exulted.
The clinic, rested and comfortable, took its leave.
“Waal, this-yer’s your farm,” called the old man, as he swung the gate to behind them, “but it’ll be a dang long time afore you get ’er, now!”
“What Does it Cost?”
V\ 7"HAT does the clinic cost its pa’ * trons? somebody will ask. Here is the scale of fees: Removal of tonsils and adenoids, $15; other minor surgery in proportion. Dental extractions, 50 cents to $1.00; fillings, $1 to $2; other treatments in proportion.
Organization—the massing together of a number of operation cases at one central point—has made possible these low fees.
Ordinarily, the private practitioner charges around $35 for a tonsil and adenoid operation, and on top of this is the expense of travel to and from the hospital in which the operation is performed, hospital fees, charges for this and for that—running up to $100 or more per patient, for the individual living some considerable distance from a good centre; and in Alberta, “considerable” well describes some of these distances.
Parents pay the fees in cash where they can, but lack of the money is no bar to immediate attention—the health of the child must be paramount in all cases.
“I’ve no money now, but I’ll give a note and pay you right after harvest,” is a common suggestion, and this method of settlement is invariably adopted. Few there are, who plead a poverty so constant and so pressing that they cannot make some offer of payment.
This economical cost of operating naturally brings one to the next question —what do the country doctors think of the travelling clinic?
The doctor in the ordinary country
practice cannot as a rule offer to undertake minor surgical operations much below $35 each. Often, too, the country doctor has been able to get so little practice at this work, that he hesitates to do it in any case, for the “T and A” operation, as it is called, though classed as a minor one, carries certain risks when tackled by the slow or the unaccustomed.
Most doctors, and most dentists, too, while perhaps in their own minds regretting, as is natural, the loss of a considerable amount of work in a practice which at the best may not give more than a half-decent living income, accept philosophically the advent of the clinic.
The view these men take is that the educational value of the clinic far offsets the immediate monetary loss to the local practitioner, and the officials of the clinic do all in their power to educate rural people to the principle of seeking a regular check-up from doctor and dentist.
It has been found, in fact, that the visit of the clinic at any point, almost invariably results in increased interest in general health problems, and as a consequence, greater demands on the local doctor and dentist.
SO THE travelling clinic goes forward on its errand of mercy. Two years ago, so great had grown the demands for its services that two separate and complete examining clinics were put on the work, with a surgical team alternating between the two examining bodies, and the whole converging only at very large clinics, such as the one held at Raymond. This year the demand has been greater than ever.
The basic idea of the clinic is service to the people, and its results thus far have shown that from the point of view of service, the Alberta government has created a very valuable institution.
And, valuable as its immediate benefits have shown themselves to be, there is that other and even more far-reaching effect to be considered—the development in the people of a health consciousness that leads them to value good health as more precious than material gain.
Finally, there is the moral effect of the clinic on the pioneer settler, and in particular, on the immigrant settler, the “New Canadian” coming to Alberta from some non-English-speaking country.
To the settler from England or from the United States or the more settled parts of Canada, the travelling clinic teaches its own lesson—that the Alberta government has an eye for the welfare of the people of the province, no matter how remote they may be from towns.
But to the immigrant from, let us say, Central Europe—who can gauge the effect it has on him? Ignorant of the language, of the customs, the people and the government, suspicious of all things not readily understood, constantly on the watch lest something be “put over” him, what must he think of this wonderful example of government thought and care, coming right into his very home, bringing to his children medical and dental care hitherto only possible for those with the money to be able to afford such luxuries?
And, last word of all—the clinic can only be as good as its personnel. No story of the clinic can be complete without a word of praise for the work of surgeons, doctors, dentists, nurses and minor workers, all fighting on, often against difficulties, in the great cause of public betterment and public health.
These public-spirited men and women are among the real heroes and heroines of Canada today. All honor to them, and all success to the splendid battle which they are fighting against disease, and ignorance, and neglect, to the end that the children of today may be healthier, better and brighter citizens of tomorrow.