THE UNIVERSITY OF CALGARY

LIBRARY

HEALTH UNITS OF ALBERTA

by

ADELAIDE SCHARTNER

Health Unit Associati on of Alberta Co-op Press EDMONTON ACKNOWLEDGEMENTS

Health Units of Alberta was commissioned by the Executive of the Health Unit Association of Alberta as a 50th anniversary project. Funding for the work was made possible through the generous contributions of the various health units, Shell Oil Company of Canada, .grants from the Minister of Social Services and Community Health and the Minister of Culture. The manuscript could not have been written without the cooperation and support of dozens of health unit personnel - all of whom gave generously of their time in digging into the records of past decades. It was they who made available the information and material upon which this book rests. ln that sense, this is very much their story. All told, hundreds of hours were spent in gathering material through inter­ views and the study of hundreds of feet of records. Unfortunately, much had to be left out of the completed manuscript because of the obvious limitations of space. Although one can not possibly mention all those who gave of their time and expertise, the efforts of Sharleen Chevreaux, Lorraine Kiel, Kevin Majeau, Jim Miller, Carol Mitchner, Robert Pool , Sandra Weir, and Iris Winston must be mentioned. A special thank you goes to Dr. Louisa Dupuis, Archivist at the Grey Nuns Regional Centre in Edmonton, for access to their records of the early years in Alberta and to Dr. E. A . Mitchner, the project's director, and his wife, Carol, for their care and assistance in nursing the manuscript into its final form.

Copyright© 1982 Health Unit Association of Alberta No part of this book may be reproduced or transmitted in any form by any means, electrical or mechanical, including photocopying and recording, or by any information storage or retrieval system , without written permission from the Health Unit Association of Alberta, except for brief passages quoted by a reviewer in a newspaper or magazine . 3

DEDICATION

This book was commissioned by the Executive Committee of the Health Unit Association of Alberta in th e fall of 1980. Its purpose was to mark the 50th Anniversary of health units in Alberta with the inception of the first two health units in Red Deer and High River-Okotoks. It is intended to record the development, growth and implications of the role of health units to the people of Alberta in maintaining a high standard of public health. Hopefully this history will not only bring an awareness ofprogress, but will instill a sense of pride in the accomplishments of the past. Armed with this historic knowledge, we who are at present involved in public health - from board members who set policy to those working in the field - can be justly proud of our role in public health today. Spurred with this knowledge and renewed interest, we can all then continue to pursue the needs of the future. The material used to write this history has been compiled by a number of researchers in co-operation with key people in health units. It was not intended to write a history listing only names, dates and events, but to record th e drama, the humor. and the "human" events which took place in the course of the past. The intent was to produce a publication which would capture the interest of the reading public as well as persons involved in delivering services in public health . Through this publication, I would like to pay tribute to those men and women, the pioneers in public health, whose lifework helped to provide an improved standard of health in this province, as well as acknowledge those who are at present in the field providing care and direction in what is becoming an increasingly more complex world. The diseases and epidemics of the past are being replaced by the social, biological and environmental problems that are here today and seemingly will be with us in the foreseeable future. I wish to thank the health units who contributed extra funds as well as material to make this history possible. Special thank you goes to the Honourable Mr. Bob Bogle, Minister of Social Services and Community Health as well as Dr. Sheila Durkin, Deputy Minister, for providing both financial and moral support in the production of this publication. Health Units have quietly and unpretentiously been delivering a heroic and unsung service to the communities of Alberta for 50 years. It is time the story was told!

DOROTHY FRENCH Chairman, H.U.A .A. October, 1981

5

CONTENTS President's Message ...... 3 Table of Contents ...... 5 Introduction ...... 7 - ) Public Health in the Northwest Territory 1859- 1905 ...... 14 --7The Formative Years of Public Health 1905-1930 ...... 22 The City of Edmonton Local Board of Health ...... 31 The City of Calgary Local Board of Health ...... 44 District Nursing ...... 54 Okotoks - High River and Red Deer Rural Health Units ...... 62 Health Unit Expansion: 1938- 1980 ...... 74 Southern Health Units: Barons - Eureka ...... 88 Warner ...... 93 Chinook ...... 96 City of Lethbridge ...... I 02 City of Medicine Hat ...... 107 Central Health Units: Alberta East Central ...... 114 Alberta West Central ...... 118 Banff ...... 123 Big County ...... 126 Drumheller ...... 132 Jasper ...... 138 Leduc-Strathcona ...... 141 Mountview ...... 148 Minburn-Vermilion ...... 153 Northeastern Alberta - St. Paul ...... 156 Stony Plain - Lac Ste. Anne ...... 161 Sturgeon ...... 169 Vegreville ...... 173 Wetoka ...... 176 Northern Health Units: Athabasca ...... 185 Fort Mc Murray and District ...... 194 Grande Prairie ...... 204 High Level ...... 211 Peace River ...... 216 The End of the Beginning ...... 222

7

Chapter 1

INTRODUCTION

ln 1832 cholera struck the eastern seaboard of North America. From St. John, Halifax, Quebec and Montreal the killer disease spread inland and up the St. Lawrence River to the settlements on the Great Lakes. Carried by immigrants and travellers there appeared to be no defence against its coming. The epidemic brought fear and terror to the Canadian countryside. Business came to a halt. Farmers feared to enter the settlements Jest they catch the infection . Those that could fled the villages and towns in panic, hoping to escape. Those that escaped most often credited it to their own high moral standards. After all it was the poorer classes that were hardest hit. To the righteous, gin alley and beer lane were the obvious culprits. As the disease swept through the crowded tenements and slums the authorities tended to see this as a result of loose living rather than a result of impossible unsanitary housing conditions. It was not the beer or gin that made the lrish immigrant and French-Canadian more susceptible to cholera but the fatigue, overwork and inadequate diet of their station in life. The first known case of cholera occurred in lndia. From there the disease worked its way into Europe and Great Britain finally wending its way across the Atlantic on crowded immigrant ships. Ship captains pressed as many people into their holds as possible. Seldom were passengers permitted to go topside to get fresh air and their food was whatever they had brought with them. Treated like cattle they could do littl~ but persevere. At sea these overcrowded conditions proved good breeding grounds for the infectious disease. Then unwilling to face a long lay over in quarantine upon arrival some of the captains dumped their human cargos onto off-shore islands or along lonely stretches of beach by night. The immigrants were to make their own way into the colony. Some of the unfortunates were cholera carriers and as they moved about seeking homesteads they hastened its spread. The first major outbreak began in Quebec in 1832. Other outbreaks occurred in 1834, 1849, 1851 , 1854, and 1866. The last known case in Canada was reported in 1909. Estimates place the total death toll at 15,000. A large number considering the small population at the time. The horrors of cholera were truly something to panic about! The disease creeps up on its victims with very little warning and swiftly and indiscriminately kills - often in two or three days. The first symptom is severe diarrhea, followed immediately by violent stomach cramps. During the second stage, large amounts 8 of vomit erupt. Excruciating spasms of the intestines result in screams of agony. Horrible cramps affect all parts of the body. Eventually, the kidneys fail and the body becomes cold to the touch. With dehydration, limbs, nails and lips turn livid and purple, skin becomes loose and shrivelled. Throughout all this , the patient suffers a raging thirst. During the last phase the body undergoes total collapse turning black or blue before death. As the body cooled to the touch , what used to be thought a remedy was placing the victim on a cane-bottomed chair wrapped in a blanket while under the chair someone would light fire to a pint of brandy. The patient was to sit over the flames for twenty minutes or so and thus drive the coldness from the body. Doctors tried everything in a desperate attempt to effect a cure. Bloodletting was favoured to calm and ease cramps and relieve the pressure when the blood thickened. It was believed that persistent bloodletting would eventually lead to good, red blood flowing. The cost of each bloodletting was one shilling and many lettings were given on each visit. At times calomel was administered as a purgative to relieve diarrhea. It was hoped this would shock the body organs back to activity. When the patient's gums became soft, the mouth sore, teeth loose and a noticeable stench of breath arose it was taken as a sign that the calomel was working. Another sure fire cure was in the prescription of large doses of opium, taken orally. These were given every twenty minutes to ease pain and reduce the vomiting and spasms. Later, in the 1870's, morphine in­ jections were used instead. Other attempted cures were turpentine purgatives, enemas, and heat mas­ sages of the cramped areas, all intended to "wake the body up" . Hot and cold water cures were tried; a variety of metals, herbs, and spices were drunk in milk or in blood. Anything was worth a try if the situation was desperate enough. Hot wine, camphor, charcoal, brandy, tea and castor oil - never knowing cause or cure, all were used. When something worked, it was considered a miracle! Still the only safety lay in not catching it in the first place. Cholera did not come upon the Canadian people totally unaware. The spread of the disease to Europe was well documented and the likelihood of it being carried throughout the world on the great waves of European immigration during the 19th century was a foregone conclusion. From the J 830's almost twelve million people left Europe on crowded ships bound for a new life overseas. Several millions of them came to North America and of these some were bound to carry the disease. Public reaction in North America to the incidence of the disease followed established European procedures. Local health boards were created to coordinate ociety's defences. Thus Canada's first Public Boards of Health were established as a reaction to the advance of cholera creeping across the Atlantic. 9

The first line of defence was quarantine. Quarantine stations were set up on off-shore islands where immigrants were to remain for two weeks before being allowed into the country. Tens of thousands were medically inspected. Others were landed at night, away from medical examiners. Penniless and des­ titute they spread the disease before health inspectors could track them down. With the onset of the epidemic frantic attempts were made to clean up the cities and their squalid living conditions. The Board of Health appointed Health Wardens to see to public hygiene and sanitation. The major cities of Toronto, Montreal and Quebec were in the greatest need. Some dwellings, particularly crowded tenements, were incredible horrors. Personal hygiene was practically non-existent. People slept on piles of rags in dank basements. In one instance some of the destitute were discovered sleeping on make-shift beds just barely above two feet of sewage water that had invaded their basement. Garbage was everywhere - ashes, offal, excrement of animals and humans were piled in heaps to be compressed into thick layers over the years. Dead animals rotted in the streets; live pigs and other creatures rooted about. The good citizens of Toronto put these dead animals onto the winter ice of Lake Ontario in the hope that when the ice melted the animals would sink out of sight. As a result, the partially decomposed animal carcasses remained in the stagnant lake­ shore water which was also used for domestic purposes. To add to this the slaughter houses poured their refuse of animal blood and guts into the nearest available river or stream. No city had a safe water supply and many people relied on their own private wells . rivers or lakes. Little did they realize that through subsoil transference their own water supplies were likely to be contaminated. Health Wardens lit tar barrels in an effort to purify the air and attempts were made to clean the houses and streets. Thousands of cartloads of filth were hauled away - but a proper dump was costly and no one wanted the refuse of years placed on their property. Still, the Wardens worked hard to get public cooperation. Clean you cellars, yards and streets they told the public. House to house visits were made. People were urged to scrub, ventilate and whitewash their homes. The Boards of Health provided lime for the poor. Lime was poured into sewers, gutters and the overflowing cesspools. But after an initial spate of activity at the height of the epidemic public response slowed with the coming of winter and an abatement in the disease. The whole clean- up campaign was inadequate and short-lived. It was im­ possible to change the lifestyle of the people overnight or to clean up the mess which had accumulated over the decades. The tragic part was that after every epidemic the public relapsed into their old ways. Dreadful living conditions returned as indifference set in - until the next epidemic. Attempting to get a healthy public to act to prevent future calamities was a constant frustration. The answer to the problem of public indifference lay in a revolutionary change in lifestyle that occurred in the countries of the North Atlantic community 10 during the 19th and 20th centuries. Part of this change lay in the area of public health and personal hygiene. The world wide revolution in the change of attitude towards public health during the last 150 years was of far greater importance than any revolution in world history. It was more important than the invention of steam power, the development of the automobile or th e discovery of nuclear energ y. And it was of far more consequence than any political revolution . It came about slowly and quietly, but surely, as individuals and societies grew in awareness of the vital importance of social and personal hygiene. So great was the revolution that today we look back with horror at the conditions under which our ancestors lived . This revolution began in England during the Industrial Revolution when hundreds of make-shift towns sprang up around factories and mines. Tens of thousands moved into overcrowded tenements in search of work. The change from an agrarian to an industrial society with the trend to urbanization caused a dramatic change in lifestyle. Along with this change came problems of public health . When diseases spread through the ghettos of the new industrial centres the public began to look to government for assistance. The effect was astounding. New inventions in the field of medical treatment and new modes of personal hygiene saw the death rates plummet as life ex­ pectancy levels began to soar. These resu lt s were unheralded and mostly un­ noticed but the fact remained that fewer people were getting sick and more people were living longer, mainly due to better health habits. This demographic revolution did not just happen overnight. It took decades before the message of the need for personal hygiene and public sanitation got through. Today, the killer epidemics of less than a century ago are no longer with us. However, the relatively recent polio epidemics and the periodic threat of new strains of flu are grim reminders that constant vigilance must be kept against communicable disease. The gravest danger would occur should defences, that are so often taken for granted, be let down. Today, the staffs of various health services monitor the public's health and keep the matter of disease pre­ vention before society . So successful have they been that most of their work is now considered standard and routine. When one looks down the dim corridors of time to Canada's first Boards of Health in 1832, the impact of the astronomical change in public health hits with tremendous force. Our lifestyle today was undreamed of in the past - refrigeration, home vacuum systems, sewage disposal and daily baths! We buy coloured meat in cellophane wrapped packages, food placed in pressurized tins, ultra-high temperature treated milk, mouth washes and a variety of deodorants. For the most part, we have become a spic and span nation! The change began in Western Canada with the appointment of a Territorial Board of Health in 1870. This board was formed as a public response to do something to counter a raging smallpox epidemic amongst the Indian tribes. The 11 smallpox was spread by traders at Fort Benton angry enough at a band of Piegans to give them infected blankets. By the spring of 1870, it had engulfed the Bloods, then the Blackfoot, the Stonies and the Sarcees and by mid-summer was dev­ astating the camps of the Cree and Metis. Natives fled to the trading posts and missions for help, but there was little the white man could do. Traders and missionaries had few medicines and no cures. They tended the sick, comforted the dying and buried the dead as best they could. They could do nothing more . At Fort Pitt two camps of Crees took up their residence hoping for help and when none was available tried instead to transfer the infection to the whites in the belief that if they could, they would stop suffering themselves. Afflicted Indians blocked the doorways and tried to force entry into the houses. When that failed, they rubbed infectious matter from their own sores on window frames and door handles . They died by the hundreds and their bodies lay rotting, unburied close to the stockades. In another instance eleven Blackfoot warriors tried tO attack a mission post but ten of them died writhing in their own agony within sight of the gates. Before winter brought relief nearly half of the Plains Indians were dead. The Board of Health made efforts to isolate and quarantine those affected by the disease in the hope that some would be saved. As well , trade was embargoed in efforts to halt the spread of the disease. Relief came only with the onset of winter. When the scourge died away, public apathy returned. The territorial Board " of Health fell into almost total disuse, resurrected only with the infrequent return of smallpox. Eventually, the growing towns of Edmonton and Calgary formed their own health services on a municipal level. It wasn't until Alberta became a province in 1905 , that the public's health became a provincial matter with the formation of a Provincial Board of Health in 1907 . From there, things moved steadily ahead. After 1919 , provincial district nursing stations were established in rural areas. The district nurses tackled any problem that came their way, from immunization to childbirth to emergency treatment. Shortly thereafter travelling clinics were organized for rural areas without benefit of medical support. The clinics toured the province, relieving youngsters of unwanted tonsils and adenoids, fixing minor complaints and checking thou­ sands of teeth. Both the district nurses and the clinics braved incredible hardships of roads and weather, in order to " get the job done" . And the people loved them - nor will they ever be forgotten! A growing gap between rural and city health services became apparent in the l 920's. This was first recognized in Quebec and led to the formation of rural health units in that province. In 1929, Alberta recognized its own need, to make basic health services avai lable to rural areas that did not have proper medical facilities. This led to the formation of two demonstration rural health units in 12

1931 . Okotoks- High River and Red Deer were the first to be established with help from the Rockefeller Foundation. This novel venture was launched, offering a range of basic health services programs in immunization and child care. Great expectations were aroused. Since then, especially after World War II, health units have sprung up to blanket the province. Today almost all of Alberta's citizens have ready access to public health facilities . In the past decade, health units have been established in the far north reaches of the province in attempts to reach the small isolated communities along the Peace and Athabasca Rivers. One of these at Fort McMurray is no longer small nor isolated thanks to the boom conditions of the synthetic fuels plants on the oil sands.

>( When the provincial health units were established they fulfilled three basic roles immunization, with many chi ldren screaming at the sight of a needle not realizing, of course, its life- saving function; school health services, where the nurse soon became loved by all, and well baby clinics where proud mothers watched their offspring being weighed and measured and received instructions on feeding and how to preserve their baby's general well-being. As time went on, and as new needs arose, new programs came under health unit administration. Tuberculosis screening became universal, pre-natal courses were begun, giving both mothers and fathers an idea of what to expect with the miracle of birth. A natural follow-up were the post-natal classes and much appreciated home visits. These visits were a tremendous comfort to the mother and invaluable to the well- being of the infant. On the heels of this came pre­ school examinations - a little scary for most youngsters - but a great help in follow-up work in the schools. In the sixties and seventies, steps were aimed at helping children with dental , speech and hearing problems. Outreach programs from the Glenrose and University of Alberta Hospitals, were, and are of immeasurable value . Now, many health units have their own personnel to cope with these problems. The new Early Intervention Program and "risk registry" allows immediate follow­ up and action where possible, if a defect is noted in a child. As for the Home Care program it touches the heart to think how many must feel deep gratitude for their shortened stays in hospitals and a cherished longer life at home for the elderly. As the work of the health units continues to expand into the l980' s it appears more emphasis will be placed on geriatrics and health education. The former as with our changed lifestyle and medical advance we are all li ving longer. As life expectancies continue to advance and with a greater number of the people reaching and living well beyond retirement years the home care program will play an increasing role in providing for their well being. Health education places the burden of responsibility for good personal health on individual hygiene. In the next decade health units recognize that greater 13 emphasis will have to be placed on the quality of lifestyles and the reduction of self-inflicted diseases caused by the stressful situations of modern living. Proper preventive care by each and everyone will benefit both the citizen and society . Once more, looking back through the dark pages of history, the contrast of what was, and what is today staggers the mind. But have many of us today fallen into the trap of "taking things for granted?" Perhaps it would not be a bad idea, to speculate occasionally on the horrors of the past in order to appreciate what we have today thanks to the work and dedication of public health personnel . 14

Chapter 2

PUBLIC HEALTH IN THE NORTHWEST TERRITORY 1859-1905

The night wind whistled around the small mi ssion house of Lac Ste. Anne, flattened the prairie grass and bent the willows low. Inside, a candle flickered . On a narrow cot, an Indian boy writhed in agony. The fever and delirium of smallpox wreaked his thin body. A cool cloth eased his feveri sh brow. In a lucid moment, the lad saw a grey shadow bending over him . Terror struck! Had the Great Spirit come for . ? ~ hIm . It was not the Great Spirit. It was an angel of mercy - a Grey Nun. The year was 1859. Although they did not know it, this Sister, along with two others, were leaving a lasting mark on hi story. These three Grey Nuns were the first white women in Alberta. They were also the first to bring the profession of nursing to the western frontier. Moth r Deschamps, their Superior General, chose isters Emery, Lamy, and Alphonse to go out to the Northwest Territory. These devout young women were more than willing to face the hardships and uncertainties of the wilderness. Archbishop Tache however, who had lived and worked in the rugged west, felt conscious-bound to give them some warning about what they were getting into' "We cannot promise you anything comforting," he said. " Our missions are poor and resources uncertain." To which the Mother Superior replied that all the sisters required was food and clothing, "for the Divine Master had assured them that our Kingdom is not of this world.'' · Tache pointed out that even food and raiment might be scarce. But she assured him that the Sisters were willing to become needy with the needy. This sentiment is typical of the Sisters of Charity, commonly known as the Grey Nuns. Founded in 1738 by Mother Youville, a niece of La Yerendrye, the Sisters make a pledge 'to be of service to suffering humanity'. Thus these three gallant women were chosen to leave the comforts of civilization for a life in the Canadian West. They said good-bye to families and friends, knowing they would probably never see them again. For weeks they travelled the tossing waters of the Great Lakes. Then they trecked overland from Grand Portage and Thunder Bay until, finally in the fall of 1858, they reached the Red River settlement where they wintered. In Spring, 15

when the warm sun had melted the winter's snow, they set out on the last leg of their 2,000 kilometer journey. They could not possibly have known what a difficult life lay ahead or how much 'suffering humanity' they would encounter as the white man's diseases swept unchecked through the western tribes. The mission they were headed for at Lac Ste. Anne was 80 kilometers beyond Fort Edmonton. It had been built by Father Thibault over a decade before. Finally, after 53 days on the trail they reached Lac Ste. Anne. Situated on barren land, with only a few scrubby willows to relieve the monotony, the little mission looked forlorn and lost. If they were dismayed by the crudeness of their accommodations, they hid it well. Their welcome was warm and very soon the Sisters were settled into their new home. Undismayed by poverty and drudgery, they plunged into their mission. The Cree and Metis came in droves - probably as much out of curiosity as anything! Long days and nights were devoted to helping the sick and the poor. While the wolves howled in the distance and buffalo, deer, bears, and other wild creatures roamed the vast solitude, the Sisters worked tirelessly . The physical labour alone was back-breaking. All their water had to be carried, laundry must be done, meals cooked and thousands of other tasks were always waiting. Within two weeks after their arrival, classes were organized to help educate the Indians and Metis. The classes were an attempt to bring to the native people a concept of God, to teach them to read and write, and to help raise their standard of living with special stress on sanitation and personal hygiene. The Sisters reasoned that through personal hygiene the health of the native people would improve. Not only smallpox but typhoid, scarlet fever , tuberculosis, measles and Rocky Mountain Fever all took their toll as the tribes suffered in ignorance and fear. The coming of the Grey Nuns was welcomed as a first step towards com­ batting the spread of these diseases. There were always sick to attend to . But the Sisters soon found out they had competition in the art of healing! This was in the form of the all-powerful Medicine Man, or Shaman. The Meaicine Man enjoyed a position of prestige in his tribe and the tribe paid well for his services. This is understandable for he did, indeed, bring about some remarkable cures! He depended wholly on the wilderness for his "medicine". Roots, barks , herbs, and leaves were all he used in the healing of his people. A paste made of roots would heal open abrasions; red willow lowered high temperatures and chewing foxglove gave his patients bursts of energy from the digitalis it contains. The natives attributed the Medicine Man with magical powers, not only over disease but evil spirits as well. It was believed he could communicate with good spirits also, thus ensuring rain when needed or a good hunt. 16

One thing the M dicine Man would not do, was deliver babies. But Indian women were excellent mid-wives as many of the early settlers testified to with warm-hearted gratitude. The Sisters, though highly trained nurses, had to use their powers of per­ suasion to the utmost in order to win over the Indians - only as time went on did they gain their trust. Rewarding as it was, the labour of running the mission was gruelling. During the summer, heat and dust and millions of mosquitos plagued them. With the coming of winter, raging blizzards and below freezing temperatures made it almost impossible to work effectively. Often the food supply was so low they went to bed hungry. The barren land at Lac Ste . Anne did not even yield a garden in spite of all their intensive efforts. After some consideration Father Lacombe reluctantly decided to close the little mission and move the Sisters to St. Albert, not far from Fort Edmonton. There the area was more thickly populated and the work of nursing and education would continue to prosper. Also, the soil was fertile there and gardens and crops would be bountiful. In 1863 , the Sisters with seven orphans in tow, made the move to their new home. As time went by , more and more Indian children and adults flocked to the mission at St. Albert. The Sisters continued their devotion to educating the youngsters and nursing the sick. During the sixth year of their arrival the first resident doctor arrived. His name was Dr. William MacKay. The Hudson's Bay ompany had brought him in to look after the needs of their traders. He toured the west travelling as far north as the frigid Arctic . Besides caring for patients at the company posts he was ever willing to lend a helping hand. He would travel many miles in the wildest of weather if his services were needed. Now the Sisters were not entirely alone. True to Father Lacombe's vision, gardens and crops sprang up. They were of tremendous help in stocking the ever-demanding larder and , almost as im­ portant, a source of revenue. Lack of money was an ever-present problem. One year when raspberries were in particular abundance, the Sisters and the children picked such an amount of the juicy red berries that they were able to sell $30 worth! While all this activity was going on, they even took up sheep raising and carded their own wool, but nursing and education still held high priorities. Besides caring for the sick and injured at the mission, regular home visits were also part of their ambitious work. Sister Alphonse often walked through the fields under the summer sun, sloshed through puddles when it rained and strug­ gled through towering snow-drifts in winter. Her people must be visited! She cared for the sick, helped and consoled the lonely and abandoned. These families loved her and unfailingly welcomed her as best they knew how . 17

One day, a government employee was brought in. The Sisters, accustomed as they were to ugly wounds and fever-ravished bodies, could not repress an inward shudder. The man had been attacked by a bear and his face was literally half devoured! They cleaned the pulpy mess of blood and mangled flesh, then patched it up as best they could. The man, of course, was in agony. Since no anaesthetics were avai lable, the ingenious Sisters resorted to humour. They regaled the suffering patient with ridiculously funny stories, played gay tunes on the piano and when they tackled a literal translation of French to English, the man finally burst out laughing. Thus they helped him through the worst of his pain. In 1881 , at a cost of$ I 0,000 the Grey Nuns established Alberta's first fully staffed hospital which was the forerunner of the Edmonton General Hospital. The new hospital with a well-stocked dispensary, served the acute needs of the smallpox epidemic which attacked the area the following year, typhoid in 1894 , measles in 1896 and the ever-present Rocky Mountain Fever. In the years to come other religious orders and charitable foundations as well as 112 more Grey Nuns, would follow these three brave pioneers to the rugged west, ready to give service where it was needed. In 1871, the first Board of Health in the Northwest Territory was established. It consisted of the Reverends Henry Steinhaure and Peter Campbell: the Fathers Leduc, Lacombe, Andre; Bishops Grandin and Faraud; Chief Factor Harding and John Bunn. These men had been intimately involved in the savage epidemic of smallpox which had all but devoured the land the year before. They took steps to prevent another occurrence of the disease. First there was a temporary stoppage of trade in furs, buffalo hides and leather. They also placed an embargo on all goods leaving the affected districts as they feared these might still be infected. At this time the battle against smallpox received a stimulating shot in the arm. Until now, the only hope of protecting the susceptible Indians was to prevent the tribes from gathering together. The more isolated each was, the better chance that some of the tribes might survive. The decision to quarantine the Indians was made by the Reverend George McDougall. He said "Scatter them, scatter them. Do all you can to scatter the people for that is the only hope of saving them." But now the Reverend James Nesbitt in Prince Albert and Isaac Cowie in Fort Qu' Appelle, each working independently of the other, perfected a smallpox vaccine which would save thousands of lives. The Northwest Mounted Police also gave valuable assistance in fighting disease. They administered to the s ic~ and enforced quarantines in the remote areas. Coming into the territories in 1874 they built Alberta's first hospital at Fort MacLeod. The police surgeon, Dr. George Kittson cared for the constables I and civilians as well. When the typhoid and Rocky Mountain Fever flared up Dr. Kittson was \ determined to ferret out the cause. He spent years in this pursuit finally coming 18 to the conclusion that the source of it must be polluted water. He examined rivers, tested streams and tramped through muskegs and swamps. Time and time again he came upon the sight of dead animals and horses rotting in the swamps. He noticed an ugly scum on the surface of the stagnant water and reasoned that when it rained, the water level rose and a run-off of this filth would find its way to the various streams and lakes that formed domestic water supplies. This contamination, he believed, carried dangerous virus. Of course, he was correct and the efforts to secure sanitary water supplies would become a major problem for health officers for many years to come. en in 1883, the Canadian Pacific Railway reached Calgary, opening up Alberta to settlement. The railway brought with it thousands of settlers and___!he prospect of a major land boom. But as is so often the case there was another side to the event. Typhoid gained a strangle-hold on the villages and townsites which ~a ng up as the railroad raced across the prairies. Everywhere crowded and unsanitary conditions prevailed. Diseases were sure to surface. Immigrant labourers were more interested in what money they could gain than in personal health. They were particularly hard hit. Thousands of railways workers and their families were exposed. Countless numbers succumbed. The railway company built a series of shacks strung out along the main line to serve as temporary hospitals. These make-shift structures were the most am­ bitious endeavour yet to bring medical aid to the West. Other hospitals were erected during the Riel Rebellion of 1885 when military hospitals were built in Edmonton, Moose Jaw, and Saskatoon . Another hospital opened in Lethbridge in 1886. The bulk of its patients were coal miners. It was put up by the Alberta Railway and Coal Company for the use of their miners. Two years later another hospital opened at Banff. Here the patients were mostly railway construction workers. It was a two storey structure, but unusual in that only the top floor was used for a hospital. The first floor was a combination of businesses and a sort of social centre. There was no permanent staff as such, but anyone could pitch in to help upstairs. The l 880's also saw an expansion in nursing services that kept pace with the gowing number of hospitals . A few miles north of Edmonton, The Hermitage, a new Anglican mission was built. It was run by Canon Newton . In 1886 his sister Mary came from London, England to live with him . She was a graduate and a former instructor at Queen Charlotte's Maternity Hospital in London. When ill health fo rced her to resign she came to Alberta. She was the first lay nurse in the province. Mary Ellen Birtles was another who would leave a lasting mark on the nursing profession. She attended the first nurses' training school in the west at the Winnipeg General. When the training school opened in 1887 , she tackled the course with verve a~d gusto. In spite of the fact that for seven weeks just before exam time she 19 had to deal with a frustrating case of nursing a fourteen year old boy she graduated with flying colours! As a full-fledged nurse, Miss Birtles was ready for any challenge. She decided to tackle the West. One of her fellow graduate mirses Miss Reynolds, thought it was great idea. She came, too! They ended up in the municipal hospital in Medicine Hat. By a special act of the Territorial Assembly, the Medicine Hat General was incorporated in 1888 and opened in 1889. It was a most imposing structure built of stone. It stood like a staunch fortress two stories high and boasted 25 beds. Miss Reynolds and Miss Birttes were the ruling queens although their duties were hardly queenly! They divided the work of running the hospital between them. This included everything from cooking, tending the furnace, sweeping, dusting, being an orderly and ward aid as well as actual nursing and assisting in surgery. Although Miss Reynolds resigned to marry Dr. Carter she still maintained a k~en interest in the hospital . When a training school for nurses was opened in 1894, she and the new matron, Agnes Miller, together worked out a curriculum based on Nightingale training schools in England. The course included a for­ midable variety of studies.

NURSES' TRAINING I . The dressing of blisters, burns, sores and wounds, the preparation and application of fomentations, poultices and minor dressings . 2. Application of leeches and subsequent treatment. 3. Administration of enemata and use of female catheter. 4. The best method of friction to the body and extremities. 5. Management of helpless patients, moving, changing, giving baths in bed preventing bed sores and changing patient's position. 6. Bandaging, making bandages and rollers , and lining splints. 7. Mak!ng beds and changing sheets while patient is in bed. 8. The preparing, cooking and serving of delicacies for the sick, to understand the art of ventilation without chilling the patient, both in private houses and hospital wards, and the management of convalescents. 9. Instruction in preparing reports for the physicians, as to the state of secretions, expectoration, pulse, temperature of the body, skin, ap­ petite intelligence (as to delirium or stupor) breathing, sleeping, con­ dition of wounds, eruptions, formation of matter, effect of diet, stimulants or medicines. 10. Lectures were given on such subjects as anatomy, physiology, hygiene diseases, surgery, maternal , medication , and obstretics. 20

But there were other requirements of the student nurse. She was expected to be lady-like , obedient, virtuous, devout and always willing to assume res­ ponsiblity when it was needed . Free time was practically non-existent. Having to put up with these stringent rules, a girl must have had a burning desire to join the profession! Several of the Medicne Hat graduates took up private nursing. These young women travelled to homes all over the West. The type of family in need of medical help, varied. Some were rich, some were poor; some were kind, some not so kind. But they all had one thing in common. They expected the nurse to undertake household tasks as well as nursing - baking, scrubbing, mending or whatever else needed to be done. The second hospital in Alberta to produce its own nursing graduates was the Calgary General. It had its humble beginnings in a ram-shackle house with an unsavory past. A couple by the name of Hoad ran it - or rather Mrs. Hoad ran it and her husband did the nursing - if you can call it nursing! He cared nothing for the patient's welfare and comfort, forcing prescribed medicines down their throats with dire threats of leaving them to die! There was no order or discipline. Patients wandered in and out whenever and wherever they pleased. These were the haphazard conditions which met Miss Birtles when she became its Superintendent in 1894. The Hoads were sent on their way. Miss Birtles had the school organized and operating in a very short time. And very soon, too, she had her first student - Marion Moodie. The girl would prove to be an outstandingly competent nurse. But the day she enrolled, she was only a probationer. This meant that for the next three months she would work for absolutely nothing in exchange for her nurse's training . And work she did . She vividly describes the hardships, the fatigue when only snatches of sleep were possible - sometimes these while wrapped in a blanket on a bare floor. Since staff was virtually non-existent, Miss Moodie, an inexperienced 18 year old girl, handled the night shift alone. Often several of her patients were critically ill, all at the same time. It seemed as though she had to be in half a dozen places at once. When her probation period was over, Marion Moodie received the five dollars a month given to her, with gratitude. The next month it was $7 .50 and the third, the grand sum of $10! She enjoyed her soul-satisfying work immensely. It was a wonderful feeling to be financially independent. She charged $12.50 a week for maternity cases, for medical cases $ 15 . It wasn't much but she got by. One thing, however, rankled. Sometimes she found resentment directed toward her. This mostly came from the local women who had posed as nurses but knew very little about nursing. Their animosity at least partly stemmed from the fact that she had taken away their jobs. They discredited her whenever possible, called her 'new-fangled' ideas downright dangerous! 21

Over the years , she had many experiences, many of them happy, some of them unsettling! One such of the latter, was a buggy ride through a pitch dark night. She was being driven from her patient's house to a neighbour's place to attend to an emergency. The journey from the very outset was unnerving. The horses, Prince and Blackie, were not a reassuring pair! One was a mean tempered nag who would kick at anything in sight. The other, understandably enough, was skittish. It was the first time in his life he had ever worn a harness. Many times, the rig came to an abrupt halt, almost dislodging her. At other times, sudden unexpected bursts of speed had her holding on for dear life! Then there were two treacherous streams to cross. The water gurgled above the axles and threatened to flood the floor of the buggy - it was so dark they couldn't even see the water. In fact, it was so dark, they couldn 't see the horses, either! As they clambered up the landing of the second stream, the wet buggy wheels slipped and at that moment, Prince lunged sideways. For a breathless second, they teetered on the edge of the bank. Would the buggy slide back into the rushing water? But no. Just then, Blackie, bless his mean old heart, gave a tremendous heave and they were out. Maybe he wasn't all that keen on getting wet, either! To add to all this excitement. there were at least half a dozen barbed wire gates to open. Not only must they be opened, they first had to be searched for in the inky blackness. Miss Moodie elected to do this job herself rather than try to handle the unpredictable horses! She relates that at last as they topped a rise, the scudding clouds broke and the moon burst forth in all its silver splendour. The road ahead lay bathed in light, smooth and still and peaceful - like the peace of mind and body after a raging fever has been driven out. As the 20th century began excitement and hope ran high that the westerners would be granted provincial status. The long-cherished and hard fought for dream of provincehood was on the verge of becoming a reality. Tens of thousands of people had arrived in what was soon to be Alberta. They took up homesteads and strung miles of barbed wire fences . They settled in, and helped found new vi ll ages and towns. Then in 1905, Alberta was born. What a celebration! In Edmonton thousands of Albertans, cheering, dancing and singing swept along the streets. Among this happy crowd, 2,000 children banded together to give a rousing cheer for Alberta. Deeply moved, the Honourable Sir Wilfred Laurier, Prime Minister of Canada, rose to proclaim the new province of the Dominion. When the celebrations ended, each knew there would be difficult times ahead and much work to be done. But the willingness and eagerness to build beat strongly in the hearts of all . 22

Chapter 3

THE FORMATIVE YEARS 1905 - 1930

With the establishment of Alberta public health became the responsibility of the province, except on federally reserved lands. The Public Health Act of 1907 provided for the appointment of a Provincial Board of Health and the division of the province into Health Districts under local health boards. The duties of the provincial board were to see to the management of the local boards, the inspection of hospitals, gaols and orphanages, the collection of vital statistics and any other matters of general concern. The first Provincial Board of Health consisted of Dr. J. D. Lafferty, Calgary, Chairman; Dr. F. G. Newburn, Lethbridge; Dr. C. N. Cobbett, Edmonton; Dr. L. E. W . Irving, the Medical Officer of Health and Mr. R. B. Owens, Provincial Sanitary Engineer. The board was reduced to three members in 191 l consisting of the Medical Officer of Health as chairman the Provincial Sanitary Engineer and the Provincial Bacteriologist. Ministerial responsibility for the board and all matters of public health at first lay with the Attorney-Generals Department, then with the Department of Agriculture from 1909 to 1918 , then in a cabinet shuffle journeyed through the Provincial Secretary's Office through the Department of Municipal Affairs to come to rest in 1919 in a separate Department of Health. The first Medical Officer of Health, Dr. A. E. Clendenan, was appointed in 1906. He reported outbreaks of smallpox, diphtheria, scarlet fever and typhoid fever. Obviously one of the first tasks of the Department of Health would be to '/.. tackle the problem of communicable diseases. To assist in the control of typhoid fever he began to establish a sanitary inspection service to monitor public health practices. He also demanded the authority to begin cleaning up the closets in towns. He suggested the use of a bucket of galvanized iron or zinc , 16" deep and 16" in diameter for every closet, with extra pails on hand so that the full ones could be taken out while clean ones could be put in their place. He also planned to fill every existing pit that gathered nuisances and employed a scavenger to assist in his work. He saw the immediate challenge of cleaning up what already was. His long range goals were to ensure continued public sanitation through the provincial inspection service. The task of keeping public and private places clean could only be accomplished in the long run if the public was willing to cooperate. But first he had to convince them of the relationship between disease and sanitation . 23

Dr. Clendenan and his staff travelled thousands of miles across the province relying on medical and non-medical people to help provide for the public's health. Wherever he went he preached the need for proper hygiene as a means of combatting disease. Aside from the province the first Public Health Inspector was appointed in the City of Calgary in 1910. He used a horse and buggy to carry out his duties, and apparently received an allowance for the upkeep of his animal. His principle duties were the investigation of nuisances althoµgh it appears that very early he became involved in the inspection of dairy farms in efforts to improve the handling of raw milk supplies. The province employed Dr. Jim Butterfield as a sanitary inspector during -I the 1918-19 influenza epidemic. Butterfield, who had been invalided home from the army in France, was hired in a futile attempt to enforce the wearing of face masks and covering the nose and mouth in public places. His particular duties involved riding the trams to ensure that passengers wore their masks and he was provided with a yellow arm band identifying him as having official status. During the epidemic over 38 ,000 Albertans were reported to have contracted the flu and some 4.00U died during the epidemic. At the height of the danger public meetings were banned and theaters and schools in some areas were closed by local health authorities. After the influenza epidemic, Butterfield accepted a permanent appointment as Provincial Sanitary Inspector. He had a wide variety of tasks to perform and was responsible for checking: -Water works Hotels Ice Supplies Lodging Houses Sewage Disposal Restaurants Nuisances Grounds Cafes Systems of Scavenging Railway Stations Livery Stables Hospitals Abbatoirs Ice cream and soft Slaughter Houses drink places Meat Stores Bakeries Dairies Schools Creameries Inside and outside Places of Noxious every business house & Offensive trades Outside surroundings Cow Barns of every private home Dairy farms Lumber camps Cemetery sites Hospital sites All summer resorts 24

The li st was formidable for him and his smail staff. In addition he and his compatriots had to investigate a variety of complaints, help with food fairs and assist in the immunization of children against smallpox and diphtheria. The flu left behind the legacy that, not only in an emergency but on a day to day basis, every community needed the availability of public health facilities. The lack of trained people to handle large scale epidemics was too apparent. It was as a result of this near catastrophy that the province acted to create a Department of Health with an increase in staff and funding to bring about province wide programs aimed at preventing future outbreaks. With this increase in status public health officials began to plan how to eliminate communicable diseases from society. In 1907, the Alberta Provincial Laboratory was Established with Dr. G . V. L.. Revell as Provincial Bacteriologist. The laboratory proved invaluable in the study of bacteria, th_e examination of water and milk supplies and in the development of vaccines. This was just in time as smallpox broke out once more . Vaccinations, the disinfection of exposed buildings and goods and quarantine were methods used in the fight. If buildings could not be completly disinfected , they were burned and many a smouldering shanty dotted the landscape. In one instance, two men, picture framers by trade, contracted what they thought was a slight illness. It was a mild case of smallpox but was wrongly diagnosed as chicken pox. One can imagine the trail of infectious germs left behind as they travelled from house to house, town to town. Many were exposed and several serious cases developed as a result. As the population grew the health inspectors reported that sanitary conditions in the burgeoning cities and towns were at a low level. Unless checked, they predicted an increase in the incidences of communicable disease. The swelling wave of immigrants and transients was blamed for the spreading of the disease through their poor to non-existent personal hygiene. Scarlet fever appeared, necessitating the closing of some schools. Diphtheria emerged once more. When caught in its early stages this disease can be cured, but in outlying districts, diagnosis often came too late. Typhoid again swept the province. In spite of the constant and diligent efforts of the health inspectors many cases could be directly traced to raw sewage dumped into fresh water streams. Tuberculosis also took its toll with 40 dead in a single year. Typhoid and tuberculosis were to become major causes of concern during the province's early years. All the while the provincial laboratory worked tirelessly sampling everything from mother's milk, to water, to animal blood. A typhoid vaccine was developed and in 1913 free vaccine was supplied to any municipality requiring it. In 1915, a major step was taken toward stamping out smallpox. Although as early as 1908 Edmonton school children received compulsory vaccination it now became mandatory that all school children in the province be so immunized. 25

Mass immunization over the years finally Jed to stamping out this killer disease not only in Alberta but throughout the world. Ultimately, the Division of Communicable Disease Control was established to assist and advise local health authorities. In sparsely settled areas where no board of health existed it took direct charge of tracing the source and keeping abreast of new methods of prevention, treatment and cures. Of primary concern to the sanitary inspectors was the safety of the milk supply. It had become recognized that raw milk wa a potentially dangerous health hazard. Yet milk was moved from farm to dairy in milk cans that often stood unrefrigerated by the side of the road or stood unattended on station platforms for hours on end . The proper care of milk, the cleanliness of stables ,/ and the sterilization of equipment and milk containers was a major concern of health officials for decades to come. Only in the last 20 years has pasteurization been universally practised. The fight to have the dairy industry change over to pasteurization was not won easily. Tbe 1945 Public Health Act allowed municipalities to pass their own by­ laws in regard to pasteurization. Because pasteurizing meant the purchase of expensive equipment there was a good deal of opposition from dairymen . This took some time to overcome. Resistance was finally overcome when in Sas­ katchewan contaminated milk caused an epidemic in Regina College. As a result of impure milk, 404 students caught typhoid fever and nine died. Pasteurization would have prevented the tragedy. Convincing milk producers to clean up their operations now became much easier. When the rumblings of World War I became a grim reality, it touched the very pulse of the province. In the Department of Public Health, Dr. N. C. Laidlaw, who had been provincial Medical Officer of Health since 1912, offered hi s services and went overseas. So did Dr. 0 . C. Rankin, Director of the Provincial Laboratory. They, and many others, were sorely missed. But the monitoring of infectious diseases and the producing of vaccines continued. In­ deed, these vaccines, particularly the typhoid vaccine, were given to young soldiers before they departed for battle - literally a " shot in the arm" . The Canadian Forces overseas also required the services of 2,000 nurses. The bulk of this number came from Eastern Canada but Alberta proudly con­ tributed 65. They were young, trim and neat in smart light blue uniforms. Each wore a maple leaf badge, staunchly telling the world they were Canadian. Life for the doctors and nurses overseas was one long hard struggle. They tended to the wounded under almost impossible conditions. Often they were in the thick of bombing raids. There was a constant shortage of equipment and materials and they were pathetically understaffed. One nurse to 50 patients was not unusual. It was heart-breaking to see so many die, but deeply gratifying to be able to alleviate some of the suffering. To the sick, they were angels of mercy. 26

One major cause of death was the lack of blood for transfusions. A direct result of this was the forming of a Red Cross blood donor clinic in Edmonton under Sister Blackwell who had served overseas and witnessed the dire need. With the end of the war in 1918, there was an expectant sense of change in the air. The boys were coming home after securing peace for the world. The end of the fighting brought forth a promise of a better life for all. With the return to normality new demands were made upon public health services resulting in the creation of a Department of Health in 1919 under the Honourable A. G. McKay. Department status brought with it renewed energy and drive. Expansion quickly followed with the creation of new divisions and new directions of endeavour. Child welfare, the mentally deficient, indigent relief, neglected children, travelling clinics, hospitals, sanitariums, venereal dis­ ease, district nursing services, and much more demanded attention. The growth of the Department of Health was in part due to perceived needs but also in part due to a new social gospel of reform that was sweeping the Canadian-American west. The Social Gospel was a movement that brought forth v the promise of a better world through social action. Its members saw in a rising crime rate the symptoms of moral decay. The leaders favoured the suffragette movement, prohibition (1916-1923), stamping out narcotics, and increased government welfare and aid to the poor and needy. Public awareness of social evils and proper education would lead to a new utopia where social illness had no place. The social gospel found particular favour amongst the rural western areas of the continent which resulted in the election of a number of farmers' governments at the provincial level. Under social reform programs the Depart­ ment of Public Health was to undergo extensive expansion. From this point on the Department never looked back. With the formation of the Social Hygiene Division in 1920 under Dr. Harold Orr, an intensive program of treatment and prevention of venereal disease came into being. By the mid-forties , free clinics, drugs, and consultations were avail­ able. The biggest enemy of prevention was ignorance. In an effort to remove public ignorance, free literature, lectures and films were used extensively. Police forces cooperated in the identification of houses of prostitution. Surveys were made of Indian reserves and Metis settlements on a province wide basis in order to identify carriers and the afflicted so that treatment could take place. The first tuberculosis sanitarium opened in 1920. It was the only one in Alberta and at that time, was jointly sponsored by the federal and provincial governments. Much later in 1954, the province assumed full responsibility and renamed it The Baker Memorial Sanitarium in honour of its first director, Dr. A. H. Baker. The high incidence ofT.B. in Alberta was due in part to the influx of people into the province seeking a cure in the sunny and dry climate. The White Plague, as the disease was then known, was greatly feared and referred to only in hushed tones. Everyone believed the dreadful illness to be fatal. 27

The Tuberculosis Control Division organized an ambitious program to iden­ tify and monitor those who were afflicted. In an effort to help victims, clinics were opened in Drumheller in 1925 and Edmonton and Calgary in 1928 . A central registry was begun to record deaths, cases, suspects, and contacts. In the mid-forties, drawing on its Christmas seal funds, the Alberta Tu­ berculosis Association. purchased two mobile x-ray units and gave them to the Alberta Board of Public Health. These mobile units were an ideal way to reach all who were knowingly or unknowingly infected. In addition to the mobile x-ray units stationary and travelling clinics help greatly with the work of testing the public. The Alberta Tuberculosis Association and the Department of Health set up ./ an extensive rehabilitation program including occupation and vocational therapy and financial assistance. In the early l 920's emphasis was placed on establishing pre-natal clinics. Once more, the ever willing and competent public health nurses were put in charge. Now, also, schools were organized into public health districts. Five additional rural health regions were added. Then in 1923 , due to a slump in the economy, the number of public health nurses was suddenly reduced to only six . The disappointed public, particularly women's organizations, clamoured to X get their health services back in operation. Meetings were set up with municipal councils and an agreement was reached whereby the municipalities would pay 50% of the operating costs of local health services. In 1923 the Department took over the province's mental health program. At this time , too, there was a growing conviction that the insane or mentally retarded person owed hi s pathetic condition to hereditary causes. It was also v commonly thought that mentally deficient people were highly prolific - much more so than those of sane minds. Consequently, it was feared that insanity would steadily increase. This belief was largely responsible for the Sexual Ster­ ilization Act. Then a person suspected of being insane and therefore dangerous was either put in prison or given into the custody of a relative or friend . He would be taken to the Medicine Hat General Hospital where a few beds were reserved for the insane. Where these beds were full, the patients were kept in jails or confined elsewhere. Those patients who were severely disturbed - "prairie madness" , they called it, stemming, it was believed from isolated living -were sent to Brandon, under an arrangement with the Manitoba government. In 1911, the province constructed its own institution for mental patients at Ponoka and some 200 cases were transferred back from Brandon. The Mental Institute at Oliver, established in 1936, was designed for pris­ oners who were suspected of mental retardation. Another facility, The Provincial Mental Institute, opened in Edmonton. It specialized in the care of long - term 28 patients. Today, Edmonton has a centre for the care of the mentally handicapped. Even the name reveals that, over the years, there has been a marked change in attitude towards the mentally disturbed. When the tide of patients became more than Ponoka could handle auxiliary hospitals were built at Claresholm, Raymond and the Rosehaven Auxiliary at Camrose. They admit only patients who have been transferred from Ponoka. Their function is mainly one of continued treatment. Today, Alberta's mental hospitals provide the best facilities available. The patients are well treated and live in pleasant surroundings. When possible, ac­ ademic subjects and trades are taught. Large farms surround the hospitals. They provide an excellent opportunity to study agriculture. They also supply fresh produce, milk, meat, and vegetables for patients and staff. The women learn kitchen and housekeeping skills and beauty culture. All inmates are supervised y a trained staff and cared for by highly qualified personnel. In conjuction with mental hospitals, guidance and mental hygiene clinics began operating in 1929. They were staffed by psychiatrists and social workers who worked mainly with maladjusted persons or those with nervous disorders. By now, Alberta had three child welfare centres, several pre-natal clinics and, for the first time, a travelling clinic' This clinic was a unique method of reaching thousands of rural children who would simply have done without, had the clinic not come to them. This all began one sunny summer day in the small hamlet of Halcourt 80 kilometers southwest of Grande Prairie. It would probably never have begun at all had it not been for Miss Olive Watherson who was the District Nurse. During the course of her regular examinations of the children she was appalled to find many in dire need of surgical, medical or dental treatment. But it was a hopeless predicament. Hospitals and doctors were miles away. Anyway, the expense that would be involved represented a staggering sum to most of the parents. Consequently, a youngster simply did not get the treatment needed. But Miss Watherson came up with an idea. She invited Dr. Carlisle of Saskatoon Lake to come into her district during the summer holidays to conduct a clinic. The doctor was somewhat taken aback. But after Miss Watherson's vivid account of the plight of the children, he willingly agreed. Together they made the arrangements to set up a clinic in the Halcourt Church. The first clinic was held on a day in July 1924. No statistics are available but we do know it was a huge success! So much so, that other clinics were organized on a provincial basis and travelling clinics began to serve the more remote areas. Dr. R. T. Washburn, Superintendent of the University of Alberta, supervised their operation. The clinic staff consisted of a physician, a surgeon, two dentists, three nurses, a medical and a dental student to act as assistants and two truck drivers. 29

Equipment and personnel travelled in the trucks and a car. The rough country roads were either thick with mud or hung with dust but a good sense of humour, high spirits and the sure knowledge it was all for a worthwhile cause, helped the group carry on. The clinics visited wherever services were requested. As many as twelve school districts would combine to form a foca l poi nt where the clinic stayed for two days . The first day was devoted to physical and dental examinations, the second to surgery - tonsil s, adenoids and other minor operations and dental work. In preparation fo r the clinic , a local committee was formed. A public health nurse or a district nurse as the case might be, met with the people and explained what must be done before the clinic arrived. Schools, churches, and community hall s served as centres. All pitched in , cleaning and scrubbing and polishing till the place was spotless . A few local people were appointed to assist as registrars, messengers, and janitors. One of the unenviable tasks performed by the latter was the carryi ng out of tubs full of blood, tonsil s, adenoids and what have you. But it was a job that must be done and they cheerfully tied ri ght in . When the time arrived , there were mixed emotions among the children. The nurse had already made preliminary examinati ons to determine who needed medical attention. Understandably, those singled out for this dubious honour viewed the whole thing wi th apprehension. Anxious parents travelled many miles, usuall y by horse and buggy, oxen or mules, to bring their children to the clinic. Each patient supplied his own cot and blankets. The parents also camped on the site until the evening of the second day when their youngsters were allowed to go home . On the third day, th e staff packed up and started out for the next centre. During its acti ve years, the clinic visited an average of 24 centres annuall y. Through years of operation from 1924 to 193 1 and again from 1934 to 1942, it did not have one fatality. The thousands who were helped, still remember the travelling clinic with deep gratitude. One of the most important aspects of public health was the training of hundreds of highl y qualifi ed totally dedicated publi c health nurses. A Division of Public Health Nurses was establi shed in 19 19. On April I , of that year, Mi ss Christine Smith was appointed superintendent of four graduate nurses - Bessie Sargent, Maude Davidson, Eli zabeth Clark, and Gladys Thurston. Before they were dispatched to do field work , they under­ went two months of intensive training at the university in lectures and practical work for the demanding services ahead. Post graduate work was approved for public health nurses in sanitation, personal hygiene , bacteriology, public health , eye examinati on, ear, throat and teeth examinations, pre-natal , infant welfare, child wefare, inspectors in school, communicable disease, prevention methods and other studies that the university prescribed from time to time. Then, according 30 to need, they were placed at various points in the province. Their task was difficult but rewarding. They enjoyed instant popularity. School boards and women's organizations clamored for their services. And thi s was but the beginning' Three competent District Nurses with special maternity training were sent forth - two to the Peace River District and one was stationed 80 kilometers west of Wetaskiwin. Recognizing the need for the nurses to have their own headquarters closer to their far- flung northern districts, Grande Prairie was chosen to fill this function. Among other things, it would store all equipment, compile reports and, to the joy of anxious mothers throughout the area, hold a clinic every Saturday. The nurses did , however, run into occasional resistance. But friendly coaxing usually persuaded reluctant mothers to bring their children in for examinations and treatment. However, the year also brought tragedy. Once more, smallpox attacked the province and, striking terror into the hearts of all, the Spanish flu epidemic ravaged the land. This deadly disease was a viral type. Hundreds of deaths occurred. Emergency hospitals were set up in a desperate attempt to cope with the fearful situation. Volunteers made meals to send out to those affected. Nurses scoured the rural areas and city slums looking for victims. Nursing services were demanded at all points. The following year with Charles Mitchell as Minister of Health, the province was divided into health districts. Each district had its own Local Board of Health. The larger districts had a full-time Medical Officer of Health. Four trained nurses were sent out with the intent of reaching the impressionable young minds of school children by demonstrations of good health practices and the extreme importance of strictly following them. Home instruction was also included in the nurses' duties. The nurse was always welcome, sometimes eagerly, sometimes shyly. By chatting with the family - perhaps sitting near a crackling wood fire and sipping tea - many valuable lessons were learned. 31

Chapter 4 THE CITY OF EDMONTON LOCAL BOARD OF HEAL TH

As the population of Alberta continued to grow so did the work of the health departments in Edmonton and Calgary. These urban boards have a long history of public service. Far ahead of their rural counterparts they served as examples of what fully staffed public health organizations could do. A look at the bustling metropolis of Edmonton today makes it difficult to imagine what it was like a hundred years ago. In 1872, the Edmonton trading post was but a small pocket of civilization set in the midst of miles and miles of sweepir;g prairie and tangled wilderness. Undaunted by the primitive condi­ tions, crude dwellings, seas of mud or swirling dust in summer, blizzards and sub zero temperatures in winter, early pioneers were determined to make a go of it. The rich furs and leathers brought in by the most skilled hunters in the world were the inducement that drew the fur men up the Saskatchewan River and into the Athabasca region. As trade became brisk and land pressure in eastern Canada grew settlers flocked in. Fort Edmonton grew with the boom . And grow it did. During the next 20 years, the lone fort became a sprawling village and finally reached the proportions of a small town. As the need for roads, railroads and bridges became more pressing, the citizens lobbied for local government. On February I 0, 1892, Edmonton became a city with its own corporate body, ready to assume the responsibilities and enjoy the privileges of municipal status. The town council immediately directed its energies toward such matters as roads, licensing acts and land expropriation for expansion. But that spring, when a smallpox epidemic broke out in the south of the territories the council came to the realization that something had to be done. So far the public's health had been virtually ignored but the council rallied quickly to meet the coming threat. A Board of Health was set up - Edmonton's first. Members of the fir st board were , Mayor Matt McCauley , councillors John Cameron, Colin Strang, Frank Oliver and P. Gaunce. Dr. P. Royal and Dr. Edward A. Braithwaite were appointed health officers with Dr. Braithwaite as Chief Medical Officer. These respected members of the community lent weight to the activities of the public health staff. Members of the board were authorized to inspect private and public premises, place quarantines, order infected articles 32 to be di sinfected and inspect incoming trains. In short, they were given the authority to make any regulations considered necessary to curb the spread of infection. There was to be a concerted effort to avoid the situation in the older European and Nmth American cities that bred disease. In Edmonton the streets were to be cleaned, garbage taken away and proper sanitation enforced. Dr. Braithwaite, a colourful character, was a busy man. Besides his duties as Medical Officer, for which he received the grand sum of $10 a month, he ran a flourishing private practice, acted as coroner, was surgeon for the Canadian National Railway and local winter camps and lumber mills, and Acting Assisting Surgeon for the Royal Northwest Mounted Police. He led a full social life as well. But mostly he is fondly and gratefully remembered for his role as first Medical Officer of Health. The smallpox scare did not materialize but other problems arose to keep the new health board more than occupied! Edmonton's population increased with astounding speed. Over 60,000 came with the wheat boom of the I890's. As the city grew, so did the problems. Litter was strewn everywhere. Many residents kept livestock and the resulting filth and odours offended even the most insensitive nose! Homes and lodging houses were grossly overcrowded; sewer and water systems almost non-existent. Outdoor privies and water hauled by tanks were the orders of the day for most. On the whole, sanitation was such that disease germs could have a virtual picnic! Obviously, they did! A sharp increase in typhoid at the turn of the century was proof. By now Dr. Braithwaite had resigned and Dr. Teman held his post. In an attempt to quell the constant threat of disease, the Board of Health set up an improved garbage collecting system. Also, a makeshift isolation 'hospital' was erected on the site which is now Clarke Stadium. But it soon became obvious this facility was far from satisfactory. Indeed, citizens referred to it as a " pest house" . Horror stories spread about the appalling state of food and sanitation. For the most part, patients were housed in chilly camp tents. Some even suffered

frostbite'But the sufferance of the populace reached a peak when a young boy contracted pneumonia and died. Dr. Teman was summoned to appear before a civic commission. He was ordered to investigate conditions at the Isolation Hospital. He was also charged with not taking sufficient measure to eliminate typhoid, that the privy-emptying of his department was unsatisfactory and that money was being extravagantly spent. Undaunted , the doctor denied all charges, stating the false accusations originated from an untrustworthy sub-foreman in the Department. The upshot of it all was that the commission decided a new modern Isolation Hospital be built at once. And it was. But Dr. Teman did not remain as Medical Officer of Health long enough to administer the new facility . In 1908, Dr. Thomas Whitelaw replaced him. 33

In 1907, the Local Board of Health lost some of its freedom. Under The Public Health Act Edmonton became one of ten health districts set up in the Province. This meant that the Local Board would have to operate under the jurisdiction of the Provincial Board of Health. Dr. Whitelaw attacked Edmonton's multiple health problems. With the steady growth of the city, more and more unwanted garbage grew along with it. The doctor delved into this problem. He hired ten more disposal teams and exerted every effort to enforce stringent regulations . Next he turned his attention to slaughter houses. The department was flooded with complaints about odours and piled-up manure. More notices were issued - improve your premises or we'll close your doors! He also urged that tighter regulations regarding sewer and water be instituted. Regulations were drawn up to halt the use of river water for drinking. In this the Department was only moderately successful as those living close to the river could not resist the temptation of drawing water from the muddied stream. ln 1910 a full time milk inspector was employed and milk inspection pro­ grams were upgraded. Since science had proven a strong link between tuber­ culosis and unpasteurized milk compulsory pasteurization was considered but not enforced. Dairymen were, however, urged to have their milk cows regularly undergo a tuberculin test. Edmonton was a pioneer in one of the most important fields of early health - smallpox vaccination. From 1908 to 1911, a program for compulsory vac­ cination of school children was promoted. Rather than realizing this as a blessing many parents were openly hostile. They claimed that an injection of this dreadful germ would cause horrible illness and even death. The newspaper was swamped with stormy letters of protest. Dr. Whitelaw attempted to cairn their fears by responding in print with proof that the vaccine was not only harmless but a life­ saver. Anyway, the Board went ahead. Their power to do so was confirmed by the Provincial Health Act. Jn 1912, when smallpox struck again, the wisdom of this program was proven once and for all. Not one of the vaccinated children contracted the disease! In 1911, the Board of Health suddenly became responsible for 6,000 more citizens when Strathcona and Edmonton amalgamated. The Board needed to expand its activities to meet the responsibility of the larger area. As a result, three additional inspectors were hired. One of them was Edmonton's first food inspector, Dr. Haworth. It was quickly shown that this was a much needed service. During his first year, the inspector ordered the destruction of 61, 113 pounds of meat, destined for sale in Edmonton! Dairies were the next to receive close scrutiny. Dairy inspections, compre­ hensive education programs, which consisted of concepts and techniques of cleanliness, proved surprisingly successful. It didn't take long for the dairymen to learn to capitalize on the prestige of spotless inspection records! A few, 34 however, still tried to sneak by with such practices as diluting milk with water and skimming cream 1 With the new addition to the city, sewer and water became more important than ever. Another outbreak of typhoid prompted the Board to take steps toward completing a year round water treatment plant. Despite constant urgings that citizens install water and sewer, many did not , because they couldn't afford it. The Board approached city council with the suggestion that help be extended to them. However, thi s did not happen . Garbage disposal was a continuing problem. Even collecting it was difficult. Garbage wagons bogged down axle deep in mud in the back alleys. After l 910 the health department began to level the back alleys and lanes in the downtown area to get rid of pot holes and ruts that collected refuse. In 19 l 3 this work was taken over by the city street department. But where to put the refuse, once coilected? The city had closed the original Grierson Street Dump and had offered no alternative. This refuse included l 20 loads of manure daily! Finally, a lot on the Hudson Bay Reserve was chosen. However, understandably enough, thi s did not please the Hudson Bay Company at all! In no uncertain terms , they let the city know about it! Finally, a new site was found on Kinaird Street. But since this was far away, many residents dumped their manure illegally, closer to home. At this time, the board wisely suggested to city council they establish a planning committee to ensure efficient and orderly growth and sanitation in the sprawling city. Proper ventilation, water and sewer services were proposed for all civic buildings despite the high cost of changeover. The Board of Health stated, " nothing will contribute more to make our city great in future than to make it possible for the honest hard-working citizen to provide himself and family with at least a reasonable approach to sanitation and comfort." Education programs were started to make the public aware of the need for sanitation. Womens' groups became involved in promoting better health prac­ tices. And for the home a "swat the fly " program was initiated. Dr. Whitelaw, still Medical Officer, kept tackling problems as they crept up . Strong-willed and outspoken, things were never dull when he was around! With never a fear of recrimination he fired staff members if he felt they were unqualified or untrustworthy. No doubt he made enemies but heated arguments were taken in stride. To him, the city's health held top priority. At one point, he was engaged in a serious confrontation with the civic health nurses at the Isolation Hospital. He felt their demands for higher wages and better working conditions, far too " lofty and nervy". The nurses retaliated. In a daring move, they marched on city hall demanding an audience with the Mayor. Dr. Whitelaw, viewing the demonstration, confided to a newspaper reporter, "I'm afraid I shall have to get rid of the whole bunch". And he did! However, after the incident, which resulted in court proceedings, 35

Judge Crawford ruled that henceforth responsibility for the Isolation Hospital, would be transferred to a municipal hospital board. Although his behaviour was often unconventional, causing both the Board of Health and town council moments of embarrassment and chagrin, his valuable leadership remained undisputed . Under his guidance, health standards rose steadily. While nations rocked under the shattering impact of World War I, individ­ uals, villages, towns and cities were all touched by the disaster. In Edmonton, all civic departments suffered severe budget cutbacks. This, of course, included the Board of Health. It took some head scratching to decide how to avoid sacrificing essential health programs with the limited money now at their disposal. Because of reduced staff, all worked longer hours. Fortunately, communicable diseases were at a gratifyingly low ebb during the war years. Very few deaths occurred. lt became a matter of patriotism to maintain one's own good health and the general cleanliness of the streets and civic buildings became a matter of pride. As a result, vacant isolation beds were used for the chronically ill. Edmonton had no facility for such patients at that time. When the war finally dragged to a close, hopes were high that health programs would soon be renewed. But these hopes were quickly dashed . In mid­ October, 1918, influenza struck Edmonton with savage force. Within two weeks, 337 patients were hospitalized, while over 1,900 more were confined to their homes. The suddenness of the blow caught the city unprepared. With the horror on their doorstep, they attempted to prevent further spread of the disease. Reg­ ulations were passed forbidding attendance at schools, large social gatherings and churches. A few weeks later, store and office hours were reduced to five. For a short period, visitors to Edmonton probably felt they were in a science fiction world! All citizens had been ordered to wear masks! However, this regulation was soon rescinded as being impossible to enforce. In all, some 6, 130 cases were reported resulting in three deaths directly attributed to the epidemic. Most of the preventive attempts were futile. The Board of Health turned instead to treating the illness, hoping to loosen its stranglehold. Nurses, teachers, volunteers all pitched in to help with patients and the many sorely afflicted families. Food and medical supplies were provided where needed. Hot meals were made available and served to the sick. A twenty-four hour automobile service was made available to flu victims. When the dreadful ordeal was finally over, the Board of Health announced, "Citizens of all classes responded nobly to the appeal for help. " Apart from all else influenza made the public aware of the need for proper hygiene and nutrition. On the heels of the flu epidemic, another rash of communicable diseases broke out, diphtheria leading the group. However, in 1923 , a new anti-toxin 36 serum was introduced on an experimental basis by Dr. Whitelaw. It was enor­ mously effective. The value of cleanliness became ever more evident in disease prevention. With increased funding, the department now hired two more sanitary inspectors. Rigid enforcement of sewer and water by-laws was attempted. But the early twenties still saw almost 2,000 outhouses in the city. Complaints about livestock still filtered in. Efforts were continued to rid dwellings of bed bugs and cock­ roaches. People were encouraged to take domestic water from fire hydrants rather than private wells or from the river. With Dr. Whitelaw' s retirement in 1929, the new Medical Health Officer, Dr. R. B. Jenkins, was immediately plunged into the dismal throes of the depression. In spite of universal poverty and hardships, he worked ceaselessly toward maintaining Edmonton's health standards. Under his leadership, the health services were expanded, nursing services broadened, sanitation and milk and food inspections were once more upgraded. Although highly respected by all, his health crusade occasionally drew criticisms. Following is one such in­ cident: Because it was almost impossible to earn a living during those dreadful days, about 50 men erected shacks at the City Dump. They salvaged anything worthwhile at all and sold it. Thus they were actually able to support themselves! As the garbage crept closer to their doorstep, they simply moved their shacks back. Dr. Jenkins was horrified. "A hotbed of disease," he declared, ordering the shacks destroyed. The men would be housed in an old downtown firehall. Many citizens protested. These resourceful men were able to stay off relief! Let them be, they screamed. But the doctor stood firm and the shacks were razed. During these difficult years, the Department of Health did everything in its power to help the needy. Because of high infant mortality, pre and post natal programs were intensified. New day care centres were established. In 1935, polio threatened once more. Again bans were placed on schools and public gatherings. And no kissing! During the early thirties, much thought was given to amalgamating school and public health. Some of the school board members were in disagreement, fearing a lowering of school health standards. Countless stormy sessions were held. Then the Legislature passed the School Health Act in 1934, permitting the transfer of school health to the civic health board. But due to continued fierce resistance and a number of other problems, the merger in Edmonton did not come true until 18 years later. To the regret of Edmontonions, Dr. Jenkins left in 1937. But his successor, Dr. G. Meldrum Little, proved to be an equally staunch and enthusiastic supporter of public health . With the end of the depression and the outbreak of World War II, unemployment and destitution gradually improved. And Dr. Little launched the most forceful campaign yet, against communicable diseases. Suprisingly Well Baby Clinic in the 1920's (Edmonton Local Board of Health) Weighing-in (Edmonton Local Board of Health)

City of Edmonton Health Department OUIRINTINED DIPHTHERIA Any person entering or leaving these premises without permission will be prosecuted. Penalty for so doing, or removing or defacing this card, $ 0 and costs. Notice of Quarantine MEDICAL OFFICER OF HEAL TH (Edmonton Local Board of Health) 39 enough . there was still some resistance to immunization. The doctor managed to convey the impression that parents who refused vaccinations for their children were no better than beastly murderers of innocent babies 1 Another disturbing fact emerged. During the war years. heart ailments increased alarmingly and topped the list of deaths. Stress and pressure were believed responsible. More responsibility for good health was placed on the individual in the name of patriotism. In efforts to assist the war effort extra care was taken by food and milk handlers to ensure safe supplies and proper diets for those on the home front. In 1943. when the Board of Health learned about 600 residents who still kept cows and goats within the city limits, it finally placed a ban on livestock within the innerci~. With the discovery of oil at Leduc in 1947, Edmonton was dismayed at the sudden surge of new residents. The Board of Public Health, always pressed for funds , found major new problems springing up everywhere. High on the li st were appalling conditions of overcrowding and a drastic deterioration of health standards in many restaurants. An indignant public demanded more stringent inspections of eating places. Inspections routinely revealed dirty pots and pans in some kitchens. Rather than threatening a closure, samples of bacteria were cultivated, then shown to the proprietors through a microscope. Sight of the slithering. crawling mass, was usually enough to start a total clean-up. No doubt , they didn't relish eating " those bugs" either! In the mid I 950's polio again reared its ugly head . This time the department decided not to close the schools or public places of meeting, but rather to encourage the population to remain calm, avoid over exertion, dampness and take reasonable precautions. Banning public gatherings was considered unwise. Keeping students in classrooms was thought better than having them run about the streets. With the introduction of Salk vaccine much of the danger of polio was reduced. Also in the I 950's health officials became involved in civil defence. At the height of the Cold War Edmonton became a possible target for nuclear attack. The Nisku air base housed American re-fueling tankers that supported Strategic Air Command B52's patrolling the Arctic coastline. Government and civic agen­ cies were brought together to plan their response to a nuclear bomber attack. It was estimated that an atomic warhead detonated above Jasper A venue and I 0 I Street would result in as many as 75 ,000 dead and an equal number of battle casualties. A number of practise exercises were carried out despite the futility of the situation. One sixth of Alberta's populace lived in Edmonton. The teeming population put a great strain on the health department grown big to include a number of extra agencies. The expansion in 1952 resulted in larger grants. A dental program was begun with classes in dental hygiene and the matter of fluoridation was 40

introduced to the public. Again, resistance was encountered. Many felt thi was " tampering" with the water supply. In the 1970's the Provincial Government, endorsed by the Board of Health , approved an emergency dental clinic at the University of Alberta. Clinic hours were week day evenings, holiday afternoons and weekends. With the coming of the I 960's the Edmonton Board of Health could no longer enjoy functioning as an intimate family unit. Under the direction of Dr. George Ball, the new Medical Officer si nce 1960, much needed reorganization took place. Health services were decentralized to neighbourhood clinics. Most of the e were built near shopping centres. The new Glengarry Clinic was con­ structed and many older clinics were renovated to meet the growing needs. The increase in population also required expanded programs to suit the public needs. More public health nurses. inspectors, and clerical staff were hired. Then in 1962 and 1964 respectively , the Beverly and Jasper Pl ace health units were absorbed into Edmonton's health system. The following year, th e overcrowded Central Health Clinic was moved to the Avord Arms Building. An old threat to health grew frightening. In 1968, Edmonton possessed the highest rate of venereal disease of any Canadian City. Education and treatment programs were intensified. The Y.D. treatment clinic wa only one of the spe­ ciali zed programs established at this time. ln an attempt to upgrade preschool screening, Dr. Ball invited Dr. Nelson, founder of the department's first preschool clinic, to study and design more effective preschool tests. New visual, hearing and behavioural tests were added to the program, whi ch included physical examinati ons as well. Youngsters who fa il ed parts of the test were referred to consulting physicians. A surprising fact emerged. There was a real need for speech therapy. Consequently, this received prompt attenti on. Ment al Health also received new attenti on. In 1969, headed by Dr. Phillips, the Mental Health Division was opened. As well as treatment and counselling, programs were broadened to help minimize social problems resulting from mental illness. The Di vision was a huge success, even undertaking, in 1972, an inves­ ti gation into the tragic problem of battered children . Special courses on child development, family life, etc. were prepared and offered to interested groups. Then as more mothers began returning to th e work force emphasis was placed on the social welfare aspects of th e day care for children. With un wanted pregnancies steadil y increasing, a fami ly clinic was set up in 1968 . Here clinical examinations and advice on birth control were offered. Even though some doubted whether the Board of Health should handle this. its popularity was soon proven . By 1973 there was need for expansion. More clinics were opened as provincial funds became available. With drug abuse rising steadily, the Board of Health set up a program combining the 47 social service agencies and volunteer groups already dealing 41 with the problem. Among them was TRUST, an organization manned totally by young people anxious to help their peers. Eventually, all were combined under one drug program which was established under the Mental Health Division. Lastly, the department felt the news media had a tendency to sensationalize - even glamorize - the issue of drugs thus making them appeal to our youth. A request was made to the news people to tone the whole issue down. Of grave concern, also, were the deplorable living conditions of Edmonton' s Indians and Metis. In 1972, a program was instigated which employed natives in an attempt to familiarize the Indian population with the services which were available. It worked out very well. During the early seventies, the Board of Health once more gave careful scrutiny to the very young and the very old. With more and more working mothers, the need for day care centres had soared. It was felt these facilities could most effectively be upgraded by establishing a Day Care Centre Board. It was realized even more fully, that most elderly citizens much preferred to stay in their own homes rather than move to an institution. Often they were not totally able to care for themselves, so in 1973, under the joint administration of the Board of Health and Edmonton Social Services Department, a civic Home Care program was set up . To the delight of the older people, they could now look forward to innumerable valuable services - help with small chores, meals­ on-wheels, errands taken care of, help with their financial affairs, physiotherapy, home nursing, and perhaps appreciated as much as anything by the lonely, just pl ain companionship. But most importantly, they could now stay in their own homes' After careful study, the Food Inspection Division, headed by Inspector Dr. K. S. Penni fold, published guidelines outlining the amount of bacterial organisms which could be present in food and still maintain a safe level. This arduous task was accomplished by purchasing slabs of meat for testing. A portion was always left with the owner so he could do his own testing, if he wished, in order to compare results. But then because of a budget cutback, it became impossible to buy this meat. Undaunted, the Division carried on. With small bowls in hand, they went "begging" for meat samples. They were laughingly referred to as " monks with begging bowls" . But most owners were co-operative. In 1973, regulations stipulated that food and drink displays must be main­ tained at no more than 140 degrees F. or less than 40 degrees F. Chinese restaurants displaying barbequed meat complained this ruined the fl avour. The merchants took their case to the Provincial Government and finally to the Federal Food and Drug Department. While the issue was being resolved, the ban was temporarily lifted. This drew sharp criticism from health officials. In 1975, the regulations were again enforced but four years later the issue surfaced again. One disgruntled merchant remarked caustically, "If this meat is so dangerous, the Chinese population would not boast 900 million!" But the board stood firm. 42

Dr. Ball will always be remembered. among countless other achievements, for his report which resulted in Bill 87. An Act respecting Public Health Regions. Consideration of this bill in 1973 , resulted, to the surprise of all, in the province taking over all funding for the Board of Health with no loss of autonomy. One result was a general upgrading of facilities in some health units that had fallen behind due to local funding difficulties. Dr. James Howell became Medical Officer in 1975. A Nutrition Division was set up and a Health Educator and Research Officer were added to the department. When the Commonwealth Games came to Edmonton in 1978, health regulations regarding food and lodging were strictly enforced. With the swine flu scare of 1976-1977 immunization programs were hur­ riedly organized - almost as hurriedly abandoned! When Dr. Howell heard of the possible detrimental side-affects of the vaccine, he had to make a swift decision whether to continue or not - and the news came at an inopportune time! it was December 16 , 1976. One thousand people had been standing in line for hours at the Exhibition grounds, waiting for their "shots". No doubt, it was not an easy task to tell them the program had been curtailed - except for chronically ill patients - until the results of the U.S. investigations were known. With the possibility of paralysis or death resulting from the vaccine. it was a wise decision. Fortunately, the anticipated flu did not reach epidemic propor­ tions. Studies of the relationship between the flu vaccine and the Guillaine-Barre syndrome concluded that a link did exist although uncertainty persisted as to the exact cause and extent of the correlation. Edmonton's eight health clinics continued of offer excellent service. Due to Dr. Howell's concern for the underprivileged, the Health Centre was opened in 1980. This year also, the government implemented a program of physical aids for the disabled. In spite of all the health units, there was a shocking lack of medical services in the inner city - specifically, the area north of the railway tracks and east of I 0 I Street, including the Boyle Street and McCauley neighbourhoods. In this area over 15 ,000 people most of whom are transients or otherwise disadvantaged such as the elderly, drug addicts, single parents and various ethnic minorities, needed some type of medical assistance. Within the region there were no resident doctors or dentists. As hi s office overlooked this area, Dr. Howell became increasingly con­ scious of the need for improved medical services. He instituted a thorough research study which was supported by the University of Alberta, Department of Community Medicine and the Medical Services Research Foundation. These results became known as the McDonald-Greenhill Report. One of its major recommendations was the establishment of a community health centre. Dr. Howell predicted that involving the community in solving its own problem would prove a difficult but rewarding task. Frustrated by a false start 43 that led nowhere, he was soon to be surprised by the wealth of talent which readily surfaced , and by the selfless commitment of those volunteers. Good will and cooperation abounded among government and community agencies, and ideological considerations did not intrude unduly. Though occasionally irritated by the need to repeatedly stress and review some of the most basic principles of health care, he nevertheless discerned a steady pattern of progress and took heart from the group's rugged determination to succeed. And succeed they did. For months Dr. Howell struggled to fulfill this need. He approached char­ itable foundations and was finally able to engage the services of the Medical Mission Sisters who brought the project to life by forming a voluntary society. With the financial support of Alberta Social Services and Community Health through the Edmonton Local Board of Health , Alberta Hospitals and Medical Care plus various voluntary donations, the cherished goal was reached. The clinic opened in 1979, providing a range of services and fulfilling an enormous need. The Edmonton Local Board of Health has been outstandingly sensitive to changing health needs, and competent in meeting these needs . During the last 100 years, it has come a long way. By 1980, it had grown into a smoothly operating organization employing 320 people - a far cry from its humble beginning as a one man show. The impact of the Local Board of Health and Health Department on the development of Edmonton has already been substantial . The gradual success of upgrading sanitation levels and reducing communicable disease rates contributed positively to the economic and social growth of the city by preventing, or at least mitigating, physical , financial and moral setbacks associated with the spread of disease and decay in urban areas. Throughout the I 980's the Board will experience continued pressure to expand its services and to develop new programs to handle the evolving health problems of a mushrooming metropolis. New administrative challenges can be expected as efforts are made to broaden and extend the scope of department programs. Through the development of increasingly complex and effective disease prevention and control programs over the years, Edmonton's public health serv­ ices have provided a solid basis for future development. 44

Chapter 5

CITY OF CALGARY LOCAL BOARD OF HEAL TH

In 1903 a proposal to establish a civic health department in Calgary was made. For some unknown reason the idea did not materialize until ten years later. Then in July of 1913 a Pure Milk Station for babies was set up under Miss Mary Patterson. This station was in the Strathcona Block on 3rd Street E. near 7th A venue. Its goal was to provide pure milk to undernourished infants. The babies were weighed each week and the mothers given advice on the care and feeding of their children. In cases where the parents were unable to pay for the milk it was supplied free of charge. Within four months 817 gallons of milk were dispensed and $246.06 was received in payment. A great many mothers of all nationalities were taught the better care of their babies. Many regrets were expressed when it was decided to close the depot. The station was closed because plans were underfoot to establish a larger infant health clinic. At the same time starting in November an infant hygiene care program for the horn was begun. During November and December 160 visits were made mostly to poorer families who could not afford the services of a trained nurse at the time of childbirth. These mothers in many cases were quite ignorant as to the general care of an infant during the first months of its existence. Thus an effort was made to call on all babies as soon as possible after they left the hospital. The mothers were taught the proper method of preparing food, care of nursing bottles, and also the value of fresh air, light and cleanliness. They were warned against the uses of patent medicines, soothing syrups and com­ forters. In almost all cases the nurse found the mothers only too glad to learn more about the care of the child. In other areas programs designed to educate the public on methods of controlling infection and contagious diseases were begun. Emphasis was also placed on cleaning up the city lanes and streets. By-laws on milk delivery and inspection of dairies and water supplies from wells helped to upgrade facilities with a noted downtrend in the death rate. The following year a free well baby clinic was established on the top floor of the Police Building. Miss Patterson was in charge. In 1921, the clinic moved to the General Hospital . But attendance was poor - perhaps because of the cold draughty hall where the mothers had to wait. So another move was contemplated. But city council insisted four regional clinics be set up. 45

One new location - in south Calgary - was in the basement of a ;chool, with, luckily , a furnace near by. Another was set up in a church hall which was usuall y too cold for undressing babies. Attendance was often nil. The other location was in Hillhurst in the fireman 's room of the Fire Hall. It was so cold pl ants in the window often froze. It had the added hazard of a gaping hole in the centre of the room through which the firemen slid down. This had to be fenced off with beds to prevent fatal accidents. Still , since younsters race around constantly they had to be closely watched for fear they would crawl underneath and fall through. Attendance was good but the firemen had a complaint - their beds were always wet! These beds were the only facility for undressing and changing the babies. After six months of trial the board went back to the original idea of a central clinic. Miss Marion Lavell and Miss S. A. Craig were choosen to set it up . In establishing the Infant and Pre-School Clinic Miss Lavell had great difficulty in finding out what had already been accomplished. Few records existed of all of the work of earlier years. She set out to record the history of her patients and to devise a satisfactory system of record keeping. The results were gratifying. The new unit was well-planned and equipped with three examining rooms. Ors. F. W . Stockton, Lewis Clark, and E. 8 . Roach directed the clinic for many years. In 1923, Dr. A. T. Spankie eye, ear, nose and th roat specialist. joined them. He remained in this post until hi s death in 1944 . In the meanwhile, Dr. E. R. Upton undertook all dental care for pre-school and elementary school children. For him, 1923 was a record year with over 5,000 children being examined. The services at the central clinic were generally welcomed. However a strong anti-vaccination society worked diligently to make their views known. Hundreds of letters were addressed to the daily newspapers. Their members marched in the Stampede parade, loudly proclaiming their rejection of immu­ nization of any kind' No one was going to inject germs into their bodies. Health officials and family doctors quietly launched a powerful counter­ campaign. A stand was taken on the Diphtheria Toxoid as the nurses were truthfully able to tell them it was not a vaccination. When the toxin did not upset the babies more and more of the protesters agreed to use it . In the same manner prevention of whooping cough and later smallpox treatment followed . In a few years the anti-immunization groups were won over and then the only question asked was when their children should have it? In 1932 and during the depression the provincial Red Cross, Saint John's Ambulance Association and the Calgary branch of the Red Cross together es­ tablished a first aid station to help those out of work and on relief. This proved to be a welcome haven where advice, help and comfort were offered to the destitute. Many unemployed transients visited the premises in search of proper nourishment and care. In 1933, the aid station was moved to the Immigration 46

Building. Patients crowded the clinic daily. More appeared when the cold weather brought to light others suffering from th e bad times . As the work load increased a medi cal officer was appointed. In hi s first two months he interviewed and prescribed treatment for over 400 patients. Great qu antities of medicine and dressings were used and special foods were also ordered in some cases . The problem of diet became so acute that a special tab le was set up at the community kitchen . Later the aid stati on was essentially taken over by the Alberta Rel ief Commission. In 1932, Dr. W. H. Hill was named as Medical Officer of Health for the city. He was the first fully trained Public Health Officer Calgary had ever had . He was also chi ef adm ini strator of the General and Isolati on Hospitals. Who was to know at that time that Dr. Hill would diligently and se lflessly serve Calgary for the next 28 years! Dr. Hill had a fascinating background. Born in Liverpool , England, he signed on with a West African shipping firm. For the next three years he plied the seas between ports on the Gold Coast, the Slave Coast and England before coming to Canada. In the fall of 1906, he arrived in Calgary and then entered medi ci ne in the University of Alberta and later at McGi ll University. Before he graduated in 1919, hi s studies were interrupted by a stint in the navy during World War I. He assumed his new position as Calgary's Medical Officer of Health with a degree of competence and dedicati on. Hi s job as Medical Officer of Health had its moments! One such incident in 1937 was more exciting than anyone could wish! He entered his office whi ch was in semi-dark ness due to a burned out li ght bulb and was about to si t down at his desk when an incredible thing happened' A woman had been quietly waiting in the dusky office. As he sat down she rushed out and shot him in the back! Then she attacked him with a saw-toothed kitchen knife! Had it not been for th e quick action of a co-worker, the doctor would probably have been mur­ dered. The crazed woman was intent on killing him . As it was, the woman, a mentally ill recipient on reli ef, was forcibly subdued. The bullet was removed from Dr. Hill 's back. As a result of thi s att ack he never again had the full use of hi s right arm . The depression years saw a marked increase in sui cides and homicides . It was generall y believed econom ic stress was a prime contributing fac tor. Chief Sanitary Inspector J. J. Dunn reported housing conditions were very bad. As a result of the depression, many fami li es had sold their po~sessions in an attempt to pay the bills and keep their heads above water. Then they ended up li ving in squalid unfurnished surroundings . Many houses were turned into apartments. As a result, li ghting, ventilation, water and toilet facilities were totally inadequate. When the in spectors criticised this situation, th e answer in vari ab ly was "Thi s is all I can afford. If I must move , I ' II need more relief. " 47

In 1935, city and school medical services were amalgamated. Dr. Hill had much to do with bringing this about. Prior to the merger all school health sevices were directed by Dr. Geraldine Oakley. The merger had the support of provincial authorities who could see more effective preventative health services coming from the move. When the health departments of both the School Board and the city were united Dr. Oakely was appointed Assistant Medical Officer. She was closely associated with Dr. Hill in the management of public health programs for the entire city and surburban areas. Dr. Oakely was given re>ponsibility for the Child Welfare Branch which incorporated the school health services she previously supervised. A spirit of cooperation was obtained in the amalgamated unit and child welfare activities were dove-tailed into the general scheme of things. In 1936, Nurse Lavell was asked by the Provincial Department of Health to take over the inspection of boarding homes for infants and pre-school children. Up to two years before this there had been no inspection of such homes. Then Miss Lavell was given the whole province to cover. She would visit the city twice a year but as soon as her back was turned the women operating these homes would take in as many babies as they could get. As a rule the type of women applying for the children was interested only in making extra money for her own living. Good women often refused to board babies because they didn't care to have their names associated with those who did. Yet the demand for boarding homes was increasing. Children were placed in foster homes trusting to government inspection to make them all right. Miss Lavell made a concerted effort to find better homes. Part of the answer lay in increasing the amount of subsidy to attract a better type of foster home. As a start an agreement was reached whereby when an unmarried mother's income was not sufficienf for herself and the baby, the city Relief Department agreed to pay part of the baby's board. In 1938 the province provided a car which helped considerably in finding homes and making inspections. Eleven years later the seventy existing shelters were handed over to the Department of Welfare. These were good homes in which foster mothers were receiving $30.00 to $35 .00 a month. That year Calgary opened a home for neglected children which took care of all cases waiting for court action. Housing became a major problem with more armed forces personnel corning into the city. Quarrels went on between landlord and tenant about such things as rent, services, vermin, small children, uncleanliness of halls, stairs and com­ mon bathrooms. There seemed to be no solution in sight. The housing situation worsened due to the war as families of enlisted men moved into the city occupying light housekeeping suites and rooms aggrevating the already overcrowded conditions. Many families lived in 2 or 3 rooms, often with several undernourished children. 48

Owners of one family dwellings subdivided them into suites. These were not subject to license or inspections. Problems only came to light when tenants complained. Most quarters were sparsely furnished with little or no provision for adequate housekeeping. Some buildings intended for office use were also converted into apartments. Since these were not designed for living quarters many were without proper ventilation. A great number required artificial light at all time. What had been considered sufficient water and sewage services for offices was totally inadequate for permanent dwellers. Most apartments were rarely repaired and fast became more and more dilapidated. All these problems, plus nauseous odours and the intimacies of many people, created dreadful living conditions. But sanitation and comfort were secondary to the need for shelter. The health inspectors did their best - but it was war time and they had their priorities. All were expected to make personal sacrifices. During the pre-war years milk and dairy inspection received much emphasis. Two full time inspectors were employed. One devoted his time to milk production from Olds south to Nanton and from Strathmore west to Cochrane. The other was re ponsible for the supervision of vendors in the city, the pasteurizing and bottling plant and also the supervision of the 200 or more keepers of cows inside the city limits. The sanitary standpoint of quality was determined by flavour, the absence of visible dirt and the legal requirement of butter fat content. Initially the inspection did not take into account the bacteriological phase as epidemics in Calgary over the previous years seemed not to have been related to raw milk. However, a number of epidemics had occurred in other Canadian centres which were traced to raw milk. Their outbreak stressed the necessity for close bacteriological examination. Calgary hoped to remove this deficiency with a bacteriological laboratory. Milk was distributed daily to about 900 children during the winter months. Dietary supplements to the needy were also supplied from various clubs and businesses. Donations which had been offered since 1934 included Cod Liver Oil, clothes. medical supplies, layettes, glasses, hospital expenses from the Good Cheer Club. Cod Liver Oil from the American Women's Club. Cod Liver Oil and infant foods from Mead Johnson and Company. Drug samples from Ors. McEchran and Merit. Infant shirts and bed clothes were received from the Hansfield Heights Club to name only a few. At the beginning of 1940 T . 8 . patients who were deemed well enough to be self reliant and independent were asked to come to the clinic for their needs. This was to help rehabilitate them and force them to do something for themselves instead of sitting at home waiting until such services were brought to them . The result was that patients made 486 office calls. This relieved the staff of many home visits. Although immunization had reduced the incidents of communicable disease in 1944 Calgary prepared for an outbreak of typhoid fever. Six cases were 49 reported due to ingestion of contaminated cheese. The source of the disease was traced to the milk supply of a cheese factory in the neighbourhood of Rosemary. A carrier had handled milk destined for delivery to the factory and the activities of the factory did not include the pasteurization of the milk used in the making of cheese. The factory also sold their produce in the green or "too fresh" state. Th re were some 50 cases in the neighbourhood of Medicine Hat. Now the provincial department of health ruled that cheddar cheese must be made from pasteurized milk and fai ling this the cheese must be subjected to a period of ripening over three months before being sold for human consumption. Fortunately typhoid did not reach within the city. During the war years the need for relief of the unemployed and the destitute fell away. Many of those still in receipt of relief were chronic sufferers of a number of conditions and it was apparent that little or nothing could be done for them . Another group had reached extreme senility and for some reason were unable to qualify for old age pension. Many of these had visited their own doctors in the past but when the doctors realized nothing could be done the private practitioner refused to see them anymore. With the war's end Calgary experienced a housing boom. As population grew so did the public demand for new restaurants and recreation facilities. Irate restaurant customers blamed their incidence of trench mouth on eating out. Others reported cockroach infestations. As a result an extensive survey was undert aken with a view to stimulating a new outlook and interest on the part of operators and employees. Prior to the survey being taken, the department undertook to give a course of lectures illustrated by film s, to employees of the food handling industry. The classes were held in the public library and the whole gamut of restaurant activity including the proper storage and preservation of food, the washing and handling of di shes and utensil s, personal hygiene and such related matters were all thoroughly covered. As a result a commendable improvement was brought about. Food supply however remained a problem. Packing house workers went on strike and as a result some farmers slaughtered their own livestock and attempted to sell it in the city. This, of course, was contrary to the city by-law. Eating meat without inspection was - and is - highly hazardous. Stopping the practice was next to impossible. In May and June of 1950, the city loaned one of its health inspectors to Winnipeg to help with the enormous job of protecting public health after the disastrous Red River flood . It turned out this experience was invaluable when Calgary had its own fl ood in December. The entire staff exerted every effort to keep things under control. As the waters were cresting, the men voluntarily went out during the night to help fill sand bags. When the raging river at last settled down long hours were spent in inspections in an effort to clean up the mess as quickly as possible. A total of so

217 homes were inspected of which 51 had to be condemned temporarily. Care was taken to instruct the people how to clean and disinfect any property touched by river water. Food stores and warehouses in the flood area were examined and foodstuffs to an approximate value of $70,000 had to be condemned. Also, 1,400 gallons of beer were contaminated. As often happens, one problem compounds another. In this case, it happened at the city dump. Some people who felt they knew a good thing when they saw it foolishly attempted to salvage the spoiled food. The situation became so bad it was found necessary to place a guard on the dump to keep them away until all foodstuffs were destroyed. The Calgary Health Department has a vast scope of routine activities but as well as these, like the flood work, extra responsibilities often crop up. It happened again in 1951, but as opposed to the flood, this was a happy occasion. The city was to receive a Royal visit by the Queen. Painstaking care was taken with the planned luncheon. Every item of food was carefuly scrutinized during its preparation, cooking, transportation and serving. It seemed that health in­ spectors were everywhere. Her Majesty could not have been better protected had she brought her own food. The caterers were very helpful and the whole thing went off beautifully. In 1952 polio exploded across the city - 143 cases and 25 deaths. Strangely, the first case remained the only one for five weeks. Then, with frightening speed the disease assumed epidemic proportions. Public places and schools remained closed for three weeks. Much research had been done on the deadly crippler but at that time all that was available was gamma globulin treatment. This offered protection for a short time only. The following year saw an even more disastrous increase in polio with 271 cases and 40 deaths within the city! The year 1953 is remembered as the worst in Canada. In July the provincial government made gamma globulin available to all family contacts. This was a good morale booster during the anxious months. Again schools were closed, swimming pools and theatres were shut down in an attempt to isolate the disease. In 1954, the United States invited Canada to participate in a polio vaccine test. Nova Scotia and Alberta took part. Calgary became involved with the innoculation of 3,000 children. Half received vaccine the other half a control solution. The results were encouraging and soon Salk vaccine began to make its way. Availability in large quantities paved the way for mass public immunization. As the city continued to expand mothers were finding it very difficult to keep appointments at the health centre. When street cars were still in use, they could conveniently transport their baby carriages, but with the advent of city buses there was no room for the little chariots. After some consideration this finally led to the decision to decentralize the central clinic. It was hoped to 51 institute five sub office health clinics at strategic points. In 1958 the city was further divided into 24 geographical areas with a nurse assigned to each. Each nurse was responsible for carrying out the departmental health program in all schools within her district. The nurses carried out a home visiting program to all newborn babies and family and baby conferences were conducted in the several infant welfare clinics held throughout the city each week. Their time was roughly allocated as 50% in the schools with the balance spent in the infant welfare centres or community home visiting. This year also, an all out attempt was made to control flies. A major portion of the city was sprayed during August and September with DDT. The project was a bit late but still fairly effective . After many years, Miss Marion Lavell retired as Supervisor of the Calgary Infant and pre-natal school clinics to take a job with the Mountview Health Unit serving the rural Calgary area. In recognition of her outstanding service to public health she was awarded the Elizabeth II Jubilee Medal in 1977. She was one of five Canadian nurses to receive this honour. In 1959 after 28 years of dedicated service, Dr. Hill retired . Not only had he been medical officer but also chief administrator of both General and Isolation hospitals as well as coroner - a positi on he held from 1932 to 1962 - the longest term on record. He wi ll always be remembered by thousands with grat­ itude and affection. In his fin al report he commented on how infectious diseases so deadly at the tum of the century were now considered a thing of the past. Effective systems of identification and control had been worked out over the years. These, along with new antibiotic drugs, had seen a remarkable drop in the incidence of communicable di seases. However he warned that antibiotic drugs were a matter for real concern. Infections by other organisms that were at one time fully eradicated by antibiotics were now quite unaffected by them. It appeared that a few organisms of the infection survive the onslaught of the drugs. Propagating themselves they transmit their ability to survive to their progeny who then are totally unaffected by the drugs. The work against infectious disease would have to continue unabated . Dr. Hill was replaced as Calgary's Medical Officer of Health by Dr. L. C. Allen who held the position until 1974 when Dr. D. J. Hosking became the chief administrator of city health services. On hi s retirement in 1980 Dr. John Garson assumed the position. Dr. Allen guided Calgary' s public health service through a period of rapid urban expansion. Programs were expanded and new ones added. New health centres were established in various parts of the city in efforts to reach the bulk of the population . Efforts to improve food handling and general sanitation were intensified resulting in a lowering of the death rate from disease related problems. By 1970 most of these programs were taken for granted by the general public. 52

With the control of infectious diseases and general sanitation well in hand the health department staff took on new responsibilities. A number of fluoridation campaigns were supported during the decade. These met with repeated failure. In 1960 with the renewed outbreak of polio health teams went into business and office blocks to innoculate workers at their place of employment. They were welcomed by management and some 4,000 immunizations took place in this manner. Within the school division education programs were intensified against smoking. All without measurable results. In some schools milk vending machines were installed by the Calgary Milk Foundation in efforts to replace "junk " food and to encourage proper nutrition amongst the school children. On a more serious note, there was the recognition of a rapidly increasing rate of promiscuity resulting in an alarming growth in the number of unwed mothers . This was attributed to many sources including lack of parental control, working parents, early maturity of the students, an increase in lei sure time and a general loosening of society's morals. Efforts to assist young people led to initial efforts to provide counselling and the development of family planning programs under a Family Planning Division, established in 1969. One offshoot of the rise in early teenage pregnancies was a noted increase in the incidence of venereal disease. It, along with measles were considered to be the last two communicable diseases in the field . The problem of venereal di sease is still with us. After 1963 the province moved to improve the environment in matters of all manner of pollution. The local health authorities acted in conjunction with the province to identify and then take action against polluters. Back lanes, tile Zoo, campgrounds and recreation areas were sprayed with DDT in efforts to rid the city of flies . In 1964 a pigeon inspector was employed to remove the pesty birds from the central core. In the first year 520 birds were taken. It was also in the mid 60's that the plight of the elderly began to demand increased attention. The general increase in life span led to a growing number of geriatric cases. Home visits began to take up more time of the nursing staff. In 1965 the United Church began a meals on wheels program for seniors; but problems grew. An urgent need was seen in the area of housekeeping and counselling for the elderly. In that same year the Joint Conference on the Aging was held in Toronto. One result of the conference was the realization that the matter of home care was a long term proposition. In I974 Dr. D. 1. Hosking took over from Dr. Allen on the latter' s retire­ ment. One of the initial responsibilities he faced was the transfer of the health service from the city to the Calgary Local Board of Health under the province's I 00% funding program of 1973 . This involved the transfer of employees, equip­ ment, building facilities , and records to the new corporate body. 53

New staff was added to keep pace with public demands in the area of geriatrics and general health education in particular nutritional counselling. In 1976 the Board took over the work of the Calgary Birth Control Association through its Family Life Planning programs which became a full divi sion on a permanent basis in 1977. At the same time the work of the Victorian Order of Nurses in Home Care was brought under the Board auspices. The V .O .N. home care program had been initiated in 1970 as an experiment financed by the Alberta Hospitals Services Commission as a pilot project in an effort to reduce the demand for hospital beds. The aim was to provide emotional and physical support in a home setting to those not in actual need of hospital treatment. Patients were admitted to the program only if they were under the supervision of a phys ician; and in need of nursing , physiotherapy, or home making. By the third year of operations plans were made to expand the services to include cancer patients, children outpatients and same day surgical patients. Support services provided housework, meal services, and home visitations. By 1978 Home Care programs had been recognized by the province and all the health units embarked on what will likely be one of their major thrusts for the 1980's. In the next decade Dr. Garson hopes to strengthen the research and education branches of his health department in addition to increasi ng the workload in the area of geriatrics. Recently a Health Education Division was developed to help carry the responsibility of public health back to the individual. With full public awareness and the cooperation of the enlightened masses it is hoped that pre­ vention of health related problems will attain new successes. 54

Chapter 6

THE DISTRICT NURSE

The basic idea of district nursing began in England. In 1859. the same year that the Grey Nuns came to Lac Ste.· Anne, a merchant in Liverpool, William Rathbone, set up his own nursing mission system. He was painfully aware of the squalor and poverty and the pathetic condition of the sick in the surrounding slum areas so he arranged for nurses to make regular visits to care for the ill. He paid their salary out of his own pocket. The concept is the same but whereas his nurses worked in congested city areas, Alberta's nurses were to serve in isolated communities far out on the frontier. Removed from the amenities of civilization they learned to cope with every kind of emergency. After World War I, Edmonton, Calgary and other towns forged ahead with improved health services. This was not the case in the rural areas . The farmers, ranchers, lumbermen and native peoples on the frontiers were totally bereft of medical help. In most isolated regions, health services were non-existent. This caused much concern. School districts, groups like the Women's Institute and United Farm Women repeatedly called for better health services. The result of all this was that in l 918 the first steps were taken toward establishing a District Nursing Service. The year before, Manitoba had set up a system to bring limited health benefits to its rural people by setting up nursing stations in remote areas. Dr. H. Jamieson, Acting Director of the Provincial Laboratory and Associate Professor of Medicine at the University of Alberta, travelled there to take a look. He was impressed and on his return urged Alberta to follow suit. The first positive move in this direction was the inauguration of the public health nursing service. Christine Smith, who had experienced seven exciting years as Superintendent of a Victorian Order of Nurses organization in Dawson City, came to Alberta and was appointed Director of Nursing. She had a staff of four. The proposal was to send provincial nurses into areas that had no other accessible medical or health services. There they would perform not only prev­ entative health functions but also take on active treatment for emergency cases. While plans were being made to bring nursing services to the isolated regions, an incident occurred which had a profound effect on the whole concept of district nursing. On a warm summer evening of that year, a horse and buggy with a sole occupant at the reins, wound its way down a narrow trail. Destination 55

was the district of Yeoford, the driver, Elizabeth Clark, one of Alberta's first public health nurses. She later became Alberta's second Director of Nursing. She was in the area on a routine school inspection but now it was growing late. With relief, she spied a warm glow of light between the trees. It was the home of an elderly English lady . With typical pioneer hospitality, the nurse was warmly urged to spend the night. The two women chatted over tea. Not surprisingly, the subject of public nursing and community needs, came up. During the discussion, the hostess made a most important suggestion. ''There are very few doctors ," she said. "A vitally needed service is obstetric nursing.'' Who was to help the expectant mother in wilderness areas? Miss Clark certainly saw the potential role for district nurses in all this. She took the suggestion back to Edmonton and after due consideration, the idea was approved. Special courses were offered at the University of Alberta in obstetrics and public health nursing - and the dazzling way in which the nurses proved themselves, soon allayed all fears. District nursing had an ally in the Honourable A. G. MacKay, the first Minister of Health. He represented the Athabasca riding which was a sparsely populated frontier region. He was more than aware of the urgent need for local health services. Dynamic and forceful, he boosted district nursing with everything available. In 1919, the department was fortunate to obtain the services of three highly qualified war nurses. These were Mary Sterritt (nee Conlin), Genevieve Hef­ ferman (nee Turbville) and Mary Hall . The first two were sent to Griffin Creek, north of Peace River while Miss Hall was off to Yeoford. All three made nursing history with their impressive work . One can imagine the excitement in outlying areas when the news of the new district nursing program reached them. However, a nursing district did not just fall into the laps of these folks. An application had to be made to the provincial government. It had to be proven that no other medical services were available within 80 to I 60 kilometers. A local committee was responsible for providing a dwelling - usually of logs in the early days - which contained an office, a waiting room and living quarters. Plans for this building had to be approved before construction could begin. The community also had to provide furnishings, water and fuel. If a home visit was necessary, that family had to supply transportation. If unable to do so, kindly neighbours would help. Once all was in readiness it was government inspected. Then medical sup­ plies and equipment were sent from the head office. The provincial government paid the nurse's salary. When the opening day arrived modest nominal fees were posted on the office door. 56

$.50 for an office call $1 .00 for the first home visit $10.00 for maternity (including pre and post natal care) The nurses were always busy. Maternity cases were always heavy. They were perhaps the most satisfying of their jobs. That first lusty cry of a new-born baby is always a thrill to all - no matter what colour or creed. When the urgent call came, it often meant leaving a hot meal or a warm bed or even, if you had just washed your hair, drying it in the oven' Often it meant returning to a cold cottage with ice on the water pail. But it was all worthwhile. Nurses were warned to have their breakfast before getting dressed. That way they were assured of a meal because when called out people would understand a delay for putting clothes on but not for finishing one's food. Often preparations for the new arrival were far from adequate. Sometimes a "bassinette" had to be hastily created out of an old apple box. Or, as Isabella Ranche (nee Thyne) aptly puts it, "Washing a new-born in a frying pan and wrapping it in my petticoat, seemed quite natural at that time." There was immunization of school children and, with the cooperation of the teacher, instruction in good health habits. Then there were the inevitable ailments of childhood to attend to. Industrial accidents such as a worker being mangled by a saw at a lumber mill or a farmer being crushed by a heavy machine or receiving a hefty kick from a horse or a mule all had to be looked after. Most nurses became adept at extracting teeth and to top the list, veterinary services were in great demand! But along with the hard work, there was fun as well - dances and box socials were greatly enhanced if " their" nurse attended! Nurses often helped with household chores when not needed elsewhere. If a family could not manage because of birth or illness, they would stay in their home for a few days to help out. The nurse was loved and respected by the community. To many, she was not only a nurse, but friend and confidante as well. The average size of a nursing district was 325 square miles, thus the nurse did much travelling. Travelling might seem like fun , but some of the modes of travel caused a dubious shake of the head! Picture a stoneboat, drawn by oxen, bumping along a rutted road. Or galloping horseback through forests to meet a dire emergency. Or crunching across frozen snow on a flying dogsled. Or else mastering the snow with snowshoes or skis. Or tackling the raging torrent of a river in flood with nothing but a small homemade row boat- and no life jackets! And then there was always just plain walking - miles and miles of it. Since the inauguration of district nurses, some 63 nursing stations had been established by 1962. Although all were not in operation at the same time. As civilization advanced some stations were closed or moved to further outlying 57

points. When this happened the community was keenly disappointed - even to the point of offering to pay the nurse's salary themselves! They did not want to lose her! She was theirs! Many things happened to these nurses. One who can lay claim to a good number, is Kate Shaw Colley (nee Brighty). During Miss Brighty's career, which covered 24 years of nursing service, she held many di stinguished posts. But she began her career as a district nurse in 1923 . It began with an urgent call from Wanham to the Department of Health . " We need a district nurse!" Immediately, Miss Brighty was dispatched. She found the people warm, friendly and enterprising. The ladies had prepared a cabin for her commonly known as Barret's Shack. It turned out the shack had a history! A short, eccentric man, always dressed in a cut-away coat, tie and bowler hat, used to live there . But one day he spotted a policeman approaching hi s abode! Off he scurried - in such a hurry he left his precious hat hanging on a peg. He has not been seen since! Why the big hurry? He had this secret habit of brewing "moonshine". He wanted no truck with the "cops"! Miss Brighty relates that every now and then, the hat seemed to give her a nod and a wink! One cold day - 48 below zero (F.)- she got a message . A sprained ankle in Badhart required attention . Undaunted by the cold . she, with a gi rlfriend , hitched up cutter and horse, heated rocks to keep their feet warm, and took off. Without event they reached the frozen Badhart River, crossed it , and started up the steep opposite bank. Then disaster struck! The strain was too much for the aging harness. With no warning, it broke! The sudden jolt sent the ''foot warmer" rocks slithering to one side. The cutter upset, spilling all into the snow. The trusty horse stopped, turned his head and gave them a surprised look as if to say, " What' s the big idea! " This was bad trouble. But the two women were resourceful. Although the bitter cold ate at their fingers, they managed a temporary patch job. ''Tools and materials" consisted of a belt, a shoelace and surgical bandages. It held till they were safely at their destination. Yet another experience during one of northern Alberta's frosty winters took place in the early twenties. When she was at Slave Lake a call came down the telegraph from Kinuso. A man was hurt! Could she come? It was bitterly cold and the roads covering the 50 kilometer distance were blocked with snow . The onl y solution was the railroad speeder. The speeder was readied. Then the RCMP and the railroad men prepared her for this "chilly" journey. The result? A fur coat, over it a large policeman's buffalo robe, an oil slicker and two empty water buckets. The buckets? One for each of her feet to keep the frigid wind off! When district nursing days were over, Miss Brighty added yet another dimension to her full career. In the late forties, she began a series of radio 58 broadcasts over Station CK UA. With these. she spread a great deal of knowledge about hygiene - particularly for children. Travelling by speeder is unique but there are more romantic ways of travel 1 Irene Stewart tells of the early days when paddle wheelers were still plying the rivers. In her book, These Were Our Yesterdays, she gives a vivid description of one such journey. Aboard the S.S. Weenusk she travelled from Peace River to Fort Vermilion. She recalls the novelty of tying the large craft up for the night - the meals on board- the indescribable beauty of the Peace River majestically flowing -- wooded banks rising and hordes of mosriuitoes! Blanche Emerson did a lot of travelling also. One type most of us have never experienced - and hope we never do' It all began one sunny summer day . In pursuit of her work as a Child Welfare nurse, she started her Model-T and blithely set off from her home base in Edmonton to Rocky Mountain House to hold a well baby clinic. This was in the late twenties. No easy ride on pavement then. Gravel and dust were the order of the day. But Blanche had no trouble with the lecture and the clinic went well. So did the trip home - until the driving rain began. Harder and harder it streamed down her windshield. Valiantly, she operated the hand­ controlled windshield wiper. But it became too much . With the car slithering about in a sea of mud, she simply must keep both hands on the steering wheel. Even so, the rain won. Mud oozed over the wheels, threatened to invade the car! Blanche got stuck - not once, but twice! During her frantic efforts to free herself the forward gears gave out. Ever resourceful, she did the only thing left. She put the car into reverse. Painstakingly, she backed on. Dusk fell. At last a farm house loomed through the trees . The incredulous farmer and his family, watched her backward ap­ proach. When explanations were done, the nurse was invited to spend the night. Next morning, the rain had stopped. But Blanche still had her problem! She had to reach a garage! The nearest one was Blackfalds, thirty-five kilometers away' With determination and high spirit she tackled the trip, still in reverse. Her progress was painfully tedious, reverse in Model-Ts being even slower than first gear' But she made it. If the garage mechanics showed astonishment at her unorthodox arrival, who can blame them! Laura Margaret Attrux began her varied and colourful career in 1939. She spent many years "district nursing" at Valleyview, Whitecourt, Smith, Slave Lake and Wabasca. In 1949, Laura interrupted her district nursing for the relative peace and quiet of teaching a course in the always necessary obstetrics. Then, out into the field once more to Slave Lake. One winter evening the RCMP knocked at her door with tragic news. "There's been an accident at Swanson's sawmill. A man has been killed." 59

So she and the two policemen crowded into the truck and set off through the cold night. When they arrived at the lumber camp, all was quiet and subdued. The foreman said, " The body is in the vegetable cooler. I know we shouldn 't have moved it but I couldn't bear to leave him out in this terrible cold." Then he added , " Come into the cookshack and have some hot coffee. " But there was no coffee and no cook! Upon questioning one of the hands the mystery was solved. Cook heard noises in the vegetable cooler. He threw his stuff in a bag. " I'm not living with no ghosts' " he yelled , and fled . An immediate investigation of the cooler was definitely in order! The door creaked open. The "corpse" was sitting up on a makeshift cot. Teeth chattering, he said, "I'm COLD!" Although all had been convinced he was dead, he had merely been stunned by a falling timber! Her next post, 1960, was at Wabasca - north of Smith and even more isolated. Laura approached the Minister of Health, Dr. Donovan Ross, with a request for a four wheel drive Landrover. To her delight, the request was granted' Wabasca' s population was mainly Indian and most became her very good friends . They affectionately called her " Maskikiskwew" - Indian for " Med­ icine Woman" . Vivacious Laura mingled well with the community. Dancing was a favourite pastime. She would dance with anyone present, enjoying it hugely! But on one occasion, a young man became obnoxious. She settled this in short order. One punch and he was out cold! She also played poker with the best of them and regularly won! In 1967, a long cherished dream saw possibilities of fulfillment. High Level was sponsoring a flying school! Undaunted by the fact that she was the only woman among twenty men - and 58 years old - she enrolled. A few months later, she was a licensed pilot - Alberta's first " flying nurse" . That same year she purchased a Cessna 150 and took to the skies. The sight of Laura winging her way across the heavens brought happiness and relief to countless northen citizens. They gave her nicknames - but with love. Two common ones were, "Flying Laura" and "Touch and Go". Laura Attrux worked with the Alberta government for 31 years . Happily, her dedication was recognized. In 1953, she received the Queen Elizabeth Cor­ onation Medal; in 1960. the Pope John XXlll Medal "Bene Merenti". Another triumph for her, was the Honorary Degree of Doctor of Laws bestowed upon her by the University of Alberta in 1970. In her acceptance speech for this last, her final words were, "This is, indeed, God's world." In 1940, Elizabeth R. Lee was stationed at Fawcett. She soon became aware that there was an elderly gentleman in the community who kept strictly to himself. 60

He mended broken harness for a li ving. Few guessed that his true love was symphony music. Fewer still understood hi s hermit-like existence. But the so-call ed " hermit" knew all too well. Day by day, like a creeping ho1Tor, hi s hearing was failing. Soon hi s marvelous collection of records remained untouched, gathering dust. This heartbreak was enough to subdue any man. But he was also sensitive. His deafness was an acute embarrassment. But when the silent days and nights without his beloved music became unbearabl e he came to a decision. He would see the nurse. It was a faint hope but perhaps she could help. Elizabeth recall s the visit with nostalgia. " He was shy and uncomfortable. Speaking loudly, I offered hot coffee. '' He nodded his head. Finally the purpose of hi s visit came out. His ears. She dug out her auriscope and took a look. Both ears were loaded with wax. She gave him a bottle of baby oil and in structed him to put some in his ears, three times a day for a week, and then come back. The next visit resulted in sheer delight. The nurse syringed hi s ears. Big gobs of black wax were coaxed out. Even before she was finished, he cried excitedly, " I can hear! I can hear! " When it was over, he eagerly asked, " How much do I owe you?" "Fifty cents." Shocked, he said . "no, no! That's not enough! " Elizabeth laughed. "Well, since you have two ears, how about one dollar. " "No, no"! he insisted . "That's still not enough. I want to give you $100!" Firmly, she refused. In those days this sum was a small fortune! But he stubbornly insisted. Finally the nurse said " If you really want to pay more than the standard fee , Mrs. Boyd (who ran a small maternity home nearby) is in need of flannelette for baby clothes and diapers. You could give a little money to her. '' "I will," he promised . Shortly, the nurse's phone rang - a phone hooked to a barbed wire fence because there was no regular line . It was Mrs. Boyd. " Guess what!" she cried excitedly. ''Your patient gave me $ I 00 to spend on the babies I' ' Before leaving the di strict nurses, two incidents should be noted as shining examples of what these courageous and resourceful women achieved. Dr. Mal­ com R. Bow, Deputy Minister of Health for 25 exciting years, selected the following as outstanding from among many , many noteworthy ones. At Stanmore, east of Hanna, Helen Southworth (nee McArthur) was urgentl y call ed to the home of a mink rancher. She found th e rancher desperately ill and delirious with a high fever. He must go to a hospital at once 1 Calgary was the closest, but he died before they got there. You would think that with the sad death, the nurse's duty would be over. But not for Helen! She went back, determined to reconstruct the strange events. What had caused the man' s sudden death? Her investigation revealed that just 61

before he became ill , he had been skinning mink for a quick sale because his animals were dying. Then she learned he'd been feeding the mink gophers which he shot on the prairie because he could not afford to buy food for them . She thought, "ls there some connection?" Next thought - could it be the dreaded "Black Plague" of the middle ages? She knew this disease was transmitted by fleas. She knew, also, it could be carried by infected animals. She lost no time in reporting her suspicions to Edmonton. A field man was sent out to investigate. The very first day he ran across a ground squirrel which had just died of convulsions. He sent the unfortunate creature to Edmonton for analysis. The suspicions proved true. It was Sylvatic Plaque! At once, the Department of Health posted warnings all across southern Alberta. "DO NOT HANDLE GOPHERS." Miraculously, not one more case developed. Had Helen not been alert and prompt, a shuddering horror could easily have swept the province - and further afield as well. There is one lone nursing station left in Alberta. It 's the district of Worsley, over 200 kilometers north of Grande Prairie. When it opened in 1931 this isolated community was jubilant. Medical help at last! The first nurse to brave this frontier was Flora Shaw (nee Linsley). Following her was Elizabeth Farr (nee Davidson) and third to tackle the job, in 1934, was Monica Thompson. She claims to be the first district nurse who had her own transportation - a fri sky horse called Starr! Among other nurses fondly remembered are Violet Hian and Bobby Ped­ erson. Bobby served the community faithfuly for many years. She has the dis­ tinction of delivering, in the mid sixties , the last maternity case in the district. Now most go to Fairview Hospital. Anne Thompson, daughter of Monica Thompson - like mother like daugh­ ter - has been running the station since 1976. For the last few years, Joyce Cox has been assisting as part-time nurse - the first in its history. In 1977 another first - the luxury of a government car! The station is extremely busy since the nearest doctor or hospital is 100 kilometers away! Roads are gravelled, not paved. Public health and immunization programs are handled by the Peace River Health Unit. Baby clinics are held twice a month. Last year, the first and much needed doctor clinic was set up. The station serves about 1,800 . Its boundaries are to the B.C. border, east to Eureka River, north to the Clear Hills, south to the Peace River. The general hope is that one day it will be a Health Unit. The district nurses mentioned in this chapter are only a few of those who served Alberta so well. It 's impossible to mention them all - but none will be forgotten by countless grateful people. 62

Chapter 7

OKOTOKS - HIGH RIVER AND RED DEER THE :FIRST RURAL HEALTH UNITS

Dr. Malcom R. Bow became Deputy Minister of Health in 1927 . Dr. Bow accomplished wonders during his long 25 year term of office before he retired in 1952. On assuming office he grappled with the polio epidemic, then later developed programs designed to identify and monitor the progress of cancer patients, provision for dental hygiene, to publicize the need for proper nutrition and to bring a high standard of health care to rural areas. Amongst all of these the one that gave greatest satisfaction was the creation of rural health units on a province wide basis. The importance of the rural health unit program lay in plans for bringing a full preventative health care program to everyone in the province. Regional centres would be established by combining a number of municipal districts into a health unit. Initial proposals were to service 100 ,000 people in each unit. Such numbers could support the establishment of full health unit programs. They would offer all of the services which had formerly been carried out by public health nurses, district nurses, local boards of health, and department personnel from Edmonton. Such organization had already worked well in the cities of Edmonton and Calgary who had their own fully staffed health departments. Dr. Bow's plan was to duplicate these facilities throughout the province and to bring the level of rural health care up to at least the level of that enjoyed by the cities. Quebec and Ontario had already developed a regional health unit system. Quebec in the 1920's. But Dr. Bow was more interested in Ontario's efforts to bring health services to remote rural areas. ln addition Ontario had set an example of the capability of efficient mass immunization of its population through its health unit structure. The effects of a smallpox epidemic that raced through the province in 1929 were minimized due to their immunization program. Decen­ tralization of services had led to comprehensive coverage. Not a single vaccinated person contracted the disease. Not only overall immunization of the public was made possible by a regional health unit system but the local staffs could monitor the state of their region's health in a more effective manner. Ontario had been divided into districts by grouping several municipalities together. This was done for the twofold purpose of providing sufficient population to make full use of a full time staff and to provide a large enough tax base to 63 reduce the per capita costs of local requisitions. Each district had a full- ti me Medical Officer of Health. The cost was shared by the province and the di stricts. Their scheme was not only feasible but practical. And it worked. Dr. Bow examined the Ontario plan closely and saw in it the potential to examine and immunize every school aged child in the province. The results would be a major improvement in public health . Once convinced of th e soundness of the proposal he moved to adapt it to the Alberta circumstances. This was the nebulous beginning of Alberta's health units. Alberta's rural health units were designed to provide a preventative health service on a much broader scale than previously available outside of Edmonton and Calgary. At first these health units made it possible for communities which are rural , but not as isolated as the areas served by the district nurse, to enjoy public health advantages previously only available in the larger urban centres. Today even the most remote areas have access to health unit facilities. Initially the units were organized on a minimum staff of a Medical Officer of Health , two public health nurses, a health inspector, and a stenographeror office assistant. A public health laboratory was to be established in each health unit office. In the end the health units became an efffecti ve organizati on for providing preven­ tive health care to the public. Today their staffs number in the dozens. Their program covers every aspect of communicable disease control, dental hygiene, speech and audiology, sanitary inspection and food supervision; pre- and post-natal services to mothers, infant and child welfare; school health service, li fe extension services for adults, and promotion of mental hygiene and nutrition. Over and above these services is the constant health education carried on by all members of the staff in their every day work. Special health messages are also transmitted to the public by means of posters, talks to schools and community groups, moving pictures, press and radio. All this i a far cry from their hesitant beginning. The first two health units in the provi nce were establi shed on an experimental basis in order to determine whether thi s type of organi zati on would provide th e preventive health services so needed in the smaller urban and rural areas. In the beginning the International Division of the Rockefeller Foundation, agreed to provide one third of the estimated budget of $ 10 ,000.00. The province and th e municipalities provided the rest. The first two full time health units were organi zed at Okotoks- High Ri ver and Red Deer. In all of the towns and vill ages in the rural areas the population served was approximately 10 ,000 by the Red Deer Uni t and some 9,000 by the Hi gh Ri ver Unit. Each unit was operated by a district local board of health whi ch met every three months and was made up of representatives of each urban and rural municipality. 64

OKOTOKS - HIGH RIVER

"An ounce of prevention is worth a pound of cure. " These words, although much used, were spoken with meaning by Dr. George Hoadley in the late twenties. At that time he was MLA for the High River area and Minister of Health under the United Farmers of Alberta government. He had a dream which was to provide preventative health services for his constituents. He was also under pressure from the local Women's Institute, a major political force for social change. The object was the preservation and improvement of public health in rural areas . To prevent disease not cure it. It was the government's policy that rural areas were entitled to the same health privileges as Edmonton and Calgary that had led to the establishment of a policy on establishing a rural health unit service. The major goal was to provide im­ munization services and to reduce the rural death rates from communicable diseases and unsanitary conditions. One June 1 , 1931 . Dr. Hoadley' s dream, now shared by many , had come true. The 'ounce of prevention' had become a reality. The Okotoks-High River Health Unit , Alberta' s first, was ready to go to work. Sun streamed through the windows of a brand new office. Adjoining this office, were a small but adequately stocked laboratory, an airy well-equipped room and a waiting lounge, walls decked with vivid posters. All were waiting for the crush of visitors who lived in the dusty hamlets and surrounding wind­ swept prairies. The place was High River - the health unit the first of two demonstration models established that year. In the eyes of the provincial government the need for improved public health in rural areas - something more advanced than the District Nurses could offer - had at long last crystalized. But the development of the unit had been delayed due to the ever-present problem of funding which had stood in the way for a long time. Then light broke through the cloudy skies! Word came through that the Rockefeller Foundation would sponsor the establishment of health units in rural America. Not only in the United States but in Canada as well! Although the Foothills Health Unit as it came to be called became a much treasured "first", High River's medical history actually dates back to 1909 when it was a bustling and enterprising community but had no hospital. This in itself 65 was not surprising. But a civic-minded and resourceful lady, Mrs. A. H. Eckford, the wife of a nearby rancher, was detemined to remedy this situation! Undaunted, she wrote the town council, stressing the urgent need for such a facility. Wonder of wonders, council took immediate action! As a result a board was set up empowered to engage nurses, buy equipment, solicit funds and even frame by-laws! Through the Victorian Order of Nurses, a supevisor and an assistant were also hired . But all this was of no use without a building! After much deliberation it was decided to rent a vacant house owned by Mi ss A. Sexsmith. opposite to St. Francis de Sales church. Mrs. Eckford's hu sband, solidly behind hi s wife's endeavours, generously provided six months' rent! At that time most Albertans were in the same shaky boat. Not many doctors were available - and those were few and far between . One did not attempt to contact a doctor unless "really sick". Diagnosis and treatment were gleaned from a huge "doctor book", usually kept on a special shelf. side by side with " truly important" books like the family Bible and the almanac! Since there was no way you could drop over to the corner drug store, medicines, usually unspeakably vile tasting, were brewed from family recipies. But a store-bought concoction could be purchased - and usually was - from the travelling salesman who call ed regularly. hi s horscdrawn buggy heaped hi gh with a multitude of goods. He always carried a large bottle of "medicine" guaranteed to cure everything from acne to gout. Dr. Hoadley took up th e cause to spread the gospel of preventive medicine as the only solid base for community health - present and future. He said , " Health is the first requisite for enjoyment of life and fulfillment. One must seek to prevent deaths due to inadequate health sevices. We are shocked, and rightly so, at the loss of 60,000 Canadian lives during the first World War. But consider the loss of 70,000 young Canadian lives during a similar period - stillborn babies, children under one year, mothers - most of these preventable deaths." health units would put things aright. At the beginning, many were skeptical. Some members of the medical profession objected to this intrusion into their practi ces. But in less than ten years the Foothills Health Unit had proven itself beyond all doubt. It had not only proved its usefulness, it carried laurels as well! In a Canada wide-search for competency among the nation 's 70 health units, conducted by the Canadian Public Health Association, the Foothills Unit was rated among the top ten! This badge of merit was certainly not based on a single day's operation! Each unit was judged on the activity of that entire year. Preventive measures, school visits, immunization, tuberculosis examinations, baby clinics, child welfare, educa­ tional work and sanitary inspections were all taken into consideration. When opened, the Foothills Health Unit covered 1.800 square miles. Travel over long distances in every kind of weather became a fact of life. The original 66

staff of four. included: Medical Office of Health - Dr. Gordon Saunders, Public Health Nurse - Miss Ethel Jones; Secretary - Technician - Mrs . W . Lockhart (nee Dole); Sanitary Inspector - J. C. Mooney. Two other early nurses were Miss S. H. Ross and Miss M. Scarr. By 1955 the original staff had expanded to eight, the area to 3,500 square miles and the population served at that time had increased to 21 ,000. During the early years, the district included High River - where the bustling main office was. Vulcan, Nanton, Black Diamond, Turner Valley, Cayley and Blackie. By 1958 Arrowood, Carmangay and Champion were added. At first the main work of the health unit was immunization and education. Strangely enough, as was to case in Edmonton and Calgary, some were still fiercely opposed to immunization. Foothills Health Unit has an incredible letter on file. It was written in 1961 and signed simply, 'A Mother" . She states, " Immunization shots are harmful, causing a weakened body , loss of appetite and weight, susceptibility to colds, glassy eyes, lifeless hair and many other complications." She forcefully stated that injecting foreign substance from dis­ eased animals into the bloodstreams of healthy children upsets the body's natural defences causing worse diseases than they are supposed to prevent. How she arrived at all these conclusions is a mystery. Certainly not from first hand observation. A few years after the opening of this health unit. Dr. Ashbury Sommerville replaced Dr. Saunders as Medical Officer of Health. From his first day on the job until he left for a post in Edmonton in 1943 , he too worked tirelessly - especially in the field of public health education. His boundless enthusiasm was infectious. As with all who are involved in public health, the message of cleanliness was spread everywhere. Nurses, where­ ever they went talked " health" in farmhouses, schools, and to any individual who would listen. The sanitary inspector visited dairy barns, farmyards cease­ lessley explaining the utmost importance of meticulous cleanliness - of its value to the community as a whole. Restaurants, hotels, bakeries and butcher shops were - and are - carefully and regularily inspected. The procedure was to educate the public in better ways. Only in cases where improvements were not fo11hcoming did the inspectors use their authority to recommend the closure of public places until matters were rectified . In the health unit's well-equipped lab, also a serum centre, milk and water samples were constantly tested . Speaking of milk , Dr. Sommerville strongly advocated pasteurization years before it became a reality in 1940, when the High River Creamery at last started to do so. During Dr. Sommerville's term of office, every school was visited to give diphtheria innoculations and smal lpox vaccinations. School visits held high prior­ / ity and each school was visited annually. During the first year, a disturbing situation came to light. An unusually large number of children had a thyroid 67

problem! The vital importance of using iodized salt was stressed resulting in a sharp reduction of cases. The first year also revealed 7 1% of the children had some defect , most commonl y eyes and teeth . These were then referred to the family phys ician. However, sometimes the instructions were not carried out. There was no health insurance then and money was often a problem. Sometimes, if parents could not afford medical care, helpful organizations came to the rescue. Another vital part of the school program was the comprehensive and forceful teaching of good health habits. No doubt this paid off. By 1939, defects in chi ldren had been reduced 41 % . The year 1940 was an important one for Dr. Sommerville. Hi s health unit had the lowest infant mortality rate in the province. Public health authorities believe the infant mortality rate is the most sensitive index of a society's well being. No doubt, the low rate was largely due to pre- and post-natal education offered by the unit, as well as the teaching of improved sanitation. The year was imporatant for yet another reason: Dr. Sommerville was elected president of the Alberta Public Health Officials Association. At this time also, the health unit purchased a motion picture projector and several films as part of the ever vigilant preventive health program. Groups and organizations were urged to make use of them . Another highlight of the health unit' s work were the "well baby" clinics. Without fail, these were held every Saturday morning. Grateful mothers learned how to keep their infants and pre-schoolers well and happy. Clinics were also held in remote areas which did not have district nurses. Other important clinics regularily held were tuberculosis clinics, child hy­ giene clinics, adult clinics and a few years later, a mental health clinic as well. The importance of the latter became startlingly clear immediately! It was dis­ covered some children needed only a slight adjustment - which they were helped with. Others were found to be slow learners. After diagnosis they could be grouped as such in the classroom. Perhaps most important of all was the help given children who found books impossible! These were urged to master manual ski ll s and thus prepared themselves for a useful and happy life. In 1943 , home nursi ng classes were started. In larger centres, the Canadian Red Cross cooperated to help keep instruction on a high level. This year also, for the first time in the history of the unit, a definite effort was made to re­ enforce the immunity of children who had had shots more than five years ago. Also, an attempt was made to contact as many pre-schoolers as possible. The growth of the unit and the expansion of its programs became an example to those that followed. 68

RED DEER The second demonstration rural health unit was located in Red Deer and opened within scarcely 90 days of the High River Unit. Documents relating to its beginning were lying in a dark comer gathering dust in an unmarked cardboard box. In 1980 a hired helper almost threw this "junk" out into the garbage. He had been employed by the government to help move the Red Deer Health Unit from the Parkland Mall to the new Provincial Building. He gave the contents of the box a cursory glance and then looked more closely. This could be interesting, he thought, and brought the material to a nearby nurse who was busily clearing out a filing cabinet. She gave a quick look, then gasped, "The minutes. The old missing minutes." Indeed they were! The priceless minutes of the first meeting held way back in 1931 - the year of the health unit's founding! The minutes of that meeting reveal that the unit opened with a staff of five including one doctor and one nurse. The story of how it came into being is one of determination and intrigue. William R. Baycroft, a bright and lively 86 year old Red Deer resident, and instigator of the whole thing relates the following: "Way back in the late twenties, I was on town council. Then I heard a rumour - a rumour that the Rockefeller Foundation was putting money in the United States and western Canada to start health units. Next thing I learned High River had been helped this way . Well, Red Deer sure as heck needed a health unit, too! Rightaway, I asked the secretary if any material had come from the Foundation. He replied, 'Yes but I didn't think it important so I filed it away.' I won't go into my answer to that but I talked it over with the other guys and they all agreed we should look into it. We knew the first thing was we had to establish need and we also had to have five municipalities in with us in order to form a health unit. It took some doing but finally five were persuaded- Pine Lake, Golden West, Arthur, Crown and, of course, Red Deer. We then approached the Foundation. As with High River, we pulled it off. Eventually, we got a grant of $15,000. With the help of the provincial government and our own municipalities, the thing was as good as done. We hired Dr. Little and a nurse - I'm not sure, but I think Cloretta Dean - later Mrs. F. P. Galbraith. She was, I know, one of the early nurses. Then we bought two Dodge sedans and opened the unit! These cars, with a doctor or 69 nurse, bumped their way around the countryside, visiting schools - about 27, I think. They examined the kids. Many had never seen a doctor or a nurse before! '' From then on, the Red Deer Health Unit grew and flouri shed. Dr. C. G . More was Medical Health Officer from 1949 to 1980. The present Medical Officer of Health is Dr. Ian Mackintosh . The cost of operating that first year was $ 10 ,000. The budget for 1981 is $2,300 ,000! The population served in 1931 was 18 ,000. In 1980, it was over I 00,000. The area covers 9 ,400 square miles which consists of 22 municipalities. Its boundaries include Red Deer cit y and county, the County of Lacombe and Improvement District #I 0 , which extends south and west of Rocky Mountain House and to the Jasper Highway. Substations are located at Lacombe, Rocky Mountain House and Innisfail. Staff at these sub-offices consists mainly of nurses and clerical workers. Specialized services such as speech pathology, dental and public health inspections are centered in Red Deer. Rocky Mountain House also has two full-time federal nurses whose work is looking after the health needs of the Indians on the reserves. When major treatment is needed, Red Deer takes care of it. When the Red Deer Health Unit first opened, one of the main tasks was tackling the control of thyroid . The introduction of iodized salt into the diet reduced the incidence of goitre. Another main job was the ever present need to provide immunization against communicable di seases. In 1932, special clinics were organized for the removal of tonsil s and adenoids. Fee was $20 per child. But this was soon discontinued as it became ever more apparent that tonsils should not be removed unless absolutely necessary. As at High River, infant mortality rates dropped dramatical ly with the unit's pre and post-natal education and baby clinics. The polio epidemics of 1952 and 1953 , resulted in eight deaths in the Red Deer area. Schools, swimming pools and theatres were closed. With the advent of Salk and later Sabin vaccines, the health unit staff worked long hours vac­ cinating the public against this disease of horror. Until the vaccines had been developed nurses could do little except call on patients and offer what comfort they could - and to ensure strict quarantine where necessary. This health unit, can with justifiable pride, lay claim to several " firsts " outside of the larger boards of health in Edmonton and Calgary. One of these was the appointment of a dental officer in 1960. He was Dr. White and did not retire until last year. In later years, the highly prized dental hygienists provided invaluable service. All this was a great improvement over a dentist going to schools trying to look after teeth. Red Deer promoted the use of dental care. Dr. More attributes this to the fact that many of the Medical Officers of Health had worked in England under 70

the National Health Services in the field of public health . There the dental programs had been available for some time and it seemed like a good item to institute in Canada. Today, dental programs are considered part of the routine practices of preventive health care programs. Red Deer was also one of the first communities to fluoridate its water. Dr. More says the impact of this action can still be felt. Four years later, the unit purchased its first X-ray machine to be used with _ the T. B. testing program. Now , however, X- rays are done by referral to hos­ pitals. This seems more practical. Red Deer was also the first, in the early sixties , to add an educational psychologist to their staff. That great benefits were derived from this, soon became apparent. It was a much needed service. Education recognized this as well. The Department of Education took it over in a few years and schools now have their own guidance counsellors. Another new venture into uncharted territory was the addition of a speech pathologist in 1972. Dr. More says interest in this area is astonishing. The health unit now has three. Pre or school children are referred here for treatment. The program is expanding rapidly, not only here but in other health units as well. Because of the lack of trained personnel, there are long waiting lists everywhere. The Home Care Program has become highly successful. The home care idea originally came from Red Deer's auxiliary hospital board in an effort to discharge patients from hospitals a little earlier than they might normally be. The advantages were obvious. More active treatment beds, more auxiliary beds and beds in nursing homes would thus be made available. Helen Hunley, then Minister of Health, was, as we know , strongly behind it. In 1974 - after years of talking and delay three pilot projects were launched. Red Deer handled one of these. Roy Anderson was the chairman of the first home care committee. Nurses were selected to devote themselves exclusively to home care. Within six years of its inception, the Red Deer program has blossomed. The budget for its initial year was $40,000. The plan for the next fiscal year is $882,000! Home Care has created a good relationship between hospitals and health units - at least in Red Deer. In 1973, Red Deer Health Unit became the first to acquire a full time nu­ tritionist. This valuable service has expanded into areas such as dental, home care and geriatric. Perhaps the truth is hitting home. "We are what we eat! " Dr. More says even private physicians refer their patients to the health unit for expert advice on nutrition. The following year, an Occupational Health and Safety program was in­ troduced - the first and only one in Alberta within a health unit. It has concerned itself mostly with small industry and in the city only. Surveys show it is highly 71 satisfactory. There is a good probability the province will initiate it in other health units as well . Here also, only specially trained nurses are on the job. The newest, and a very important program, was launched in 1979 - He­ reditary Diseases Identification and Genetic counselling. One nurse, with degrees in both nursing and social work, helps families who have a hereditary problem. She gives them advice and perhaps more importantly, warm understanding. Her help is particularly valued by young couples wishing to have a family. At the moment, this entire program is monitored by a professor of genetics from Footh­ ills Hospital in Calgary. The public health nurse has always been of vital importance. Today, this is more true than ever. Twenty-seven are working out of the Red Deer Health Unit, engaged in educational school programs. This is done in order to encourage proper hygiene habits at a young age. Hopefully these habits will become so routine they will be carried over into adult life to the benefit of all. The time to teach the children is when they are young, is their philosophy. At the present, each nurse is responsible for about I ,000 youngsters. It sounds like a staggering load, doesn't it? Dr. More agrees with others that today' s biggest health problem is venereal disease. The health unit works closely with the provincial social hygiene de­ partment. This work is not really part of the health unit but it helps all it can in such matters as tracing contacts. Although a myriad of activivites go on and there is much hard work to do, there is always a lighter side. Take for instance, one of the nurses one sunny summer morning driving gaily along, off to visit one of her schools. She rolled the window down in order to enjoy the fresh air. She was humming a little tune. Then disaster struck! Horrors! A hornet! Before she could defend herself, the hornet had its way - wham - right on her rear. Excruciating pain! Mary leapt up two feet. Crash! Her heaa banged the roof of the car. More excruciating pain! "l must control the car," she thought wildly, " but can l when both of my ends are screaming with pain -'' But control it, she did! However, she didn't hear the end of that episode for some time. Nor did she forget. Her sore head and painful 'sitting' saw to that' ln conclusion, Dr. More says staffing is always a problem, particularly procuring specialists like speech pathologists and dental hygienists. As for him­ self, much as he loves field work, he now does very little. With the health unit ever growing, there is just too much paper work. He smiled ruefully. "Most of my colleagues share the same fate. The work of a medical officer today is mostly administrative." During his years as a Medical Health Officer, there have been highlights in his career. He feels privileged to have become acquainted with a great number of talented and worthy people working with the health unit over the years. He 72

has a profound respect for those in the public health service. He is intrigued by the great strides in medicine, like new vaccines. new treatments: the age shift in population - people are living longer - people are healthier. All this is drama, he says, but it moves slowly - especially as compared to the swift miracles performed in the operating room! One of hi s comments was that after the unit had been going for sometime its existence was still not widely enough known. '·People were very often un­ aware of such a thing as a " Health Unit". This may still be true today. We tend to hide our lights under bushells, because we're pretty busy with getting on with the job. The trend of course, nowadays is to improve the education of the public in all matters relating to health, and I would imagine that it is only a matter of time for each Health Unit to have a Health Educator on staff." Dr. More's thoughts on what may happen with health units in the future are optimistic. "There is an indication that the traditional preventive approach is gradually changing. There's more concentration on newer programs - on services such as nutrition, speech pathology, genetic counselling and lifestyle education. All these things are fairly recent but they're likely to gain in impor- "·=- tance. Along with this. a very real need will come for more trained personnel in these fields. " Those long ago and dusty minutes of that first Red Deer Health Unit meeting in 1931 , paved the way for undreamed of progress. Today sitting in the newly relocated offices in the Provincial Government Services Building, is it not in­ teresting to speculate on how the minutes wi ll read in another 50 years?

* * * * * *

The success of the two experimental Units made Dr. Hoadley determined that modern, spotless health units would one day stretch all across Alberta. Hoadley believed that public health was the first line of defense. He had noted that the outstanding weakness of Alberta conditions was that the people were insufficiently served by full time health units. These services were to be augmented with necessary equipment for pre- natal and post- natal care, for healthy mothers and strong children. He pointed out that on an average Canadians lost 3 mothers , 54 children under 5 years of age, 42 under 1 year and 24 stillborn babies every day. This was, in hi s eyes, a national di sgrace. The nation could not reach its potential greatness in the face of such waste. An important factor in this sorry showing was seen as being the inability of so many Canadians to secure or pay for proper medicalization. Dr. Hoadley pointed out that at that time one half of all Canadian incomes were less than $1,000. a year, which was not sufficient to provide health security. At least 25% of Canadian families could not buy medical services. 73

The development of the health unit scheme would bring the best results in preventative treatment. Venereal disease control would be achieved with syse­ matic attention. The early diagnosis and adequate treatment would result in diminishing needless suffering and death. In the case of communicable disease there was a cure for pneumonia, bringing remarkable results. Yet there were 7 ,281 deaths every year from pneu­ monia. Diphtheria was absolutely preventable, yet there were 311 deaths annually from this cause. Typhoid had been practically wiped out in many parts of Canada, and yet there were 271 deaths annually, traceable to a great degree to inadequate public heath supervision. The challenge was to reduce the mortality rates through public health pro­ grams administered by regional health centres. Dr. Hoadley continued that it was significant that the major causes of death for children under one year were prematurity, injury at birth , malformation or congenital debility. These four causes claimed 41.4% of infant deaths in 1924; 44.6% in 1933 and 46.4% in 1938. Adequate pre-natal and post-natal care would bring a vast change in thi sad record. Neither, he noted, was there any improvement in the maternal death rate in Canada in the previous 25 years. Deaths rising out of pregnancy and childbirth were divided as follows : 49% associated with live births; 19% sti ll births: 32% cases the 6 112 month pre-natal period. Childbirth and attendant conditions are the leading cause of death amongst women from 15 to 50 years aside from tuberculosis. Average age of mothers lost, 31 years. Proof that maternal mortality can be reduced is given in the groups of mothers served by the Victorian Order of Nurses where the deaths were only 2.7 per 1,000 to 4.6 per 1,000. The state of public health prior to the establishment of health units on a provincial scale was not encouraging. From the start it must have seemed as if the problem would defeat all efforts at improvement but by the early sixties almost 90% of the province's people were under health units' care. Much has followed since the pioneer work of Alberta's first two health units. Today the gleaming modern Foothills and Red Deer Health Units are busier than ever. And serving more people than ever. From the very beginning, their staffs have worked hard and with dedication. There is very little free time. But steadily improving health standards throughout the districts, they have served for so many years, makes it all worthwhile and richly rewarding. 74

Chapter 8 HEALTH UNIT EXPANSION: 1938 - 1980

The two demonstration rural health units established in 1931 were the forerunners of the province's health unit history. The two units had responsibility at the local level for health education, sanitation. inspection, T.B. control, communicable disease, child and mental health hygiene, food handling, water and milk sanitation, and dental hygiene. The whole was based on preventative programs. After a few years of operation, their unqualified success left no doubt in anyone's mind that this phase of public health must be expanded. However, due to economic conditions and lack of trained staff, no further steps could be taken at that time. But in 1938, a third unit was established at Lamont and in 1940 a fourth at Stettler. The Lamont Unit was the first to add a nutritional program to its operations. Considered of first importance. the evolution of a community nutrition program was to serve as a practical and workable model for the rural areas of the province. A nutritionist was attached to the staff of the Unit which had already been active in nutrition education. In 1943. the Unit had conducted, as a publicity and teaching enterprise, a six-week camp at Elk Island National Park, for under­ nourished boys. The unusual nature of the camp, together with the general l improvement in the health of the thirty boys who had attended, aroused universal interest. Accordingly, projects in community nutrition were continued and ex­ panded. These included distribution of vitamins to pre-school children, in some cases provision of milk during recess breaks and hot lunches for some classrooms. Public participation in a nutrition program proved to be a particularly unique and effective phase of the work. In selected school districts, housewives were invited to attend study groups where they received instruction in the preparation of adequate diets and the assembling and evaluation of diet records. They pre­ pared reports on such matters as the use of Canada approved flour and bread in their respective districts, the probable vitamin and mineral content of local diets, the quality of the school lunches and the relative distribution of pasteurized or non-pasteurized milk. Topics of discussion varied with the needs of each district, which were in turn determined by the dietary surveys conducted by the house­ wives and school children taking part in the project. In conjuction with this project, a summer school in public health and nu­ trition for teachers of the district was operated in August of 1944. Fifteen teachers were trained to give material assistance with the work and to act as leaders in 75

the organization and preparation of study groups, both in the school and com­ munity. Two special nutrition camps were also conducted for housewives in 1943 and again in 1945 . Due to the lack of personnel, further development of the nutrition program of the Department of Public Health was not then possible, but it will be of interest to note at this time that the appointment of a fulltime nutritionist to the Department of Public Health occurred in 1949. The first nutritionist was Miss Elva Purdue, a graduate from the Department of Household Economics at the University of Alberta. In 1940, two more health units were begun. The one being Rosebud Health Unit at Didsbury, the other, the Sturgeon Health Unit at Legal. Following on the heels of these were Holden and Clover Bar. But now, because of the war, the original plan for province-wide expansion had to be suspended. Staff was simply not available to permit the goal of six new units a year. With the scarcity of trained personnel due to the war, the Department of Health had to make do with what it had. Nursing services were expanded and the number of travelling clinics offered were extended. In order to ease the strain on scarce resources, in 1944 seven additional health units were opened but not with a full staff. In stead. one public health nurse was placed in charge of each. More "one nurse" clinics followed in 1945. These units continued to thrive until the establishment of fully staffed units in the l 950's. After the war. dental programs were stepped up . Topical fluoride treatment was initiated for pre-schoolers and children in grade one. The biggest obstacle in the way of a well-rounded dental program was again a shortage of dentists. With the ever-growing population, it was difficult to keep up! In 1949, a policy of providing dental care through the health units was approved. The chronic shortage of dentists in rural areas saw dental treatment become a matter of public concern. In some instances, basic and emergency treatment was provided by local dentists or by mobile clinics. The government encouraged the development of dental service through additional grants. In re­ lation to these programs, it is of note that Lamont had a dental program as early as 1943 and the Eureka Unit by 1954 followed by Jasper Place and Sturgeon in 1957 . After the war. it was decided to look into the matter of health service for federally administered Indian reserves. Help would be given some of the far northern communities at Trout Lake, Sandy Lake and Fort Chipewyan by offering a limited nursing service. The cost was to be shared with the federal Department of Indian and Northern Health Services. This was the first major step toward the province accepting responsibility for Indian health . In 1955 , public health units had vaccinated Indian children on th e reserves and in some cases, health education classes were conducted. 76

During the next ten years, the growth and development of the public health care services was satisfying as new benefits emerged. Free care for rheumatoid arthritis victims was offered to all those under 25. Cerebral Palsy clinics opened in Edmonton and Calgary. The Nursing Services Act expanded nursi ng service. Provincial Hospital Insurance was provided and the province delved into Aux­ iliary Hospitals for the chronically ill, just to name a few. The only black spot in an otherwise brightening picture was the polio epidemic in 1952 to 1953 . Another health unit had been opened at Drumheller in 1948 and with the passing of The Health Unit Act in 1952 , the rural health unit system forged ahead! Dr. Baster, the Director of the Communicable Diseases Branch spent countless hours travelling across the province persuading municipal boards to agree to apply for health unit status. As a result, a health unit boom occurred in the early fifties. New units opened at Jasper Place, Fort McLeod, Wetaskiwin­ Ponoka, Forest Lawn and Lethbridge. Then in 1954, unit boundaries were made co-terminous with those of the surrounding counties. This resulted in some changes to already established units . As new units were formed, changes in boundaries occurred. Units near urban centres were usually absorbed into the larger region. By the end of the fifties , 93% of the population was covered by health units. This rapid expansion was made possible by the recruitment of trained per­ sonnel at home and abroad. Of particular impact in the province was the re­ cruitment of a number of Medical Officers of Health from Great Britain. There the public health program, was well developed along lines not ever thought of in Canada. These doctors brought with them not only a dramatic energy and drive, but the experience of new directions and the ability to move government agencies along new paths. Had it not been for their coming, the health unit system would not have become what it is today. In 1956, Dr. E. S. Oxford Smith was put in charge of the Local Health Service Division of the Department of Health and made responsible for the administration and well-being of the burgeoning health units. The I 960's saw a dramatic change in the demographic structure of Alberta. Continued urbanization drew population from the rural areas into its cities, towns, and villages. This meant those remaining on the farms and ranches were more isolated than before. In addition, the development of an industrial base often led to temporary settlements of workers situated throughout the northern forested areas. Consequently, in January 1966, with the help of the Department of Mu­ nicipal Affairs, a nursing service was opened at Fort McMurray. Other outlying districts were also in dire need of help. It was decided that part-time service would be offered at Calling Lake, Fort McKay, Anzac and Conklin, plus several Indian reserves. The Department of National Health and Welfare lent a hand with the latter. 77

At this time, a series of meetings were held with the staff and boards of 15 of the health units. It was felt there was a need for change in services and directions. A decision was reached to cut down on routine physical school examinations and thus eliminate what were essentially non-productive programs. Instead , pre-schoolers would be examined before school entrance. The time this saved could be put to better use in referral programs - vision screening, hearing, teaching nurse conferences, pre-natal home visiting and attention to senior cit­ izens with chroni c health ai lments. Another innovation was the setting up of At Ri sk Registries in several health units . This was preventive medicine at its best! Family hi story , maternal factors and other conditions were recorded. Special observations were made from birth to age one or two. In this way, problems could be identified before they had a chance to flourish . In 1956, the Division of Local Health Service, now called Community Health Services, was created to bring together responsibility for communicable diseases, health units , municipal nursing, nutritional, entomology and health education. Then there were 18 health units in operation, with the total staff of 18 medical officers, I dentist, 82 public health nurses, 24 sanitary inspectors, 1 dental assistant and 18 secretary-treasurers. These units took full advantage of the department's many consultant services - tuberculosis control, social hygiene, mental health, industrial health, provincial lab, medical service, sanitary engineering. Tlie first Director of the Divison of Local Health Services was Dr. E. S. 0 . Smith. An amendment to the Health Unit Act provided for a grant to each health unit at a per capital rate of $1.45 less one cent for each 1,000 population, subject to a minimum of 95 cents and an additional grant for dental services. Health Units were required to requisition local councils for a sum equal to two­ thirds of the amount contributed by the province. This method of payment resulted eventually in the collection of " have" and " have not" health units, where larger areas with bi gger population could provide a wide variety of services and pay better salaries than could small er ones. A proposal was brought forward in 1967 to improve health care services in the province by cloning many of the smaller units and nudgi ng them into nine regional organizations and the di stricts of Edmonton and Calgary. It was fe lt that the nine regions would attract better qualified staff as the increased population was more suitable to full-time employment. Some medical officers refused to accept employment in smaller population areas. Each new region would serve between 60,000 and I 00,000 people including Indian and Metis colonies. The province offered to take over staffi ng of all the units and provide for a provincial salary scale under the civil service. The province would also establish province­ wide standards that would be applied to all programs. The cost of the new 78 organization including specialists contracted by the province would be on an 70/ 30 cost share basis. A host of meetings were held during 1968 for purposes of discussing the proposed changes. By and large, discussions at the elected board level on the proposed reorganization was found to be negative. The greatest stumbling block was the fea r of a loss of local autonomy. Despite the efforts of departmental officials, this proposal was eventually withdrawn. Still the problems of the poorer units persisted. In some cases, because of budget restraints, it was practically impossible to establish new programs. Thus, in the province, the ability to fund or not to fund new programs left some of the citizens in a disadvantaged position. ln an effort to rectify the inequality of service the provincial government, in 1973, began funding l 00% of health unit costs including that of the Local Boards of Health of Edmonton and Calgary and the federal areas of Banff, Jasper, and Waterton National Parks. It was anticipated that with full provincial funding , a number of services would be upgraded to the benefit of all. Each unit was to carry a full staff with a full or part-time Medical Officer of Health, a Nursing Supervisor, community health nurses, public health inspectors. In more recent years staffs have been expanded to include in most areas, a dentist, dental hygieni st, speech therapist, audiologist, and an administrative officer. Although the matter of full staffing is a department policy in some cases this is not always possible due to the inability to attract qualified personnel. For example, in 1980, nine of the units were administered by directors with nursing backgrounds and a local doctor acting as a Medical Health Officer in a consulting role.

As programs in the preventive health field have grown, so has the staff of /j the Division of Community Health Service. There are now consultants in nursing, nutrition, dental health, speech and audiology, health promotion, environmental health, family planning, home care, administration and finance. A separate Com­ municable Disease Branch was established in 1978 and the Divisions of Social Hygiene and Tuberculosis Control came under a Director. The first dental health program to be offered by a rural health unit on a full­ time basis was established in Lamont (later - Yegreville Health Unit) in 1943. By 1965, 18 of the 24 health units were operating a dental health program and ten communities were fluoridating their water supply. The range of dental services now offered to the population varies. Basically, however. the health units provide the following services: school dental inspec­ tions, school visits and classroom instruction, oral prophylaxis and topical fluor­ ide applications, individual counselling, and community consultation on dental matters such as fluoridation. Dental treatment services are available in the larger cities and in one rural health unit. ln Edmonton and Calgary, treatment is provided by salaried clinical dentists for children of deserving families. Barons-Eureka Health Unit, through 79

its Dental Officer, operates a school based dental treatment program for Grade 2 and Grade 3 students. The Mobile Dental Clinic, funded by the Department of Social Services and Community Health and staffed by students and instructors from the Faculty of Dentistry, commenced operation in September 1974. It operates on a year­ round basis and provides both preventive and treatment service to northern areas of Slave Lake, High Level and Manning. Complete dental treatment is provided by the Department through the fol- lowing programs: 1. Public Assistance provides complete dental care to the poor. 2. Extended Health Benefits provides coverage for senior citizens. 3. The Cleft Palate Program provides full coverage for all persons with cleft palates. 4. Handicapped Children's Services Program provides full coverage for other hereditary or congenital conditions requiring major dental care for children. 5. Alberta Health Care Insurance Commission provides dental coverage for beneficiaries requiring major dental service from an approved list of procedures. In 1978 approval was given to significantly increase the numbers of dental hygienist and dental assistant positions in community health . Today, the Dental Program is becoming much more actively involved in public education through the promotion of Dental Health Month and the pro­ duction of educational resource materials and publications. ll With the appointment of a full-time nutritionist to the Department in I 974, consultative services were provided to public health personnel and the dietary staff in hospitals. There was then a thrust to employ nutritionists at the local level to ensure and strengthen the nutrition component in the public health programs. This trend has continued and in I 979 there were fourteen community health nutritionists in Alberta. Eleven were attached to the local health authorities and provided services for sixteen health units. The remaining units received nutritional service from three consultant nutritionists employed by the Com­ munity Health Services of the Department. In the early l 960's a continued population shift led to workers and their families moving from rural to urban areas, thus concentrating on what was a formerly scattered population. Agriculture, which in I 950 employed 33% of the labour force, now employs 8% of the labour force. The increase in labour activity in construction, transportation, other primary industry and services has meant that large segments of the total population changed from limited risk occupations to occupations with multiple risk factors in terms of workers' health. In the early I 920's, district nurses provided some of the first health services to workers through their first aid service and treatment of workers injured on the 80

farm and in lumber camps. in i 964, the Division of industrial Health Service of the Department of Health and Social Development was established. Its services were directed toward small industries. A staff of ten including four graduate field staff and three laboratory workers provided the services. During this time, occupational health services were being established chiefly by larger companies whose parent companies required such services as a matter of policy and in industries where the health of the workers could affect the health of the public, namely meat packing plants. hospitals, and department stores. in the early l 970's, due chiefly to further oil discoveries, the labour force increased dramatically. The work force which in 1968 was 480,000 increased to 962,000 by December 1978-,-- doubling in a decade. A growing concern by both unions and government was toward occupational health and safety matters. This led to the establishment of an industrial Health and Safety Commission in 1973. The Commission recommended the coordination of occupational health and safety programs and policies in the province. In 1979, the Occupational Health and Safety Division was established as a separate division reporting to its own Minister. In I 974, prior to the realignment of Industrial Health Service to the new Division, it was recognized that there was a need to provide services to small industry. Ninety-five percent of industry in Alberta employs less than 100 work­ ers. A demonstration project within the Red Deer Health Unit was established. Currently, two Occupational Health nurses working under the direction of the Medical Officer of Health are providing comprehensive occupational health serv­ ice to 70 small industries employing 2,400 workers. A study is currently un­ derway to assess whether this demonstration project could be extended to other health units in the province as a way of meeting the needs of small industry. Speech, language, and hearing services are provided indirectly by the De­ partment through the funding of programs operated by health units. In 1973, funding was provided for five speech pathologists positions. By 1978, 49.5 positions had been funded in 22 of the 27 health units . Of the health units without speech pathology positions, 4 share services with adjacent local health authorities. Today, there are some 560 community health nurses employed by local health authorities. They conduct generalized programs offering service to people of all age groups. In addition, there are seven Nursing Consultants in the Division of Community Health Services, one of them being the Director Community Health Nursing. Each acts as a consultant to a specified number of health units and each has a specialized area of knowledge such as maternal and child health , geriatrics, and school health, in which she may provide nursing consultation to all local health authorities. Home Care programs had their beginning in Alberta in 1970. Until I 978, there were nine programs offered by seven local health authorities. The provincial 81

Coordinated Home Care Program started on 1st of July , 1978, and is now operating in all but a few of the local health authorities . Home Care is the first program that has been based on local health authorities that is strictly regulated. Each local health authority appoints a Home Care Management Committee and a Home Care Coordinator. Patients admitted must have a need for a " medical'' service, such as nursing, physiotherapy, occupa­ tional therapy, or respiratory therapy. There is a small fee for support services such as homemakers and meals-on- wheels. based on income. The cost to the patient per month may range form nothing to a maximum of $150.00. Priority for admission is given to the elderly and the handicapped. Before 1969, the law made it impossible for any sector, public or private, to offer a full range of family planning services. However, with the change in the Criminal Code, the provincial government of Alberta in cooperation with the municipalities, established family planning clinics in two major cities - Edmonton and Calgary. These clinics provided a range of medical services including information and instruction on birth control, counselling on family planning, physical examination, and the fitting and/or prescription of contracep­ tives. Subsequently, government health and social service agencies were en­ couraged to provide family planning education, counselling, and referral services. Jn 1974. the family planning consultants and the committee initiated a special research project which was undertaken by the Department of Community Medicine at the University of Alberta. The purpose of this project was to study the nature and extent of the family planning services in the province and to identify a strategy for the future development of such services. In the following year, the Family Planning Coordinating Committee sub­ mitted a brief to the Minister recommending increased departmental involvement in the provision of family planning services for Albertans. As a direct result of this brief, three very significant developments occurred. I. The provincial government made a decision to fund future developments in family planning services through either the Local Health Authorities or the municipalities via the Preventive Social Services Branch. There­ fore , in essence, all decisions regarding the establishment of family planning services are made at the local level. 2. A second significant development was the establishment of a family planning consulting team within the Local Health Services Branch (Now Community Health Services). 3. A third development was the creation of the Family Planning Advisory Committee to replace the Coordinating Committee. The Family Planning Consulting team, in the Community Health Services Branch, was established in August 1976. It is multidisciplinary in nature and is made up of a Senior Consultant, two Field Consultants, and three physicians who provide medical consulting services to support the family planning staff. 82

Like other consultants in the Community Health Services Branch, the team relates to personnel in the community health system, as well as to those in other associations, agencies, and institutions. To facilitate the operation of the program, each of three staff consultants is responsible for provision of services to specific local health authorities and for different aspects of the program. The southern consultant position is decen­ tralized to Calgary. It was at this time of tremendous program growth that the health units formed an executive association with offices in Edmonton. Although it was not formed until 1970, the Health Unit Association of Alberta had its genesis in the early I 950's. During this period, health units were largely funded by participating municipalities and tended to operate in an independent fashion. In March of 1954, the first Minister's Conference was called by the Hon­ ourable Donovan Ross. These conferences were designed to bring together Board Chairmen, Medical Officers of Health , and Secretary-Treasurers for the purpose of hearing government policy. As these meetings evolved, health unit represen­ tatives brought forward resolutions for discussion and at times the Minister's Conferences became rather stormy sessions. At one such meeting, the government introduced a salary scale for health unit personnel which it considered mandatory (regardless of the fact that mu­ nicipal funds made up most of health unit funding). It was then announced by the Minister at the meeting that no more funds would be forthcoming from the Department to honour such a pay scale. It was suggested by the Board Chairman of the Drumheller Health Unit, Mr. Emile Cammaert, that if there was no more money, then perhaps the meeting should be adjourned. This suggestion was accepted by the assembly and only through the frantic efforts of an embarrassed civil servant did the Minister manage to find additional funds in the afternoon of the same day. Towards the end of the l 950's many health unit board representatives began meeting in the absence of government representatives. The first such meeting was held in Wetaskiwin in 1959. Throughout the l 960's, this independent course continued and such meetings became annual affairs held in Red Deer. With the formation of the Society of Medical Officers of Health in Alberta in 1969, it was then decided by a small group of health unit board members and personnel that a formal health organization should be formed . A committee of four individuals: Mr. Phil Stonehouse, Board Member, Medicine Hat Health Unit Mr. Earl Foxall , Secretary-Treasurer, Barons Eureka Health Unit Mr. Marvin Labarge, Board Member, Alberta East Central Health Unit Mr. H. Nummi, Board Member, Barons Eureka Health Unit were given the task of organizing the Association. 83

On December 3, 1970, the inaugural meeting of the Health Unit Association of Alberta took place in Edmonton. Mr. Emile Cammaert of Drumheller was elected as the Association's first Chairman and Mr. Marvin LaBarge of Camrose was Vice-Chairman. Mrs. A. Lowther of Drumheller was appointed Secretary-Treasurer. Subsequent chair­ men have been Lawrence Kluthe, Hilton Pharis and Dorothy French. By-laws of the Health Unit Association of Albe11a were discussed and adopted and a membership fee established at 50¢/ 1,000 population per health unit. The first Executive Committee meeting was held in Edmonton on April 14, 1971, at which time the annual budget was established to be $738.03. For the next few years, the Health Unit Association of Alberta Executive Committee met about twice a year and held an annual meeting usually in No­ vember. Other than establishing its independence as a provincial organization representing local boards, the Health Unit Association of Alberta remained rel­ atively inactive. Throughout the period 1970-75, one particular theme re-occurred, namely the need for a province-'wide salary and benefit scale. In 1973 , the concept of a provincial labour relations organization for health units was approved by the membership. In 1974, funding for the employment of an employee relations individual was approved by the Minister of Health and Social Development, the Honourable Neil Crawford. In May 1975, Mr. E. Clarke was hired as a Personnel Liaison Officer. His responsibility was to assist in the establishment of regional employment agree­ ments and in negotiations between health units and employee unions. With the creation of the Anti-Inflation Board in 1976 came a significant reduction in the demand for the services of the Personnel Liaison Officer and it was determined that the Association should seek the services of an Executive Director. This position would have an expanded role due to the introduction of a joint planning proposal in 1975. The Association acquired the services of John Mason as Executive Director. It had become apparent that the Association and the Department must work together in a number of areas and that a spirit of greater cooperation should exist. The Executive Review Committee was established in 1975 for the purpose of long-range planning. Shortly after its formation, this joint Association/government committee established three task forces which were charged with examining future needs in the area of Child and Maternal Health , Health Inspection, and Dental Services. These Task Force Reports have now been completed and accepted by the Executive Review Committee. Recommendations proposed are presently being reviewed on an ongoing basis and implemented where possible. 84

On December 10 , 1975 , a revised constitution was presented to the annual meeting . Under the newly revised constitution, the proposal for division of the health units into regions was presented and accepted. The divisions became the North, North Central, South Central , and South Regions as well as City of Calgary and City of Edmonton. Most regions have formed their own executive and hold meetings with members health units within the region . Meetings are held at least three or four times within a year and from each of these regions one representative from each region is elected to sit on the board of the Health Unit Association. The Chairman and Vi ce-Chairman are elected by the general assembly at the annual meeting. The Health Unit Association Executive Committee has a total of eleven members. Along with the six elected regional representatives, a member from the Medical Officers of Health and Nursing Supervisors is each appointed by their respective societies to sit on the board. Since 1976, the Health Unit Association of Alberta has developed an em­ ployee relations program which serves a majority of its membership in addition to other needed services. The Executive Review Committee has remained intact and has served as an important link between local health units and the Government of Alberta. As the health units began to experience a change in direction and organi­ zation , they came under the Ministry of Helen Hunley. Hunley's political career began in 197 1 when she was first elected and became Minister without portfolio. In 1975, she became Minister of Social Services and Community Health. She was fully supportive of preventative health service programs and did all she could to further the health unit program. She was, and is, a great believer in community health , particularly the preventive side. Health units are the logical vehicle for this . With an expanded budget, she was able to thrust the health units into new areas - in particular, home care programs. When asked whether the units should become involved with the handi­ capped, she gave an emphatic " no ". Her reasons - the handicapped require specialized education. The health units should concentrate on preventive work. Also, the handicapped should be placed in useful occupations when possible and the units are not equipped for that, nor do they have the time. From Hunley's experience with health units, she wryly explained they are all different - some aggressive, some reactionary and some totall y cooperative. But they all have one thing in common. They move easily into most aspects of community life . While in office, she had two programs she aggressively promoted. These were that health units move ahead more aggressively with in-home care , and that "Aids to Independent Living" be approved and handled by the health units. She also proposed a bill providing for pensions for the totally disabled in addition to welfare and Aids for Daily Living. "When one reaches the magic age of 65 , 85 manna falls from heaven - glasses, teeth, crutches, etc., are immediately avail­ able. But if you are 45 and unable to make your own living because you are disabled, you pay for such things yourself or do without or go on welfare. Surely a pension would be more dignified ." Hunley and her Deputy Minister of Health , Dr. Nelson, met extensively with Health Unit Association Executives to di scuss the units taking over these new programs. Although she was unable to see the beginnings of the Aids to Daily Living and Handicapped Pension programs before leaving public service, these became the responsibility of her successor, Bob Bogle . Under her ministry , home care moved ahead rapidly . However, there were problems. Some health unit personnel did not approve of the idea of moving into what could be seen as the area of active treatment. This enraged her. Countless hours were spent in winning over the doubtful. Nor did she have much sympathy for county councillors who would spend money on roads but not on preventive health. When Hunley was asked what she thought was in store for public health, she answered, " The greatest challenge that we have is individual accountability for our own health. Even though we know safety rules, like seat belts, crash helmets, not smoking, and on and on, do we fo ll ow them? Or must we be hit on the head with legislation concerning these things? One other potential area of danger has arisen with travel so accessible to all. She cautioned the Medical Officers of Health to be on top of monitoring exotic di seases that could be brought back from abroad. What with international travel and large sporting events, the dangers of new epidemics are ever present. The incidence in America of particularly virulent strains of venereal di sease is but one example of what could occur if vigilance is not maintained. Helen Hunley now lives at Rocky Mountain House. When asked, " You have seen your local health unit grow. How valuable do you think it is?" . She replied, " I think health units are much more valuable than people realize. They don't stop to think why their children don 't have measles, diphtheria, smallpox - all the rest of it. They simply take these priceless things for granted! " During her last speech, she also made a fin al pronouncement in regard to health units in general. " You are too effacing. You are far more important to the health of Canadians and to the world than hospitals. Hospitals deal with casualties along the way. You keep us well. You' ve come a long way baby! " One of the major objecti ves of Bob Bogle who succeeded Hunley as the Minister of Social Services and Communmity Health was to consolidate new programs and to standardize their delivery throughout the province. By the end of 198 1, he planned to have all of the units delivering services under the Heredity Di sease Identificati on Program, a program of preventive dental care for all chil­ dren and the Coordinated Home Care Program. These programs were to be 86 phased in gradually to a point where they would all be in place on a province wide basis. Another major objective of the new Minister was to move in support of local autonomy while still maintaining a high level of basic services. The local boards were to have an increase in responsibility for four broad areas of program development and funding , namely administration, preventive health, co-ordi­ nated home care and auxi li ary services. His ultimate objective is to see global budgeting incorporated into the health unit structure. However, before and if this goal is to be reached , there will have to be a re-examination of the total funding picture. Perhaps a change from 100% funding now in effect to permit boards to institute new programs particular to their own situation. Such programs could come from local tax levies. Mr. Bogle points out the move in the direction of global budgeting would likely also mean some kind of accreditation or accountability to ensure that the basic services did not suffer. During his term of office, Bogle became concerned over the size of some of the smaller units. Without large budgets, the units were often without their own specialists. They depended on other units or contracts to fill some of their needs. These were on a part-time basis. Two of these units, Warner and Chief Mountain , did in fact join with larger units. Now with the economics scale of a larger unit full services can be provided on a full time basis. He also feels that the figure of 50,000 people appears to be a reasonable base for a full health unit program. Bogle feel s that it could well be in the interests of the public to have some of the other units join together but he maintains that it should be the local boards that decide. After all, they are closest to the scene. In 1981 , new legislation was being prepared by the government in the field of public health. How this will affect the health units remains to be seen. However, a study is now underway to find out just where the twenty-seven health units stand in relation to their delivery of services. Bogle is determined that current programs now in place reach satisfactory levels before new programs are planned. For the immediate future the Minister sees his principle priority as one of gaining acceptance for the new health act. After that is through the Legislature, then we'll see. 87

THE SOUTHERN HEAL TH UNITS

A hot dry wind blows acro~s the flat, treeless southern prairie. The short grass plains, pocked with thousands of gopher holes, rustle as occassional dust devils swirl and rise only to be quickly dissipated in the everlasting wind. Enormous cattle ranches sprawl here and there along the foothills and around scattered ridges of low lying hills . Their herds of cattle feed on the sparse forage. Interspersed with the ranches are the crops of large consolidated farms. The South Saskatchewan, Bow, Old Man, St. Mary's Rivers supply water to huge reservoirs and irrigation canals. It is these that make the irrigation possible. Where irrigation is not needed dry land farming techniques and drought resistant crops transform the semi arid lands into a bountiful harvest. Yet it cannot be denied. the south has a harsh side. Dust storms can roll across the prairies. invading houses , sifting into cupboards and layng the grasses low. Through the hot summer, clouds raise ominous heads. With a roar, they come closer and burst - spewing forth destruction with hail stones as big as goose eggs - flattening crops in minutes, lashing gardens, and shattering win­ dows. Deafening thunder and vicious lightening add to the drama. Winter has its own curse - howling, raging blizzards - gigantic snowdrifts making travel hazardous. Ranchers have lost countless cattle to the snows with no food and no way to reach them - a tragedy for both cattle and rancher. These vast rolling miles are dotted by lovely towns, villages, and cities. Over the years there has been a steady pull of population into the urban areas leaving a small and scattered rural population behind. As the population has consolidated civic services have been re - organized to best service the need of the people. Schools and other government services have centralized to serve larger regions. So have the health units. In 1980 the units of Warner and Chief Mountain were absorbed into Barons - Eureka and Chinook. Today the people of the southern part of the province have access to a wide variety of public health services from the Chinook, Barons - Eureka - Warner, City of Lethbridge and Medicine Hat Health Units. 88

Chapter 9

BARONS EUREKA WARNER

In 1953 , the sweeping Barons Eureka area was busily being travelled by public health nurses, promoting the idea of a public health unit. Many people were not familiar with the services offered by a health unit and strangely, many were mistrustful of the change. Some preferred going to their own personal doctor and perhaps some found it difficult to believe that anything free could be worthwhile! The persistent nurses spoke at meetings and went from door to door, attempting to gain support. Dr. Norman Bastar played a central role in this new venture. He virtually formed up the present unit and actually planned it. He was the first Medical Office of Health and held that post until 1963. Then the position was taken over by Dr. Palmer who held it until 1980 when he retired. Dr. Oshiro became the Medical Health Officer for the enlarged unit at that time . Throughout its existence the unit has experienced total support from its local board that has encouraged and funded programs above and beyond those approved by provincial officials. Once the idea of the health unit caught on, the whole thing flouri shed. For the past five years it has been housed in lovely facilities in a community centre that also houses social services personnel serving thousands of people in an area covering thousands of sq uare miles. The head office is at Coaldale with sub - offices in Yauxhaul, Barnwell, Havis, Taber and Picture Butte and now Warner and Raymond. Life for the health unit worker is seldom dull. One nurse tells of being called to Petry's Pantry on a suspected food poisoning case. It turned out the young man was not ill at all! He had eaten two enormous steaks - but couldn't pay for them! His complaint was an attempt to get off scott - free! Then there was the irate father who threatened a law suit because his child had been immunized. What he didn't know, was that his wife had signed the consent card. As any health unit knows, plenty uf serious incidents occur as well. Like the school bus driver who had tuberculosis and infected nine youngsters before he was detected. Then there was the excitement of discovering gamma globulin which was most effective in curbing hepatitis! A Hutterite showed up with the disease and was told to come in for a dose of this magic substance. He came, alright - two weeks later' By then most of the colony had been infected. 89

A provincial fir st for this health unit was the development of a dental clinic under Or. Erickson. At first there was only a semi - mobile unit operating out of Coaldale. With Dr. Erickson's persistance a totally mobile clinic was designed and went into operation. The mobile clinic offers preventative and active treat­ ment services. The unit regularily visits seven major schools. Another aspect unique to Barons Eureka was the fact that for a number of years they had a social worker on staff - Dennis Exinore. His work has since been taken over by Family and Community Support Services. In 1971 the expansion of the health unit into a health and social services board was accomplished. Most services supplied by the health and social services program were to be financed on a cost sharing basis, with the provincial govenment supplying 80% of the funds and the nine communities splitting the rest on a per capita basis. The program's welfare officer and social worker. plus an assistant to work with both, travel regul arly among the communities involved, offering marriage and financial counselling, medical services counselling, rehabilitation, welfare, financial assistance, school guidance counselling and li aison services among various related agencies. The board also hopes to establish new sevices including an expanded coun­ selling program, day care servi ces, a pre - school program similar to the Leth­ bridge Head Start Demonstration Project and a phychiatric referral service. Combining wclfar with health has proved to be tremendously rewarding. The nurses also take part in the social w~rk. At Christmas and Thanksgiving they visit needy homes and make lists of those needing food hampers. Shockingly enough they come across homes which have literally no food in the pantries! In that case, they buy the necessary groceries and deliver them. What gratitude those families must feel' Aside from food problems there are households with deeper troubles. In such cases. the nurse would usually take a doctor or the R.C. M .P. with her. The R.C.M.P. are always most willing to obilge. In many instances the protection is really needed. One such case was when a call was received about a woman who had obviously lost touch with reality . With a vengeance, she was hurling house plants out the door! There was also the case of a typhoid patient who was so mean-tempered the nurse never visited him without the protection of the R.C.M.P. A unique experience for public health workers was the arrival of Tibetan refugees. India did not have room for them so Canada agreed to take some. A community centre was set up in Taber. Here they were taught English and things like how to shop in stores. They simply had never had such experiences. And, of course their health was thoroughly looked after. Extra T. B. clinics were held and the necessary immunization was given. 90

They were amazingly quick at learning and very hospitable. If you went to th eir home, you absolutely must partake of their deep-fried delicacies and lukewarm tea and milk with plenty of sugar. To refuse would have deeply offended. They loved riding in cars! Once they were in one it was almost impossible to get them out' But although they tried and tried, they could not learn how to drive , much as they yearned for that coveted driver's license. They simply had no conception of machines. They just couldn't handle them' When one of the local doctors attempted to teach them birth control they were fascinated - but also acutely embarrassed! Eventually, they dispersed to larger centres like Lethbridge, Toronto and Vancouver. The same procedures were followed in attempts to immunize and resettle Vietnamese refugees. Like the Tibetans they too immigrated to the larger centres after an initial period within the unit. In 1965 , a typhoid case was uncovered in the area. Health unit people worked long hours in an attempt to immunize everyone. A larger task still was trying to track down contacts. It was thought they were workers on a beet farm but by now they had scattered far and wide. Some were from as far away as Bonnyville, Alberta some 300 kilometers northeast of Edmonton. A special clinic in Coaldale was established and approximately 125 persons were contacted personally and asked to submit to laboratory tests because of their direct contact with those stricken with the disease. An eight year old girl and a sixteen year boy were sent to the Coaldale Community Hosptial following confirmation that they had typhoid fever. Area residents were urgently requested to refrain from using irrigation water either for drinking, bathing or domestic purposes without chlorinating the water or boiling it. It was suggested that raw garden produce, watered with irrigation water should not be eaten without being either boiled, pealed, or at the very least soaked and washed in chlorinated water. Although it wasn't proven as the source, it seems likely that ditch water was the source of the outbreak. Anyone who had a prolonged or unexplained fever was to contact hi s doctor. All those who had been drinking untreated irrigation water or had eaten raw fruits and vegetables from irrigated land were requested to come to the clinic for typhoid shots. Almost I , 125 persons received typhoid shots at a special immunization clinic held in Coaldale following confirmation of the two typhoid fever cases. The reaction to the immunization is unpleasant, often involving fever, and the clinic officials didn't want to put people in that position unless it was nec­ essary. About 400 persons were turned away from the clinics because the doctors 91 felt immunization was unnecessary for them making the total response to the clinic about 1,600 persons. Thanks to the various news media the response to the clinics was first class. Then another problem arose. Transient families, who had never been im­ munized, brought diphtheria and strep throat with them. They had to be quar­ antined for several weeks. It was extremely hard on them . The fathers desperately wanted to work- desperately needed the money. The health unit obtained some financial relief assistance for them. It was arranged that only one person would go into an infected home. That person would do the grocery shopping, get the mail or do whatever was necessary. About this time, another case of diphtheria was discovered in Vauxhall. A young boy became dreadfully ill and had to be transferred to Lethbridge. He soon went into respiratory arrest and before the horrified eyes of the nurse, the boy was literally turning black! Her quick action probably saved his life. She gave him mouth to mouth resuscitation. Then he was whisked into emergency surgery to have his throat opened. Another example of the far-reaching aspects of various diseases occurred one summer in the Grassy Lake community. The local church minister and his wife travelled to Holland. When they arrived there, it was discovered the wife had active T .B. ! How she was missed in the screening no one can understand. At any rate, the report came back which meant the health unit had to check out every single member of the congregation. Nothing was found. It proved to be an isolated case of the wife and one of her children. Religious groups which do not believe in immunization against disease are always a potential hazard. The groups involved are spread throughout the Barons Eureka area. Some of the groups do not allow any immunization, others a limited amount. Some accept oral polio vaccine but no innoculations. Some groups will accept immunization and fluoridation only if they must by law. Others only when they are travelling out of the country. In another area, Dr. Baster's far-sighted view resulted in the development of a preventive mental health program. He said, "If you have stresses you will tend to get physical and mental illness. We should not only prevent communicable disease but we should also try to prevent accidents, alcoholism, hypertension and strokes.'' Almost 20 years later occupational and stress related diseases have been recognized as a major problem for the I 980's. A tragic example of what stress and strain can do lies in this story of a Dutch mother of eight. Having just come from Holland, she spoke no English. She moved onto a piece of land with her family which was very difficult to farm. Her husband seemed to think having 8 kids to care for, the housework , the shopping, and all the while struggling with language difficulties was not enough work for her. He insisted she help on the farm as well! She became pregnant again and was very toxic . She actually lived on to have three more babies but 92 with the eleventh one, she finally succumbed. It was a completely avoidable death. When Coaldale first started fluoridation, having won a 60% majority during the plebiscite, there were still those violently opposed to it. This was overcome as in most other units in a nefarious way. The fluoride was added two weeks before the public announcement was made . Those who opposed now complained loudly about the horrid taste - claimed they were vomitting and getting diahhrea - all because of the water. When it became known they had already been drinking this water for two weeks - there must have been some red faces! In 1978 the unit underwent a polio scare. A suspected polio carrier was identified amongst a group of people of Dutch descent at Picture Butte. They did not believe in immunization. That hectic summer over 10,000 doses were given. As population expands the unit's health inspectors will have their hands full with complaints about the odours and general undesirability of slaughterhouses and landfill sites. The industries were there first but this will not stop public demands to move them away from new subdivisions. How to resolve the issue is not known. As with the other units, Dr. Oshiro the newly appointed Medical Health Officer, is rapidly expanding the unit's ability to provide Home Care Services. In this he is fortunate about the close relationships between his own staff and that of F. C. S.S. He also has a full time occupational therapist on staff and a nutritionist was appointed in 1977 . Miss Benson provides dietary advice not only to Barons Eureka Warner but to Chinook also as well as almost all of the southern part of the province. In April 1980 the Barons Eureka unit became the first to operate its own TR S 80 computer. The entrance into the computer age provides the potential for a wide range of information storage and retrieval programs. Gregg Pratt, the Administrative Officer eagerly pointed out the ability of the new technology to support the work of the unit in everything from payroll to medical records. The major activity of the unit in 1980 was in the absorption of the Warner Health Unit. Services that were at one time supplied to Warner by the City of Lethbridge Unit will now come from Barons Eureka. The added responsibility will be a challenge to the smooth functioning enlarged unit. 93

Chapter 10 WARNER

Colourful , dependable and efficient - such was Warner County's first municipal nurse, Miss Comish. During her long period of service there, she did an enormous amount for the community - everything from setting bones to tossing out mattresses if they were too dirty or infested in some way! The people loved her. And when the County Hospital was built they were desolate to learn that their beloved nurse would have to leave. Miss Comish moved on to the Medicine Hat Health Unit and later nursed at Brooks. Meanwhile, her Warner people realized they would need some other health service besides that of the new hospital. Concerned citizens held several meetings, among them Mrs. Dorothy Hirsche. The idea of establishing a health unit cropped up . The more they thought about it, the more the idea grew . The necessary applications were made and on October 1, 1965 , the Warner Health Unit opened its doors. Dorothy Hirsche was appointed senior nurse . She had been in the area for many years. One of her jobs included doing immunization within the Sterling school system at the request of the school's principal. Ann Walker, a nurse at the health unit, laughingly recalls, "Talking about immunization reminds me of the old days when I was a kid. Every once in a while, mass immunizations would take place in the school or the town hall. Practically everyone in town would show up! Older people reminisce about this, telling how Dr. Walker would go up and down the line-ups, laughing and shooting them all! '' The structure of the unit was devised by Dr. E. S. 0. Smith, Director of Local Health Units whose advice was greatly appreciated. Offices were estab­ lished in both Warner and Raymond. Mrs. Hirsche also sought advice from the Sturgeon Health Unit. Notices were sent out to the county doctors in the county to select a Medical Officer of Health who would be available one day a week in the unit's two centres. Because of its limited population, the unit would have to contract some of its services such as a health inspector from the City of Lethbridge. Once operating, the health unit really began to move. One of the first nurses was Vera Cassel. Next came Kay Croteau and Mrs. Brenda Albright. "The first major job", says Ann Walker, "was setting up the records. Health history forms were sent to the home of every child. Then there was the 94 wait for the response from the parents so that files could be opened. Doctors were also approached for material to put in the records - but this material only went back to '55. Altogether the paperwork became a massive job". In those days, the keeping of records was the service most appreciated by parents. This responsibility was now off their shoulders! Within time, of course, they grew to appreciate the many other services the health unit offered. There was a large colony of Hutterites nearby. One of Mrs . Hirsche's first decisions was that the nurses should visit the colony rather than have them come in. This is still done today and has, and is, working very well. Several years ago many Hutterite women were still giving birth at the colony assisted by a mid­ wife. Dorothy made every attempt to be friendly towards the Hutterites and they responded very well. They were most interested in the health unit and babies are now being born in the hospital. Mrs. Hirsche also gently but firmly pointed out health hazards in the colony and gave advice on how to correct them. One such bit of advice was that the school had no wash basin and should get one. The kids would fly outside to answer nature's call and return to the classroom without washing their hands! Today, of course, the colony is completely modernized. Ann Walker says it is not necessary to spend as much time in schools as it used to be . Mrs. Hirsche however, took on the added responsibility of visiting the high schools every Monday morning and the students knew she was available for counselling and for discussion of any problem which they might have . Always thrifty with her time, she took paper work with her in case she found herself with time on her hands' But she was always ready to lend a sympathetic ear. Ann Walker tells of the dreadful blizzard of 1967. Then 150 cm. of snow fell during one weekend! Eeveything ground to a halt. The power was out, roads blocked and people stranded everywhere! "It started Friday," says Ann. "I went home for lunch but by the time l was ready to go back to work, it was impossible to get my car out of the driveway. Dorothy had stayed over but somehow, she managed to get home to Sterling that afternoon." Both Saturday and Sunday morning Dorothy Hirsche had emergency calls. How to get out? Her husbsand, Clifford, solved the problem. He cranked up the tractor and with her standing behind, bundled tip to the ears against the cold, away they ploughed through the snow! Dorothy said afterward that once she got off the tractor, it was impossible to walk in a normal way . She had to swing her legs over the surface of the snow, it was that deep!" One day in March , 1979 Dorothy Hirsche did not show up for work. Ten days later this gallant lady was dead from a brain tumor. She was only 53. The shock to all was painfully severe. No one had even suspected she was ill. The polio epidemic of '55-'56 threw everyone into a panic . The health unit was deluged with frantic calls asking "Am I up to date? Do I need a booster?" 95

Hours were spent looking up records and doing immunizations. Some insisted on a shot whether they needed it or not' One couple came in wanting booster shots. The husband was 60 and the health unit had been told people over 50 did not need the shot. The couple was on thei r way to a square dance festiva l in Cranbrook and the wife stubbornly stated. "We are NOT leaving without hi s polio booster shot!" So he got it 1 When asked about the life of a nurse, Ann Walker revealed an astonishing number of activities! Periodic visits to immunize residents of the Raymond Home; local immunization clinics twice a week - five Hutterite colonies on a regular basis. Ann also looks after Sterling. In her words, the fo ll owing is a typical week: " I visit an elderl y couple in their home once a week every Friday. The husband is a diabetic. He can ad­ minister the insulin himself but because of poor eyesight , he is not trusted to fill hi s own syringes, so I fill up enough syringes to last him all week . I also take hi s blood pressure. Another lady I visit twice weekly to give her injections. Every week I visit Ridge View Lodge, the seni or citizen's home. I take blood pressures, do some injections- generally check on health problems and visit wi th them. The doctors look after their real medical needs - and they do an excellent job. When asked about her feeling about the funct ion of the health unit. she hesitated, then said, "For the most part it ' s a sati sfying job - but sometimes we seem to be taken fo r granted. Yet if any emergency comes along, like the polio epidemic people do need you urgently. That makes you truly feel your work is worthwhile. In 1980 the Warner Health Unit moved to seek its future with the Barons Eureka Warner Unit. 96

Chapter 11

CHINOOK

The Chinook Health Unit was formed in 1956. From the very first, great enthusiasm was shown for this new and vital venture. It was christened " Chi­ nook" during the board's very first meeting. No doubt this charming name was chosen in recognition of the warm winds which periodicaly waft across the prairies. The region covers the Crowsnest Pass area as well as the foothills to the west of Fort McLeod. With the merger of the Chief Mountain Unit in 1980 the enlarged region now extends to the United States border serving a population of some 30,000. Even before the merger, Chinook supplied most of the services to Chief Mountain where 3 nurses provided health care programs to the Cardston and Magrath regions with a population of some 9,500. Members of that first board were: Mr. J. Gunderson, Claresholm, Chairman Mr. Thomas Story, Fort McLeod, Vice-Chairman Mr. F. Lynch-Staunton, Lundbreck Mr. Thomas Blunden, Fort McLeod Mr. P. A. Stonhouse, Medicine Hat Mr. F. Abousaffy, Coleman Mr. W . J. Gray, Blairmore Mrs. lgna Day. Fort McLeod, Secretary-Treasurer At that first meeting and only after much debate it was decided the head­ office would be in Fort McLeod and that they would rent the lower floor of the municipal building plus two rooms upstairs to house it. With the arrival of Miss Bogland, things really got underway. She stayed nine and a half days and her services were greatly appreciated. Two staff nurses were hired, Mrs. Jakoblec and Miss Jarman. Nurse Elaine Jorgenson has some fascinating memories of the early days. At that time she was part of the school system and as did the other nurses, worked strictly with clinics and schools. Schools unlike the modern establish­ ments were small with perhaps l 0 to 30 students. Grades one to nine were taught. The nurse recalls the 32 little schools which she visited regularly. And driving in those days was no picnic! She remembers getting bogged down in mud countless times! Usually horses, handled by some kind farmer, pulled her out! 97

As she moved from one school to another, all her equipment, including the heavy awkward scale, all the records , everything had to be loaded and then unloaded. And there was plenty of paper work including consent cards, individual records and reports for her superiors. Nurse Jorgenson also took part in the 1954 Polio Pioneer Program. Each child was given a button which he proudly wore, stating "I am a Polio Pioneer" . On the button were code letters and numbers. Some of the codes designated vaccine others only water. Laughingly, she recalls how hard the students tried to break the code. It would be nice to know who had the vaccine and who didn't. The code was a challenge but try as they might, they couldn't figure it out. In the end when all was revealed, it turned out to be very simple - A and C were the vaccine, 8 and D the sterile water. Nurse Jorgenson says the disease seemed to be especially severe in their area. The nurses had to do a complete survey of each polio victim, including a full family history. A startling fact was revealed. Two or three cases were family related. These victims had relatives in totally different parts of the country who also had polio! Mamie Godwin had been with the Chinook Health Unit since 1958. When asked if any particular time or event stands out in her memory, she answered promptly. "Yes. The diphtheria epidemic in '63 . It was dreadful , terrible - beautiful children, dying, choking. We worked night and day - and under terrible strain. The big horror was, it could have been prevented had the parents had the common sense to immunize them! '' The public health nurse must often perform strange and unusual tasks. A few years after the health unit was established a banquet was held at Fort McLeod. To everyone's consternation, a large number of the guests came down with salmonella - a chicken related disease. This was a real puzzler since chicken had not been served at the banquet but potato salad with eggs in it had. The chickens who provided the eggs for the salad were tracked down and guess who got to do the investigating? The nurses, of course! Their feelings ranged from upset to bitterness. It couldn't have been very much fun chasing chickens all over the yard, capturing them and then swabbing their behinds. Their efforts were not in vain . Some of the chickens were infected and the total lot had to be destroyed. Nurse Jorgenson concludes with, "Public Health has taken giant strides over the past few decades. All the hard work and dedication has, and is, paying off tenfold. '' Today with the merger of Chief Mountain the Chinook Health Unit provides a full range of expanding services to the southwest comer of the Province including Waterton National Park. There is excellent co-operation between the National Park Service and the health unit personnel who provide the handful of residents and their children with a full range of services. "This is the way we brush our teeth " (Chinook Health Unir ) (Chinook Health Unir) 100

In the summer a student health inspector assists in monitoring the food handling and sanitation systems within the Park and its campgrounds and vacation schools. Jim Burger the senior health inspector has had only one instance of difficulty within the Park. It had been customary for his staff to make a yearly survey of ticks in order to monitor the incidence of Rocky Mountain Spotted Fever. This is done by dragging a white cloth through the bush, then capturing the ticks that adhere to it. In the case of the National Park he was not permitted to conduct a sample survey until he had procured a special Park license for the hunting and capturing of Park wildlife.! Jim Burger also tells of a unique experience he had in Blairmore. There a bachelor had boarded himself up in his house with 53 dogs. The dogs were quiet, seldom barked and never went outside. One can imagine the condition of the inside! Floors were covered with dog excrement and when the smell of stale urine began to pervade the neighbourhood complaints were received by the health inspector's office. As an owner occupied dwelling and as the dogs were not a nuisance, Burger had no means to charge the recluse. Eventually the man was brought into court to see if he could not be commited to an institution where he would receive better care and proper food. When the grease covered odiferous defendant came into court the rest of the people threw open the windows despite the sub zero temperature. The Judge recessed the court due to the smell but would not act against the man as he had not done anything illegal. Later, a court appointed psychiatrist found the man sane with only a loving care for dogs. There was only one alternative open. The Society for the Prevention of Cruelty to Animals was informed of the case and the habitation declared unfit for dogs. All but 6 were taken away. Still later, the man suddenly killed his dogs which had now grown back in numbers from 6 to 20, set fire to his house and then sat down across the street and watched the conflagration. He was subsequently committed. In the last few years Burger has noted a tremendous improvement in water supplies, sanitation and food handling systems within the region and particularly in the Crowsnest Pass . This he attributes to the new wealth from Japanese coal contracts. With new funds there is not the resistance to spend money on im­ provements to facilities. Now its a matter of further upgrading as the needs arise. In 1976, the Chinook Unit promoted the Province's first regional land .fi ll site near Cowley. With increased expansion of urban areas in the narrow mountain pass it became impossible to find a suitable location for nuisance grounds. The solution was to arrange for a land fill site outside the region to the East. This was made possible by proposing that several adjacent municipalities should be encouraged to share in it jointly. The government contributed $400,000 for captial costs. Now the refuse of the Pass, Pincher Creek, Blairmore and Cowley 101 is trucked to the regional site for disposal. The idea of regional land fill sites worked so well that now several other parts of the province have adopted the idea. Irrigation also poses special problems for the health inspectors. Many farm­ ers take their domestic water out of the irrigation ditches that cross their lands . A small amount of Javex purifies their cisterns. How much chemical to put into their water is ascertained with the help of health unit personnel. They test the water and recommend the proper amount to the homeowner. This has become so common th inspectors don't even bother to record it. The inspectors though are concerned over a rise in nutrient levels in the headwaters of the rivers that cross their unit. This has been caused by the large numbers of cattle using the streams and canals. They are fed with enriched foods and fertilized crops. Continued irrigation also has a leaching effect on the soils. Some of the fertilizers and salts are fed into the rivers from the streams and canals promoting a rise in nutrients in the headwater regions. Not a danger today but a problem for the future. One to which Jim Burger feels there may be no answer. Today Dr. M. Corriveau is guiding his staff into expanded programs for the l 980's. The demands for the region for increased support in social services have risen dramatically. In the last three years the unit had to cope with a major polio scare, the screening of Asian refugees for tropical diseases giving them a battery of immunization shots - major increases in budgets for home care programs with over 170 active cases as well as providing health services to the large numbers of Hutterite colonies within the region. The Hutterites and their love of candy have kept the dental facilities of the unit fully occupied in monitoring and identifying cavities in their children which are far above the regional norms. Unit staff are certain the high incidence is due to the abnormal amounts of candy the mothers feed their offspring. The unit also provides full school testing as well as food, water and sewage tests . Dr. Corriveau hopes that eventually the process of going out to the colonies will be reversed with the Hutterites driving into the regional offices. The immediate task facing the unit is the re-organization brought on by the absorption of Chief Mountain. Dr. Corriveau is optimistic the merger will be beneficial - in particular providing expanded services to Cardston and Magrath. Because Chinook had in the past provided many of the specialized services to Chief Mountain on a contract basis , Dr. Corriveau feels that the merger of the two units will proceed on a positive note, without interruption of health care programs within the region . 102

Chapter 12 CITY OF LETHBRIDGE

Lethbridge, a busy attractive city of 55,000 is justly proud of its countless thriving enterprises - and a good deal of this pride is directed toward an efficient smoothly run health unit. After several years of planning and investigating the potential of health unit status, the unit was formed in 1958 - and the city was off to a new and expanded field of public health - .a large step from its early beginnings. Lethbridge had its first Medical Officer of Health in 1894 - Dr. L. J. DeYeber. In 1909 he was joined by Mr. J. J. Vallance who became the city's sanitary inspector. He had obtained his training in public health from London, England and remained with the city for the next four years. In the early days the pioneers faced the diseases and epidemics of summer with dread. Old timers still remember the relief of the first killer frost that seemed to reduce the hovering flies, pests, and the germs from decaying nuisance grounds. They also recall the 28 day quarantines for those unlucky enough to come into contact with communicable diseases. There were no vaccines, anti­ biotics, pasteurized milk or chlorinated water. Typhoid, diphtheria, T.B. and smallpox regularly visited the city. The typhoid epidemic of 1916 saw 125 stricken and 14 die. It was not until later that the chlorinated water struck a mighty blow at that particular killer. By 1920 progress in sanitation and garbage disposal saw epidemics become the exception rather than the rule. By 1951, the city had developed many public health services. Health in­ spectors looked after food handling and plumbing. Physicians looked after im­ munization in the schools. A tuberculosis clinic had been in operation since 1949 along with a social hygiene clinic. In that year exploratory meetings were held to see what advantages would arise from uniting all the various programs into a public health unit. These decisions did not come to fruition until 1958. When the health unit first opened, the staff consisted of Dr. H. M. Brown, Mrs. G. Law, senior nurse and four other nurses: Miss Agnes Short, Mrs. H. Furlong, Mrs. D. Gooder, Mrs. D. Foster, and Mr. M. Friend, Sanitary Inspector. Miss Agnes Short has been an able and capable supervisor of the unit since 1964. During her career as a nurse, this lady has had some remarkable experi­ ences! She graduated in 1939 and immediately was offered a position with the 103

Galt Hospital. About five years later she tackled the busy life of a school nurse. In comparing those days with today's health units, she says there are both advantages and disadvantages. In the past the nurse became very close to the school children - and the children loved and trusted her. But the sad thing was she never saw a child before it entered school nor did she see that child again once it had left school. In the health unit, if the family doesn't move away, it's possible to follow a child right through - from pre-natal until that child is grown and comes back to have her own baby' The dutie!> of the school nurse were many and varied - first aid, immu­ nization, counselling and home visits. The nurse was the liaison between home and school. Then, of course, she had to be on the lookout for disease, rashes, signs of scurvy and lice! Miss Short tells of one particular experience with lice. In one of her districts, a family was repeatedly plagued with them. And this was no small problem! There were 14 children in that family. And these youngsters went to different schools so the lice were spreading everywhere! No matter how often the heads were cleaned up, the little pests returned. For a while this was a puzzle. Then a possible reason dawned! The father made his living going about the countryside working for different farmers and living in bunkhouses. As a result, he went for weeks without a bath . Could he, time and again, be bringing new lice home and re-infecting the family'? As gently as she could, the nurse asked to be allowed to examine the parents as well. Both were reluctant but finally agreed. As she had thought, the father was infested. This was bad enough but the mother had long thick hair - and she was infested, too! Now that the riddle was solved, the problem also, was finally resolved. After years in the public schools, Miss Short left to join the health unit when it opened. Schools would now be under this new jurisdiction. The major programs in the early days were the Well Baby Clinics and child immunization. Wednesday afternoons were devoted to immunizing adults because at that time, all businesses closed on this afternoon. It was hoped this would encourage people to come in. The health unit now has a staff of 15 nurses and Miss Short has an assistant. Also on staff are two dental hygienists, two dental assistants, three speech therapists and three public health inspectors. High on the list of activities are community visits - post-natal, the ill and the elderly. The unit staff also works closely with social services personnel . For instance, if child abuse is suspected - or alcohol-related problems or any social problems for that matter, they try to work something out between them or else refer the problem to a suitable agency. Special attention is shown to the child or adult who has repeated admissions to the hospital. Nurses go into the home trying to find out why, trying to help the patient. 104

This is one of the first health units - if not the only one, who has a liaison nurse who regularly visits the hospitals, to find out what cases need following up; she visits such cases in the ward and asks if they would like a nurse to visit them when they go home. Most are delighted that someone cares! Lethbridge is unique in its team nursing, also. This means one group, under a "captain" will be responsible for certain areas of the city. This ensures that the work load is evenly divided and is also a great help for the nurses to discuss problems they run across. Although the advances in modern health and medicine are awe-inspiring, sometimes it's intriguing to take a glimpse into the past. In bygone days, communicable disease was, indeed, a spectre to be dreaded - and rightly so since there were no antibiotics to combat it. Thus, isolation and quarantine were rigidly enforced. In the early I 900's no isolation facilities were available so the unfortunate patients were stuck in tents which were pitched behind the Galt Hospital. Speaking of tents, Miss Short remembers as a child, a member of a neigh­ bouring family who had had tuberculosis and been sent to the sanitorium. When the person returned home months later, a tent was pitched in the backyard and that's where this person slept every night because fresh air was, and is, of prime importance. She also has a highly dramatic and vivid childhood recollection of first hand experience with isolation! The dread disease, diphtheria, had attacked her. She lived in a 'firehouse' as her father was a fireman. When the awful state of affairs was discovered, her parents bundled her up - it was a cold winter's night - and at the urging of the fire chief, they used his open car and sped to the Isolation Hospital and left her there. This hospital was situated at the far west end of the cemetery but has since been torn down. This was during the diphtheria epidemic of 1922 . A total of 28 cases had been hospitalized here. And as if things weren 't bad enough for this wretched little girl , that night a violent snow storm battered the city. Roads were blocked, telephone lines down and the matron was the only one there to look after all who were so desperately ill. Her helper had taken some time off the previous afternoon and because of the storm was unable to return . In fact , no one could reach them. This was isolation in more ways than one! Miss Short still clearly remembers this dreadful time - and it lasted for several days! ''The matron placed my bed beside a little friend of mine who had also been struck down. Then at night she slept across our feet to keep us warm, because we were the youngest and the sickest." Another incident concerning quarantine is also a childhood memory. The next door neighbours came down with scarlet fever. They notified the Medical Officer of Health - a must or one could be faced with a $50 fine! So up went a plaque on their door - "Quarantine!" That meant no one would go near that 105 house until the ban was lifted ! However, her mother would cook food fo r the unfortunate neighbours, take it over as far as the porch were the family had placed some dishes, fill them and return . When she was gone, the lady in the sick house would take the food in . The same with the milkman . He 'd pour out a pitcher full and leave it on the step. The Lethbridge Health Unit also took part in the Polio Pioneer Program. It also suffered through the ravages of the epidemic of '52. At that time there was no protection available except gamma globulin and even this offered pro­ tection for only a limited time of from three or four weeks. Besides, it would have been impossible to administer it to all. It 's a scarce commodity and un­ derstandably so. It is derived from human blood and takes 10 pints to produce one dose! Another exciting incident in the nurse's career was watching the first dose of penicillin being administered to a desperately sick young woman - and more exciting still, watching the miraculous recovery! Still another story illustrates the astounding thing a nurse sometimes has to do! This happened when Miss Short was working at the Galt Hospital. Once more, a blinding snow storm was raging. A man rushed into the hospital yelling excitedly, "I've got a pregnant woman in the car! Hurry , hurry!" "So," says this nurse, "I and a relatively new probationer rushed out into the storm. The woman was screaming and it was plain to see she'd never make it out of that old Model T and into the hospital in time! By now they had managed to get the story out of the agitated man . He came from the Coaldale area and this little pre-schooler came running across the snowy fields and gasped, 'Come! mommy needs you! PLEASE! ' The man had no idea who the woman was but he felt duty-bound to help. He saw, of course, what the problem was and bundled her into his car and drove her to the R.C.M.P. baracks. He didn't know what else to do! They took one look and said, "Take her straight to Galt Hosptial!" which he did. By now the man was so excited and worried, he bolted off down the street. Meanwhile, my companion crawled on the hood of the car, kept wiping the driving snow from the windshield while she attempted to light up the interior of the car with a flashlight. And 1 attempted to deliver the baby - which I did . No complications for mother or baby!" The Lethbridge Health Unit, from modest beginnings, has always enjoyed the services of a professional and competent staff who have earned the gratitude of thousands in the area. Public response to the service was such that it was soon necessary to increase the staff and provide for more space. Thus the Health Unit moved in October 1959 to the main floor of the City Hall Annex at 909 - 4 Avenue South. Dr. A. A. Byrne arrived December 21 , 1963 to take the position of Medical Officer of Health as Dr. H. M. Brown had resigned September 30, 1963. 106

In addition to the well established programs of community health nursing and inspection services two more programs were added in 1966 i.e. Speech Pathology and Preventive Dental Health Services. The Health Unit was encouraged to move to the former Galt Hospital in order that the building could be updated and made functional for the benefit of the museum which occupied the second floor. The move in June 1967 proved to be a wise one as the Health Unit increased the staff to 14 for services to a population that then stood at 37 ,022. An added service to the province was provided when it was agreed to contract special services out to the Warner Health Unit. With the merger of the Warner Unit with Barons Eureka in 1980 these services were taken over by the enlarged unit. In 1975 a Geriatric Nursing Service was developed to provide for counselling and health surveillance for citizens 65 years and over. In 1976 the Health Unit began to seek new accommodation as the premises were developed to accommodate an expansion of the Museum. When Dr. A. Bryne retired in July, 1977 , Dr. Barbara Lacey assumed the position of Medical Officer of Health . Early in 1978 Genetic Clinics were instituted on a monthly basis under Dr. B. Lowry, Alberta Children's Hospital, Calgary . On August I, 1978 a Coor­ dinated Home Care Program with the contracting of nursing services from the Victorian Order of Nurses came into being. With the anticipation of funding new programs to a population of 50,268 citizens in developing pre-natal classes and a Family Planning Program in 1979 the Health Unit staff of 31 moved to the Lacidem Building, 542 - 7 Street South on March 1, 1979. This spacious complex was designed for the specific use of the Health Unit and the Department of Social Services and Community Health. In 1980 Dr. Barbara Lacey and her staff are prepared to provide a full range of preventive health programs to meet the various needs of this thriving community. 107

Chapter 13 MEDICINE HAT

Come with me and let us visit one of Medicine Hat's many old but gracious mansions. Our destination is first street. And here we are. It is a large brick building with a wide outside veranda. Now we walk into a fairly large hall with a snug den off to one side. Ahead is a gracious archway which leads into a spacious living room. Sliding doors lead the way into an attractive dining area. Also, next to the dining room, a large pantry makes a passageway to the kitchen. From it a stairway leads to the upper regions. From the living room, another flight of stairs, broad and shallow, leads to the upper floors . Up we go but pause on a landing as large as an average room! Now we've reached the bedrooms - four of them and all large. One has its own fireplace and one its own sink. Up yet another flight of stairs and we have three more bedrooms! But where is everyone, you ask? Had you perhaps expected tea served by a butler! Well, there's no one here right now . But tomorrow, July l , 1953, this silent mansion will burst into life! Why? The Medicine Hat Health Unit is leaving its old offices above Gus' Food Store which it had occupied since its opening in 1952, and moving in . For all this grandeure, it paid $150 rent a month! And move in they did - lock, stock and barrel. They found good use for each of the many rooms. Offices, waiting rooms (these by the way were furnished with old church pews) storage and coffee rooms, all found pleasant homes. And the health unit plunged right back into its ceaseless round of activities. When the unit opened in 1952, the staff numbered two - Miss Marge Middleton as nurse and a part-time stenographer. At this point, neither one knew much about public health. They were, as to say, holding the fort till more staff could be procurred. And slowly, more staff did drift in. The first one was a public health inspector, Jack Maynard and an assistant Jim Henderson as part­ time inspector. He had been plumbing inspector for the city and spent half his time at his old job. Then Nurse Beth Pohol joined them and next Medical Officer of Health Dr. Brown. Then Miss Ragen and lastly Miss Marion Story, who was appointed first senior nurse to be followed by Dot Nickel in ' 53 and Miss Marge Middleton in 1954. Miss Middleton held this post until her retirement in 1972. She was followed by Mrs. Pat Yates. During Dot Nickel's sojourn , she spent half her time travelling back and forth to Brooks. There was a sub-office there but no nurse! But in six months, this situation was, happily , rectified. Health Unit Offices 1953-1965

Unit Staff 1953 . front row: Dr. Tripp, Arlene Scherer, Orma Johnson, Mary Hershak. rear row: Flo Dale, Millie Hage l, Harry Huddleston , Helenda McElree (City of Medicim' Hat Health Unit) 109

For the most part , the public was pleased to see the health unit established. But one section of the community definitely was not! This was Bow Island. The people there were very unhappy with the situation because they had had their own district nurse for years. With the coming of the health unit , she, of course, had to leave. True, they had a doctor at that time but why pay a doctor when they were used to free treatment? So, in the end they had to depend on the health unit. Another group that wasn't all together happy about the coming of the health unit was the schools. They were used to hav ing their own nurse and they made good use of her! As Miss Middleton says, ' 'They would phone the nurse for any little thing - any little accident and the nurse would go and check it out. But there was not the time nor staff for us to offer what almost amounted to a baby­ sitting service. So there was some annoyance when we didn 't jump as fast as they were used to." The staff of the Medicine Hat Health Unit are working in a lovely setting. This city, known as the "gas city" because of the surrounding gas fields and although it is often the hottest spot in Canada, is extremely attractive. Majestic trees line the streets and fl owers bloom in profusion . The South Saskatchewan River flows through its heart . lts lovely banks enhance the whole and it's known as " the Okanagan of Alberta" - a sharp contrast to the bleak country sur­ rounding it. And over the prairies, herds of antelope roam. The city sets up feeding stations for them during the long, cold winter. Because of the attractive nature of this ctty, many Albertans and a large number of people from Saskatchewan come here to retire. So, the city has a large number of senior citizens. In 1976, the health unit started a Geriatric Program - supportive and educational with Mrs. Beryl Ebert in charge. In 1962, a survey was made of school children's teeth. The survey revealed that 83% of the children needed treatment so the dental program was stepped up with emphasis on preventive dental health. Fluoride application to preschool­ ers and school children continued. Also, the health unit published a series of articles on home care of the teeth. A few years later, new restaurant regulations were drafted: chipped or eathenware dishes not to be used; left over food not to be reused; breads, buns, butter, cream, milk and milk products to be refrigerated at all times; pastries and perishable products to be refrigerated at all times; cube sugar wrapped, granulated in dispensers. In 1967 , more new regulations - all employees must have medical checks and tuberculosis tests. Two years later, through the generosity of the Medicine Hat - Redcliff Lions Clubs, a Scarborough Scanner for far-sightedness and squinting children's eyes was purchased. The scanner was operated by the Lionettes under the supervision of the health unit. 110

In 1965, Dr. McArdle became the Medical Officer of Health. Dr. Clementi followed the next year and still holds the post. For a while the unit was without a director and capable Miss Middleton and Dr. Huddleston took charge. This health unit also went through the Salk and Sabin programs. In 1972, two polio cases cropped up. The people, quite unnecessarily panicked. They streamed to the health unit for shots and boosters. There were still periodic difficulties at Brooks. For some reason, it was difficult to keep a nurse there. On some occassions a nurse from the health unit - often it was Miss Middleton, would go up there and stay part of a week, serving Brooks and from Brooks, Bassano, Gem and Dutchess clinics. During all their country travels, these nurses had some unusual experiences! Miss Middleton had several herself! Following is her account of one: "One day I had gone to a baby visit on a fann. To my chagrin, there was nobody home. When I got back to the car, I heard this ominious Hssss. Oh no, I thought - but yes, one tire was going down! What I didn't notice until then, the yard was strewn with nails! Apparently the fanner had been doing some repair work. Well, there was nothing for it but to try to change the tire. In my heart, I knew it was hopeless. I had never yet been able to manage this horrible task! So, I got out the equipment and finally got the hub cap off. Then I began struggling with those miserable bolts. I struggled and struggled and finally got one or two nuts off - but that was all. I finally gave up. Glancing about, I spotted a farm house about l/4 mile away. Maybe there's a man there who will rescue me, I thought. It was a lovely summer day so I started off down the road. Just as I walked into the yard, a truck pulled up . This was sheer luck! Had I been a little earlier, there would have been no one home here either! But the man was most kind. He changed the tire in a twinkling and my troubles were over!" In 1971, the unit joined the Alberta Health Unit Association. A few years later, teachers were given special training in Family Life Education. This program includes all aspects of family life. It originated in London , Ontario. More new programs were introduced as well - Student Health Services at the Medicine Hat college; Health Awareness Clinic at Senior Citizens Apartment; Genetic Counselling and Home Care. During all these miles of travel, another nurse got involved in something much more serious than Miss Middleton's tire! She was driving merrily along, deep ditches filled with water on either side of her - then she rounded a bend and crash! Right into a huge truck! In an instant both car and truck slid into the water-filled ditch! In seconds, water was rushing into both the car and the truck! It was impossible to open any doors! Acting swiftly, the trucker bashed out his back window , crawled out and helped the nurse to safety! Naturally, the girl was thoroughly shaken and she suffered aches and pains for a long while after. But it certainly could have been much, much worse! 111

As an aftermath to this, all the schools records and equipment which she had been can-ying, had to be spread out to dry! One common mishap which occun-ed to our travelling nurses , was getting lost - an easy thing to do on those prairie roads - especially in the early days when there were about 36 little schools to locate! Most of the nurses were city girls and east, west, north, south meant little to them. "But ," says Miss Mid­ dleton, "I was lucky. I grew up on the prairies and my father used to take us for car rides in the country. Suddenly, in the middle of nowhere, after countless turns, he would ask, "Which direction are we going?" If we didn't know, which we often didn' t, he'd be most unhappy. But graduall y our sub-conscious learned . So when I was travelling through the unit, if a farmer said, 'Go six miles south and two east', I knew just where to go. But our city girls needed left-right or landmark type of directions. These are hard to follow, especially the landmarks. The farmers were explicit but their wives were not. They might say something like, 'Go to the house on the corner with the green roof and turn left.' So you did that. But there would be a house with a green roof before the one she was talking about! She'd forgotten about that one! So, you were on the wrong road. And usually they added. 'You can't miss it!' If they said that you know you'd miss it!" " Often we got directions from the Department of Municipal Affairs and we had some maps which were helpful. " Miss Middleton told of her one ex­ perience in getting lost. "I was driving to one school when I got my instructions mixed. When I came to the railroad, I turned left instead of right. This road soom petered out into a mere trail. It was spring and we'd had a lot of rain, which was unusual. But anyway, before I knew it, I really got bogged down! I was hopelessly stuck! I saw some men working on the railway track. I would ask them to help. Which I did, but they refused . Then I saw a farm house a mile south. I' ll try that, I thought. So I walked across that mile long field through hordes and hordes of mosquitoes! But the farmer was just great. He got out his tractor and hauled me out. Also, he got me on the right road to the school!" Roads were often a serious problem - mud and ice. But any nurse, although her heart might be in her mouth all the way, would tackle any conditions, just so she could get home at night. During Miss Middleton's sojourn at the health unit two cases of leprosy appeared. One was a little Chinese boy. When the nurse examined him at school , she was totally puzzled. She told Dr. Brown, "This youngster has something awfully peculiar wrong with his skin!" So Dr. Brown examined him and di­ agnosed it. The poor lad had to be sent out for treatment. The case was kept totally quiet. Eventually, the boy was healed. He was extremely bright and entered University at a remarkably young age. None of his friends ever knew that he had had leprosy! 112

Miss Middleton said a misconception about this disease should be cleared up. " We' ve all been told leprosy is very contagious. This is not so. You have to have very long intimate contact before you get it. We believed this boy had the disease when he came out of China four years ago. All this time he, of course, had intimate contact with his family - and no one else in the household got it." One of the strengths of the unit is the dental program built up over the years by Dr. Tripp. In 1962, Dr. Tripp made another dental survey. The dental program is focused on the school children. The children are told, "Rinse with water or milk after eating. It's so easy, so simple and it may even reduce cavities more than brushing! Or eat a raw fruit or vegetable. They do a superior cleaning job!" Extensive water sampling was done during these years. Pollution was high­ est in the Old Man River. The air was polluted with fumes and smoke from the burning flares from the oil wells at Brooks. A sex education program was attempted but because of public resistance, it was dropped. In 1964, a registry was set up for handicapped children and adults. This has always been a fast-growing health unit. In 1966, it became too large for the dear brick house and moved into its present quarters. At the moment of this writing, another more spacious and better designed building is under discussion. When this unit first opened, it served well over 30,000. Today, the number has swelled to 69,000. Looking at those figures, no doubt a new bulding is well in order! 113

CENTRAL ALBERTA

Central Alberta lies between the fringe of the northern forest and the Bow River in the south . This parkland area is the most densely settled of Alberta's geographic regions. It is within this region that the major cities of Edmonton and Calgary lie surrounded by their attendant towns and villages. Initially developed as a farming and ranching district the region had wit­ nessed consolidation of its once scattered farming population into urban centers. The past few decades have also witnessed the development of major resource industries. Petrochemical plants and pulp mills and other manufacturing facilities gather about major population areas. The growth of urban areas has placed increasing strain on Public Health facilities. The situation had become further aggravated by the booming economic conditions that Alberta has experienced in the last decade. Overcrowding, and shortages are part of the price paid for rapid growth. And in the periods of growth thousands of newcomers have flocked into the region from all parts of the world. To provide public health services for them all is a formidable task. Another problem that is prevalent within the region is a large geriatric population. As sons and daughters leave the rural areas for the cities the rural population had quickly become much older. As a result Home Care Programs form a larger component of health services provided by this region's health units. 114

Chapter 14 ALBERTA EAST CENTRAL

The Battle River, with its shallow sloping banks, flows serenely through the vast health unit officially known as Alberta East Central. Here we have gently rolling tree covered hills giving way to flat "almost prairie" land with only the occasional shrubs and trees to enhance the scene. Agriculture being the main industry, large flourishing farms are scattered about. Dairying is also a major industry so it is not surprising numerous cheese factories operate here. Although Camrose is the major city in the health unit, the town of Stettler is the hub. One of the largest in the province and the tenth to be organized Alberta East Central Health Unit has been operating since September, 195 I. It actually grew out of Stettler's original, smaller health district. Since the amalgamation, this health unit spreads over the County of Stettler, the County of Paintearth, the County of Camrose, the County of Flagstaff, the M. D. of Provost and the two larger centres - the City of Cam rose and the town of Stettler. Sub-offices have remained in the same locations since its organization. This health unit has taken big strides over the years. Its original budget was $80,000. Today it's $1,400,000. This includes a new Home Care service. All the services started on a small scale but steadily grew. They started with one health inspector in this huge area and it was pretty much a matter of hit and miss! Now there are five. Originally seven nurses held down the fort. Today there are 22. Since this is a predominantly rural unit, attracting staff is sometimes a problem. Not, of course, in Camrose and Stettler. There is seldom difficulty with getting nurses although there used to be! Most were single and most, before long , found some nice young fellow and got married and quit work. But times have changed. Now a large majority of the nursing staff is married. However some of the health inspectors, if they 're married, do not like the idea of bringing their wives to live in the rural areas. About 50% of the staff is locally trained. This makes for a good situation, says Mr. Francis Blue from the M.D. of Provost and chairman of the board for 15 years. Dr. McKay was the first Medical Officer of Health and held that position for most of the health unit's existence. He was active and efficient and popular with everyone. Among his many other duties, he would check on all the schools 115 each fall. When he reached pension age, the health unit was a little worried about getting a replacement. Frankly, they also hated to see him go! The doctor cheerfully stayed on for another three years. He retired two years ago. Dr. Rawlinson took his place for nine months. He was followed by Dr. Jeanette MacQuarrie. Some of the health inspectors also stayed on the job for a long length of time - two for at least 15 years. However, the employee who has been with the health unit the longest, is Nurse Agnes Hillker. She has been with them for 23 years! Another much appreciated and admired long time employee was Flo Canadine. She was a dedicated secretary for many years. She lived and breathed the health unit. Even when she was home, and her phone would ring, she would answer with a brisk, "Health Unit"! When Mr. Blue was asked what was the greatest need which inspired the health unit, he replied, "It seemed we were the only area which had no system for that all important job, immunizing children. The only access to anything was through the Victorian Order of Nurses. But the people needed to be educated in what a health unit would do - so we educated! The only positive resistance came from some of the doctors. Perhaps they were afraid they would lose business! At any rate, before long, everyone was enthused and the health unit and the doctors were working well together. " With an amused smile, Mr. Blue described their "premises" in those early days. Actually, there was none as such. They operated in a church basement, legion halls, schools, hospital waiting rooms or any place they could find where they could set up to do their immunizing and other jobs which had to be done. However, the health unit did supply cars from the very first. An unusual incident surrounded one of these cars! A young nurse applied for a job - and got one. "Can you drre?" she was then asked. "Oh, yes," she replied con­ fidently . So, on one of her first assignments, she was sent to Hughendon, the sub-office for the west end. On the way back, she stopped in for a chat with Mr. Blue's wife. When it was time to leave she made a strange request. "Mr. Blue, could you tum my car round for me? I - I don't know how to put it in reverse." The only real epidemic in the health unit's history was the polio epidemic. Then, as was happening everywhere, they were rushed off their feet. In their anxiety and apprehension, everyone wanted their shots immediately. Just recently, this health unit was incredulous to discover there was an infestation of head lice in the Stettler schools! In the early days this situation was not uncommon but in this day and age? The health unit was incredulous while the parents were furious! Impossible! Their kids could not have head lice! Naturally the health unit took immediate steps to remedy this intolerable problem. The schools were not closed but regular fumigations took place. Soon the matter was cleared up. But the unfortunate incident left hard feelings. Well Baby Clinic (A/beria East Central Health Unit)

(Alberta Ea st Central Health Unit) 117

The health inspectors, like health inspectors anywhere, always have plenty to do. High on their list is restaurant inspection. Mr. Blue says many restaurant owners spend much time trying to figure out what day the inspector will come! Then they quickly clean up their kitchens and pantries. To their chagrin, they often guess wrong! Today, all board meetings are held in Stettler but in the beginning they rotated to different points in the health unit area. Mr. Blue feels they were a more closely knit group then - today the trend is more toward everyone going their own way. Mr. Blue relates one incident connected with a winter board meeting which could have ended in disaster! "The meeting was held in Stettler and it was an unusually long one. Before it was over snow began to fall and very soon, the wind was whistling around the corners. We were in for a real blizzard! After a consultation with the health inspectors and one of the nurses - I think it was Lorna Hart, who had all come with me in my car, we decided to wait awhile to see if it would let up . Well , it didn't. My wife was waiting in Camrose and l knew she'd be worried. We decided to start out. Things weren't too bad until we got to Bashaw. Suddenly the storm redoubled its fury .. . and the road simply vanished! We couldn't see a thing. Then someone got the bright idea that, with the headlights on, one of us would walk ahead of the car and try to stay between the fences! Which is what we did for several miles . We took turns trudging through that howling blizzard. The car inched along behind. Finally, we made it to Camrose. My wife was absolutely hysterical! " This chairman of the board feels some of the major changes in the health units are that more services are now brought to the people rather than have the people come in for them; there is more diagnostic work being done with children. Services used to be directed mainly at children but now have shifted dramatically to include senior citizens. He also feels this health unit is particularly successful, due to general cooperation. Mostly the boards have been generous with the staff, and the staff has respect for the board - a staff which, for the most part, has always been treated as a member of the family . Mr. Blue thinks the whole health unit system is more efficient that it used to be - but perhaps a bit colder because there is not much time for personal contact and the numbers of staff are too great. But he has thoroughly enjoyed hi s years of participation in all this. He says, " If you feel you are doing the people some good, that is a great satisfaction in itself." 118

Chapter 15 ALBERTA WEST CENTRAL

The town of Edson has witnessed a lot of growth during the past two years. New public buildings, restaurants, and supermarkets have sprung up everywhere. Naturally, this means more people to look after - not only in the town but also in the far flung regions which this health unit encompasses. In 1957 when the health unit was formed the region had undergone rapid growth due to the con­ struction of the pulp mill at Hinton. At the same time there was an extensive outbreak of dysentery. Hundreds of workers had been employed and Hinton had leapt from slightly over 300 to 3.000 people. Many new families lived in tem­ porary and primitive accommodations with sanitation levels below standard. Infection spread rapidly. Improvement of housing and sanitary conditions in the area contributed to the disappearance of dysentery. There was al so an explosive growth in populati on in the Drayton Valley area following the establishment of an oil field in the district. A sanitary inspector was needed on a full time ba5is but the health unit was not large enough for this. The government therefore, put one of its inspectors at Drayton Vall ey. Frequent inspections were made at the trailer-coach parks, industrial camps, restaurants and food stores. Substandard housing was replaced but the problem was only r solved when many workers left the oilfields due to lack of activity.

Logging camp inspections were carried out in two sections around Lesser Slave Lake and the Edson district. A wide variation in sanitary conditions was found , and health dangers did exist. The short working season, the location of the camps and the difficulty one frequently has with road conditions made in­ spections difficult to carry out. Inspections were made at a number of other industrial and construction camps including road building camps and oil develop­ ment camps and camps associated with the Hinton Pulp Mill Project. In 1961 , the total area of the unit was nearly I 0,000 square miles, the total population well over 22 ,000. The Unit included four towns - Hinton, Drayton Valley, Edson and Lodgepole; two villages - Wildwood and Evans burg and five Improvement Districts. One year later two townships with a total population of 500 in the Brasseau Dam area were added. At this time, also, a Hutterite colony was established north of Wildwood. This meant increased activity as these people avail themselves freely of the health unit's services. In 1963 , the Muskeg River area was added - I 00 more square miles and 124 more people. 119

Today the West Central unit looks after the needs of some 40,000 people and covers 14 ,000 square miles. Industries within the region include logging, mining, oil, gas, a little ranch­ ing but very little farming as there is a great deal of muskeg except in the Wildwood region. The growth of the new town of Grande Cache has added to the responsibility of the health unit. Indeed Edson itself was begun as a railway centre by the Canadian National Railway. Mrs. Deleff, the unit's supervisor, outlines some of the health unit's activ­ ities outside of the routine programs. Close touch is kept with a child from infancy until the age of 18 . Contact is made every two years during the school years. Usually, within a few years of graduation if the child was a girl, she is back again for pre-natal classes. So, they've got them again! Adults are screened for blood pressure and a great deal of follow-up work is done. The school programs are very thorough. At the age of 4, a child is given the Denver Development test. It is not an 1.Q. test but it checks things like hearing, speech and reflexes. By this time, immunization is usually up to date. Boosters will come later. From Grades I to 6, an extensive health education program is followed including T. B. testing in grade I. It is piloted by the school division but the public health nurse is responsible for getting it underway and supervising it. In grade 6 the girls are immunized for rubella. In grade 7 there is a vision and audio screening and a monitoring of scoliosis. In grade 8 boosters are given. In grade I 0 a nurse talks to children individually and privately. Since they have no formal sex education program, this subject is frankly and openly dis­ cussed. Nutrition and general good health such as skin problems are also thor­ oughly covered. However, they have an excellent family life series in Grade 9. The nurse helps with instruction here also. This health unit also has special services for diabetics, M.S. and epilepsy. Self help groups have proven to be most supportive for the sufferers. Patients talk to each other about their problems and how to cope with things like diet, lifestyle and so forth. Also, workshops are held which develop specialized knowl­ edge up to date in a particular field. The health unit plays an important role, monitoring these diseases and puts the people in touch with each other. On its inception and for a number of years a major effort was made to control hepatitis and other communicable disease. In 1962, routine samples of pasteurized milk at retail outlets were taken. Oddly enough, a local producer asked permission to distribute raw milk to Edson. At that time, regulations permitted this providing the producer/distributer's prem­ ises were of a good standard. At this time a good deal of stress was put on standards of milk producers. Two were suspended. A few years later emphasis was placed on the content of children's lunches. Since many travelled many kilometers, the school day became very long . An 120 attempt was made to teach mothers to include more protein and less carbohydrates - and, to be sure to include milk. The never ending task of T.B. surveillance is carried on - for children and adults as well. In one instance, an adult proved to be just as frightened - if not more so - than the kids of the needle test! On this particular day in Edson, the Grade 9's were being given the T.B. test. An official from the head office in Yellowhead School Division was there. " Has your school had the tests?" the nurse asked, " No , no , but I'll have mine today since you're here." The nurse brought her kit and tray . Horrified, he exclaimed, "You're not going to use a NEEDLE!" But she did, and got the test safely over with! " In the old days," says a nurse, "we had to sharpen needles between patients. If you didn't do this, you'd end up with a jagged hole in some poor person." Another very capable nurse was Donna Callen. She had a wonderful way with the Metis . She'd whisk in and out of the teepees and have them immunized almost before they knew what was happening! Something else unique to this health unit are the periodic visits into the oil rigs and pulp plants. They are always warmly welcomed. With the growth of industry in frontier areas it was not unusual to run into cases of dysentery. In 1963 when an epidemic of flu threatened the workers at the pulp mill at Hinton, the company purchased serum for its workers which the unit's nurses administered. In 1965 the health inspector reported difficulties in securing safe water for Hinton due to the silty water of the Athabasca Ri ver. The towns filtration system was not adequate. There also was the problem of indiscriminate dumping of refuse and car bodies throughout the unit. It was not until 1967 that marked improvement in construction camps was noted due to modem portable trailers, first class accommodation and eating places. There were numerous garbage disposal problems. During one year alone, 8 houses were labelled as unfit for human occupation. As late as 1971 , a house survey was conducted by the Division of Pollution Control , the Department of Health and the health unit in west Edson. These were the shocking results - 70% of the 167 householders had outdoor privies! Immediate plans were made to service this area with water and sewage. With the cooperation of the Department of Agriculture, Department of Welfare, and the health unit, a home visitors program was set up in Edson and Hinton . Construction and pulp camps were also inspected. In 1969, a major change occurred in the Alberta West Central Health Unit. Its area was increased to 14,000 square miles; its population to 25,000. All this happened because of the new coal mining town of Grande Cache. The Department of Municipal Affairs and the Department of Health made additional funds avail­ able to compensate for this rapid population increase. For the first while, clinics were held at Grande Cache in the recreation building. The following year a 121 permanent sub-office was set up. All this added activity required additional staff. Mr. W. H. Campbell was appointed senior health inspector. Mr. B. Heard was hired as public health inspector. His main duties were regular inspections of Grande Cache and area. Another new position was an added staff nurse. The Alberta West Central Health Unit also provides health inspection serv­ ices for Jasper National Park. In February of 197 l , an ugly problem emerged - head lice. Every effort was made to control the situation but all was in vain. Mainly this was due to the lack of cooperation from a fairly large group of people who had recently arrived from Eastern Canada and Europe. By early April, the infestation had reached epidemic proportions. Clearly something must be done - and it was. But only by applying the full power and authority given to the medical officer and the full cooperation of community officials and community residents was the epidemic finally eradicated by the end of April. In the early 70's, an unusual event occurred. It started at Hobbema and ended within the boundaries of the Alberta West Central Health Unit. One day at Hobbema, Chief Smallboy - after much serious thinking, came to a decision . He felt his people were losing their identity - their heritage - all because of the influence of the white man. He talked it over with his tribe, using all his persuasive powers to convince as many as he could that the only answer for them was to leave Hobbema and retreat to the wilderness . There they could go back to their native lifestyle. Many agreed with him and he set off toward the moun­ tains, his band following. They settled about 80 kilometers south of Robb, and did, indeed, revert to the old ways. But the Department of National Health and Welfare still felt responsible for them. So a contract was drawn up whereby the Alberta West Central Health Unit would provide preventative health services to people living in this camp, which they called, not surprisingly, Smallboy Camp. The road to this isolated spot is rough and rugged, the weather often vile, but health unit staff do manage to get in. Then a clinic is set up. Also, the dental hygienist does her own job. Although immunization is strongly advocated, few youngsters here come to the clinic because most parents don't want it. In 1972 , the unit had the services of the speech pathology and audiology travelling clinics. Starting in November the clinic, staffed with a team from the Glenrose Hospital in Edmonton, began active speech therapy in addition to diagnostic assessments. The service includes therapy sessions, in-service edu­ cation, parent counselling and workshops. The clinics are sponsored by the Elks and the Order of the Royal Purple. In 1977 , office space was made available for the administration of Alberta Alcohol and Drug Abuse and Mental Health Services. A counseller for A.A.D.A. 122

is stationed at Edson. Mental Health workers come on a bi-monthly basis from Edmonton. By 1975 the need for a shift of nursing services to a home setting seemed to be of particular interest in the community. Nursing staff received frequent requests to assist families in the care of family members in the home. Before this program came into being the unit's nurses had been able to give only minimal assistance in these areas. Also health education began to play an increased role in the unit's activities, since the basic function of the health unit is of a preventative nature. Health education was given some priority within the community. Consideration was given to initiating diabetic and hyper-tension screening and education programs as weli as many more areas. However, the nurse case load would not permit more rapid expansion at this time. With the emphasis shifting to more community and home involvement, it is apparent that a liaison between family doctor, hospital, and other social agen­ cies in the community is of paramount importance. Closer working relationships with the medical and social services personnel to provide a more comprehensive approach to presenting community needs may develop. 123

Chapter 16

BANFF

There is public health history behind every health unit in Alberta - but each is just a little different. The history behind the lovely mountain town of Banff is probably the most unique. Perhaps many of us are not aware of this, but for many years the people of Banff, being situated in a national park, were in the peculiar situation of not being truly provincial and not being truly federal. Understandably, this resulted in a great deal of confusion - the very worst of which was a total lack of responsibility for public health. This was a deplorable situation. So, in 1948, a group of local nurses, formed a chapter of A .A .R.N. and then volunteered their services to fill this gaping hole. The community eagerly raised funds for the volunteer nursing program by holding bake sales, rummage sales and anything else they could think of. Gen­ erous businessmen and civic organizations - anyone who had extra room , donated space. So this gallant group of nurses established a well baby clinic which was held once a month. Needless to say, new mothers found this tremendously satisfying. The nurses would answer questions which perhaps busy doctors didn't have time for. They would also give out information about feeding, formulas and general health. The babies were weighed and measured with a degree of regularity. A few of the nurses had worked in public health so there was plenty of expertise in this area, says Jean Shafto. She was one of the first employees of the Banff Health Unit when they finally got one. She was certainly an all around person - nurse, stenographer, and receptionist from the time of the unit's formation in 1959 until 1965. But in the days when this dedicated group of nurses were running things, they did have a doctor in when he was needed. With the polio epidemic of the early fifties, came the need for hospitals to open special rehabilitation services. Many patients from Edmonton and Calgary were sent to the Banff Hospital because of its excellent physiotherapy department. When the Salk vaccine was introduced in 1955 , the nurses saw an oppor­ tunity to extend their services especially since the doctors were so busy. So, they embarked on an immunization program as well as a well baby clinic some­ times seeing as many as 50 children in one afternoon. Another step forward had 124

been made. But there was still a lot to do. For example, there was still no school health program. The nurses began petitioning both the provincial and federal governments to take responsiblility for the public health of Banff's population. In Jasper, a home and school executive was doing the same thing. Between the two groups, enough pressure was finally generated. The provincial and federal governments agreed to share the expenses equally and the responsibility of operating a full health unit in the community. Unlike other units, there was to be no local tax levy for unit costs. In 1959, the great day finally came. Dr. R. W. Fleming became the Medical Officer of Health and the unit hired one nurse and one nurse - receptionist. Marilyn Gourlay, one of the unit's first public health nurses - she retired in 1978, says of the pre-health unit days, "Dogs got their shots for nothing, but there was no health program for people! " So, naturally there was rejoicing when the community finally got its own health unit. The well baby and pre - school clinics were continued and plans were made to start the immunization of all the school age children. At first the unit operated just two days a week. The first day was devoted to a well baby clinic; the second, Nurse Gourlay spent the mornings in the schools and the afternoon was devoted to adult immunization. One of the first jobs was collecting a medical history and consolidating what medical records of the people that were available from a variety of sources. During the l 960's, another half day was added to the clinic's operations. The nurses used this for home visits and pre - natal classes. At that time "I felt l was giving a full time program on a part - time basis!" Marilyn said ruefully . The unit also established a pre - school clinic at Lake Louise on a once a month basis. Although attendance was small to non-existent earl y attempts to abandon the clinic at Lake Louise were resisted. All this time the unit's programs were managed on a very limited budget. Their success was due to the dedicated nurse who was willing to give freely of her time with very little financial reward. The units' health inspection program was sorely taxed due to the rapid increase of the tourist trade and the need to monitor seasonal sleeping and eating establishments. For the most part proper food handling and sanitation practices have been well received by the owners and National Parks' employees. Programs were also run on T.B. testing of government employees. In 1964 audiometer screening was begun as well as a program of health education lectures to groups upon requests . A big step forward was taken in 1972 when a Home Care program was instituted and a much-needed part - time nurse was added to the staff. Before this, those who were unable to care for themselves in their own homes had to go to Calgary for help. 125

When this program was first launched, it was unofficial and did not have an operating budget - probably a first in Alberta! Still the need was there and somehow the challenge was met. However, in 1978 , the province provided full funding for Home Care. During this time, there was an increase in personnel at the Banff Health Unit - now housed in the Banff High School. As well as a full - time nurse, public health inspector and steno-technician, there was also a part-time home care worker. ln addition, this unit shared responsibilities for the Senior Citizens' Lodge in Canmore and some services with the Mount View Health Unit - like audiologist's and dental health services. Today, public health in Ban ff is managed as part of the provincial health care program. Programs proceed on a regular routine basis. The health inspector monitors campgrounds, restaurants, food handling and water and sewage sys­ tems . His work is particularly heavy during the summer tourist season when campgrounds are full to overflowing. His findings are passed on to National Parks' personnel who take appropriate action where required . This rosy state would probably never have been reached had it not been for a group of willing and dedicated nurses, backed by local doctors, who saw an urgent need and plunged ahead to fill it! The program today operates effectively to fill the needs of the community . 126

Chapter 17

THE BIG COUNTRY HEALTH UNIT

Each August, the town of Hanna, home of the Big Country Health Unit, bursts into a whirl of festivities. These are the exciting days of the annual fall fair. Most of its almost 2800 population line the streets to watch the parade march by . At the fair grounds, stalls bulge with handicrafts, art and vegetables - proudly displayed by their owners. Other events which liven up this town are horse shows and the annual 4- H calf displays. And everyone loves sports! The first health service came to this area in 1938, when the district nursing stations were opened. lt is interesting to note that there was a nursing station in Hemaruka for a short period manned by Mrs. Sheila Russell author of the book, The Lamp is Heavy. During the early stages of operation the nurses lived in small homes heated with coal and wood. They had no type of conveyance but had to depend on neighbours to take them from place to place. Many times they were taken on a "speeder" on the railroad tracks when the roads were impossible. They were on 24 hour call for the large monthly salary of $150.00. Their program consisted of innoculations, physical examinations, general inspection of schools, and checking for fire hazards. The nurse had to make diagnosis, prescribe medication and know when it was necessary to take the client to a doctor. It was sometimes possible to check with the doctor by phone. ln the beginning the telephone was the only modern convenience at hand. With coal oil lamps, coal and wood stoves and no car it is surprising that the nurses were willing to stay in such isolated areas. When the district nursing offices were closed in 1961 most of their equipment was used to furnish the Big Country Health Unit- the 25th in Alberta. However, before the unit opened there was much to be done! Dr. Agnes O 'Neil had applied for the position of Medical Officer of Health and got the appointment. When she moved to Hanna there was still no office, no furnishings, no equipment and no other staff. The Chairman of the Board showed her the premises they proposed to lease. It was a charming little brick house formerly occupied by the telephone exchange. The floor space was small but it was bright and cheery with many windows - and even window boxes! Arranging offices and working areas was a challenge, indeed! 127

Shortly after Dr. O ' Neil 's arrival in Hanna. Dr. E. S . 0 . Smith, Director of Local Health Services of the Department of Public Health, met with her there to give her advice on how to start up a health unit. While they travelled about the country familiarizing themselves with thi s large area and selling the idea of a health unit to the people they came upon a strange sight! A lady, carrying her shoes, was walking barefoot toward the service station in Youngstown' To their dismay, the lady turned out to be Mrs. Dorothy McPhail , Asistant Director of Nursing Services for the province. A flat tire and a broken shoe heel were the cause of her predicament! It turned out she was there to arrange for the disposal of furni shings and equipment from the three Di stri ct Nursing Stations. Big Coun­ try Health Unit ended up purchasing some of these and a few of the original chairs are still in use today. With the full cooperation of the board, the health unit was soon ready to open. Those first board members were: Chairman - Lloyd Hutton, Ferg James, Dick Oxford, R. E. Bi shop and Secretary-Treasurer, Marjorie Blair. Two sub-offices were also established - one at Oyen and one at Consort . Staff had also been hired. Mrs. Pauline Pennock as nurse for the Hanna office, Mr. Larry King-Hunter as Public Health Inspector, Lorraine Franklin as Steno­ Technician and Miss Falasconi, R.N. in the Oyen office. This sparsely populated health unit covers 8,400 square miles and serves approximately 14,000 people. At the time of its opening, the nurses had to visit 22 little schools. Now this has changed through school centralization, but the warmth and friendliness of teachers and pupils will never be forgotten. Due to the limited space in those first quarters immunizations were done by appointment. Because of the alert secretary reminding people when to come in, immunization went ahead at top speed. When the polio vaccine first became available things really hummed! Most times Dr. O 'Neil and Nurse Pauline Pennock started at 7:30 a.m. to travel to rural schools arriving home around 6:00 p.m. after a busy, tiring, day. There was so much book work to be done obtaining records of families, obtaining written consents, visiting families to sell the idea of health services, but what an enjoyable busy time. Nurse Pennock remarked that the services are changing as the population changes. Although the numbers of people remain fairly consistent their needs are different. There are many new homes in the region but these are mostly inhabited by couples or older single people. Hanna, for instance, has many homes with only one or two occupants. On one street where there were 38 children in the l 950's, now there are only 3. And at the rate these children are growing they will soon grow up and be gone. Most of the youth will not remain as they are attracted to the glamour of the larger urban centres. At one point there was 22 schools for the Hanna nurse to visit, but this number has now been reduced to 7 as a result of the closure of so many of the small schools. 128

The budget for the health unit when it first opened, was about $47 ,000. Now its about $330,000. Of this Home Care is at the top of the list. Over the years, many changes occurred. After almost twenty years of serv­ ice, Mrs. Pauline Pennock resigned. Part of her term, she served as Director. At this time the health unit was without a Medical Officer of Health - as it is today. But it functions we ll with the capable assistance of Dr. Donald, a local physician and Mrs. Janice Blair as its Director. The dental program also enjoys a consultant who is stationed at Oyen. Besides the Nursing Director, another nurse works full-time in Hanna and a part-time nurse covers the rural area. All labour diligently to fulfill the many programs being offered. At the beginning, a job of prime importance for the school nurse was the testing of vision. The reason for this concern was poor lighting in many of the little schools. Today the programs are more advanced. School nurses give referrals to the Occupational Therapist, who is working on a basis of need. A dental hygienist is stationed at Oyen and occasionally travels to Consort. In Hanna itself, the dental program is restricted because it is difficult to find anyone to fill the position. However, a new dental hygienist has been hired for Hanna and will also cover Consort. There is a Speech Therapist stationed at Oyen. She lives there by her own choice because her husband's job lies there. She travels to Hanna two days a week, two to Oyen and one to Consort. Thus she covers the whole area - and is another greatly appreciated and valued member of the staff. The health unit also has a part-time Nutritionist and a Home Care Program was started in 1979. This meant the hiring of a Home Care Co-ordinator, a Home Care Nurse and a Homemaker. At the moment, Home Care is restricted to within a radius of ten miles of Hanna. It is hoped to extend this service soon. For the most part, hospitals and doctors were happy to see this new program develop. There is also a Geriatric Counseller who makes periodic visits to the elderly. He works closely with Home Care and the senior citizens love and appreciate the attention. There is a fairly large geriatric population in the area; most young people move away to look for greener pastures. In this vast land, bad road and weather conditions have caused some anxious and exciting moments! One which caused grave concern was the night Dr. Murphy got lost! He was a Torontonian and working hard to get the dental program on its feet. He was miles out in the country when a blizzard sprang up. The people at home waited and waited, but no Dr. Murphy! It turned out he had ended up at some little village and spent the night there. At any rate, he returned safe and sound! Another incident occurred when Nurse Polly Pennock was at Cessford. She received an urgent call from a rancher at Wardlow. He was ill with infectious 129 hepatitis and needed a shot of gamma globulin . As these nurses wi ll , she set out at once. even though it was 30 below with a strong wind blowing and drifting. But she arrived okay. However, on the way back, she high centered on a snowdrift. Nothing to do but shove! Which she did - but to no avail! What to do now? But her native ingenuity did not desert her! She lit a flare - by now it was dark - put it on top of a cardboard box and set it on the roof of her car. Then she got back in the car and waited. The road was little travelled but surely someone would see the flickering light. Across miles of snow swept prairie, Jean Becker, who was expecting the nurse for supper, spotted the strnnge light. She immediately phoned a rancher who came and pulled her out. When Sheila Wiste (nee Ward) came to work for the unit in 1967 the only paved roads in the entire area were Highway 9 and the two mile approach to Oyen. All other clinics, reached by poor gravel roads, were held on a regular monthly schedule, rain or shine, snow or gumbo. The program consisted largely of new baby visits, well-child immunization programs and the school programs which were immunization and vision testing. Some of the innovations seen with the unit were: pre-natal classes, developmental screening, hearing, screening, meals on wheels, all initiated by the health unit. A decrease in emphasis on immunization saw a much greater emphasis placed on prevention and education rather than treatment. Nurse Wiste had her fair share of excitement as well! One day, while travelling in a raging snow storm just outside Oyen in freezing temperatures she slid into the ditch. Finally, she tried to light her catalytic heater which the cars were equipped with at the time. To her horror, the heater exploded singeing her eyebrows! So, she settled down for a long wait. Finally, she thought, "I may be here all night!" Just then , a tow truck and the R.C.M.P. appeared. Help at last! But to the dismay of all, the tow truck slid into the ditch, also! Now, eveyone was stuck! Eventually, a little Ukrainian farmer came along in his truck and pulled them all out! Incidentally, the only reason he happened along, was that his farm had no power and he was on the way to plug hi s truck in in town because it was so cold! On another occasion, this same nurse once more got into trouble! This time she was travelling to Jenner, approximately 150 kilometers from Oyen. It began on a lovely February day in 1971. But while at Jenner, a freak slush storm occurred. By the time darkness fell, the roads were glare ice. She drove very, very carefully, but before long, she was off the road and in the middle of nowhere! Once more, there was nothing to do but settle down for a long wait hoping someone would come to the rescue. Before long, she heard the haunting whistle of a train . Always game to tackle anything, she turned on her car lights, crawled on the roof of her car and waved like mad! 130

And the crew saw her! They stopped the train, came over and tried to help. But the car would not budge! So, they all got back on the train, nurse included, and chugged off to the nearest town which was Buffalo. Here, the train idled on the track while our nurse made arrangements for help! Later, they told her how lucky she was! The train passed through here only once every two weeks! Travel in this large health unit is always a major problem. The nurses think nothing of travelling a hundred miles to do a clinic. And in order to keep a clinic date, they think nothing of rain , sleet, snow or gumbo, because the clinic must go on! In fact, clinics of a totally different nature used to be held for new unit members. These were how to change a tire, how to get out of ditches and so forth . As far as travel is concerned, health inspection gets its fair share. Mr. Larry King Hunter, Senior Public Health Inspector has been with the health unit since its inception. Now, a second health inspector has been added to the staff, Mr. Jim Green. Both are stationed in Hanna and their aim is to "sell" public health with tact and diplomacy. This is not always easy. For example, a store keeper may not appreciate their suggesting how his operation could be improved. Through their tireless work in sanitation, they have also spread much good­ will. Following is a classic example: They received a call about an old bachelor living in a basement suite. Someone thought he needed looking after. The health inspectors were contacted because no one else really filled the bill . He was not on welfare, so he was not their responsibility. He had not committed any crimes, therefore the police would not get involved. So, who gets asked to help? The public health inspectors. They called on the old man. They found him cooking a stew in an old oil can he had cleaned out. Courteously, he offered them a portion. Politely, they refused, saying they had already had lunch. But something must be done! They arranged to have him moved upstairs, thinking better quarters might improve the situation. But things deteriorated . The stairs were very difficult for him, since he had become partially crippled. At last, the health inspectors took him to a hospital, arranged for a garage to store his things. They thought that was the end of it. But one evening, after the man had been in hospital three or four weeks, another call came, this time from the hospital. "Could you come and pick him up? And bring some clothes." "What happened to his clothes?" "We burned them'' said the hospital . So, that meant searching through a dark garage, trying to find hi s clothes. At last the man was dressed and ready to leave the hospital. But what now? Where to take him? His room had long been let go. So, the health inspector started driving around, looking for a place for him to stay. The whole mission was complicated by the fact that the poor man had to answer the call of nature at least every twenty minutes. Being crippled, all this was most difficult. 131

The worst of it all was, no one would take him - motels, boarding houses, hotels. (He wasn't even allowed to ride the bus!) After three hours of driving around, a kindly old lady in Hanna agreed to keep him for the night. At last, a niece from Saskatchewan came for him. It turned out he had money so perhaps she thought it worth her while, say the inspectors. Another sad case was a family in Youngstown. There were six children involved here, the oldest being seven and the youngest a set of three month old twins. The nurse, Pauline Pennock, visited them once a week. Conditions in the home were deplorable. Each week, without fail, the nurse would bring the twins and the laundry in, look after everything - bathing, washing, folding diapers, medication - and then return all to the home. This was always accompanied by the admonition, "When I come back next week, I want to see this house in better condition!" Health education programs have grown and changed over the years to accommodate the needs and priorities of the communities in the area. In Consort in 1976 , pre-natal classes were introduced on a twice yearly basis as an addition to the maternal and child health program. In attendance have been as few as two and as many as fourteen parents at these sessions. Recently, 38 people turned out to a midwinter first aid course. Consumer workshops, nutrition programs in school and kindergarten, fitness testing, geriatric clinics and exercise programs, and parenting seminars are some of the programs that have been accepted with enthusiasm in this area. Teaching has been done in the schools by health unit personnel at the invitation of local schools in cooperation with the school di­ visions, in such subject areas as communicable disease control, normal growth and development, nutrition, principles of first aid, smoking and drug abuse. Now, a new exciting venture is looming on the horizon. By means of strip coal mining, Alberta Power is going to erect a new power plant at Sheerness. This will naturally mean an influx of people over a two year period . An estimate is that about 200 families will move in . Construction workers will number about 800. However, permanent employees, once construction is over, will probably be around 200. No doubt, this will have impact on the health unit! Although sparse, this population, comprised largely of mid-Europeans and Germans no doubt appreciate the health services offered. And as for the health unit itself it will soon be moving into new quarters in the Provincial Building. The future looks bright, indeed! 132

Chapter 18

DRUMHELLER

In the valley town of Drumheller, echoes of hurrying footsteps, robust voices and the rustle of vanished dollar bills, are everywhere. Memories of coal dust hang over the city - memories of those bustling days when coal was the backbone of the area. During these years, roughly during the Second World War and after, the two major coal companies issued a monthly payroll of $1,000,000! They deliberately staggered the payroll to alternating two week intervals because the miners and their families - shopping, visiting, and partying - were too much for the town to cope with at once. On the whole, they were an exhuberant bunch! Drumheller is a friendly place. A fairly large part of its population is from Eastern Canada or Europe. These arrived during the coal boom and some stayed. The main industries now are agriculture and oil. Although most of the population left when the coal gave out, the nearby Badlands and its dinosaur fossils are a constant tourist attraction. The town's emblem is "Dinny", an engaging replica of a dinosaur. He assumes special importance during the exciting annual July I st celebrations. In this setting, the Drumheller Health Unit first emerged - but not easily! The people didn't really know what a health unit was or what it could offer. No one was anxiously wanting to promote health , so once again, it meant educating the public. Small group meetings were held outlining what the function of the health unit would be. At someone's kitchen table over a friendly cup of coffee, the people began to understand and see the benefits. A big problem at that time for health units was, and still is for some, to find a suitable place to live. In this respect, Drumheller felt lucky! A new building was going up and the government allotted part of it for health unit occupancy. However, when the first Medical Officer of Health, Dr. Thompson, an experi­ enced man from Britain, who brought a wealth of knowledge and experience to this health unit saw the layout he was appalled! "There was a front room resembling a small lobby. Partitioned off by a sheet of 1/8 inch cardboard was the medical office which contained two desks - one for him, and one for the health inspector. These were so cramped that a third person would have to sit on the corner of a desk! Adjacent was another room just as small, also containing two desks and a cardboard box filing system! This is where the females worked. On the back wall of the medical office was a swinging door, the type used in 133 saloons which led directly into the washroom . When the ladies needed to use this facility, they had to squeeze by the two men , and once in the washroom, because of the nature of the door, when they stood up, their heads were visible and their feet were visible at all times! " The board held their meetings in the front " lobby", seated on kitchen chairs around a folding picnic table. When everyone was seated, it was so crowded, the door could not be opened! " Because of the cramped quarters it was exceedingly difficult to hold proper clinics. Dissatisfaction with this arrangement went on for several years. But the government would not agree to a move to larger premises because of the expense involved. Even though by mutual consent of the municipalities they had legally saved I 0% of their annual grant for years and put it in the health unit's account , and they had some money, they could not build their own quarters. Another clause in the Health Unit Act prohibits a health unit from owning property, however, how they got around this law is a fascinating story which will be told later. When the health unit opened, it served about 20,000. Today's population is around 28,000. Its area has remained constant ever since Acme joined. Dr. Thompson said that the first staff was a reflection of the state of affairs at that time. "We had two newly graduated nurses. It didn 't take me very long to find out they knew very little about public health ! Routine office procedures were totally beyond them! Obviously , they had never been taught, so how could they know? Our sanitary inspector had no training whatsoever. A stint as manager of a hotel coffee shop was the extent of his training in public health! We had a typist, a very nice girl, but typing was not her strong point. Spelling posed problems as well and as for filing - well, who can blame her. The cardboard box system wasn't easy!" The main office of this health unit has always been in Drumheller. They have two sub-offices as well and total staff now includes, one medical officer of health, two public health inspectors, a dental director who comes in a half day each week to supervise the program , one dental assistant and two dental hygienists, eight nurses, and one nursing supervisor, three full-time steno/tech­ nicians and several part-time, plus an administrator who is bookkeeper, secretary­ treasurer, and looks after personnel as well as mileage of cars. A sharp contrast to the early beginning! After over twenty years of service, Dr. Thompson retired in 1975. Dr. Agnes O'Neil took his place as Medical Officer of Health. And why did Acme dally so long before joining the fold? The answer is simple. The doctor in the village had served this area since practically the dawn of time! He was also the mayor and he had also appointed himself Medical Officer of Health . He wanted no part of the health unit; he wanted to keep this 134 comfortable state of affairs. The people had loved and respected him for years, so it never occurred to them to want to make a change. This posed problems as far as school visits were concerned because the children from the surrounding areas were entitled to health unit services but the children from the village were not. So, every child would have to be asked, "Where do your parents live?" However, in 1955 when the polio Salk vaccine first came out, things came to a head. The serum was distributed to the health units only. It was felt some kind of a program for distribution should be set up since the material was extremely scarce. Also, because it was so scarce, each nurse was instructed to never, never waste a dose. Once unrefrigerated, it could not be used again. When the nurse went into the Acme school and had done the group entitled, she had two doses left. Since her orders were to give it to anyone rather than waste it, she asked for advice from the principal, who lived in the village. So, he chose his own child and the child of a village counsellor. Word of this got out very quickly! Less than an hour later, an irate mother met the counsellor in question on the street. She really tore into him. "You don't care about our children, only about yours!'' The counsellor was totally bewildered because he had not heard anything yet. Without mincing words, she told him exactly what had happened and what she thought of him . He quickly demanded an immediate council meeting. In less than a week, Acme became part of the health unit! A week after Dr. Thompson arrived in Drumheller he got truly initiated to this new land! A medical convention was to be held in Edmonton and all thought attending it would be a valuable experience for him. So, he and the two nurses decided to attend. Since he had no driver's license, the actual driving would be up to the girls. The plan was to leave Sunday morning, but it rained heavily all day Saturday. Their plans remained unchanged in spite of the fact that pavement was almost non-existent. Sunday came, but to their dismay, it was impossible to get out of the valley! Finally someone said Monarch Hill road was passable. Off they went, and although cars were stuck all over in the oozing mud , they managed to get by . "l took my hat off to those nurses," Dr. Thompson said. Fighting mud all the way, they finally arrived at Calgary and then on to Edmonton it was still pouring rain. Here they caught up to a car that was veering all over the road! Whether the cause was poor visibility, his vehicle, or himself, they never knew. At any rate, it was miles before they were able to pass. After having been on the road since 1:00 P.M., they finally arrived in Edmonton at 3:00 A.M. - exhausted and dirty. With the doctor's arrival in 1951, he found the water and sewage situation appalling. The town, at that time consisting of about 2,700 population , was a proud possessor of piped water. This water came from four shallow wells. When he saw the filthy water coming out of the taps, he was horrified. There was no 135 treatment plant. Testing the wells revealed plenty of iron and contamination! The doctor talked to the people telling them they must boil the water. As with hi s attempt to clean up the sewage, people looked at him as if to say - " Who is this Englishman, trying to tell us what to do! " Finally, Dr. Thompson shut three of the wells down , while constantly pre~ s uring the department for funds for a treatment plant. As for the sewage, it was simply dumped in ditches some with a slop pail , some of the more sophisticated piped it to the ditches. This saved walking. All raw sewage eventually ended up in the Red Deer River. At one point, Dr. Thompson told a minister, " It is medieval, simply medieval to pour slop where ever the spirit moves you to throw it! " The response was a blank stare. Problems abounded not only in Drumheller itself but in the surrounding "hamlets". These had originally been miner's camps when coal was booming. Conditions here were, if anything, even worse! People dug their own shallow wells and on the same property another hole for sewage - both liquid and solid including human waste. Soon, of course, there were more "sewage holes" than wells. The water was a positive menance! The disposal of household garbage caused another headache. In 1953 , Drumheller decreed (Carbon had already done so) that all garbage like tin cans, paper cartons, empty jars, be packed in a fly-proof recepticle and set out in the back. Once a week, a garbage truck would pick these up and haul them to the nuisance ground. This sounds like it might be an improvement, but the nuisance grounds were a horrible mess! Although there was a pit, the truck drivers dumped everything on flat ground. The reason was that backing up and dumping could result in garbage, truck, driver, and all ending up in the pit! Dumping on flat ground would have been O.K . had bulldozers come regularily to push everything in, out of sight and out of smell. But this was only done once a year, and considering the mounds of garbage, things got pretty bad! Considering also, the type of refuse made it even worse! Dead cows, dead dogs and cats hauled out by individual owners. Finally, the doctor's untiring advice filtered into the minds of the people. At one of Mr. Taylor's political meetings - he was in the legislature at that time - the whole question was brought up . Dr. Thompson was asked for his opinion on the water, sewage, garbage problem. He gave it, loudly and clearly. Low and behold results! And the whole mess was at last on its way to being cleaned up! However, the doctor says he still suspects the decision was mostly for political reasons. Dr. Thompson has one more " muddy road" story. One morning in March, they started out to hold a clinic in Morrin. Frost was still holding the roads together. The sky was blue, the sun was shining. But that same lovely sun melted the frost and many troubles began! Soon, they came upon a mass of cars, all hopelessly stuck! Someone said, "Take the west road. It's O.K." So they did, 136 and being little travelled, it was O.K. But the sun crept there too! Suddenly the car ground to a halt, four kilometers from the town with its wheels wrapped in gumbo. Very quickly, two more cars behind were in the same predicament! A consultation was held. Decision: Roll up your sleeves and claw out the gumbo! All fhree drivers chipped in. At last they were ready to give it a try. The doctor slid behind his steering wheel. The other two fellows crawled up on his bumper and jumped up and down as hard as they could. Slowly, the car inched ahead. By now, it was late afternoon and holding a clinic was out of the question. So, the mud-bedraggled travellers approached a coffee shop and asked for a little water to clean up. A small request - but not there! There was no water system. The proprietor gave them a small amount of water in a basin and they did the best they could. Next thing, have supper and wait for the frost. Well, they waited and waited! For the first time in years in that March of 1952 , no frost came! Finally, Dr. Thompson was told of yet another road that might be O.K. since it was little travelled. "It leads to a correction line," he was told. Even­ tually, he reached his destination. To his dismay, it seemed as though every car in Alberta was on this correction line! Headlights criss-crossed everywhere! Out of the darkness a voice shouted, "You can get by if you don 't stop! Stop, and you've had it!" Yaliently, he ploughed on and did get past! He was safely away to the road that led eventually home. But this road was flooded, worse than he had ever seen it! But, in a way, it was a blessing. All the mud was washed off the car. At 3:00 A.M. he finally got home, but had achieved no work. This experience developed a new philosophy for the doctor. "If road con­ ditions are bad, I will not go out. It's a waste of time and money." And he adhered to it. In a mining community, says Dr. O'Neil, she expected to find a high incidence of T . B. She was surprised to find the set of figures to be one of the lowest in the province. One thing though, she found most strange and was most unhappy with, X-Rays were being taken at the local hospital and the plates sent to the Calgary Sanitorium for diagnosis. How, she wondered, could a doctor in Calgary accurately diagnose without seeing the person or knowing any symptoms or history? So, she approached him, about this. "That's true," he said, "but we do the best we can. What would you suggest?" Her reply was prompt. "Why don't we set up a clinic in Drumheller and you come down once a month and see the people personally." So, that's what they did. This health unit offers all the regular services except Occupational Safety. They feel they are too small for that. However, since Drumheller has one of the highest rate of retired people, much work is directed toward that area. Home Care is run out of the sub-offices. 137

Here now is the intriguing history of how this health unit managed to acquire their own building. An original group of local health units had banded together and met annually. The main topic at these meetings was always the same - premises, premises! One night, driving home from one of these meetings, Dr. Thompson relates the fo llowing conversation between himself and Arthur Brown, one of the board members: "It's always the same old story - talk , talk resolutions - but the government will never do anything! " said Mr. Brown . " What do you mean?" "We are so obsessed with the Health Unit Act, we're forgetting there are other acts. For example, municipalities are free to organize a project if it 's to their mutual benefit. So why don't we get together and build a health unit building?" The problem, of course was who would own it , because health units cannot own property! So, an excellent lawyer, Mr. Sanderick, was consulted. He said one of the municipalities could hold title but an agreement would have to be signed stating the owner could do nothing with the property without the consent of the people. So it was decided the City of Drumheller would own the building. A firm of architects was approached, Strong, Lamb and Nelson, a local con­ struction company contracted, and the building went ahead! Financing was pos­ sible because of the 10% saved from the grants over the years. Provincial inspectors checked the plumbing, electricity and gas . Everyone was extremely helpful. Every angle was covered and Dr. Donovan Ross, after checking with the Attorney General's Branch, agreed everything was legal. So now they had their building, but no money left. They then rented the basement to the Civil Defense, and with that rent money saved $1,000 and built a board room. Things progressed slowly, but satisfactorily. They had their own building at last, even though the City legally owned it ! So, if echoes still hang over this city, they are also hanging over this unique health unit building which is a monument to initiative and determination! 138

Chapter 19

JASPER

Nestled at the feet of the lofty Rocky Mountains, the small Jasper Health Unit, the smallest one in Alberta, staunchly carries on all the duties which other health units perform - although much of the work is part-time. Being in a national park and having only one centre of population to look after makes for a nice arrangement. The unit is housed in the hospital and health unit staff are often hospital employees as well. But everyone knows everyone else and they all pitch in to lend a hand wherever needed. One advantage of being in the hospital's building is that the health unit staff gets to know about their clients first hand. Edith Gourley is senior nurse and Fred Kofin is secretary-treasurer to the board as well as administrative officer of the health unit. He has been with the unit for 25 years! After years of agitating for it, this unit became a reality in I 959. But it took the combined efforts of civic groups and other interested parties both in Jasper and Banff to budge the federal and provincial governments into action. The chairman of the board is the Superintendent of the Park or his nominee. In fact, the composition of the Jasper board of health is like that of Banff in which members are appointed and not elected. One of the members is a Canadian National Railways representative. CN used to comprise 65% of the total popu­ lation of the town but now it is down to 20% or 30%. Then there is a nominee from the Chamber of Commerce, representing business, and one from the RCMP - a very good cross-section of everyone in the community. That very first meeting of the proposed unit had a distinguished guest - Dr. E. S. Oxford Smith, Director of the Division of Local Health Services. He was shown sincere appreciation for the large part he played in making it possible to establish the health unit which would now compliment health services provided by the Department of Northern Affairs and Natural Resources. The total population of this mountain community is around 4,000. However, when summer skies begin to smile, the tourists come in droves - 15 to 20,000 of them! Understandably such an influx creates problems! But Jasper is used to this and the unit is prepared! During the tourist season, everyone is extremely busy! Although residents of the same town, one might walk down the street in early fall and meet someone you have not seen since May! And, of course, there is a large amount of summer help. For instance, Jasper Park 139

Lodge, which can accommodate about 750 people, needs a lot of extra help. During the tourist season, the staff swells to 800! The health unit works closely with a nurse hired by the Lodge to provide programs on personal health and hygiene for the young staff. Classes on personal hygiene and food handling are often held in the Lodge for the young staff that comes from all over the world. The health unit is directly affected by all these young workers. Most of them plan to work during the summer and then travel - to many different parts of the world. Therefore, towards the end of the summer, they flock to the health unit for travel immunization. Smallpox is not on top of the list anymore. Many, however, travel to eastern countries in Asia. That means typhoid, cholera shots and sometimes even typhus. But the health unit works beyond immunization. Long hours are spent counselling these young people on how to take care of themselves in a foreign country - warnings about water and use of maleria pills. Often they ask what kind of first aid equipment they should take. The unit has pamphlets covering this and hands them out. The multitude of visitors who stream into Jasper each summer consists of a wide range of people. There are those who seek the luxury hotels, the regular campers who use the campgrounds and then the inevitable horde of transients. These are the ones who sometimes cause the problems. However, for the most part the Parks Department looks after this. A few years ago they constructed a "free camp" so that these wanderers would have a place to sleep. It has the necessary facilities. But they built it too close to town and it was badly abused. So the next year they built it out a little further - and this has been the practice ever since - every year a little farther out. Edith Gourley says there was strong objection to this camp from the very beginning. The argument was, it attracted undesirables and once there, encour­ aged them to stay longer. But the Parks Department staunchly defends its po­ sition. " If we don't give them a camp, they ' ll be sleeping on the lawns and in front of the Administration Building and Information Building. And probably littering as well!' ' At least with the camp there is the advantage of knowing exactly where they are. And knowing where they are proper inspections of sanitary conditions can be seen to . Since the new hospital was built in 1974, the public health office has been located in that building and a close working relationship has developed between the hospital staff and the health unit. "For example," says Edith, "if a patient is about to be discharged, we know about it and can arrange the home care if needed. Also," she continued, "we try to be as helpful to the school as we can - other than the routine things we do. If a youngster has a problem at school - it's just across the street - they send him to me. I check him over and if I feel he needs to see a doctor - well, Dr. Bykowski, he's our part-time Medical Officer of Health, is able to examine practically right on the spot." 140

The summer work force numbers between 4,000 and 5,000. Naturally, some of these are food handlers. A program, probably unique to Jasper, has been set up for them in cooperation with the Parks Department. Every employer must send a would-be employee to the health unit for an examination. Here they look for such things as skin conditions, upper respiratory infection, scrapes and rashes and cleanliness. However, this has its problems also. Because of human rights, no one can be forced to come. Also some employees are hired on the promise that they will go - but don't. Employees are sometimes guilty as well . If they're short of help, especially near the end of the season, they don't bother about the health unit. At any rate, the program is certainly a step in the right direction! Restaurants are regularly checked by the health inspector - especially kitchens of new chefs - they have been known to sometimes try to get away with a few things! Then there are outlying areas to be checked through the summer - Miette Hot Springs, Sunwapta Bungalows, and the Icefields . Before the health unit opened, all immunizations were done by local doctors. Today, there are wardens scattered all over the park - some 80 kilometers from town. If there are children involved, they are brought to the health unit for their shots. The unit does not have to do any travelling in this respect. In 1959, health unit staff consisted of a staff nurse, a secretary-treasurer, medical officer and steno-technician and as with Banff, was open only two days a week. Additions today are two more nurses (part-time) and another steno­ technician and dental hygienist and they are open five days a week. There is also a part-time dental officer. The health unit has an excellent educational program for venereal disease. After having checked it out with the parents, instructors in social hygiene are invited out from Edmonton to talk to the high school students. They do an extrememly fine job! The health unit sends information to the free camp and the nurse at the Lodge so she can hold clinics there. The unit does not carry out direct examinations or treatment. These are referred to a doctor. Although Jasper Health Unit may be the smallest in the province it steadily and efficiently supplies essential health services to the local population as well as the thousands of visitors that flock in every summer. 141

Chapter 20

LEDUC-STRATHCONA

For four hours, the man , a known mental patient, sat in his car staring at a blank wall. Nervous neighbors watched. Finally, a call was put through to Dr. McCourt at the Leduc-Strathcona Health Unit , from the unit's nurse in Thorsby . She had been called in by the R.C.M.P. to help with the problem. As always, the health unit promptly responded. Although not specifically trained in mental care, their nurses step in and help as best they can, until trained help is available. So says Dr. McCourt, Medical Officer of Health , fortunately the unit has a good liaison with the mental health nurses who are stationed in Fort Saskatchewan and Leduc. Says Dr. McCourt: "This man had been sitting there in the car for hours and hadn' t moved. The R.C.M.P. were notified, and they in turn happened to know that the man had a hi story of significant mental illness. This was on a Saturday evening around 9:00 P.M., and they wondered what should be done. As usual , they called the public health nurse who phoned me . They were afraid this fell ow was going to do something, as he had a violent hi story in the past." Then Dr. McCourt told the nurse to ask the R.C.M.P. to help out and take the man into the University Hospital and let somebody there have a look at him . But they could not do that as there were only two R.C.M.P. officers on duty at the same time, and one could not go away and leave the other. Eventually, Dr. McCourt asked the nurse if she thought she could get the patient into her car. She said she thought she could . Then he told her to get a relative, or somebody responsible in the town, to go with her and take him into the University Hospital. This was done. Once released from treatment, the unit's nurses endeavor to follow-up mentally disturbed people. But there is a limit to this in that the nurses are not really mental health nurses as such. They are not experts, whereas the mental health nurses are trained. What the unit tries to do is follow them up to the extent that the nurses are satisfied that they are making some progress. In other words, says Dr. McCourt, " they have been in hospital , they come out, they are on medication, we follow them up , we go to their home, see how they are getting on. As far as we can, we try to ascertain if they are taking their medication and watch them over a period of time. Visits are made once a day at first, then once a week, and finally once every two or three weeks to see how they are getting on." 142

''If we see a sign of deterioration we contact the Mental Health Department. Quite often, the mental health nurse will go out to see the patient and then we hear no more about it." Leduc-Strathcona used to be part of the Edmonton Rural Health Unit. When it was decided to split up in 1951 , they used the North Saskatchewan River as a boundary line. Henceforth, the portion south of the river became Leduc-Strathcona. Since then, the health unit has steadily been growing. It now has a staff of 74. including 4 health inspectors who do a superb job - particularly with eating establishments. During his term as Medical Officer of Health, Dr. Mccourt has instituted an extremely important function of the health unit. For two years, he tried to convince the government that it was essential to have one person fulfilling the sole function of health promotion. He has , at last, fulfilled this aim, but his dream is to have three health education specialists. The work of the health education specialists is not only to prepare films, lectures, and slide presentations for public awareness, but to help his own staff get to know what each other is doing and to provide inservice on new information and procedures. The role also includes liaison with both professional and volunteer agencies. The largest program in this health unit is Public Health Nursing. It employs the greatest number of people. Unlike the rural areas, most of the people have ready access not only to their own doctors, but to clinics and government agencies as well. Thus, the units' main emphasis is on the nursing and health inspection programs. Infant, pre-school and school children are all immunized, and pre-natal classes also play a large part in the workload. Usually six such clinics are offered during pregnancy - two during the early months and four later on. The father's attendance is almost !00%. It is an excellent way to prepare both parents for what lies ahead. The "At Risk" registry began over a decade ago and enables unit staff to keep close touch with any child who may have potential problems. Genetics and hereditary disease is another important area. But it is also a difficult one. For example, a diabetic may ask, "What are the chances of my passing this disease along?" A solid answer is impossible because enough is not yet known. Technically, the chances are one out of four that it will happen, but no one knows when or if it really will. ln this area, the unit is closely linked with the genetics department at the University of Alberta. Another area of concern is the woman who is over 35 and has her first pregnancy. There is a possibility here of a defective child and the woman is advised to have some tests. lf danger is lurking, the parents are of course told. There are two definite responses . "I will not take this chance" or, " l will not terminate this pregnancy.'' Either way, there may be regrets way down the road. Family planning is another touchy area. Most schools will permit some sex education - even in the younger grades - but invariably, there are strings 143

What do you hear? (Leduc-Strathcona Healrh Unit)

Speech and hearing (Leduc-Strathcona Health Unit)

Dental Check (Leduc:-Strathcona Health Unit) Community Health Nursing (Leduc-Strathcona Health Unit)

Health Inspection Home Care Physiotherapy (Leduc-Strathcona Health Unit) (Leduc-Strathcona Health Unit) 145 attached. The unit has staff available to help the older students on a consultative basis or by appointments. During the many years when Molly Policha was senior nurse at this health unit (she retired in 1978), a film in sex education was offered to students in the schools. A local minister took exception to this. The nurse retorted. "Film or no film, they'll learn all about it - among other related things - in the street. Why not let us teach it properly?" This health unit has had a full-time nutritionist for the past few years. However, Nurse Molly Policha takes us back to a fascinating experiment con­ ducted before this date. A nutrition camp, with Molly in charge and run by Dr. Stevens, was organized by Lamont Health Unit at Elk Island Park. Eight and nine year old boys from various social areas were invited to attend. A nutritionist was supplied by the Department of Agriculture and a physical education instructor by the Department of Education. This was done in order to prove that good food and exercise do, indeed, make a difference. These 30 boys were periodically weighed and their blood checked. Results were astounding! And all these boys became totally involved in meal planning and doing their exercises! A profound lesson had been brought home. Now, the boys stopped to think about what they were and how they should exercise their bodies. And the whole program went a joyful step further! Parents were invited to attend. They came for what turned out to be a combination of a holiday and health education. Another complicated field is that of child abuse. Teachers, neighbors, any­ one will phone the health unit if they suspect this dreadful thing is happening even though the unit has no jurisdiction in dealing with the problem. The only people who have a legal right to handle such matters are social workers from the Child Welfare Department. They, and they alone, have the authority to take the child out of the home if it seems necessary. All the health unit can do is take a look and notify these people if it is deemed necessary. It is unfortunate but true that in a high pressure, fast - paced society, it is sometimes the children who suffer the consequences of failure in the home. The health unit also gets contacted in cases of poisoning and accidental or attempted suicide. In these instances, they will (if no one else is notified) take the victim to emergency in a hospital. In the case of would-be suicides mental health people are contacted since the health unit has no mental health department. People seem to think if something goes wrong the health unit staff will help. And they do! No deaf ear is turned here. Staff even follow up poisoning cases in the hope of preventing reoccurrances. The Leduc-Strathcona Health Unit has a forward looking and commendable program for older people. There is a pre-retirement program aimed at helping people who have always worked, on how to cope when there is no job to go to. Suggested hobbies and activites are always available. They also have a post-retirement program and a geriatric one. Visits are made to Senior Citizen's homes (not so much nursing homes because they do have nurses) in an attempt 146 to assess the old folks' condition. No doubt this is much appreciated because so many old people are being forgotten. They immunize those who travel abroad and check the at risk patients for chronic illness such as flu and asthma. Molly Policha once more takes us back to the exciting days of Leduc oil wells . Except, about this time, a different type of excitement errupted! With the coming of oil, trailer camps sprang up, and so did the town of Devon. But then, in a place called Hector's camp, this not so pleasant "excitement" cropped up . Typhoid appeared, and before long, 17 cases were reported! Miss Policha and her nurses were right in there immunizing and trying to identify the source. It developed that the people had been drinking the river water without boiling it ! Once more, proof that a lack of understanding causes most problems. "But it's so nice and clear, why should we boil it?" they exclaimed. The nurse replied, "Even the clearest water can be teeming with 'bugs'!" Only when the people complied did the epidemic die a natural death. But then, to everyone's horror, another case appeared in Devon itself! How could this be? The town was on an approved water supply! The patient was a young boy living with hi s grandmother, and the poor grandmother was the unknowing carrier. Miss Policha has another interesting story. Throughout the Province tub­ erculin tests were regularily done on all students and teachers. ln 1962, when Haythome Junior High in Sherwood Park was tested, there were several positive cases - in primary stage. Those with positive results were X-rayed and put on treatment if needed. Then they were told to check with their doctor if they didn't feel well. Often the symptoms would disappear of their own accord. At any rate, one school teacher developed a very bad cough and naturally went to see his doctor. The doctor gave him some antibiotics and said, "This will fix you up ." The teacher asked, "Should l not have an X-ray?" "No, no, " said the doctor. But the teacher's cough persisted. So during the Christmas holidays , on his own initiative, he had an X-ray. The results revealed open T.B. By now, as subsequent tests proved, he had unwittingly infected 130 school children. Seven were admitted to the sanitorium immediately and three or four went in after a few months. Fortunately prompt action rectified the situation. An unfortunate part of the whole thing was that the press got hold of it. The mobile clinic had been recalled from Peace River to help in the testing of the students, staff and residents in the county. When the Peace River papers told their readers why their clinics were cancelled, the Edmonton Journal picked it up. Soon the county was swarming with reporters. They accused Dr. Siemens, the then Medical Officer of Health , with supressing information on a raging epidemic. When he told them there was no epidemic they wouldn't believe him. They went to the school, but the principal wouldn't let them in. So, they took pictures 147 outside the school. After the initial testing, Dr. Siemens told them there were 92 positive reactions. You can imagine his amazement when the press reported 92 cases of tuberculosis. It did no good then to point out that only 7 required further medication. The doctor went on television to try to undo what the press had done. It was to no avail. When the clinics opened for business the next day, it seemed the whole county was lined up outside of the offices for T .8 . tests . At least that year the monitoring for tuberculosis was exceptionally thorough . Today as the unit becomes more industrialized and its population grows , new problems have arisen. Industrial health has become a matter of concern, not only through accidents, but more importantly in air, water, and noise pol­ lution. The unit's four health inspectors work with the other government agencies to try to keep the rapidly expanding petro-chemical industry within acceptable environmental standards. Here the main emphasis is in controlling gas and liquid waste emmissions, but when new plants come on stream, noise, toxious odors, and the amount of wastes poured into the air and rivers will put increasing pressure on the environment. The only real solution to this is through the edu­ cation of the public to the dangers that industry poses for their surroundings. The individual must be made aware of the conditions in which he and his children will live. Only then will the public react as a whole. Until that time, the health units must monitor the situation and act for him. Dr. McCourt would like to see the utopian state where every individual looked after his or her own health in every shape and form . He stresses that it is the individual's responsibility to himself and to society to maintain good health through proper diet and personal hygiene. In order to arrive at this point, it will be necessary to expand health education programs. He sees this and the unit's extensive Home Care Program as the prime objectives of public health for the I 980's. The biggest thing is to get the people to cooperate. They will, but only if aware of the situation. Public health intends to do just that. As this book was being prepared, the City of Edmonton annexed large portions of the Leduc-Strathcona Unit's area. Dr. McCourt is not overly worried about this, as with the enormous growth in the rest of the unit, there is plenty of work to go around. 148

Chapter 21

MOUNTVIEW

''The secret of the old pioneer is that he didn't have anything and was therefore forced to improve his lot." These wise words were spoken by 86 year old Mr. George Boyack, recently retired chairman of the Mountview Health Unit Board. He is one of the true pioneers of public health in Alberta. One might wonder, why this involvement with public health? He is not a doctor - not a medical man of any sort. Hi s answer to that is simple and direct. "I know too many of my generation who have died well before their time - simply because there was no public health care available." All those who know Mr. Boyack love and respect him. He is a kind and generous man - and there is ample proof of this . In one instance, he gave work to a family in dire need so that they could afford a much needed goitre operation for their daughter. Another time, when a friend of his was down and out but needed a prostrate operation, he paid for it. This same friend seemed to be bedevilled by bad luck. Later he developed gangrene and one leg had to be amputated. Once more, Mr.Boyack paid for the operation. Because, with no public health and no insurance, what were people to do? The above are but a few instances showing his care and concern. When an epidemic of scarlet fever swept the land, he was more determined than ever to do something about public health. However, the hardest blow of all was the Joss of a son to polio. Now his determination turned into a blazing crusade. He pushed hard for a health unit and with the staunch help of local residents in 1940 the Rosebud unit was formed. The new health unit, which covered an area roughly corresponding to the present county of Mountview had representation from Olds , Crossfield , Sundre, Carstairs and the municipal districts of Mountview and Waterloo. The first health unit office was located in the town of Didsbury. Dr. McPherson was the first medical officer. The unit grew and flourished . As immunization took place in the schools - as children streamed through the clinic for immunization, Mr. Boyack must have paused - and thought with regret, ''My son never had this kind of protection - and it should have been available!'' But there was pride and happiness in the thought that hundreds now were able to take advantage of this vital service. 149

Dr. McPherson left in 1943 to serve in the Medical Corps of the Canadian Army. He was followed by the capable Dr. Leslie Allan who was medical officer until 1949. During his term of office, he pioneered in the area of preventive medicine in rural areas. When he left, he became medical officer in the city of Calgary. By 1950 a public health inspector was added to the staff and the medical officer was no longer required to do inspection work. In 1956, a major boundary change took place. Rosebud and Bow Valley Health Units amalgamated and became Mountview Health Unit. Although this amalgamation had been considered for sometime, the year before held some other activities. Salk vaccine was distributed but of more immediate dramatic value, was Operation Life Saver, the Civil Defence evac­ uation of the north east section of the city of Calgary. As for Operation Lifesaver - a unique and valuable exercise which took : . place in late summer - a large number of evacuees where directed to centres at Olds, Didsbury, Carstairs and Crossfield. The true purpose of this was to assess how local communities could cope in such a situation. Therefore, health unit staff did not take an active part but acted as observers. However, sanitation and hygiene were the direct responsibility of the unit . Although only a small number took part, valuable lessons were learned. A report was sent to the Civil Defence Authorities. Staff conferences were held during the year, and as part of the training program, Dr. Keys and the nursing staff of both this health unit and Bow Valley Health Unit paid visits to the Provincial Training School at Red Deer. Dr. P. Yann and his staff were most cooperative. School visits showed the major defects were teeth - 736 out of 2,666 examined. There were 275 referrals to the family dentist. Today Dr. Rick Val­ entini heads a well established dental program within the unit. Also causing concern were tonsils and adenoids - 227 with 53 referrals to family physicians. Immunizations were carried on in full force as were child and infant welfare clinics. T .B. testing was wide spread, including the Hutterite colonies. Vital Statistics - Births - 710, deaths - 164. As for sanitation, Bowness and Montgomery still presented the never ending problem of municipal water and sewage systems. The town of Crossfields had difficulty keeping up with the water supply. New wells had to be located. Carstairs had water problems, also. Contamination was present both in the town well and school well. The only answer seemed to be chlorination. Olds and Didsbury were doing okay and restaurants throughout the area showed improvement. On the first of April, 1956, the much discussed new Mountview Health Unit took solid shape. This change resulted in dividing the Bow Health Unit into three parts. One portion would amalgamate with the existing Mountview Health Unit, another with Drumheller and a third with Medicine Hat. The assets 150 of the Bow Valley Health Unit were divided proportionately between t.he three receiving units on a population basis. The office of the Bow Valley Unit was adopted as the main office and Didsbury became a sulr-office. The whole area now became officially - Mountview. Miss M. Lavell, R.N. undertook part-time duty with the board to help with Well Baby Clinics in Bowness and Montgomery. These clinics had been too large for the normal staff. Miss Lavell 's appointment was a great help - es­ pecially si nce she had years of experience behind her. Regrettably, scarlet fever and strep throat occurred again in the spring of this year. Field work consisted of taking water and milk samples, inspecting food establishments, butcher shops and slaughter houses, fur farms and schools. There was one prosecution. During the following year, the staff remained the same except for the resignation of Miss E. Allgard, R.N. This health unit had visitors for a few days - two Medical Officers of Health, Dr. D. Steward and Dr. I. Lewis. They spent some time observing before taking up their new appointments at Sturgeon Health Unit and Edson Health Unit,.respectively. Starting in January, a first aid course was taught at the Mennonite Bible College by Dr. Keys. It was very successful. Thirty out of 32 candidates passed the test for a St. John's Ambulance Certificate. Scarlet fever and measles attacked the area during the first half of the year. There was also a rabies scare. A dog died under suspicious circumstances but it was later proven he actually died of jaundice. The Asian flu epidemic was another serious problem. The first case occurred in a young man who had recently flown back from Denmark. The disease originated on the Chinese mainland and was traced to Hong Kong in April . From there it spread rapidly westwards. Large numbers of people were affected. A vaccine was made by Connaught Laboratories and was distributed free by the Department of Public Health - earmarked first, for priority personnel of essential services. Unfortunately, by the time it arrived, many had already succumbed. During the year, the town of Sundre and the village of Airdrie passed a vote to install water and sewage - a wise move but a hard won battle! In each case, enthusiastic preparation paid off - by a single vote! In each case, also, a sick person had to be brought to the polls so they could cast their vote! Without these votes the resolutions would have failed! New, modem schools should not have sanitation problems - but one did! Complaints were received from teachers about foul air. Both teachers and students were falling prey to headaches and lethargy. So Mr. Pillidge, Mr. Ings, and Dr. Keys visited the schools several times. The complaints appeared to be justified. The cause of the trouble seemed to be lack of proper air movement. 151

Suggestions were mad to the firm of architects responsible for the school and soon the problem was rectified. Teachers and students drew a deep breath of relief - a breath of fresh air. Dr. 1. O'Gorman took over the unit in 1972 from Dr. Alan Ellis. In the past decade it has been his driving spirit that has guided the staff along new and rapidly expanding lines of endeavour. Audio and speech programs were tough to get off the ground due to lack of trained personnel. But they managed to survive and take root. The unit could still use more than the single speech pathologist that it has on staff. One of the more exciting and much needed newer programs has been that of Home Care. In 1974 Lillian Rutherford carried out a pilot project looking after the needs of home care patients in both Olds and Didsbury. This was so well accepted that since then the program has expanded to the point where 14 nurses and physiotherapists as well as 20 homemakers are now with the program. Still Dr. O'Gorman feels this is not enough. This excellent and viable program must be further expanded in the 1980's to ensure those in need are not passed by for want of either funding or staff. Although the unit does not have an Early Intervention Program it does have an Observation Registry set up some time ago by Dr. Jean Nelson. In addition plans are in the works for a "3 year old" assessment screening. Joyce Miller has developed an excellent program on drug abuse using the resources of ADAC. She presents the program in classrooms by invitation. Also by invitation the unit presents Family Living programs in the schools. The parents are asked to preview the program and are also asked to assist in its presentation. The unit staff is also available for individual counselling on request. Funding may become an even more important matter as boom conditions continue to place a strain on the towns and villages near to Calgary. Some have experienced a 40% growth in a single year as Calgarians move out to the suburbs in droves. In another unrelated area the unit's sanitation staff came under extreme pressure this past summer when 20,000 Boy Scouts from around the world gathered at Kananaskis for a World Jubilee. Alex Mackenzie feels they certainly learned a lot about the habits of crowds during the frantic summer. Think of all the problems and all the things that can go wrong in handling the food, water and sanitation needs for that number of hungry youngsters who never seemed to stop eating. Although problems did creep up it was a good rehearsal for the Olympics just down the road. Apart from all that he and three other full time inspectors are kept busy with the mushrooming housing developments throughout the region. From the initial days of the unit Mountview has grown to a staff of 50 and 8 sub-offices serving a growing population. 152

The growth and development of health units across that province, must be sheer delight to Mr. George Boyack. It is ample proof the his words are true - ''A nation is people and people crowding those in authority can force a government to do something." 153

Chapter 22

MINBURN - VERMILION

Hills swell gently in the Minburn - Vermilion Health Unit Area. Cattle roam, and grain waves in the summer wind. In the winter, these same winds can become savage - blizzards swoop down on the countryside, but on the whole, it is a pleasant land, with Vermilion at its centre. Vermilion, main office of the health unit since it opened in 1952 , is famous for its Agricultural College, which students attend from near and far. And on a summer's evening, the strains of the town's renowned pipe band may be heard floating over the hills. The town of Wainright, which joined the health unit the following year and became a sub-office, may also lay claim to glory! It is well known for its Horticultural Society. That residents show keen interest in it, is amply evident by the many lovely gardens in the town. But the society's activities have spread well beyond local boundaries. Since 1964, it has hosted an annual flower show with hundreds of entries! This health unit covers an area of 5,000 square miles and serves well over 28,000. When it first opened, the staff consi sted of Dr. Brown, M.O.H., one sanitary inspector, one nurse, and a steno/technician. Dr. Brown was first Medical Officer of Health and one of the first Senior nurses was Mi ss D. Salisbury. Other long-serving members were Mrs . 1. Marian, senior stenographer for ten years; Mr. Bill Boulton, Public Health Inspector, also close to ten years; Mrs. M. Elford, Mr. C. Barber, and the present Secretary-Treasurer who, over the years, has given an enormous amount of time and effort trying to control the budget. The year the health unit opened, the Municipal Nurse at Tulliby Lake became associated with the health unit, no doubt grateful for the extra medical support. The following year, sub-offices were opened in Innis free and Kitscoty. The nurse spent every Tuesday and Thursday morning at the latter office. All the nursing staff were busy with the polio vaccine field trials. Six hundred children were involved. By now, the office space was getting cramped as the health unit continued to grow. In 1955 , all were delighted to move into new quarters especially designed for them! But still a shadow hung over the unit. The dreaded polio was alarmingly on the increase. The immunization program was increased to all grade one to eleven students. 154

In 1957, the health unit joined the province-wide rush to immunize as many as possible against polio. Other regular immunizations were also, of course, kept up. The need for this became especialy evident in 1969, when, to the dismay of everyone, the number of diphtheria cases sharply increased. The gonorrhea rate also rose - just as it did on the national and even world level. Vermilion boasted another educational institution in 1959. A new school for retarded children was opened. Next year, polio was prevelant once more, as well as measles. Sadly enough, some people were still not taking full advantage of the immunization service so gladly offered by the health unit. The year 1961 was an important year for this health unit. At long last, the essential and much needed dental program was introduced! Another big step was the establishment of Guidance Clinics at twenty locations. The following year, as had been happening all over the province, another Municipal Nursing Station was closed - Tulliby Lake. This meant an increased area for the Health Unit Nurse to cover. An attempt was made to bring Chauvin into the fold , but failed. Also, a long talked about plan was at last put into motion. Testing for nitrates in the water was now a reality. In 1963, Wainright moved up in the world! New quarters were acquired and a full-time 'steno/technician was appointed. Two surveys were carried out during the following two years. One was testing of a garage worker to discover how much carbon monoxide was absorbed in the blood during a day's work. The other survey brought an alarming situation to light! It revealed that the health unit service was under used by those who needed it most! An immediate plan was made to direct intensive home visiting to these target families. It was hoped that this would shake them out of their apathy. Staffing difficulties were encountered in 1970. One important position which was vacant was that of a dental hygienist. Naturally, the dental program suffered. This year also, for the fifth consecutive time, the birth rate dropped significantly. However, a bright spot was that Wainright voted in a fluoridated water supply. But the bright spot did not last. Three years later, for some reason, they rejected it! The Mental Health program was extended to the supervision of patients discharged from the Alberta Hospital. A new program was initiated in 1972, one which several health units still reject - Family Planning with evening classes, in Vermilion and Wainright. The next year, there was a further advance. Glenrose Hospital extended Au­ diological and Speech Therapy services to the Vermilion office two days each month - one audiologist and three speech therapists. In 1974, still another first. 155

A Family Living nurse speciali st was added to th e staff. This brought the staff number to 16.: (I) Medical Officer of Health (2) Steno-Technicians (I) Nursing Supervisor ( I) Part-time Steno-Technician (6) Staff Nurses ( I) Senior Steno-Technician (I) Dental Hygieni st ( I) Family Living Nurse Specialist (I) Public Health In spector ( I) Dental Assistant In 1973 Dr. Reid joined the staff as Medical Health Officer. This was the year that the province assumed 100% funding fo r programs. The New M.O.H. soon moved the unit along new directions. Speech and audio programs were greatly expanded. These were well utilized but acquiring staff over the years was a problem. Today, although budgeted for two full time posi tions only one has been filled and there is a waiting li st of over 50 clients. The dental program has now reached a point where a fluoride rinse program is being in stituted. The unit has two Dental Assistants and two Dental Hygienists on staff. In 1978 Mrs. G. Hancock became the Director of the unit just at the time that coordinated home care was gaining province wide recognition . The fo ll owing year, 1979, Mrs. Jean Mercier established the Home care program with the first patients seen in March. This program has had good public response in the three years si nce its beginning. Although still in its four year implementation stage the unit staff can see the potential for rapid expansion in the years to come. In May, 1981 , the unit moved from its headquarters in the old Brunswick Hotel to the new Provincial Building. The present staff of twenty-seven full and part-time personnel is looking forward to expansion to cover the increased popu­ lation growth in the di strict over the past five years. This is particularly crucial in the eastern regions around Lloydminster. In the I 980's the unit is discussing the possibility of bringing in programs such as early intervention, regional landfi ll , and expanding their home care, family life and sheltered workshop programs. Of particular interest is the possibility of hiring a Health Educator. As the decade moves forward there will be a need to cast the responsibility for good health back on the shoulders of the individual. Only through public awareness will the true meaning of prevention become a reality. This awareness of good health habits and proper living styles will come from public education and thus the need to be looking in this direction. Considering all the new programs which have been added, the concern shown for the residents, the health unit will undoubtedly continue to grow and serve its people. 156

Chapter 23 ST. PAUL NORTH EASTERN ALBERTA

Sparkling lakes and groves of trees make pleasant landmarks in the area encompassed by the North Eastern Health Unit. The people here are mostly engaged in the age old and respected acti vity of farming. Running a close second are mining and oil exploration. And most of the residents firmly believe that the development of the Cold Lake oi l sands will become a reality in spite of everything. These people did not have a health unit until January 1, 1958 . What sparked its establishment was the tragic death of a child from diphtheria in Lafond, not far from the town of St. Paul. The person who really "got the whole thing going" and aroused the public's initiative was Mr. Bibby, a school principal from Ashmont. He generated so much enthusiasm that the proposed project was taken to town council and passed. Thus, the ball started rolling! This health Unit covers almost 6,000 square miles and serves 40,000. Its border lines are the North Saskatchewan River to the south , Beaver River to the north, Cold Lake and the Saskatchewan border to the east, and Weskatenau to the west. When it first opened, the larger settlements were at Smokey Lake, Bon­ nyville, and St. Paul. In addition, there were some 2,000 at the R.C.A.F. base at Cold Lake including servicemen and their dependents. Squadron leader White­ head was one of three servicemen on the Board. Later, Grande Centre and Medley joined and lastly, in 1965 , Elk Point. St. Paul is still the main office; the others are sub-offices. Staff at the main office consists of: Medical Officer of Health/Director, one supervisor of nurses; four Community Health Nurses (two full time and two part­ time); one speech therapist; one Audiologist; one Dental Hygienist; and three stenographers (one full and two part-time). Sub office's staff consists of: Elk Point - one community health nurse, one part-time steno. Smokey Lake - three part-time community health nurses, one public health inspector, one part-time steno. Bonnyville - three community health nurses, one public health inspector, two part-time dental hygienists, one part-time dental assistant, one steno. 157

Grand Centre - three community health nurses, one community health aid , one speech therapist, one steno. Medley - two community health nurses and one steno . When this health unit opened, it had a staff of six. Without a medical Health Officer, the nurses had to go it alone. The first Senior Nurse was Mrs. H. M. Steinhauer, P.H.N. First health inspector was Paul R. Stone, C.S.I. (C) . The first Medical Officer of Health was Dr. John B. Newton who was appointed in July of 1969 to bring the unit up to full complement. Today, the staff is over 40. The annual report for the first year of activity reveals a busy time! The first task was to collect old records from family doctors and the school board so they could set up their own system of family histories. Clinic openings were rushed by the fact that the family doctors had already given two doses of polio vaccine the previous year and the third dose was now due. Anxious parents deluged the health unit with phone calls. "When will you be ready to actually work?" It was important that the third dose be given in order to meet the requirements of the series of shots as well as not to destroy the community's confidence in the newly formed unit. The first of the regular clinics were set up in March 1958. The first held at R.C.A.F. base Cold Lake followed by St. Paul , Smokey Lake and Bonnyville. By 1960, the unit was offering over 400 clinics a year with attendance at 13 ,972 . One of the first programs instituted was that of testing for tuberculosis. One bus driver and one food handler were found to have mild cases of the disease. All in all, 20 people were sent to the Aberhart Sanitarium for treatment. To all those discharged from the sanitorium , the unit provided bi-weekly visits for streptomycin injections and dressing changes all at the request of the T. B. Control Division . The usual rash of measles, mumps and chicken pox occurred. A large number of infectious hepatitis cases broke out in the fall. Two cases of typhoid were discovered, both from one of the several Indian Reserves in the area - Saddle Lake Indian Reserve. Local doctors reported 35 cases of venereal disease to the Division of Social Hygiene . Two home nursing courses were given. The health inspector was extremely busy too! His aim was to "sell" public health rather than force it. However, he was prepared to "force" if he had to, and in several instances, he did have to! Water supplies, dairies, general stores , barber shops, restaurants, and schools were all thoroughly and regularly in­ spected. In the area of sanitati on, the Health Inspector, Paul Stone, resorted to a spring clean-up campaign in an attempt to improve the character of the nu­ merous garbage dumps within the region . In addition, several producers of raw milk were warned of action to close them down if they did not conform to standards. Of greater concern was the habit of most store owners to provide noon - hour lunches from meats left out of the coolers, confections and candies out 158 in the open and in one case, ice cream standing alongside fish . A few food handling tips brought immediate relief in this area. In the Glendon Hospital kitchen, a doughboard that was infested with grain beetles was destroyed and the area sprayed with D.D.T . In 1961 , Dr. 8 . P. Harris became the Medical Health Officer. Hi s stay with the unit was brief as were those of his immediate successors. One of his first tasks was to look into the continued presence of typhoid fever on the Saddle Lake Reserve. This time, the carrier was an 83 year old woman who had had her original attack in 1919. She survived but her husband and two children died . After the outbreak, all the school children were given shots. Also efforts were made to improve the water and sanitation on the reserves. Still , the idea was to educate the natives in proper personal hygiene, a matter Dr. Harris felt would take many years to accomplish. The work on the reserve was directed by Dr. Davies, the regional Medical Officer for the Indian Health Services. The health unit staff gave valuable assistance both on and off reserve lands. That year, there was also some difficulty over proper facilites for Red Cross swimming classes. And it was noted that through pressure of the R.C.A.F. base, the dairy at Cold Lake had begun pasteurizing milk supplies to the base with a remarkable lowering of the plate content from an average of 50,000 to under 3,000. The other dairies in the area were now moving to pasteurizing in their operations. In 1962, the unit developed a dental health care program with the use of local dentists. At first, only grade one children were given the benefit of topical fluoride applications. The inability to attract staff in the area underlined a problem that most rural units were experiencing at the time . This year, the unit also held several guidance clinics in which 68 children with behavioral or personality disorders were given help. In 1965 , the Town of Elk Point joined the unit. By then , Dr. D. N. Lawton had established a dental program under his part - time direction with the aid of two dental assistants. That year, the unit's health inspectors expanded their efforts to deal with extensive noise and dust pollution from the concrete plant. Several employees were found with hearing defects. In 1967, the mobile T. 8 . unit spent two months in the unit in another effort to control, if not eliminate, this persistent problem. One of the problems lay with a number of people who refused testing. How to track them down was quite a problem. Still , the effort was made. Plans were also made to conduct family life education in the schools at the request of teachers and staff. In relation to the schools, it was during Dr. Ian Ashford's term as Medical Health Officer that it was reported that at Vilna and Iron River a number of children had become dizzy and started vomiting during gym classes. Samples of water supplies were taken. Sneezing powder brought in by the children was 159 ruled out and food samples showed negative. The only other possible cause was that of the school buses running their engines close to intake fans so that when the wind was in the right direction carbon monoxide was forced into the schools. Removing the vehicles from the area solved the problem. In the l 970's, the unit directed its energies into the area of public education. Numerous contacts were made with civic organizations to promote the advantages of better public health. The development of this and other new programs was made more difficult through the chronic inability to attract and hold qualified staff. Just as new programs got underway staff changes would place them in jeopardy. Much of the slack was taken up by local volunteers . In 1977 , the unit set up a speech pathology and audiology unit which was to work on the St. Paul School system. The following years, its services were extended throughout the unit. ln 1979, Dr. Ray Corns became Medical Health Officer at a time when the unit was taking part in a Home Care experimental program. At that time a new sub-office was opened in Grande Centre and plans were made for expanded facilities in the head office at St. Paul. In preparations for co-ordinated Home Care, every effort was made to solicit the help of civic organizations in identifying areas of need. Today, Mrs. Winnifred Shandro is the Director. She has an impressive record' Six years of her career were spent in the Yukon as a district nurse. Where, she says, she did everying from delivering babies, stitch wounds and do sutures, change dressings, look after accidents, and go on rescue trips. Then, before coming to this health unit, she worked at the Jasper Place clinic for fifteen years. On her arrival , she found the unit carrying on with well established procedures in school examinations, pre-school testing, and immunization. Mrs. Shandro feels the high point since her arrival in St. Paul is the unit's expansion into new programs. In the earlier days, the health unit had a family atmosphere. Today, many people are strangers. She says the programs are bas­ ically the same, except they have been greatly extended. Diphtheria and tuber­ culosis are two areas which require special constant vigilance since there is an unusually high incidence of both in the area. There were three cases of diphtheria during her first two years. One year a study was done to discover where diphtheria was most prevelant - native or white. They were about equal. Mrs. Shandro has a number of nurses and secretaries who work on a part­ time basis. This works very well , leaving the women time to spend with their children. When asked what a Community Health Nurse really is , she explained. "The nurse must be an R. N. and she must also have an additional two years of University training - this mainly for teaching purposes." Speaking of nurses , an interesting fact emerged. Alberta Public Health Nurses were the very first who were given authority to do immunization! Mrs . Shandro says that to this day, in Ontario, all immunization is done by doctors! 160

Still on nurses, she feels that a nurse involved in Home Care should do only that. Doing other community work as well just doesn't work out. Home care has many advantages - one being, she has discovered , many people (par­ ticularily the elderly) prefer to die at home with loved ones around them. This health unit has a high geriatric population - several percent higher than the provincial average of 7.8%. Therefore, it follows that their geriatric program is fairly extensive. The Town of St. Paul has a population of 5,000 and there are three lodges for senior citizens. The health unit makes sure these folks get medical care, visits them regularly, checks their blood pressure, and offers a physical fitness program. In short, they truly take the well being of these seniors to heart. More time is spent with this program than any other. Mrs. Shandro says they are absolutely delightful people to work with! At the ai r base at Grand Centre, two nurses look after preventive care but only for the dependents. The Airforce looks after the men . Naturally, there are no geriatrics here, nor are there any at Medley , which is a military base. Elk Point, being industrial, has a special hearing program for loss of hearing. Some of the activities are rather noisy! In looking to the future, Mrs . Shandro sees the I 980's as a decade of challenge for the unit. Especiall y if the oil sands megaprojects for the region go ahead. Think of all the problems of the boom conditions. 161

Chapter 24 STONY PLAIN

lt was one of those cold, still winter mornings when the frost bites to the very bone. However, the staff of the Stony Plain Health Unit, as always, punc­ tually arrived for work. Their offices were located in the gracious old house which used to be the residence of Dr. Oatway, first resident doctor in the area. It had been converted to accommodate the health unit and was known as Oatway House. For 40 years, it was referred to as "The House of Goodwill" . But this December morning, with temperatures hanging at 30 degrees below zero, all was not as it should be! Every pipe was frozen! The temperature indoors was as frigid as it was outdoors! Obviously , work under these conditions was impossible. But not quite. One person still determined to travel , arrived at the health unit for a "shot". And he got it! He is probably the only person who ever got vaccinated in 30° below temperatures! At least his vaccine was well refrigerated! When this health unit opened in 1953 , two Municipal Nursing Districts were still in operation - Sangudo and Tomahawk. But as the services of the unit spread, they were closed in 1959. This unit covers 6,000 square miles. When it opened, it served 25,000. With the discovery of oil in Drayton Valley and Pembina, the population rose sharply, putting an extra strain on the health unit. But they coped admirably . The main office has always been at Stony Plain. Mayorthorpe, Entwhistle, and Sangudo used to house sub-offices, but with the shift in population due also to the lumber industry booming in Whitecourt and with Drayton Valley joining the newly opened Edson Health Unit, sub-offices are now stationed at Whitecourt and Fox Creek. The Stony Plain Health Unit opened with a budget of $21,500. Now it's over a million. ln the beginning when funding was 40/60, new programs were hard to come by. lt meant that the board would have to go to the taxpayer and say , " Hey, the health unit wants this or that. Will you be willing to pay?" Then gradually, funding became 50/50 and at long last, the government, in 1973, funded totally. This, says Dr. Ian Ashforth, present Medical Officer of Health, has resulted in the government offering new programs which a health unit may accept or reject. The 100% funding has permitted the "have-not" health units to catch up. 162

When this unit was being formed,it like many others, benefitted from the advice and knowledge of Dr. Norman Baster who was Director of Local Health in the fifties. After it got on its feet, Stony Plain Health Unit is gratefully remembered for its generosity in sharing experience and knowledge with new units just getting established. This health unit, of course, also had to have a starting point. Miss Marion C. Story, Senior Public Health Nurse, was responsible for setting up the first programs. Other first staff members were Miss Vivian Gould, Miss Lucille G . Laferriere (both public nurses), Miss Adel Thompson, steno/technician, and Mr. Harold Dean, Sanitary inspector. ln 1953, Dr. D. N. Keys arrived from London to complete the staff as Medical Officer of Health. One nurse recalls that at this time starting salary was $280 a month! Strangely, it took the people a long time to realize the services offered by the health unit. Even after ten years, some were still going to Edmonton for these very same services! However, being practically in the lap of Edmonton, this unit does not offer treatment, since treatment centres are so nearby . But this very closeness also causes problems. With the city ever expanding, over-flow popu­ lation finds its way to Stony Plain. Summer villages also cause headaches for the Sanitary Inspector. More often than not, sewage systems are inacjequate. As for the initial difficulty in getting people to make use of the health unit , the Medical Officers think that it is because of its purely preventive nature. lt cannot present statistics as to how many people did not get sick or die because of its activities ' As with other health units, communicable disease was, and is , high on the list of priorities. ln spite of the dramatic drop, vigilance still must be exercised. For example, diphtheria is still around, but smallpox has virtually been stamped out. The last reported case in the world was in Somalia, five years ago. According to Dr. Ashforth, health units do not even carry the vaccine anymore. Health education in the schools and community has also always been high on the list of health unit activities. ln the past, school examinations had their own difficulties! The nurse or Medical Officer of Health often found there was no proper place for these examinations. Sometimes it was carried out in an occupied classroom and once in the janitor's storage supply room! But, the work was done - one way or another! School lunches were also inspected for nutri­ tional value and vitamins given at cost. Pre- natal, post-natal and pre-school programs have always been of vital importance. Valuable as they are, some can become trying, particularly pre-school examinations! While nervous mothers wait, the little ones - some terrified - stand in the clinical assembly line. They are checked for dental problems, then on to another station for weighing and measuring. Next stop - speech, hearing, and vision checks, and lastly, immunization or boosters and Health instruction, 1958 (Stony Plain-Lac Ste Anne Health Unit) mn Pllll·llC STE.lllE HEALTH UllT 10.17 . HEALTH UNITS RURAL HEALTH SERVICES

Health Unit Display (Stony Plain-Lac Ste Anne Health Unit) (Stony Plain-Lac Ste Anne Health Unit)

(Stony Plain-Lac Ste Anne Health Unit) 165 medical history. No doubt , when all this is over, a collective sigh of relief is breathed by all! A long cherished dream was realized in 1962 when a dental program was launched. Dr. Patrick D. Finnigan was hired as Dental Health Officer. With him at the helm of "Dental Health and Preventative Dentistry", and his able assistant, Sandra Balkan, the program forged ahead. Because of the acute shortage of dentists, he also visited other health units at Red Deer, Drumheller, and Barons-Eureka . His first step was a survey of children grades one to eight. Fluoride sup­ plements pills and drugs , stanous fluoride treatments and organized "brush ins" followed. In 1970, clinics were held one day a week at Leduc-Stathcona, again because of the extreme shortage of dentists. But in spite of all efforts, some children still had hopelessly decayed teeth. For these, a policy of extraction was instituted in 1972. But the overall dental picture was becoming brighter and brighter. Fluoride rinses are being done weekly and the health unit has three dental hygienists and two assistants. These people feel that the enormously improved dental situation is due to increased awareness on the part of both children and parents. Many live in rural areas where it 's rough to wrest a li ving from the land . Understandably, most used to feel there were more important things to worry about than teeth! Leave them in until the pain is so ferocious the teeth must come out. The only thing left to do then was settle for dentures! Thanks to education, this attitude has changed. But the health unit feels it cannot claim all the credit. Parents and children alike are being constantly bombarded by TV commercials stressing the value of good dental care - surely this must have some effect. The Salk and Sabine polio vaccination programs kept the health unit hum­ ming during those hectic epidemic years . Dr. Ashforth says this extensive im­ munization will probably stamp out polio forever, if we remain vigilant. During those frightening years when polio seemed to lurk everywhere, the following recommendations were widely circulated: I. Avoid contact with known cases of polio. 2. As far as possible, children should be protected from over- fatigue as this leads to a severe type of paralysis in anyone incubating the disease. 3. Use water holes and swimming places with caution. Avoid any spot likely to be contaminated by human excretions or much used by other bathers. 4 . Keep hands clean by washing before meals and after going to the toilet. 5. Every toilet should be effectively fly-proofed . 6. Protect food from exposure to insects. 7. Wash fresh fruit and new vegetables before eating. 8. Be on the alert for the warning systems listed here. 166

WHEN TO SUSPECT POLIO During an epidemic period, the following symptoms must be viewed with suspicion: headache, head cold, moderate fever, pain or stiffness in neck or back, a feeling of general weakness aching in the arms or legs. Only some of these may be present in any particular person. If suspicious symp­ toms occur, call your doctor. Early care will often prevent or limit crippling. The Swine Flu in 1976 caused another flurry of activity. As for the government, it was left in the unenviable position of deciding between experts - did the vaccine have side effects or not? The year 1973 saw speech and audio testing added to the health unit's programs. But long before this, during the fifties, there was a speech therapist at Leduc-Strathcona - the very first. In 1969, although they had no official program of this nature, Stony Plain Health Unit helped in testing children. Even after speech and audio testing were officially initiated regular screening programs were not possible due to lack of personnel and time. But many children were referred by qualified people such as Public Health Nurses, teachers, school councellors, doctors, and Glenrose and the University of Alberta Hospital staff. (In 1976, the Glenrose travelling clinic was withdrawn , due to lack of funds .) The most common disorders found were language delay, articulation defects and voice di sorders associated with cleft palate, stuttering , perceptual problems and combinations of these. Aside from the above, and many other problems, there is another which plagues a multitude of mothers and always has. Over and over, these same distraught mothers come with the same complaint - "I can't get Junior to eat and I've tried everything!' ' The Stony Plain Health Unit has compiled a comprehensive and entertaining assessment of the problem, outlining why this dilemma occurs and how it may be resolved. Here it is: ''Apparent failure of children to eat enough food is the commonnest be­ haviour problem encountered by pediatricians. Yet, no difficulty is more easily prevented or more readily cured. The salient facts are simple: No healthy child, left to his own devices , will refuse his food or starve himself. But every small youngster loves to be the centre of things. As soon as his mother and father make an issue out of whether he eats or not, then he has available what he wants - a first class attention seeking device. Better still , one which can be exploited indefinitely. How should a child presenting a feeding problem be treated? Most important is a change in the parental attitude. Never, never should it be indicated to him (by action, speech, or expression) that anyone is the least bit interested in how much food he takes. At mealtimes, he should be made to sit at the table for the conventional period. 167

If he leaves his portion, it should be quietly cleared away at the conclusion without comment. On no account should he be praised for eating or scolded or punished for not clearing hi s plate. If he has eaten sparsely, no food must be allowed until it is time for the next meal. There is no doubt that the problem will be rapidly solved if hand!ed along the~e lines . As soon as the child realizes he can't attract attention by refusing hi s food. he ceases to do so. A mother may say, " I've tried everything to make him eat!" If only she hadn' t tried anything, there never would have been a problem. The establishment of Home Care in the I 970's was a blessing to many - particularly the elderly. It put off the dreaded day of going into a Senior Citizen's Home and shortened hospital stays for numerous patients. When the program came into being, a Home Care Management Committee was set up . Its function was to act as an advisory body. Many are involved in this program - occupational therapists, physiotherapists, homemakers and vol­ unteers who dash around with meals on wheels. The Hereditary Di seases Identification Program is rel atively new, and still in the planning stages is the Earl y Intervention Program. Its purpose wi ll be to catch defects, or " risk youngsters" in time and educate the parents in how to deal with the problem. In 1974, an added feature was a Mental Health Nurse from Community Nursing Services. Dr. Ashforth says there is a gradual change in the health unit. It has shifted its emphasis from infant and immunization to malnutrition, mental health, risk registry and services to people of all ages. While activities go on as usual at the health unit , the Public Health Inspector leads hi s own sometimes frustrating life. While trying to sell health safety he often encounters resentful attitudes. But what would we do without him? He keeps our work safe for us. Since the first health inspector, Harold Dean, among others, Allan J. Newmann, Cherian Stephen and Robert Weston , have fought the ceaseless battle to keep things "clean" . This means constant vigilance over sewage, public water testing and also testing of wells, inspections of dairy farms, grocery stores and restaurants - plus beer parlours. Perishable foods and tem­ peratures on food hauling vehicles are monitored during the summer months. For the most part, these units are refri gerated for long hauls or carry only frozen goods. Inspection of beaches is also a major portion of a summer's work. In 1964, a step was taken which lightened this load somewhat. The provincial government required beach operators to obtain written permission and a permit from the health unit before they were allowed to operate. Ensuring eating places are safe is a constant and difficult problem for the health inspector because many operators tend to backslide. The second visit often 168

reveals the same undesirable conditi ons as we pointed out at first. The feeling seems to be that more frequent inspections are a necessity. A general increase in population and the annual influx of tourists, compli­ cates the job of the health inspector - especially in regard to sewage. This message is constantly spread, but too often, not heeded: It is expressly forbidden by the Provincial Board of Health Regulations to deposit liquid waste upon the ground in any town, village , hamlet, roadway or watercourse. Following Dr. Keys, several Medical Officers of Health have served this health unit: Ors. Haines and Nicholson, Dr. Gillespie - who had several cases of typhoid on hi s hands in 1957 due to people drinking untreated water, Dr. Leslie Spinks and Dr. H. M. Brown and Dr. Ashforth. During Dr. Brown's long term of almost ten years, he had many experiences - among them an outbreak of infectious hepatitis in an oil workers' camp. It all began with a 23 year old married lady who paid the camp a visit. Quick action on Dr. Brown's part soon brought it under control. Upon Dr. Brown's retirement in 1972 , he had some straightforward com­ ments on how the health unit idea could be improved. He feels health units should be incorporated into a regional health unit set up. He believes it would be easier to get more money that way. He also said, ''The function of the Medical Office of Health should be administrative and advisory to the rest of the staff. His knowledge and experience should be available when needed. With the retirement of Dr. Brown, Dr. lan Ashforth joined the present staff. Stony Pl ain Health Unit's first quarters were on the second floor of the Com­ munity Centre. ln 1953 it moved to Oatway House where it stayed until the " frozen pipe" disaster. Its next move was to temporary quarters in the County of Parkland building. Finding office space was a tight squeeze, but they managed, and were charged no rent! But in 1972 , the unit found a permanent home on 47th Avenue in Stony Plain. This fac ility was especially designed for the func­ tioning of a health unit much to the satisfaction of all concerned. This health unit offers services which complement, but do not duplicate, the treatment service of hospitals and general practitioners in the area. Dr. Ashforth offers the following words of wisdom: " We should not, in our enthusiasm for new approaches, forget that many of the "traditional " diseases still ki ll. It is important that we should maintain our endeavors to ensure that the population is adequately protected against com­ municable disease. Diphtheria, for example, sti ll exists and investigation and control proves very time-consuming to our staff. Polio, often considered a disease of past decades, is presenting problems in other countries, and if we fail to maintain a sufficient level of immunity in our own area, it may once again return with its attendant mortality and crippling morbidity." So, let us not be caught unawares. Killer diseases could still swoop down on us. 169

Chapter 25

STURGEON

Almost 120 years ago, the three Grey Nuns , Sisters Emery, Lamy, and Alphonse - with 15 orphans in tow , trudged to St. Albert to offer their services in the then almost non - existent field of public health. Sheer delight would fill their hearts today if they could watch the bustling, energetic Sturgeon Health Unit in action. The very ground they trod is now the scene of all the many health programs plus several programs exclusive to this unit alone - a variety of activities which they could not possibly have dreamed of! When the Sturgeon Health Unit opened in 1951 the unit area covered 2,000 square miles and served 3,500 people. Its formation was a result of the division of the Edmonton Rural Local Health Unit along the lines of the North Saskatch­ ewan River. Dr. J. M. Brown became Medical Officer of Health and Mary MacDonald, a nurse who had served the region since 1940, became the senior nurse. Soon after its inception the towns of Westlock and Barrhead and the Villages of Thorhild and Clyde were added. Mary MacDonald resigned in 1964. Her position was taken by Nurse Mrs . Gwen Law who later became Supervisor of Nursing. She was also appointed Chairman of the A.A.R.N. Public Health Study Committee. In 1953, the health unit moved to larger facilities on the second floor of the Sturgeon Municipal Building. It was here the field trial of Salk polio vaccine was held. Five years later, a dental program which became extremely successful, was launched. Part of this was a much needed and appreciated mobile dental service. The main thrust of the program was to teach and encourage people to look after their teeth. However, in the midst of all the dental activity, sadness crept in. Dr. Potter, the Dental Officer, collapsed and died in his office in 1962. Tribute was paid him when Dr. Zacheral, of the University of Alberta, said later that Dr. Potter's dental health program was one of the finest, most thorough, well planned and most advanced of any he had ever seen . Steadily, the dental work of the unit expanded. In 1979, the health unit prepared and had published in the Journal of the Canadian Dental Association an article entitled ''Computerized Oral Fluoride Program''. As a result, inquiries came streaming in from various parts of Canada and the United States. In a further effort to promote dental health care, the unit set up a display 170 in the local shopping mall, using a theme " Keep your teeth healthy for a life­ time ." The Dental Officer at this time was L. D. Nobert, D.D.S. As with most health units, priority in the early days was in immunization. One such recipient of the needle , Mr. George Hoke of Dapp, wrote a verse to Nurse Joyce Hetherton:

To a small young health nurse, with thanks She was little and sweet and gently toiled Prepared my ann for the shot. I fel t quite important and brave and secure So intense her concern, that I thought, "She ' ll smi le with compassion to help ease the pain As firmly , the needle goes in ." But watching intently, I saw with a start Shucks! twasn't a smile - 'twas a grin!"

ln 1962, following close on the heels of the first di sposable syringes the unit entered a float in Legal's parade. The central figure was Public Health Inspector Hostler being immunized by Nurses Wheatley and Durery with a six foot syringe! Hopefully, he remained healthy for years after! Other activities abounded during the late fifties and sixties. Once more feeling cramped, a long range planning committee was formed to anticipate future developments because of the rapidly growing population. Dr. Elizabeth Hill prepared a report on the dangers of glue-sniffing - one of the earliest to appear on this subject. It was reproduced in the Alberta Medical Journal and was a foretaste of the more serious drug scene which was to follow . One of the most important programs introduced at this time was psychiatric after care with the cooperation of the Alberta Hospital , Oliver. Al so, a decision was made to delegate some of the nurse's duties to a health assistant. This was another first and worked so well that the first publication of Sturgeon Health Unit News advertised for volunteers to undertake some of these duties. Sixteen women responded! It was gratifying to know that not only was the health unit serving the community, the community was involved in helping deliver these services! Routine checks of developments and hearing were introduced for nine month old babies. An anti - smoking clinic was held in Westlock but results were not too impressive although the abolition of cigarette smoking was a major goal in fostering the health of the community. Drug education programs were expanded for students and parents. Some basic principles of screening had been established in the pilot program in Thorhild. These were now employed in a new program for pre - school children, designed to identify children with developmental problems before the age of school entry hoping to increase their capacity to learn . Dr. Hill left the unit in June of 1967 . Dr. James Howell arrived to take up the post of Medical Officer of Health. One of Dr. Howell's initial projects was 171

to investigate the value of multiphase screening in a rural area. Thorhild was chosen and March-April 1968 saw perhaps the most ambitious short term project the unit had yet undertaken, termed, 'preventicare'. The project arose following di scussion between Dr. Howell and a local general practitioner. The whole community became involved through a central coordinating committee and sub - committees responsible for publicity, appoint­ ments, the recruitment of voluntary help and the provision of refreshments. These were establi shed in each of the four main villages within the unit. The entire resources of the unit were used in setting up the clinic, with a supplies budget of $2,000. Further assistance came from the University of Alberta, the University Hospital , the Provincial Department of Health, various voluntary societies and from the Thorhild County Council. The basement of its main office was adapted for a temporary clinic. In the end 1,332 persons were screened for possible health problems of the blood, mental health, immunization and hearing. In addition, a pap smear test was offered for women . In 1971 the unit came to recognize the need to change their health service programs to meet the needs of a changing population; they began setting up new goals for the future . They asked themselves - how well had they coped with heart di sease, cancer, alcoholi sm and drug abuse, mental illness, arthritis, the battered child , salmonellosis, environmental pollution, venereal disease, the problems of aging - and over population? They came to the conclusion that the health unit and community must have the potential to deal with the problems of the next two decades . These problems mirror large increases in the numbers of people in the area. The then sporadic services of guidance and speech therapists from mobile clinics would have to become full time. Environmental health services would have to be improved . And above all else the unit would have to acquire its own specialists in many new areas, particularly in the field of family planning. At this time, Mrs. Susan Hays coordinated a two day travelling speech clinic at St. Albert. It operated out of the Glenrose Hospital and four therapists were in attendance. Speech defects such as lisping, stuttering, the inability to say certain letters or sounds were found and referred for treatment. The unit's nurses offer stop smoking courses on a regular basis. Another first in Alberta is the clinic offered at Thorhild County Office. Usually, when one thinks of health units , infants and youngsters come to mind. This clinic, however, is aimed primarily at middle - age and old people. The purpose is to discover di seases and ailments which may lie undiscovered for years. One person attending was found to be harbouring five different ailments which she was totally unaware of! Such cases are then referred to personal doctors. Across Canada, only a handful of such clinics are in existence. In 1975 Dr. Sheila Durkin was appointed Medical Health Officer. In her four years as Medical Officer of Health the unit underwent considerable expansion 172 with special emphasis on Home Care, Health Education & Promotion and Speech Pathology programs. All this occurred despite the need to maintain levels of health services in the face of a rapid increase in population. Much of the increase was in the younger age groups with heavy demands on child care and other maternal aspects of the nursing program. New homes and subdivisions tax the unit's staff to the limit. In 1979 Dr. K. W . Hodgins replaced Dr. Durkin who resigned to take up a senior position within the Department. When Dr. Durkin arrived on staff there were 33 members. When she left in 1979 there were 63. With the coming of 1979, growth was apparent everywhere. The population served was now almost 80,000. The school population alone was close to 20,000. The area now was 6 ,800 square miles with sub-offices in Redwater, Barrhead, Westlock, Mornville and Swan Hills. Parenting courses are now being offered and another program unique to this health unit is the "Health and Fitness Connection". It brings out awareness of the components of a healthy lifestyle in direct relation to both physical and mental health .. This was first launched to coincide with the Alberta Summer Games which were held in St. Albert in 1979. It was extremely well received and consequently the project was expanded to include participation in rural fairs at West lock, Barrhead and Redwater. Also, a display system has been established which will facilitate future health promotion projects. Although most programs are extremely active, high on the priority li st are those of Family Life Education, Nutrition and Fitness, Maturation and the ever present Communicable Disease. Many new eating establishments have opened and comprehensive inspection has greatly reduced food borne diseases. Health Promotion Coordinator Peter Palfenier produced a most successful film for T . V. showing this health unit staff at work in the unit itself and in the schools. In 1978, the health unit had its first Home Care client. Within the following year, it became obvious that most in need of this service were over the age of 65 - in fact, this age group constituted 80% of all Home Care patients. Mrs. Elizabeth Hallett is Home Care Coordinator. This year, also, the health unit had its first full time nutritionist. The $700,000 headquarters which the Sturgeon Health Unit moved into in 1977 were opened by Helen Hunley, then Minister of Health . The building is a far cry from the humble beginnings of the Grey Nuns - but a perfect example of progress and what education and work of dedicated people can do. 173

Chapter 26 VEG REVILLE

Everybody in the town of Vegreville knows Miss Black - and loves her! This nurse has faithfully and competently served the area for 40 years! Yes, everybody knows Miss Black, and she knows almost everbody - but not quite! Margaret Kuzyk, sister to the nurse, who by the way , is often introduced as " Miss Black's sister" (a good indication of just how well the nurse is known) relates the following incident: The nurse was walking downtown when two or three young fellows stopped her for a chat, calling her by name. The nurse did not recognize them. When she asked who they were, they grinned and announced, "We all have your mark on our arms!" Immunization of course! Prior to health unit days, Miss Black spent years working as a district nurse in this region - years of hard work , satisfaction , and excitement ! We will hear more about this later! When the Vegreville Health Unit was established, she became the first nursing supervisor. The following group of loyal and hard-working people are a part of those connected with this health unit. They outline some of its hi story and present day acti vities: Ed Majdziak - Started with the Vegreville Health Unit as a student Public Health Inspector when it first opened in 1955 . Walter Kropielnicki - has been Chairman of the Board for over ten years. Pat Yates - Nursing Supervisor from 1967 to 1972. Marg Cyr - Secretary-Treasurer to the Board from 1957 to 1966. Amlie Cholak ·- started in 1965 as a dental assistant. Lorie Cunningham - current Director of the Vegreville health unit and has been for 4 112 years. J. A. Dkachuk - started in Lamont and has been with this health unit for over 25 years, and enjoyed every minute of it! B. D. Samorl - long time member of the Board. When the Vegreville Health Unit opened in 1955, it was the result of an amalgamation of three smaller units - Holden, Lamont and Two Hills. Some of them had been operating since the late thirties, bu_t with the coming of war, it was impossible to acquire and keep staff. So, things slowed down for awhile. This union was found to be desireable mostly for economic reasons. For example , why duplicate services? Why have three directors when one would do? It opened 174 with a staff of nine, plus nurses in the sulroffices - one at Holden, one at Two Hills, one at Lamont, and two at the Vegreville head office. Today, average staff numbers 55 . Having launched the regular programs at the outset, the health unit's first step toward dentistry occurred around 1959. By special arrangements, third year dental students from the University of Alberta came out during July and August and set up clinics in the various schools. Later, of course, a full dental program was introduced. For the most part, the people in this area readily accepted the opening of the health unit, but in truth, many did not see a great need for it since they had become accustomed to having a district nurse. But as the unit grew and expanded its worth was readily recognized. New programs were also readily accepted because much of this work had already been going on informally. Health in­ spectors tended to many jobs even if they weren't "in the book". Nurses visited homes which was actually a type of home care; they examined childrens' teeth and when the need arose, referred them to a dentist. The only real difference today is that funding is available. This health unit also had the usual fluoride controversy. However, most towns agreed to it. People in rural areas take the fluoride drops or tablets which the health unit supplies. These rural areas are mostly vast open spaces consisting of large farms . These same open spaces can cause serious problems in the winter when storms unleash their fury. Among others, Miss Black can testify to thi s! During the very early days of her distrct nursing , a whooping cough and smallpox epidemic swept this land. It was mid-winter with snow drifts piled high and roads blocked. How to get out in the country to do the essential immun­ izations? Resourceful , dedicated and not afraid to tackle anything, she solved the problem. Although she had , in the past, covered miles riding or driving horses - cars were practically non-existent - she now came up with a unique but certainly practical idea! Black Motors of Vegreville had taken on a truly pioneering project. They built a homemade snowmobile! At this time, these machines were a thing of the future! Well, this nurse wasted no time. She borrowed this contraption and it worked perfectly! As she sailed around the countryside, people stared and gasped in astonishment! Never had such a sight been seen before! When cars became more readily available, Miss Black was supplied with a Model T Ford. But very soon after this , as well as having the reputation of being an excellent nurse, she developed another one as well - a reputation for burning out clutches! Every month or two, she would bum out a clutch! Fixing these clutches was becoming tiresome. But out of due respect, no one had the courage to give her a bit of driving advice. So, the irksome problem occurred over and over. Finally, Miss Black realized that possibly she was doing some­ thing, wrong. So she said to one of the board members, 175

"I wish someone would tell me why my clutches always bum out!" Gathering courage, the man asked, "Miss Black, do you really want to know?" "Of course!" she snapped. So he told her, " If you' II just keep your foot off the clutch, you won't bum it out!" She answered nothing, but later was reported saying, " How do I know that young whippersnapper knows what he's talking about!" Finally, about five years after automatic transmissions first appeared, the board was convinced, if somewhat reluctantly, to spend the extra $25 and buy her one of these. Further pressure was put on to include a radio also! The excuse for this last item was she could then listen to weather reports - a safety feature surely, especially when storm warnings were being broadcast? When Miss Black at last retired from her position as nursing supervisor at the health unit, Joy Clare took her place. The unit continued to grow. During the last three years, particularily, many new programs have been added, Home Care in 1979, speech and hearing also. Lashing winter storms caused another big problem for yet another nurse who started out for a farmhouse but soon got tightly stuck, in a snowdrift! Undaunted, she was a tiny person weighing maybe 100 pounds, she pulled out her shovel and got to work. Somehow, she finally managed to get turned around and off she went on another road. She did reach the farmhouse but about 15 minutes after she left , a sudden blinding storm came up - one of those that reduces visibility to Zero! The farm wife was worried sick! In desperation, she sent one of her boys out to look for her. He was back in minutes. "Mom, it's no use going out there. You can't see a thing!" So they phoned the neighbors . Yes , they had seen her pass by . They phoned the next neighbor. Yes they had seen her pass by. But the third neighbor had seen no sign of her. A search must be made! Using a four wheel drive and inching along, at long last they spied her car in the ditch. Plowing through feet of snow, they managed to pry the car door open. No Miss Dandy! Now what? The logical thing seemed to be to visit the farmers along the way. At last they found her! A passerby had rescued her. The early work of health education and disease prevention, begun long ago by the district nurses, has through the health units reached undreamed of pro­ portions. The Vegreville Health Unit has a sound, sturdy philosphy- "Promote health and EDUCATE throughout the entire community!" And that's exactly what this thriving health unit is doing as it looks to the future . 176

Chapter 27 WE TO KA

Once they realized the many advantages that health units provided, it was the pressure' of organized civic groups that brought the Wetoka Health Unit into being in 1956. The first reference to establishing a health unit in the area came from Alderman J. Pike. He pointed out that rather than have everyone running to the doctor for immunization, for an estimated $2.00 per person, why not use the money to set up a health unit that would provide a variety of services for the people for the same amount. At that time, and prior to the formation of the health unit, public health services were given to the public by the district nurses. A total of twenty-seven district nurses had been at work serving the area and acting as friends, mothers, and advisors to everyone. As Albert Strohschein, the unit's first Secretary-Treasurer points out: "Every community had its own chosen benefactress whose work exemplified the resourcefulness and selfless devotion by which they came to be known." Very soon, the idea caught on. The counties were ready to take the plunge; the villages of Millet and Ponoka were ready but Wetaskiwin was not! Being an older community, perhaps the thought of change was not appealing. Or perhaps the concept was not fully understood. At any rate, a period of heated and sometimes stormy debate ensued!. Every effort was made to inform and persuade the public by means of newspaper articles, radio, and lectures. It was pointed out it would certainly not be a great expense with the government funding 60% and the municipality only 40% of the costs. Many organizations, particularly the Kinsmen Club and Women's Institute got into the act in a big way. They even built floats for the civic parade! It was of vital importance to win Wetaskiwin over because We­ taskiwin held the key. Eventually in 1956, it happened. The town council, with C. D. Enman as Mayor, voted to set up a health unit with the town of Ponoka. Thus the health unit of Wetoka became a reality! The first board meeting was held on April 19th with Earl Baker acting as temporary chairman. Later, he became Chairman. Don McCrimmon of Ponoka became Secretary-Treasurer until that position could be filled; other members of the board were Herman Strohschein, John Pountney, Ivor Davies (of Ponoka) and Hector VanNess (of Rimbey, as it was included almost immediately). Dr. 177

S. P. C. Casey was appointed the first Medical Officer of Health. He was the one who coined the name Wetoka, after Wetaskiwin and Ponoka. He was a colorful person who is remembered for his interest in public health and for his quick wit and Irish humor. The area served by the unit is 3,100 square miles and looks after approx­ imately 33,000 people. Over the years, the population has remained fairly stable but is now experiencing more rapid growth due to Alberta's boom condition. The first staff consisted of a senior nurse, Miss Cogland, and other nurses one of whom was Margaret Fawcett. Since that time Miss Fawcett, now Jones, rejoined the staff as area home care coordinator in Ponoka. Jim Hoskins, the first Public Health Inspector, left the provincial service to take on the latter appointment and remained with the unit until his retirement in 1979. Miss Bums was put in charge of the Ponoka office. Albert Strohschein, who retired in I 977, recalls the main office had always been in Wetaskiwin - first in the old Singer Sewing Machine Centre north of the Chevrolet garage. Then in 1957, it moved to city-owned quarters at 5 I st Avenue and 50th Street. Since those early days, sub-offices have been opened in Ponoka 1956 and Rimbey 1957. The most recent was Winfield opened in I 972 with Dorothy Sherwood in charge. As with other health units, Mr. Strohschein related that at that time , funding depended on the number of people served, the number of programs offered, and the size of the unit. The Department of Health provided a salary schedule, but often it was so low the unit had to find extra money to pay salaries that would attract good people. According to the government, the province paid 60% of the units costs and the unit 40%. In reality of funds expended, the reverse was what happened until the province took over 100% funding in I 973. Immunization and communicable disease control were of the highest priority in the early years. The ffrst baby and pre - school dine was held in August, 1956. It wasn't long before the numbers at these clinics doubled, keeping the nurses extremely busy. In I 957, testing of all food handlers and beverage attendants for tuberculosis was put into practice. Oddly, there was one objection. One store manager and his staff in Ponoka steadfastly refused to take the test! Then, during public testing, another problem arose. Some, especially those with positive tests, flatly refused to allow themselves or their children to be X-rayed. Their attitude seemed to be, "If we ignore the disease, it will simply go away! " In 1958, the health unit was startled to discover a case of leprosy in the area! Because the disease is so rare, no one was aware of the cause or cure, if any. A frantic amount of reading took place. The patient was sent for treatment to New Brunswick and was eventually cured. But all contacts had to have regular blood tests and other specimens taken. To everyone's relief, no one else devel­ oped this dreadful disease. Sabine Vacc ine line up , 1963 (Wetoka Health Unit)

~-··.. ~~ ~i .• ,_ \~ ~ .-= ~ ~- 1..ailll . ' \ ~ --1

Dr. Casey and ax present tire changing course g _ (Wetoka Health Unit) - - ::S Health rules presented by Mrs . Laura Hayter (Wetoka Health Unit) J

Mobile dental chair espe­ cially designed by Dr. V. Potter (Weroka Health Unit)

Dr. V. Potter and Miss Melda Doran at work in 1960 (Wetoka Health Unit) 181

On the lighter side, it was during this year also that one of the community nurses had a most unusual experience as these ladies often do . Roads were often terrible at that time . Skidding into the the ditch was not unusual! Well , one evening it happened again! Hopelessly stuck, the nurse tramped several miles to a farmhouse . When she arrived, the house was deserted . Undaunted, she broke in, hoping to find a telephone. She found a phone alright, but it was disconnected! Ever resourceful , she set to work and managed to connect it! No sooner had she achieved this feat when she was startled out of her wits! In the dark empty house the phone rang ! She must have jumped two feet! The caller turned out to be someone 11 :'. kilometers away from Edmonton! She asked thi s stranger to please send out a tow truck. No sooner said than done, and before too long, this nurse was back on the road! Stress was also placed on sanitation and garbage disposal. Rimbey organized a week-long clean up campaign and Jim Hoskins began to look into Wetaskiwin's nuisance grounds. Standard garbage containers with lids were suggested for local home owners and businessmen. In the year 1959 three cases of typhoid broke out in a lumber camp likely caused from drinking unboiled water. Swiftly, the health unit was on the spot innoculating the contacts. One contact, however, refused to be innoculated! "My corpuscles are perfectly capable of protecting me! " he staunchl y declared. But they failed. He came down with the disease and also infected another member of his household! In 1959, the unit began using their new audiometer in testing school children for hearing defects . 1960 was a big year for this health unit. For the first time, a dental program was introduced. Wetoka was the fourth unit to implement a dental program. This important work was handled by Dr. V. Potter who was on staff. So, with his supplies, equipment, a collapsible chair which fit into the trunk of hi s car, and dental assistants he tackled the task ahead. Queries on the design of hi s collapsible chair were received from as far away as New York. Fluoride was still in the future . Unfortunately due to a lack of manpower the program was discontinued a couple of years later. In the 1960's, a small outbreak of food poisoning occurred. One day, after eating a food caterer's meringue pie for lunch, several people became ill . The same pies were served again at 7:00 P.M. and midnight. By late afternoon and evening, more people succumbed, suffering high temperatures, diarrhea, and abdominal cramps. Ten people were affected and four were hospitalized. The health unit was notified. Finally, the source was isolated. It was in the meringue which had been made from a powdered mix . The contamination was in the dried egg in the mix. That egg was infected with salmonella. The pies had been lightly browned in the oven - not enough heat to kill the germ. To make matters 182 worse, after lunch , they were stored in a warm cupboard. Understandably, they had become highly toxic . The mix was seized and handed over to local federal authorities and was then taken from the sales of various wholesalers. An earlier outbreak had been suspected that year and there had been food and drug warnings in June. This is only one of many stories that Jim Hoskins can tell of hi s years of service as health inspector for the unit. Hoskins said that the most effective means of raising public health standards was through education and persuasion. "It was kind of great talking to all of those people. You started talking about the transmission of bacteria on their hands and through the dishes and so on, and they looked at you like you were talking through your hat. So, you had to put it in their language and tell them that you were only trying to raise their standards and although the government wasn't going to punish them for this now , certainly they were going to have to do something about this one day .'' And says Hoskins, "A lot of the public health seeds I sowed did blossom . That was the nice part of my work; that was the nice part of it." Hoskins' duties took him into the schools with their " one and two" holers in the yard. Water supplies were tested and retested. A sampling from milk cans took place on a once-a-month basis as well as inspections at the farm level. All these paid dividends with a dramatic improvement of quality. In 1968, Dr. Casey left for Vancouver and his position was filed by Dr. Paul Schnee. Dr. Schnee, with good foresight began a number of pilot projects at a local level. They did not stay local for very long. Most of them drew the interest of the department's staff and soon deputy ministers began to arrive to see what was going on. Wetoka started up family life programs, home care programs, speech and hearing programs and reinstituted dental health programs. Dr. Schnee was instrumental in getting these and other programs off the ground. Perhaps the biggest decision to be made by the government was whether home care should be delivered through the hospitals or the health unit system. Wetoka was down for one of the pilot projects. This pilot project was visited by Chief Deputy Minister Mansbridge and the late Deputy Minister Dr. Jean Nelson. After observing home care in operation they were so impressed that they promoted its expansion to the provincial level through the Public Health System. Thus, Wetoka's foresight was instrumental in the estabishment of home care services as a provincial program in 1978. The implications of home care services are only just beginning to be understood. In 1973, Wetoka Health Unit assumed responsibility for health services for the Alberta Hospital Ponoka employees with Verna Boddy in charge. This pro­ gram expanded in 1975 to one of occupational health and safety . At this time Debbie Jones, who had training in occupational health and safety was hired to develop there services for the hospital staff. Due to the provincial government 183 mandate to provide health services to its employees the unit withdrew its funding in the program in 1979. In 1977, Mrs. Carol Blair became the Director of the unit. She notes that since 1956 when nursing and health inspection were the only programs, the unit has experienced massive expansion. Today, the unit provides services in Com­ munity Health Nursing, Dental Health, Environmental Health Services, Family Life Education, Hereditary Diseases Program, Home Care, Speech Therapy, and Alberta Aids to Daily Living. This expansion led to new quarters in 1977 when the Board purchased the former Catholic convent. However, the remodelled convent shortly became too small and today, the Home Care and Environmental Health Services Programs are located next door. New premises also opened in Winfield in April, 1980, and in Ponoka in October of that same year. As to the future, Carol points out that the 25th Anniversary which saw an expansion of the unit's staff from 7 in 1956 to 80 in 1981 , is just the beginning. " Preventive health services and rehabilitation services have a major role to play in the future health status of our population. We must stress the necessity to prevent debilitating disease and promote continuous health control through a strong delivery system of high quality community health services. There is so much we can do, given the resources and the consumers desire to improve th eir quality of life. " 184

THE NORTHERN HEALTH UNITS

Mighty rivers, rushing streams, myriads of lakes scattered about like far-flung jewels - this is Alberta's north. Vast reaches of wooded wilderness, swelling hills, towering mountains, acres of muskeg and clouds of mosquitoes - this, too, is Alberta's north. With the coming of winter, she shows us yet another face - raging blizzards, snowdrifts piled high as miniature mountains, temperatures plunging to 40 below and lower. Ice-blocked lakes and the eerie howling of wolves, these too are part of the scene. But on a clear winter's night, the sky becomes entrancing. Big, shining stars hang so low one can almost reach out and touch them. And more often than not, blazing northern lights crackle across the heavens. Small lonely villages huddle on lake shores. But wait. One also can hear the scream of a power saw as loggers cut wood for some nearby lumber camp . A trapper pursues his prey with relentless vigilance. Still others tackle the chilly job of ice fishing . And in sharp contrast, here and there arrogant oil rigs raise their heads. But as one travels further south , sweeping farm fields appear. Dairy herds graze contentedly in the meadows. Villages grow larger, towns spring up and a few even mature into cities! Indians and whites, for the most part live har­ moniously side by side. And where you have people , many needs arise. One of paramount impor­ tance is public health. As we have seen, the district nurses were right in there. As we have also seen, as civilization advanced, one by one the municipal nursing stations were absorbed into a newer and more modem method of serving the community - health units. The northern tier of health units is relatively new in comparison to their more southerly neighbours. They serve a far flung region of small , scattered settlements and towns . Peace River, Grande Prairie, Athabasca, Lac La Biche, and Fort McMurray are the major population centres. Of these only Grande Prairie and Fort McMurray have experienced the boom times of industrial development. Nor have the prospects of future industrial growth disappeared. Boom conditions have added to the region 's instabiiity and the work of their health units as transient labour forces have appeared on the scene. Then too there is the responsibility of serving the isolated forest communities to the 60th parallel - the border with the Northwest Territories. All in all the northern health units provide community health services to half the area of the province. 185

Chapter 28

ATHABASCA

In the early days, travel for the public health nurse was not a matter to be taken lightly. In winter, it could mean struggling out of a sound sleep at 5:30 a.m. to catch the Northern Alberta Railway or it could mean aking a jaunt down the rails on a summer's day, in a railroad handcart efficiently run by a man who knew all about such mysterious things! Former District Nurse at the Athabasca Health Unit, B. Parr, recalls such incidents with an air of nostaligia. And she staunchly states that without the ever present help and support of Mr. Val Breckenridge, this health unit would have been born much later. The birth of this health unit occurred in 1952 . Val Breckenridge, a pillar of the community, was the first Chairman of the Board and a powerful support in the health unit's endeavours. Once established the health unit grew rapidly. ln 1953 , the village of Kinuso was included: '54, the village of Boyle; '55 the town of Lac Lac Biche and in '61 the town of Slave Lake. ln 1976, municipal nursing stations were established at Kinuso, Smith and Calling Lake. A year later, Wabasca and Desmarais were added. Also included, were four isolated lakes north of Wabasca - Chipewyan, Trout, Peerless and Sandy Lake. A few summer villages have come in very recently. Most big things have a modest beginning. So was it with the Athabasca Health Unit. It began with a staff of five and the first year budget was $22,000. The present staff, fulltime and part- time, is 75. Budget for the 1980-1981 fiscsal year was $1,447 ,984. Payrolls have become computerized along with a vast increase in record keeping. Problems, outside of running the regular programs, simply cannot be an­ ticipated by any health unit. Athabasca had one which certainly could not have been forseen by anyone - the raging flood of 1961. The rising water in Lesser Slave Lake eventually turned to mud making it unfit for human comsumption. Since this was the town's water supply, it was a disaster! Health Inspector Ed Almond was urgently called upon to assess the situation. It was a Sunday evening on July 2 but, as public health people are noted for, he sallied out with no hesitation. And solved the problem! He rounded up two huge cisterns of 10,000 gallons each, one at a convent and one at a school. Neither had been flooded and were full of good fresh water. lt meant rationing water for two weeks but Chris and friend

Germaine Harris Lynn getting ready for business (Athabasca Heal!h Unit) (Arhabasca Health Unit) Nurses Duffy and Appelt (A1habasc:a Htalth Unit)

Ellen Gustaf All dressed up and lots of places to go (Athabasca Health Unit) (Athabasca Health Unit) Cree ladies in food handling class (Athabasca Health Unit)

Lynn and Ed presenting food handlers course in Cree (Athabasca Health Unit) 189 all cooperated and when the flood water receded the crisis had been sucessfully passed. In the meantime the unit's nurses were busy out in row boats dispensing medicine, giving shots, and generally tending a helping hand. But during this flood-stricken period, as almost always happens, when disaster strikes a light side emerged. One day, at high noon, the residents of Slave Lake gaped in astonishment! Chugging along, on what used to be the highway, came a motorboat! This fellow had come all the way from Kinuso on the highway utilizing the flood waters! D. Crawford (nee Appelt) tells of an experience she had in the mid-fiftie s which clearly shows that the health unit nurses sometimes had to endure much in the line of duty. At that time she was stationed at Lac La Biche. Later she became senior nurse at the head office in Athabasca. Those first few months of isolation in this vast land, had many frightening aspects not the least of these were the roads - or perhaps more accurately - trails winding through the woods. Although she was the proud owner of a newly acquired driver's license the mud and the snow taxed her ability to the limit! On one such trip - a monthly school visit to Imperial Mills, she ran into drastic troLible. The trail was deeply rutted and very muddy. However, it was broad daylight and she managed to straddle the ruts. All went well at the school. The boys, as usual , had rushed out to carry in her equipment. But after lunch , which the girls served, tea, a cookie or piece of cake saved from someone's lunch box several children returned with notes, asking the nurse to look at the sick people. She, of course, would not refuse these requests . At the first home she visitied the patient was a very much overweight lady who had miscarried four days before. She had lost a lot of blood. In Nurse Appelt's words, "she was absolutely yellow." There was no question here. She must be taken to the hospital at Lac La Biche . Since the farmyard was a sea of mud she had not been able to drive the car up. So, a stretcher was improvised and four stalwart men carried the lady to the car. She was made as comfortable as possible in the back seat. Then on to the next farmhouse . The patient here was a seven year old girl with a severe respiratory problem. The nurse made a swift decision. This child, too, must go to the hospital. So, she too, was loaded in. Her father accompanied her. By now darkness had fallen and the miserable road was waiting. The nurse managed fine for a few miles but then slipped into the ruts! What to do now! With the added weight, the car was lodged as solid as a rock. She, and the father, tried everything - pushing, putting sticks and logs under the wheels - but all to no avail. Finally, the father said, "I'll go back and round up some men. " Which he did , armed with nothing but a flashlight. After what seemed like an eternity, a truckload of men arrived. They literally lifted the car out. Once more nurse and passengers were on their way. Lac La Biche was reached without further mishap. But, the problems were not over yet! 190

The hospital, of course, was locked at this late hour. Nurse Appelt, undaunted, rang the emergency bell. A Sister answered the door and stared in astonishment! Who was this bedraggled creature - white shoes, navy uniform - all plastered with mud! Once the situation was realized swift steps were taken to admit the patients. Later, the nurse learned that the little girl had pneumonia and the woman a dangerously low haemoglobin. But both recovered. Athabasca Health Unit is administered by a local board of health. It serves a population of 25,000 and covers an area of 20,000 square miles. industries in the area cover lumbering, agriculture, oil and gas prospecting and drilling, fishing and mink farming. The population is mainly British and Ukrainian - also French, native Indians, Metis, Negro and Assyrian. The tuberculosis rate is one of the highest in the province, particularly around the Lac La Biche area. Mobile clinics make periodic visits to the area covered by the unit. A special project team for follow up of tuberculosis patients has been established. It includes one community health nurse, two community assistants, and a stenographer. They will blitz certain areas of high incidence and keep very detailed records in an attempt to eventuall y eradicate the disease. In the late fifties there was a suspicion of algea poisoning in Lac La Biche. Chickens, ducks, and gulls were dyi ng along the lake shore. Chemical and bacterial water samples failed to reveal the cause. Four gulls, eight ducks, and two chickens were sent to Edmonton for analysis. From Edmonton, Dr. C. H. Bigland said it appeared that the birds had ingested a strong neuro- genetic toxin. This toxin is transient so water samples may have been taken after the toxin had moved on - usually to shallow water in hot weather. Residents were advised not to use the water unless taken from very deep areas. In 1959, tuberculosis was still a major problem. The large Metis population and poor living conditions fos ters the disease. They move about a lot and thus spread it. The highest number of infections lie within this group. It becomes very difficult for nurses to track down cases and carriers. Metis are shy of authority and hide when they can. For example, a Metis youth slipped out of the Aberhart Memorial Hospital while under treatment. He was a dangerous open case, but he wandered from place to place, knowing full well he was wanted. This made him more elusive. In spite of warrants for hi s apprehension he con­ tinued to evade the law for months. Finally, he was arrested and taken back to hospital. No one knew who he had been in contact with or how many others he had infected. In the past, well-meaning organizations have sometimes caused a serious health problem. They get the idea that they will set up a summer camp for children. The trouble is many have no knowledge of and give no thought to basic sanitation. Privies are set up without pits - a practice which was condemned 191

many years ago. Buildings are built without windows, premises are crowded, no garbage di sposal or garbage cans, unimproved wells and food from dozens of homes. These camps are often established in the name of religion or philanthropy. But the health unit official who condemns these conditions is usually branded as a narrow minded kill-joy. A province- wide carbon monoxide survey was launched in 1966. Improp­ erly ventilated buildings were weeded out. In one instance, a worker was found to have a reading of 16% . When the ventilation of this garage was improved, a subsequent blood sample showed the same worker to have a content of only 7%. Since fi shing is an important industry in thi s area, great care is taken to ensure sanitary conditions in the fish plants. Three agencies work together on this - Provincial Fish & Game officers, Federal Department of Fisheries and the local health unit. Sometimes surprising things come to light through the course of health investigations. A few years ago two cases of food poisoning were reported. After a thorough study it was discovered it wasn't food poisoning at all . One illness was caused by propane gas leaks. The other revealed a faulty plumbing system. So many defects were fo und, it was decided the disposal system should be dug up to see if a septic tank even existed! A crude contraption was there but in terrible shape! One nursing station is situated 150 kilometers north of Athabasca. This station provides limited treatment and preventive health services to Wabasca, Desmarais, Reserves A, B, C, and D of the Bigstone Band, Sandy Lake and the isolated lakes of Chipewyan, Trout and Peerless. The health unit has a plane at their disposal and two nurses are flown out once every two weeks. They hike into remote villages, sometimes walking four to five kilometers a day. Period­ ically, a doctor accompanies them. The idea of active treatment of patients is almost unique to the Athabasca Health Unit, but because of isolation and tradition it continues to be a limited part of their program. Many people in these areas speak only Cree so the health Unit has hired community health assistants as translators to help bring information and programs to the native population. This innovation has proved to be of great benefit. Another step forward for improved communication was made when a food handlers' manual written up by the health unit was translated into Cree and made available to those working in the school lunch programs. Probably one of the most significant sanitation events took place in 1978 . One of the oldest premises in the area was closed down voluntarily. It was a general store. Raw fur was brought in at one end of the counter and fresh meat sold at the other. Everything from nails, to food to coal oil was available. While 192 one is saddened to see such a fascinating place disappear, one also gives a sigh of relief that no food poisoning resulted! The following year was a big one for the dental program. After being dormant for four years due to lack of staff, it was revitalized. A part time and full time dental hygienist were hired in Slave Lake and Athabasca respectively - also a dental assistant. Due to the energy and enthusiasm of the two new staff members preventive health was re-introduced in the schools and pre-school clinics were held in major centres. Concern was expressed for the lack of dental treatment service in outlying areas . So in 1979 , the new dental consultant, Dr. Tom Curry and University of Alberta mobile director, Dr. M. Womac, went in to survey the school children at Wabasca and Desmarais. As a result, a new mobile dental trailer was placed in the area. But this year, disaster struck at Wabasca. Fire destroyed the new St. Martins Health Complex just one month after moving into new office space. Extra staff was hired to handle the tremendous work of tabulating the loss and rewriting smoke-damaged charts. This year, also, a visiting service for senior citizens and the handicapped was established. It is funded by manpower, immigration, and the federal government. It has created employment and to the delight of home-bound lodge and senior citizens provided visitors for them. An Early Intervention Program is hoped for in the near future. One segment of the Athabasca Health Unit was recently faced with a real challenge. A two day rock concert was coming. Twenty to fourty thousand visitors were expected. To find how best to handle this staggering problem they consulted with centres who had already experienced it - Woodstock, Ontario, and the British Rock Festival. lt came off beautifully - it turned out they had to cope with only 10 ,000. Senior staff at present is : Mrs. Rosemary Neaves, Director, Mr. V. Mar­ kowski, Administrative Secretary; Dr. A. Bene - Dental Health Office (Con­ sulting); Mr. E. Almond - Senior Public Health Inspector; Mrs. Z. Patry - Home Care Co-ordinator; Mrs. C. Nimco - Senior Steno Technician. Most recently a rather unique food handling program was offered to a number of native ladies in the Cree language. At the request of School Food Services of the Alberta Education Department a two day course for the food handlers of the hot lunch program from Wabasca­ Desmarais, Sandy Lake and Chip Lake was designed by E. H. Almond, the Senior Public Health Inspector at Athabasca and Lynne Bollinger, Public Health Inspector at Lac La Biche. As School Food Services prepare daily .hot lunches for over 3 ,000 students reaching these food handlers was very important. The inspectors felt there was a genuine response well worth the time and effort involved in putting together 193 such a course. They prefer the educational route to good hygiene a they believed an informed person will follow good public health practices if they understand the reason for the law. The uninformed follow the requirement s out of fear but only when the inspector are present. This attitude th ey deplore; education is the key to a healthy environment and as more help becomes available more emphasis and time wi ll be put into this approach. At the end of the course a written examination was given and the successful participants received a National Sanitation Training Award Program Pin and a wallet card. The following ladies attended: Lena Bigston from Chip Lake; Eliza Ri chards, Maggie Ahyasou, Georgina McLeod, Dorothy Alook, Ida Yellowknee, Yvonne Gulliou, Mary Cardina, Linda Noskeye, Marian Alook , Cecile Alook, Eileen Orr, Virginia Yellowknee, Dorothy Yellowknee, from Wabasca, Violet Carlson, Marlene McAllister and Ida Yellowknee from Desmarais. As the unit moves into the 1980's in appears the region's public health services are in good hands. 194

Chapter 29

FORT McMURRAY & DISTRICT

"Nurse, come quick! Come pick out the lice!" Lynn Bryant, senior nurse at the Fort McMurray Health Unit, relates ruefully that she used to get dozens of calls like this from panic-stricken teachers. Her immediate reaction was "Why me?" Picking lice out of a child's head certainly isn't the most exciting job in the world but as we shall see Nurse Bryant and others like her, have plenty of excitement in their lives. Then she added, "The lice situation is much better now." The health unit hums with the activities of standard programs and some exciting new ones as well! All this has been going on since October, 1974, the year it opened. Before then the community was served by a Municipal Nursing Service, local physicians and the Fort McMurray Hospital. The nursing service began in January, 1966, with only one full time nurse. Public Health Inspection Services were provided on a visiting basis from the province's staff. As the town grew, and mushroomed with Syncrude so did the need for more staff. At Janvier and Fort McKay the Department of National Health and Welfare provided house trailers for the fly-in nurses. A community centre at Conklin and the small school at Anzac.gave only limited working facilites. From the start there were heavy demands on the growing staff especiall y in the area of tuberculosis. This communicable disease was particularly prevalent amongst the native people. When the Health Unit was set up the members of the Hospital Board took on the added responsibilities of administering the health unit. A Medical Officer of Health and a part - time secretary - treasurer were added. And as new staff was required new facilities were opened to house the unit's offices. The Fort McMurray and District Health Unit services a vast area from Conklin in the south up to the Northwest Territories border and over to the Saskatchewan border. Within this huge area there are only a few isolated pockets of habitation outside of Fort McMurray. Regular visits are paid to four remote centres - all native - Conklin, Janvier, Fort McKay and Anzac. The first two are reached by plane - Conklin once a month, Janvier, weekly. Fort McKay and Anzac are visited once every two weeks by car. Not only the townsite but the outlying communities have experienced the effects of the oil boom. Much thought has gone into planning for the future. 195

The economic basis to sustain the smaller settlements is fragile . Because of the rapid and heavy influx into Fort McMurray the health unit's programs include efforts to help the Indians overcome social , educational , economic, and health problems resulting from boom conditions. However, before all this , the unit must provide assistance in the areas of poor nutrition, skin diseases, tuberculosis, venereal disease and alcohol related problems. The unit provides care to all the Treaty Indians and also looks after the transportation and accommodation for natives sent down from Fort Chipewyan. Because of its closeness to the Syncrude pl ant there has been a dramatic change at Fort McKay. They even have a daily bus service! But things were not always like this! In the early days the roads were atrocious - mere trails winding through the bush, pocked with mudholes. Indeed they were so bad the supervisor in Edmonton worried about her nurses driving under almost impossible conditions. The decision was made to abandon the driving and fly . All flights are by local charter. However, one time the only plane available for the trip was on wheels. It should have been a float plane for landing on the broad Athabasca River. Fort McKay is situated on its banks but has no air strip. The plan was to land on the road. So, off they flew - and land on the road they did - but it was difficult and dangerous! "We caused quite a stir - made a grand entrance," laughed Nurse Bryant. ''The villagers gaped in astonishment - but they certainly knew their public health nurse had arrived! They wondered about her sanity but they knew she was there! " So the plan to fly in was abandoned. Back to the heavy cars, usually a Pontiac Biscayne, and back to the miserable road. Another episode on a trip to Fort McKay occurred in the dead of winter - 40 below weather. The nurse and a girlfriend bundled up against the cold and set off with a batch of vaccine. About seven miles from their destination a coyote dashed across the trail. Braking violently to avoid hitting it, they skidded - hit and killed the coyote - and ended up in the ditch! No amount of effort could get them out. So the nurse stuffed the vaccine in the pocket of her parka and they strode off through the snow. However, they had only walked about a mile when a couple of villagers in a sleigh appeared. They were on their way to chop wood in the bush. Seeing the plight of these two courageous ladies they drove them to the village. What a relief! Today, the drive to Anzac takes about 40 minutes. The Fort McMurray Health Unit has no sub - offices but does have three locations in the city. When it opened it had four full time nurses, one part time, a community health aid, two stenographers and a part-time medical officer - Dr. Nicholson. Today Dr. Nicholson has l 1 nurses and the unit has its own medical in­ spector. Its services have increased to meet thriving Fort McMurray's growing 196 needs. Two full clinics are held daily and one each evening. Community nursing attempts to service the whole lifespan from birth to death and they have their hands full. An average of over 60 babies are born each month! The average population age is 22 and so most of the services are directed toward the young. Three pre - natal classes are held. Seeing the need for such programs the health unit launched an ambitious project. They made a series of 13 T.V. pro­ grams. These are shown 3 times weekly, morning, afternoon, and evening on local cable T . V. A new mother is visited two to three days after she is home. Aside from checking the infant the nurse gives moral support to the mother. Most of the husbands work a 14 hour day at the Syncrude plant so some mothers get very lonely and depressed. Often a routine visit will stretch to a couple of hours because the young mother is desperate for someone to talk to . The uprooting of people from family and friends , shift work and long hours, and little to do has led to a high incidence of family breakdowns and the need for counselling services. Just having someone to talk to, such as a visiting nurse, has positive results . At present, Lynn Bryant, Dr. Nicholson and two stenos are the only ones left of the original staff. But Nurse Bryant says the new staff is terrific showing boundless energy and enthusiasm. Bustling Fort McMurray has grown into an attractive, modem city - a far cry from the early days when the streets were rivers of mud, shopping was limited to a few essentials and the road to Edmonton was a ribbon of dust or mud. With the opening up of the tar sands the population boomed. From July I, 1977 , the population increased 17 %. Six months later it surged to 55%! Builders couldn' t keep up with the demand for homes. Families moved into unfinished sub - divisions. There were no street signs, no phones. Because the streets oozed with mud a nurse made a baby visit dressed in boots and jeans. Often the husband would pick her up on hi s motor bike! One result of the oil boom was increased pressure on active treatment facilities at the hospi tal. In 1977 , on an unofficial basis, the health unit established a home care service designed to provide for the early discharge of patients. This eased the bed crunch so they could get patients in and out of hospital quickly. It was to be another year before home care became official at the provincial level. The population today is over 30,000. And out of this only about one hundred are over the age of 65 ! Sadly, there must be many little kids with no grandparents around. Today, of course, the hi ghway to Edmonton is paved . Then, the only link between Fort McMurray and Lac La Biche was the Northern Alberta Railway. Check-up time On the Road (Ft . McMurray Health Unit) (Ft . McMurray Health Unit)

New Parent Classes (Ft. McMurray Health Unit) Dental Display on the Mall (Ft . McMurray Health Unir) 199

There were several signposts dotted along this track. The curiosity of the staff was fully aroused. Who lived in these wilderness communities? They decided to find out' The chairman at that time was Phoebe Spice. She and two nurses persuaded a railroad man to take them out in a speeder. So, clickity-clack, clickity-clack, on the railroad track they went! Eagerly, they stopped at each signpost. Nothing but oceans of blueberries. They didn ' t find a single person! The mystery of the signs was never solved. But the time was not wasted. It was a gorgeous day and they thoroughly enjoyed their unusual ride! Reminiscing once more, Lynn tells how she used to Jove the plane flights. " I probably went more than necessary!" she confessed. The local charter service will take only single engine planes into Conklin because the runway is extremely short. In fact it's just a meadow and not looked after at all. So when you land in summer, you're keeping your fingers crossed that the wild horses that roam here are out of the way! ln winter the landing is done on ski s- and this can cause trouble also." Lynn recalls one time struggling in snow !Ip to her hips, trying to help turn the tail end of the plane around so they could take off! With every trip to outlying areas, the R.C.M.P. are notified of the nurses' destination and expected time of return . It must be comforting to know that someone would come looking for you if something went wrong! By agreement with the Federal Government, Fort McMurray Health Unit looks after Treaty Indians. Fort McKay, Janvier and Anzac all have Reserve areas. Mostly, the natives enjoy having a nurse come in . There are occassional problems like child neglect and malnutrition. The health unit works closely with child welfare. Sometimes social workers have to take action . The teachers especially eagerly await the nurse's visits. She is often the area's only outside contact. She brings in any number of things and she takes things out and delivers messages, mail, small parcels back and forth. A typical visit to an outlying area; check the new babies, tend to sick children and adults, contact the teacher to find out if there are any particular concerns about some of the children, check them, hold a regular clinic for immunization and boosters if necessary, and talk and teach good health practices as much as one can! The nurses are trying to foster a responsibility amongst the Indians to look after themselves on a one - to - one basis. The unit's relationship with the Treaty Indians is positive. "there's a change in looking after health here " says Lynn, " but not necessarily an improvement. Our main area of concern is to foster independence among the natives. A re­ sponsibility for their own health - learn basic skills and knowledge - things every lay person should know. They have come to depend too much on the health professional . They think we have mysterious powers and can cure anything! 200

·'Now they are asking for an over - amount of care. They push the panic button too soon, but we must understand if a child in an outlying area gets sick, there's little the parents can do - if we don't happen to be there. So, when we are in, the attitude is, " Maybe my child will get sick tomorrow - or the next day - or the next - so treat him now." ''Then when you went in you realized that you were one of the few people from the outside world so to speak, who was coming in , and you might be expected to do a whole lot other than what your actual job was.'' The health unit has another important role in relation to Indian health care. This lies in the field of transportation. For example, the nurses at Fort Chipewyan will send patients down to Fort McMurray to see the doctor and the unit will look after the boarding and transportation of the patients around town and then back home to Fort Chipewyan. The pre - natal women come down and stay in Fort McMurray for a week or so before they have their baby and again the unit will look after that. When people need hospitalization or medical care, particularly for the Treaty Indians, the unit was in a position to authorize transportation . For some, the unit became and possibly is a transportation agent. If a patient is very ill, a paramedic or doctor will fly out also. In most cases, this is Dr. Nicholson. If they need a plane in an emergency its seldom more than an hour's flight in from Fort McMurray. The unit is set up to handle a lot of emergencies themselves. As with most northern units, tuberculosis is a major health concern. Fort McMurray has one person who does nothing but look after T.B. testing and monitoring. They feel this service is essential. Mrs. Bryant tells of yet another plane-related incident one summer when there had been an enormous amount of rain. She and Dr. Nicholson had to fly to Janvier. "Because cf the extreme wetness" she said, "we knew we'd never be able to land on wheels, so we took a float plane, intending to land on the river. This decision probably saved our lives! As we flew serenely across the countryside, suddenly disaster struck! The engine quit! No amount of coaxing could make it come to life! A forced landing was the only answer. But where? By a piece of sheer luck, we remembered crossing a slough! We landed on it - safe and sound." Thank God for those floats! Later, when they fai led to show up at their planned destination a helicopter was sent to search for them. What a relief! An interesting program was introduced in 1979 - Early Intervention. It was transferred from the Association for the Mentally Retarded. The program assesses the child, sets up a program, goes into the home and teaches parents how to help the child develop. It 's a superb support program for those children who are lagging, but not with a specific illness that you could put a finger on. The excellence of the 201 program is, in part, due to it being provided in the home. It is a program that is most reasonable in a home environment. In the program the parent is taught how to assist the child on a daily basis. That same year, the health unit got its own venereal disease program - the only health unit in Alberta to have one! They used to work with the provincial staff as other units do, but because of the high incidence of this di sease, due to the high transitory rate of the population under boom conditions it was strongly felt that this program should be locally based. Its working very well. Cases are found and they are found faster. A unique program has been developed by one nurse, Chris Hoffman . Over and above her regular duties - because she saw a real need - a program of moral support for families who are in the tragic position of having a child with cancer. This often means catastrophic changes to all their lives. The child will have to go to Edmonton. As treatment, Nurse Hoffman, prepares them for this - what to expect. In short, with her considerable knowledge of cancer she helps in any way she can. One family wished their child to die at home. So Miss Hoffman put herself on 24 hoUi call every day to be ready to help at the appropriate time. The health unit also has a poison control program. If a child is accidently poisoned, a nurse goes into the home , assesses the situation, tries to give hints on home safety and also comforts the mother who is often guilt - ridden. Each year, a pre - school poison education program and displays are conducted at the local mall hoping to alert the public to potential dangers and to make homes safer. Appropriately, the program is called Mr. Yuk! Another new program just getting underway, is called Bereavement and Still Birth. A minimum of two visits is paid to families who have had a young child die or a person of over 65. Comfort and help is generously offered. This is important in a transient society where the usual family support may not be present. Public health nurses certainly do meet interesting and fascinating people. One such resides in Fort McMurray. This person is a perfect example of the tension that still lurks between old and new in this boom town. She is an elderly Indian lady living in a derelict house. For months the community used every means at their disposal to expropriate her land. She stubbornly refused. The health unit helped her raise enough fuss until she was allowed to stay! If this had not succeeded she would have been sent away to an old folk's home since there is none in Fort McMurray. The staff believes such a move would have killed her. They don't know this lady's age. They think she does know herself but would never give this dark secret away! She is a total hermit and will not accept anyone except for one nurse who managed to become her friend. She is allowed to enter the house by a front window. The door is boarded up! The nurse 202 periodically checks on her and brings her food and makes sure she has plenty of firewood and needs no medical attention . Through clever persuasion, she manages to wash the old lady's hair about twice a year! Then she went a step further. She tried to talk her into having a bath . Wonder of wonders, she finally succeeded! They have a tub at the health unit which is used to clean up some of the kids when necessary. so, triumphantly , the nurse brought the lady in . She managed to get her into the tub but from there on it was a fierce battle - a priceless production! She flatly refused to ever come again. One of the other speciality area programs that was put into effect in 1977 was the family life education program in the school system. That program was developed by the health educator. The health educator is also recognized as being an expert in the area of family planning, information and health throughout the province as well. She has been delivering the program in the school system. The aim is to get a direct delivery of the program and its consulting aspect into the hands of the teachers teaching it. Parents are welcome to attend classes when their children are in class receiving family life education. If the parents want to come and discuss or find out, or ask for further information, she is available to them. She also conducts parent evening meetings prior to the program being offered in the school so that the parents know exactly what is going to happen . In September of 1980 the unit was given the go ahead to start a family planning program as a separate program within the health unit. Two years down the line the unit hopes to have a family planning clinic in Fort McMurray as part of the whole family planning program. Fort McMurray has quite a progressive atmosphere. As far as the clients are concerned, family life education is more suitable here than in older com­ munities. Mrs. Bryant notes that they seem to have it easier because there are no pre - conceived ideas that have to be fought over. " Its very challenging in the way you work in this town , but its also fun because you can do a lot, " she commented. Anita Hanrahan has noticed tremendous change in the past seven years . In 1974 the roads were mud, the town was beginning to come under tremendous boom conditions. The lineups for stores would be out in the street and down the comer and around the block, the road to Edmonton was not paved, the shopping was very, very limited. In 1980 Fort McMurray is a beautiful city, lovely shopping centres, streets, lights on the comers all tell of dramatic change. And since Fort McMurray Health Unit has established its nursing program extreme growth has never stopped. No one has had time to stop and get hold of what is going on because change is so rapid. 203

The 11 nurses are really excited about the programs that are offered. Through community nursing they are attempting to provide nursing services from birth to death . Miss Hanrahan notes that because of the young age of the people the bulk of the services are to the young people. They provide special classes for single parents. The staff could not care less if you 're married or not. What they are looking at in that class is basically the very young girl 14, 15, 16 years of age who really doesn't know whether she should or should not keep the child. Her needs are quite different. She has to make some very large decisions. They bring in a social worker to tell what will happen if they do give the child up and what kind of financial aids they can look for if they keep the child. There is also a new parent class. And because in Fort McMurray the people have moved in from someplace else, they don't have the family supports of .. mother, grandmother, or aunt. The unit provides that type of support. Particularly for those quite new to the community who do not have any friends. Fort McMurray, because of its rapidly growing community, has been a place where community health services have to race just to keep even with the growth. The nurses feel that they are always in a catch up stage. Between 1976 and 1977 the town had a 50% increase in population. This resulted in the unit expanding quickly. All those people coming in had a lot of needs. To fill these needs the health unit is really on the move. 204

Chapter 30 GRANDE PRAIRIE

Grande Prairie today is a thriving city of over 25,000. It is the base for the annual international "hot air" balloon races and home of the rare Trumpeter Swan. But 28 years ago when its health unit was formed it was a small town with muddy streets in summer, icy ones in winter. During those early years the unit saw good days and stormy ones! According to Mr. Burt Tieman, first chairman of the health unit board, scenes somewhat like the following did, occassionall y occur as it was difficult to obtain qualified staff. "The nurses watched with horror - but didn't know what to do! After all, the doctor was their superior! He gave the needle another wipe on his soiled shirt sleeve and began to proceed with the injection. This was too much! Both nurses sprang forward . One snatched the hypodermic and cried , "Doctor! It's empty." He scowled. "You're busy. Thought I should help," and left the office. This doctor was careless with everything - hi s dress , his manner and his work. Needless to say, he didn't last long! The board gave him three months pay and discharged him. Thank heavens there were very few doctors like this around! The first Board of Health was formed in 1953. It consisted of Chairman, Mr. Burt Tieman, L. Hawkes, A. E. Hawksworth , R. M. Laurie, Dr. N. Bastar, and Dr. Brooks. Grande Prairie had long wanted a health unit. Now it was becoming a reality . But they would have to move quickly if they were to take advantage of government offered money. They rented two rooms and after some difficulty engaged a staff of six. Today, the staff numbers 50! But all this was making Mr. Tieman nervous. He knew nothing about running a health unit so he travelled to Stony Plain and asked for advice. The health unit there was most cooperative. Mr. Tieman came home an informed chairman. However, before he left Stony Plain he took careful measurements of a desk he had greatly admired in the unit's office. It was two meters long and had ample drawer space. The desk cost $750 but, being a carpenter, he decided to build one - and he did . This same desk has travelled with the health unit to four different locations in the city. Today, a new spacious permanent facility is being constructed. But the desk will no doubt follow! The health unit was ready for its grand opening in July complete with the purchase of two Pontiacs from Sargent Motors at $2 ,341 each! Miss S. Mcintyre 205 and Miss Mina Pool, two of the earlier nurses , travelled many kilometers across the lovely countryside in these sleek cars. By contrast with its beginning, today the Grande Prairie Health Unit serves 53,000 people and covers 15 ,000 square miles. Sub - offices are at Beaverlodge, Spirit River, and Valleyview. In the early days, it was inevitable that problems would arise. One such was in the character of the first sanitary inspector. He was somewhat of a gay blade, sporting a flashy Monarch car and fancy clothes. Understandably, the farmers he visited in the course of duty , were not impressed! However, he did not stay on staff long. Keeping doctors at the unit was another problem. Mr. Tieman points out that often good doctors didn't stay long. Some left to set up their own practices, having used the health unit as a sort of stepping stone. As a result there was continuous advertising for qualified staff. One of those to answer was a doctor from Ireland. He was gladly accepted. But before he and his wife left their native land they made a pact. If either one of them did not like Canada they would both return home. So, they and their small baby, crossed the seas. He turned out to be a very good doctor and was especially good with children. After a year, he really enjoyed it . But she did not! When her baby buggy got stuck in the mud that was the last straw! In no uncertain terms, she reminded her husband of their agreement. The unhappy doctor, told Mr. Tieman about the situation. Mr. Tieman suggested he send her back for a holiday . Perhaps she would change her mind - perhaps home was not as rosy as it seemed. "I already suggested that," he said sadly, "but she won't hear of it. " So, homeward bound they went. In 1961 , Mr. Cliff Turner joined the staff as sanitary inspector but he was without papers. So the board hired a retired sanitary engineer from Edmonton, Mr. Edgar Powell , a distinguished man , who was also the author of the regu­ lations book! He took Cliff under his wing. Excellent training for Mr. Turner, who is now Senior Public Health Inspector. Today, Dr. H. M. Wynters is Medical Officer of Health and has been since 1976. She speaks glowingly of new programs that have been added to the regular ones most health units carry. " But," she adds wryly, "there could be more needed new programs and more specialists on staff if the ever present problem of funds wasn't looming over our heads. " She says that in 1976, things really started to change. Speech pathology came to Grande Prairie as an outreach program from Glenrose Hospital. As more and more people needing speech therapy came out of the woodwork it soon became evident how greatly this service was needed. They now have two pa­ thologists but are looking forward to five. The unit's dental program, which began in 1963 , teaches all the basics of preventive care. They are also involved with the tlouride rinse program although Cliff Turner, Senior Health Inspector (Gr. Prairie Health Unit)

Dr. Hilary Wynters, M.O.H. Eye test (Gr. Prairie Health Unit) (Gr. Prairie Health Unit) 207

Speech Pathology (Gr. Prairie Health Unit)

How much do I weigh? (Gr. Prairie Health Unit)

Pre-Natal Classes (Gr. Prairie Health Unit) 208 a small percentage of parents do not agree to it. "It's good to work with chil­ dren ," she said. "Small children are excellent ambassadors. They probably have more influence on their parents than any advertising company.'' As was Peace River, Grande Prairie Health Unit was asked if there was interest in the community rehabilitation program. There definitely was and they are now actively engaged in the program. Dr. Wynters also said she would like the health unit to become more actively involved in geriatrics. "The older the province gets the more senior citizens there will be and more community health will, and should be, directed toward them.'' This health unit has an extremely advanced hearing program. They gratefully thank the Royal Purple of the city for the impedance bridge they presented them with this spring. They also thank the Elks for the audiometric equipment which is forthcoming when the unit moves into the new building. The Grande Prairie Health Unit and South Peace Planned Parenthood As­ sociation have formed a joint project with the latter responsible for its guidance. Object of the project - to facilitate responsible personal decision making relating to human sexuality. In earlier days, Grande Prairie had the two unpleasant problems of garbage and sewage. The worst offenders were those who refused to use specified garbage containers. These were also the ones who complained bitterly about the garbage collecting! Mr. Turner relates how they cleaned up the problem. They toured the city and took down names and addresses of all the guilty. It was effective! One morning, poetic justice was done! He and another officer were driving by a particular house when a man came out carrying a large cardboard box of garbage. Before their eyes and to their delight the bottom fell out of the box! Sloppy wet garbage slithered all over his clothes! Sewage wasn't only a problem in the city but in outlying areas as well. Mr. Turner gave an example. Valleyview has four service stations along the strip development. All four had a chronic sewage disposal problem and each had a private system. His department had repaired them over and over. One day, all four broke down at the same time! This thing had gone too far. They were ordered to hook on to the town sewer which they did to the tune of $13 ,000 each! Fox Creek also had a serious sewage problem with raw sewage running down the ditches and septic tanks being pumped into the ditches. " Many com­ plaints came in, "says Mr. Turner, "and we answered each one and warned the guilty parties that this must stop! But as Fox Creek was far away often the evidence was gone by the time we got there so we did not always have proof. One day a fellow civil servant offered to join us at the offensive site. As we stood there by the ditch he suddenly waxed into poetic prose. "Here we are watching the sun glint on the trash cans between the open privys and listening 209

to the murmur of the sewage as it ft oats down the ditches " . The problem was n't really solved until community sewer services were installed. Fox Creek is no longer under this health unit's jurisdiction. Grande Prairie still has a problem with sewage in sub-divisions which are springing up all over as a result of boom conditions. Mr. Turner believes de­ ve lopmental control is at fault . Structures are being allowed to be built without proper sewage facilities . A practice which he abhors. Another incident cropped up between two farmers. The two were bitter enemies. One lived on a hill, one below. Although the land had a natural drainage the farmer on the hill gleefully directed his sewage so it would run into the yard of the farm below and eventually it ended up in the ditch of the nearby highway! When this practice was discovered the health inspector quickly put a stop to it. During the heath unit's early years, a startling thing occurred. With no word of explanation, an excellent nurse handed in her resignation! "What is that for?" exclaimed Mr. Tieman. She looked uncomfortable but said nothing. Finally he coaxed it out of her. Her face burned. Her voice was bitter. " My boyfriend left me for another girl. I will not stay in the same town with that creep!" Mr. Tieman looked solemn. Then, "Why don 't you take four weeks hol­ idays and think it over." ' 'I' II think it over but I' ll never come back!" Her father had a store way out in the country and that's where she headed . She was back in two weeks!" We couldn't afford the loss of such a valuable asset" , said Mr. Tieman. About this time another nurse was in trouble but of a totally different nature. She was driving to work one winter's morning when disaster struck! She rounded a corner, then went into a frightening skid on the glare ice and side - swiped another car! Thoroughly shaken, she stayed glued to her desk all morning . She went home for lunch. On her return she cautiously rounded the same comer and heaven forbid , in spite of all her efforts, it happened again! There was a garage on that comer and later a service man exclaimed, ''I put my hands over my eyes! I was so sure she was coming right through the window!" No one deserves such an experience twice in one day. Sometimes there's trouble. One such incident follows: a restuarant on the main street of Grande Prairie had a dreadful sewage problem. It was oozing out all over the place! The customers, of course, didn't know this and continued to eat there! Mr. Turner told the owner, in no uncertain terms, "You've got to do something about this mess !" Although he was prodded several times, the owner refused to do a thing! Since only a doctor or the board chairman have the power to shut a restuarant down, Mr. Tieman went along and did what he had to do! The owner begged him not to lay charges and made hearty promises he would fix things up immediately. No charge was laid and the owner was swiftly true to his word! 210

Another incident which happened in this city appeared to be quite the opposite. Stories were coming in from Calgary that the city's health unit was closing down one of its prominent restaurants because of a cockroach infestation. Mr. Turner said they had no intention of doing such a thing! They were convinced there were no cockroaches around. However, six months later, the stories proved to be true! There was an infestation. The place was hurriedly closed. The res­ taurant tried everything under the sun to get rid of the little pests but nothing worked. Finally, on their own, they brought in professionals and the problem was cleared up . Health officials stress the fact that cleanliness in the kitchen is by far the most important factor in any establishment's operation. Often, although a dining area may not be totally spotless, the kitchen is top-notch. Also, a dining area may be spotless and the kitchen found to be well below the standard of clean­ liness. The ideal , of course, is to have both areas meet health standards and many establishments do just that. The health inspector relates an incident which is a classic example that education is the key to almost everything including safe cooking. Recently he visited a newly opened chicken outlet. He found everything in superb shape! But as he watched their operation, he noticed a serious health hazard! As with all raw meat, the surface or utensil used in preparation should never be used again, unless scrubbed first, for the cooked meat. Food poisoning could easily result. These people were using a pair of tongs to put the raw chicken in the cooking pot and then they used the same tongs to take the cooked chicken out. When he explained, they were astounded. They had never heard of such a thing ! The Grande Prairie Health Unit is justifiably proud of the splendid array of doctors and nurses who have served so capably and faithfully over the years. And it looks forward to many more years of the same! After a decade of dedicated service Mr. Tieman resigned in 1963 . Deep regret was felt. But happily , many good chairmen have followed in his footsteps . Mr. Tieman's parting words, are, I think, food for thought. "When you stay in one position too long, there's a danger of falling into the trap of thinking you know everything and no one else knows anything. Better to get out in time and hand the reins of authority over to some one else." In Grande Prairie community health has changed over the years. Control of infectious di sease is no longer the major problem. Health programs are moving more to the promotion of a high level of public health awareness through edu­ cation and individual responsibility. Promotion of higher standards of li ving is done through making individuals aware how they can prevent disease through clean living. 211

Chapter 31 HIGH LEVEL FORT VERMILION HEALTH UNIT

Prior to its formation in 1976 public health services in Alberta's far northwest among the scattered communities along the Peace River were handled by district municipal nurses, relates Mr. J. Andrews, the Acting Director of the High Level - Fort Vermillion Health Unit. In those communities the local nurse had to be a type of person that could move right in and make herself at home in some pretty rough territory. They were, and are, remembered for the community service they provided over the years before the health unit was formed. It took a strong character and the survival instincts of a pioneer to last. Not to say that much the same isn't true of the unit's 19 member staff although things are quite a bit easier thanks to modern communication. Today the unit has sub-offices in Rainbow Lake, La Crete, Fort Vermilion, Meander River and Paddle Prairie and covers an area of approximately 85,000 square kilometers. These provide programs in nursing services and dental health . More specialized services are offered in Rainbow Lake and at La Crete. Unlike most other units the Board of Health is composed of the same members as the Hospital Board. Mr. Andrews feels this is a good thing as it eliminates conflicts that might occur if the jurisdiction were separate. One of the major costs of health services in the north is in transportation. A lot of the travel is by airplane. Another cost is that brought into the human character through isolation. Those that stay tend to be strong willed with a dedicated purpose. They have to fall in love with the north in order to stay. The woman was trembling. She raised panic-stricken eyes. "my baby - ", she whispered. "What about your baby?" Dee Hampel, public health nurse asked kindly. "Your baby isn't due for four months." "But you don' t understand!" now the woman was weeping, "I - my baby will be marked. This morning I almost stepped on a snake!" Dee Hampel sighed. "No, no, your baby will be fine. There is absolutely no truth to that old superstition." The above scene could very easily happen in the isolated sub - office of the High Level Health Unit at La Crete. The community is mostly Mennonite and to this day , old wives tales will abound in spite of every effort by the nurse to educate. But old wives' tales aren't the only problem. Some of the people 212 still resist immunization, claiming it's against their belief. However, a frank talk with the Church ministers revealed thi s was not so. It was only an excuse and, believes Nurse Hampel, another attempt to thwart progress. As a result of the lack of immunization, a few years ago diphtheria spread through the community like wildfire. Because the people are so isolated, they have absolutely no resistance. Whooping cough followed on the heels of this . Even those who had shots, succumbed - but not so severely. Whooping cough immunization does not offer 100% protection. After 9 years with the health unit, says the nurse, immunization is generally accepted. She has also been accepted, as much as anybody can be who is not of Mennonite origin. Another reason why they accept her is that they consider nursing suitable work for a woman. However, they do not believe in women being highly educated. As a result, most girls are pulled out of school at age 14 or 15 . They then help the mother at home. Families are usually large. The accepted role for a girl is to get married and have babies, the sooner and the more, the better. This is supposed to be their education. But if the girl is not too badly needed at home she is allowed to go out for a job perhaps for the money. She then usually goes to High Level or Fort Vermilion and works as a waitress, a chambermaid or perhaps a ward aid. These are considered suitable jobs for girls. ln essence, this is usually just a stop gap before marriage. To find an unmarried girl over 20 is almost unheard of. Girls are not allowed to date. lf a girl does, she is immediately labelled as "one who runs around". As a result, most girls marry the first fellow who shows an interest in them. This takes care of the vital step of " being married". But it often leads to marital trouble later on. But such things are not talked about - not even to their minister. The policy seems to be to keep it within the four walls of home. The Mennonites will not become involved in politics or government control. They speak low German - a dialect evolved from German, Russian and Dutch. They were always on the move because they were persecuted, much like the Jews. That's why they picked up bits and pieces of different languages. Most of the children speak English by the time they enter school. The younger gen­ eration speaks mostly English, although the old language is never forgotten . The main health problems in this area are rheumatic fever and strep throat, both usually caused by a rundown condition, which, in tum, is usually related to a poor diet. A few years ago these people used to eat large quantities of potatoes but very little meat. Now they are great pork eaters, mostly because they have more money. But pork is fatty and obesity is now a real problem. Thus heart attacks are fairly prevelant, especially, among older people. These are taken to the hospital at Fort Vermilion. If the condition is serious enough, they are air-lifted to Edmonton. The strep throat and rheumatic fever 213 problem has improved somewhat but there is still much followup work on rheu­ matic fever cases because of subsequent heart trouble. Some of the children have difficulties in school , sometimes repeating grades two or three times. Nurse Hampel thinks poor diet may be a factor here. It could also be caused by the fact that in this remote area, the children don't have the wide range of experiences that city children have. For example, they don't even know ~hat a city looks like. Many have never seen an escalator or an elevator. Still, diet is of vital importance. The nurse says they are trying hard to emphasize the importance of the four food groups. The schools also make use of the Department of Agriculture personnel. And a priceless asset is a home economist at Fort Vermilion. La Crete is a vast farming community. Although the Mennonites have their own lifestyle - mother cooks, cleans, has babies, father is the breadwinner and father has the last word - they are expert tillers of the land. And the government continues to open up new areas for homesteading. This brings in more people. An added advantage to this is there are more people and in-breeding, which was a problem years ago, has virtually disappeared. Most accidents brought to the health unit occur in a car or on the farm . Most of the former are alcohol related. Although drugs are not a problem here, dances are held and where there's a dance, it seems there is alcohol. Dances are strictly forbidden to Mennonite young people but some manage to get there anyway! One of the worst accidents Nurse Hample recalls happened to a 13 year old boy. He was operating a hammer mill when something went wrong. He stopped the machine to investigate. He reached in before the belt had come to a dead stop. It happened in a split second . With horror he stared at his arm. From above the elbow, it dangled loosely, held only by two centimeters of ski n! His mother rushed him to the nurse a distance of 30 kilometers. By a marvelous stroke of luck, the doctor was there that day. Swiftly, he gave the boy a pain killer and intravenous and air - lifted him to Edmonton. Another bad accident happened to a 70 year old man while he was ploughing. A problem occurred with the plough. He jumped off the tractor to investigate - without shutting the tractor off! Both of his legs got caught in the power take - off. After a desperate struggle he managed to get out. But his trousers and his underwear were ripped off and mangled in the mechanism. Both legs were crushed but luckily it was a soft tissue injury . Miraculously, there were no broken bones! But he had deep gouges - right down to the muscle - so deep, they had to be stitched. The nurse said very serious injuries sometimes by - pass her and the victim is taken straight to Fort Vermilion. 214

Strangely enough, the request for a nurse here was spearheaded by a Men­ nonite school teacher. Then, the local La Crete Nursing Association took shape and grew. The health unit was formed in 1974, with the head office in High Level and sub - offices at Fort Vermilion and La Crete. Fortunately, two doctors are available here. Of the programs offered in the health unit, pre-natal classes are the most popular, especially with young girls. Due to early marriages, teen-age pregnan­ cies are common. These girls realize that they need to learn things other than what their mom teaches them -even if she has had a dozen babies! For example, some mothers still, in spite of great attempts at education, feed their babies only baby cookies and milk until seven or eight months old. The result is fat, anemic babies. And then there is also a general reluctance toward hospitalization. A mother may not take a sick child to the doctor even if the nurse tells her to because she is afraid the child may be put in hospital. However, this problem is lessening with education available and more doctors around to inspire confidence. But basically they are interested in health . The nurse held first aid classes and they were well attended. One year, another nurse held a home care nursing course and it was quite well received. Recently, High Level got a new dental service. This meant they could get rid of the trailers they'd been operating out of and move into a new office. So the old trailers were sent to La Crete for renovations - hoping La Crete, too, would get a dental service . Because people are becoming aware of dental needs, they now phone and ask, " Well , the trailers are there. Why aren't they oper­ ating?" Up to this point, the only dental help available was free fluoride drops to any interested mother. However, now a dental hygienist has been hired . She outlined a truly ambitious program but wisely first consulted the Peace River hygienist. She was firmly , but sympathetically informed, "You've bitten off more than you can chew ." Her plan was to do all the schools in High Level, Rainbow Lake, Fort Vermilion, and La Crete. It was just too much. The school population in La Crete alone is about 1100. For a long time another big problem was eyes . Although a child obviously needed glasses the closest place to go was Peace River some 320 kilometers away. So, many parents said, " My kid doesn't need glasses anyway. " Nothing was done. But after complaining and complaining to the head office arrangements were made to have an eye specialist come up from Grande Prairie every four months. Dee Hampel took a specialized course in community health. But she has found new programs are difficult to introduce if they do not relate directly to the 215 lifestyle of her people. In fact, some parts of the program could never work in her area. One such is family life education. This would be strictly taboo. The Men­ nonites are, of course, totally aware that sex and pregnancies are a very real part of life but they refuse to talk about them. The nurse says if she ever. attempted such a program, she would immediately be blacklisted. She says, " I think it is a terrific program. But to try to get it into the school would mean a big fight on my hands." Sometimes, dear as they hold their religion, it does interfere with their health. Many women have far more babies than their health permits. But birth control is forbidden . However, Mennonite churches vary in the degree of strict­ ness. In the La Crete area there are four - the Old Colony Mennonite Church, Sommerfelder, Bergtholler, and Free Christian Fellowship. But the churches get more liberal as time goes on. Nurse Hampel works full time with another nurse. The clinic is open every afternoon from I to 4. While one nurse is running the clinic, the other may be out on home visits or any number of things. Mornings might also include home visits, paper work or dealing with emergencies if no doctor is around. Activities at the clinic include dressings, accidents, bums, allergy shots, vitamin B-12 and iron shots for women needing them . Immunization is, of course, a large part of it all . However, they do not operate this on an appointment system. Many of the women do not drive - although more and more are doing so. Thus, in this far-flung rural area, they come in when their husbands can drive them . If the appointment system was initiated, immunizations would drop drast­ ically - simply because appointments would not be kept. Dee Hampel's philosophy on public health , comes through loud and clear. " We try to prevent illness. We try to teach common sense health to everyone we can reach. '' 216

Chapter 32 PEACE RIVER

In bygone days, Alberta's health units operated in many unusual places - community halls, schools, churches, private homes and one room log shacks . But no nurse worked under more unique conditions than Mrs. Hildegard Camp­ sall, now director of the Peace River Health Unit. Frequently, her 'office' was the trunk of her car! Why? Because the determined crusade to spread preventive medicine took her and other nurses to isolated villages miles away in the wilderness. Roads in these areas were tricky at the best of times but between May and November, they were totally impossible. So, once the frost was out of the ground, she'd drive in as close as possible, set out her immunization supplies on the trunk and presto! She had her clinic! The people, with their children, always eager to see "their" nurse, walked long distances to get their "shots" . Peace River lies along the broad banks of its namesake . The head office of the health unit is located there, but the area served is enormous - some 27 ,000 square miles with a population of 50,000. When it opened in January, 1955, the area was only 12,000 square miles and the population was but 25,000. Mrs. Greenfield, a public health nurse, had both the distinction and re­ sponsibility of becoming the first member of the staff. On April 14, Mrs . Hawkins joined the unit as a full time stenographer. March 24 brought Mr. F. J. Finlay on staff as sanitary inspector for the area and Dr. J. Russell joined the staff on April 14 , as Medical Officer of Health. One more nurse was needed to make a full complement and the vacancy was filled by Miss S. Seldon on May 26, 1955 . Three municipal nurses came within the area of the Unit at its inception, Mrs. Anderson at Dixonville, Miss Roebuck at Hines Creek, and Miss Triska at Worsley. Mr. R. Beggs was secretary-treasurer. Present staff numbers 45 full and part-time workers as opposed to the original five. The health unit offers all the standard programs plus a few additional ones! They now have five sub-offices. High Prairie is on the eastern boundary of the health unit's territory and serves that immediate area as well as 200 kilometers north and they go south as far as Sunset House. Imagine how far the nurses travel! There is another sub-office at Father, which serves 6,000 French-speaking people. Manning serves the Manning-Deadwood area and goes 217 as far north as Keg River and south to High Level ; the fifth sub--Office is located at Fairview. There is still one municipal nursing station at Worsley . The fom1ation of the Peace River Health Unit brought many public health services to the area. A poliomyelitis vaccination program was started with the cooperation of the school divisions and the municipal nurses . With a number of tuberculosis cases on record and an unknown number of contacts, home visits began and patch testing was carried out in the schools. Letters were sent to new parents advising them of and explaining well baby and pre-school child clinics and the importance of protection from diseases by vaccination and innoculations. Also child guidance clinics, an Ophthalmological Clinic and School Health Services were provided. Health education is a constant accompaniment of all activities. The local newspaper, the Record Gazette and the local Radio station C.K. Y .L. took con­ siderable interest in the unit and did much to publicize its existence and purpose. The sanitary inspector started a program of "clean food" courses and the unit is now awaiting the arrival of a movie projector to aid in this work. Our "car-trunk-clinic" nurse had many exciting and humourous adventures - as did other nurses in the early days. Appropriately, the first occurred even before she arrived in Peace River. It was October, 1957. She had come as far as Grande Prairie on her way to her new job. But that day a raging snow storm struck - a storm such as she had never seen before! In 24 hours, a meter of the white stuff had piled up . She was stranded. No cars could get through and the buses weren't running. She took the train next morning and arrived a day late for her new job! In those days keeping a staff was a real challenge mostly because of the dreadful roads. It was not unusual for cars to be hauled through giant mudholes by caterpillar tractors! At that time , most of the health work was done in the community except baby clinics and pre-natal classes - and still is today because of the huge area. But roads were not the only culprit. One nurse tells of going to the town of Falher to set up an immunization clinic. It was a 120 kilometer drive and as usual the roads were bad. Top speed was 35 kilometers an hour. But when she got to the town the streets were even worse! Buses were getting stuck in the middle of town! She had to carry her equipment ten blocks and all this with a line up of people waiting. This was during the polio scare of 1957 and the need for immunization was at its peak. As many as I 00 people in the one afternoon were processed. At that time only basic services could be offered. Nor were the nurses supplied with any drugs except salves for impetigo and VDT powder for treatment of lice . When Hildegard Campsall was asked about the lice problem she said it used to be much worse. Not only native but white children as well were infected. Then added with a grin, " Lice are very democratic creatures!" 218

Today, speech therapy is a very important program in thi s health unit. There are many , adults and children alike, with serious speech defects. Although speech pathologists are hard to come by, they have three. They insist on experienced people who also have their masters degree. This is slow work. The teacher and the child must understand each other and the problem. Also, endless time must be spent before even a small amount of progress is made. Surprisingly the incidence of tuberculosis is lower here than in many other health units. This is probably due to the fact that the native population is not large, and, also, tuberculosis control has been very thorough. Today the people in the area are almost totally immunized. But in the past there were a few problems with the Mennonites and the Jehovah Witnesses . They objected to forced public health services. A large number of the Mennonite colony at Worsley moved to Bolivia. As a result of the move, the health unit was barraged with requests for smallpox shots because they would not be allowed into Bolivia without them. But in spite of earnest persuasions to accept other immunization as well , most of them refused. There is still no law that says the state can take over if a case of life and death exists because of religious beliefs. But a doctor can get a court order stating the patient has a ri ght to life - saving measures. This supersedes the parent's rights. However, once a person himself understands the implications of refusal, he has the right to make up his own mind. But herein lies confusion. For example, if a seven year old is taught the horrors of diphtheria and wants immunization but his parents refuse, what should be done? As well as school and pre- school children programs, this health unit is staffed with University of Alberta students who work under the supervision of qualified dentists and dental hygienists. On a rotating basis a dental clinic travels to larger centres like Falher and McLennan. One unusual program is Community Rehabilitation. It came about when patients from the Mitchener Centre and the Red Deer home for the retarded were being discharged and sent back home. Handicapped services decided there was a real need for a rehabilitation program directed at retarded or handicapped children. This health unit and Grande Prairie were approached. Peace River, proceeded to hire a physiotherapist and set up the new program. One aspect of it is the " Moms and Tots" activity. Mothers with handicapped children and mothers with normal children meet in an integrated way at regular intervals. This gives everyone the experience of group activity. The physioth­ erapist shows the physically handicapped and potentially handicapped how to maximize their abilities. Reaching out, this program goes into areas which have no physiotherapist in Manning, McLennan and Falher. Here the hospitals willingly cooperate to provide room where local people can get therapy with an expert. 219

Hildegard Campsall tells of experiences in remote areas like Cadotte Lake, Little Buffalo and Loon Lake! These communities are totally native but she was overwhelmed with the warmth of the welcome every time she came. Usually she was received in a one room log shack but tea was always on and no matter how poor the family, the table was spread with a white cloth. After tea, the business of the day began. The women did not speak English, she notes. They had just started to send their children to school on a sporadic sort of basis, but they themselves tended traplines and such things. So, an interpreter was always needed. Communication was difficult but humour was not. Even though there was an interpreter, these jokes were not shared. "They are a private people but have a terrific sense of humour, and I know the jokes were not malicious . I know they thought I, and white people in general, were extremely funny ," she remembers. This supposition was heightened when , during one of her visits, she tackled the tortuous trail between Cadotte Lake and Little Buffalo. It was winter and, in spite of the best efforts she slid off into the soft snow seven times! And seven times she was shovelled out - and the distance was only 11 miles! Each time the shovelling began the Cree language flew back and forth faster and faster. She was convinced those remarks were not too complimentary about this nurse who couldn 't stay on the track! After that, an Indian from the community always did the local driving. Because the general thinking was, " How can we trust this dippy public health nurse who can't stay on the track?" Missions in this area helped make life easier for the nurses. They were located at Cadotte Lake, Little Buffalo, Gift Lake and Loon Lake. The nurses were always gladly welcomed, offered a bed and hot meals. This was just as well as one of these trips usually took about three days. At Loon Lake in particular the only white woman there rejoiced whenever a nurse arrived. During the summer months she often did not see a white person for long periods of time and had no chance to speak English except with her husband. Hildegard goes on to relate yet another experience: " I was on my first trip to Keg River which was 125 kilometers from Manning. I drove and drove" she remembers. "Over an hour dragged by and I had still not met a single vehicle. Was I on the right road? Then, to my delight, an old beat-up pick-up truck approached." She stopped and asked them, "How much further?" But the truck passed right by. It was overflowing with Indians. Obviously they were indulging in one more of their jokes. Laughing and waving vigorously, they sailed past probably thinking, "What's that crazy white woman doing out here all by herself?' ' I thought, "Well, they came from somewhere. I had best keep going . And I did - and eventually, to my great relief, saw Keg River Cabins, which is nothing but a few cabins and a school. Eagerly, I stopped - but soon, to my 220 chagrin, found I had another 20 miles to go before I reached the community proper." At this point, no story about the Peace River Health Unit would be complete without mention of Dr. Jackson. She is an English lady who arrived in Alberta in the mid-twenties in response to Canadian advertising for doctors. No one knows exactly why she chose to come. Perhaps because a woman doctor would have a hard time getting established in England at that time or perhaps she had a taste for adventure - which she must have had anyway to venture into such a profession at that time! Eventually she landed at Peace River, boarded one of the paddle wheelers plying the river between the town and Fort Vermilion. She was dropped off at the Notikewon area and plunged into practice. Here she met her husband Frank, and off they moved to Keg River. She did outstanding work among the Indians. She is recognized across Canada for her contribution to preventive health - she had the community totally prepared for it. She had tuberculosis pretty well under control. When x­ rays were taken and shadow on a lung showed up, she would show them the picture and say, "If you go out for treatment right away we' II beat this thing!" She practised until she was 70. She is now 76 and active as she is will probably never truly retire. She and her husband have built up a large and successful farm - so successful, they won the Alberta farm family award in 1953. Before we leave Dr. Jackson, it should be recognized she received a Doc­ torate from the University of Alberta and also one from the University of Dal­ housie in recognition of her services. Back to the health unit. A graduate nurse, Doreen Mackin (nee Knowles) after only two days on the job, was sent out on a fascinating but frightening expedition. The background which led up to this is as follows. The year was September, 1957. It had been a soggy summer with rains lashing the landscape almost every day. Not pleasant for anyone but for the people at Loon Lake it was a disaster. It was impossible to get in or out. Consequently, basic staples like flour, salt, sugar and lard were soon used up. Before long, these folks were starving. In desperation, one of the men walked the 70 kilometers into Little Buffalo and telephoned the health unit, urgently explaining their dire plight. The unit went into action. A plane was loaded with food and Doreen, who had not before been out of Edmonton, was assigned to fly out with the food . The pilot landed on Loon Lake without mishap and eventually, nurse and food were brought ashore. Then after unloading she examined the people for mal­ nutrition and general health. The whole incident came off well but people still marvel that this novice nurse stayed on the job after that first dramatic trek into the wilderness. 221

The experience of being lost is frightening . Yet the nurses in those days took this chance over and over again. And how easily it could happen. One wrong side road and she could be totally lost sitting in the middle of nowhere. But they were always instructed to carry food, wood, matches, candles, extra clothing, and a bedroll in case such a thing happened. And happen it did! Then the nurse would light a fire, fortify herself with food and try to endure the night. Next morning, the search began for the right road. And, thankfully, every nurse eventually returned to home base! Although there is no longer a risk of getting lost in the wilderness; no longer a need for holding clinics on the trunk of a car, there is still an ever growing work load. The nursing program promotes good health by providing information on healthy lifestyles, child development and preventative practices. The nurses teach safety, nutrition, family planning, fitness and pre- natal health. They provide liaison between hospitals, physicians, community groups, and agencies and among other professionals on the health unit staff. Their people are constantly screening for tuberculosis, vision impairment, hearing and speech impairment. They all also give counselling on obesity, drug use, smoking, and diabetes. The unit's Health Inspectors work to maintain an environment that will protect community health. They inspect restaurants, food stores, swimming pools, barber shops, beauty salons, dairies, water supplies, housing, industrial camps, and refuse disposal sites. They deal with complaints from citizens, in­ vestigate food poisoning outbreaks and genteric disease. The unit's dental program provides clinical and educational aspects to the public on dental care. The clinical portion is maintained through children's examinations, prophylaxis, teeth cleaning, and the application of topical fluoride. The Home Care Program brings community services, support services and volunteers together with the professionals to assist people in remaining in their homes while ill or recuperating. This program provides an alternate to the in­ stitutionalization of clients who could remain at home if nursing services, support services, such as meals on wheels, homemakers, home help, and handyman services and rehabilitation services, where available in the community. The Rehabilitation program strives to deliver physiotherapy services to all community residents where services are not available to them through a hospital. These persons are seen on a home visit basis. The program offers education to the public and to other paramedical disciplines, as requested, and strives to gain and maintain communication with doctors, nurses, social workers and educators within the community. 222

THE END OF THE BEGINNING

Good health is the foundation on which the happiness and progress of the individual and society rest. Without it, personal life becomes meaningless, often painful; nations falter and grind to a deadly halt. Today, in 1982, we are fortunate indeed! Great advances in health have been made not only here, but throughout the world. It did not just happen. The struggle was long and hard . Attempts at medical care go back as far as the Dark Ages. But here in Canada, it really began with our first Boards of Health - 1832 in Eastern Canada and 1871 in the Territories. The chief aim of these boards was to try to execute treatment and control of disease. Next came the District Nurses who ventured gallantly into far-flung northern frontiers, covered the vast prairies where they tended settlers and ranchers. Then 50 years ago, after many trials and tribulations, the first health units were established in Alberta. At first, they were somewhat of a novelty! But as more and more units sprang up across the province, the public became aware of their inestimatable value. Now, after all these years, they are almost taken for granted. The advent of health units revolutionized health care. Rather than treatment, which is left to specialized fie lds, the emphasis is on prevention. As a result, communicable disease has been almost totally stamped out. Does the public truly realize this? How many parents stop to wonder why their children don't succumb to the dreadful diseases of the past? Do they remember the anxious days when Johnny turned blue from whooping cough? When Sall y tossed and turned with raging Scarlet Fever - and too many little ones drew their last shuddering breath. Does the public ever think of the dark days when measles, smallpox, polio, typhoid, cholera, the Black Plague and other killers stalked the land? Perhaps it would not hurt to take an occasional look back in order to fully appreciate the endless safeguards to our health which surround us today. We can thank our health units for the safety and good health we enjoy, through their constant monitoring and control. They remain ever vigilant and so they should. Without diligent watching deadly diseases will renew their vengence. Health units offer excellent programs like Home Care, Dental, Geriatrics and many others. But the most vital is education. Education centres on community 223 and individual health with emphasis on self-education. In this day and age, certainly none of us can plead ignorance. We all know it is essential for each of us to practice good health habits . So why not? Who wants to be a drag on society? Why not rather be an asset? It stands to reason, does it not , that if the individual takes proper care of himself, the community and eventually the nation , will reach its own high level of health . Because he is often out in the field , the health inspector is sometimes overlooked as being an integral part of the health unit. Yet, without him , our life would be fraught with hazards. He sees to it that we have clean restaurants and hotels, pure milk and water, properly handled food and, among many other things, he keeps that germ-laden sewage under control! Although the Department of the Environment has taken environmental duties out of his hands, he paved the way for the work being done today and still keeps a sharp eye out for anything which is harming our air, water, and our irreplaceable land. According to Senior Health Inspector Mr. Cliff Turner of the Grande Prairie Health Unit, there is still plenty of pollution around! He believes the reason is that: "Environmental supervision and control are not keeping up with industrial development.'' The public health nurses and the entire health unit staff are constantly stressing the need for sanitation - constantly pointing out how sanitation helps prevent the horrors of disease. Their idea is vital but by no means new! Centuries ago, evangelists spread this word: "Cleanliness is next to godliness'. As the past shows, this sound advice was not heeded! But small wonder the message was lost! At that time, word of mouth was the main means of communication. Today, the importance of cleanliness and all aspects of health is spread far and wide by the use of films, lectures, radio, and newspaper. Periodically, special campaigns are launched - heart month, cancer month , dental week, anti-smoking cam­ paigns and countless others. The work of the Medical Officers of Health and their staffs of specialists, nurses, inspectors, and administrators perform a vital service to the community at large. As well as accepting without question the life-giving benefits of health units, we tend to forget the tireless vigilance of public health workers in their efforts to achieve and maintain our present high standards. Few realize the long hours, the hardships these people are willing to endure when the need arises. Behind the scenes, and receiving little glory, are the steno/technicians. They are ever ready to undertake the painstaking and time consuming jobs of corre­ spondence, ordering supplies and keeping records. The enormity of the job of keeping school records, alone staggers the imagination! These unsung workers, as well as the pleasant and courteous receptionists, deserve a salute from us all! While so many labour on our behalf, the sad truth is , most of us don't think about health until we lose it. Then, how eagerly we seek help - and get it! At last, awareness is awakened once more - our health is in good hands.

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F255 RT Schartner 97 Health units of Alberta. S34 1982