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sylvania, in a rich section of Bucks County. Included in h r

equipment is one of the nne <
Pennsylvania Dutch barns, used
as the core of a project in this
interesting attempt to apply
modern educational methods to
the study of agriculture. Seven
farms have been turned over
to the senior students to be
managed by them. Their work
is supervisory and they are re-
sponsible for the successful




c t f - ooo ooo to be used to make provision for a
fund of ^ 000 ' 00 o < he instituti on coeducational through-
i Grl Unlearn te principles and the practical method,
of farm-home management and all aspects of farm work .-
able to women, and rural sociology.



HEALTH



An Institute of Trusteeship



By ANNE R. WINSLOW



PUBLIC health nursing in this country is now fifty
years old, if we go back to its beginnings, and
twenty-five years old, if we consider its phase of
rapid and general development. For some time
special courses of training have been offered to
nurses to fit them to practice their profession, which covers
such a wide range of subjects as nursing, sociology, psy-
chology and education in complex interrelationships. On
the other hand groups of lay people, with no training, have
been supporting and guiding the work of these nurses.

The members of the boards of management who go out
into the community to raise money often in large amounts
for their various public health nursing organizations, are
at last beginning to realize the responsibility which is theirs,
of seeing that this money is spent wisely and efficiently, and
the need for rendering back to the public an account of their
stewardship. This realization was crystallized at the Health
Congress in Atlantic City in May, 1926, in the proposal
for a Board Members' Section of the National Organization
for Public Health Nursing.

There are three outstanding problems which confront the
members of a board of management in any field of social
activity :

1. How shall the necessary funds be raised?

Shall an association join a community chest? If it does,
how shall it take a cooperative part within the chest, and
yet maintain its own growth and development? If it does
not join the chest, how shall it most effectively present its
cause to the general public?

In either case an adequate and available system of records
is essential as a means of checking up and studying the
association's work, and estimating its contribution to the
public. A modern and exact system of bookkeeping and
treasurer's reports are essential to show the public just how
its money has been employed. This must be summarized
for the convenient information of the public, and for the
guidance of the board and its professional director in a care-
fully studied budget. In either case the need for publicity,
for catching the public ear in order to raise money, and
in order to develop a demand for the service offered is
increasingly borne in upon the guardians of the contributors'
monies and of the health needs of the community.

2. What kind of a nurse shall the board employ?
Bearing in mind the obligation to expend their funds

wisely and efficiently, the board members must know some-
thing of nursing education and, above all, must know
where to go for advice. The average board member must
and should turn for professional counsel to professional
sources, to recognized leaders in public health nursing, to
schools of public health nursing, and above all to the final
coordinating center, the National Organization for Public
Health Nursing. She herself, however, should know



enough not to employ "any good nurse" but to try to get
the nurse most soundly trained, and therefore most capable
of playing the important role in the community.

Perhaps the supreme task of the board is the choice of the
nurse director or superintendent. In this day of fine-drawn
specialties on the one hand and of coordination of the forces
of the community on the other, the work of the public health
nursing director is a very technical business. It involves
knowledge of the community in which the nurse works, a
capacity to establish discriminating relationships with the
medical profession, the social agencies, the law courts, the
hospitals, and so on. A grave responsibility devolves upon a
board in choosing a nurse who can make all these contacts,
and keep up fully with progress in the changing field of
public health itself. After choosing the superintendent or
director the board must realize that she is absolutely re-
sponsible for the technical professional side of the work.

3. Having raised the funds and chosen the technical
expert, what else has the board to do?

It must direct general policies, while not interfering with
professional standards. It must represent the viewpoint of
the community and determine, after receiving the advice of
its expert, what is most important to be done and what the
community at the moment can afford to do. It must maintain
contacts with other local social forces and it must aid and
strengthen its director at every step in her difficult task. The
most effective boards realize that they and their nurses are in
a copartnership and that, together, they operate the asso-
ciation, both having separate, real and yet allied functions.

TO help answer the question as to the true function of
a board and the board member in fulfilling it, the first
Institute for Board Members of Public Health Nursing
Organizations was held in New Haven last month under
the auspices of the New Haven Visiting Nurse Association
and the National Organization for Public Health Nursing.

Early in the winter a questionnaire was sent to some four
hundred public health nursing associations asking if the
board members, not the nurses, would take part in a three-
day institute to discuss problems which are the peculiar
concern of the board member.

In response to this letter more than two hundred people,
men and women (including several health officers) rep-
resenting ninety local nursing organizations and twelve
national organizations and educational institutions, met at
New Haven. They came from the New England states,
New York, New Jersey, Pennsylvania, Delaware, Mary-
land, Michigan, Indiana and the cities of Washington and
Montreal. The speakers at each general session represented
respectively the points of view of the board members, the
public health nurse, and the physician or the community,
the speakers including the most outstanding experts in their



218



Uay 15, 1927



THE SURFEY



l.ifferent fields. The fee of ten dollars charged to those
Ittending made it possible to pay the speakers a modest
Jionorarium as well as to cover the general expenses. After
lach group of formal papers the members of the institute
leparated into four small groups, representing associations
Jmploying one nurse, 2 to 5 nurses, 6 to 16 nurses, and 16
lind more nurses respectively. These smaller groups gave
Importunity for intimate, informal discussion of the subjects
presented in the preceding papers, in their application to
J.-ommunities of different sizes. A nurse was in attendance
|it each round table to answer technical questions.

The principal topics considered and the speakers were:
The organization of the board and its relation to the pro-
Ifessional staff: Lillian E. Prudden, president, New Haven
Visiting Nurse Association; Katherine I. Tucker of Phila-
delphia and James I. Coddington, representing the Harmon
Association for the Advancement of Nursing. The function of
Iboard members: Josephine Goldmark, Mary S. Gardner, and
IDr. C.-E. A. Winslow. Public Health Nursing in its relation
Ito the medical profession: Dr. Haven Emerson, Janet Geister,
land Florence E. Hegeman. Mobilizing public support for
I public health nursing: Dr. W. W. Peter, Ira V. Hiscock, and
Hazel Corbin. New trends in nursing education: Annie W.
I Goodrich. Financial problems: Allen T. Burns, Anne L.
JHansen, and Mrs. Richard Noye. Public health nursing in its
I relationship to social agencies: Kenneth Pray. Dinner meeting,
I address by George E. Vincent. Education of board members:
Mrs. George A. Kent, Jr., of Binghamton, N. Y. ; Mrs. G.
Brown Miller, Elizabeth G. Fox and E. C. Lindeman.



219

It was the feeling of many of those most competent to

m , J K f I' d f ingUished Hst f s P eakcrs was f "'ly
matched by the enthusiasm and earnestness of the audiences

Which took acnve part in the discussions. Several similar
institutes are to be planned for various sections of the
Untted States, as well as less ambitious one-day institutes
where the whole time can be devoted to an intensive study
Ot the individual problems of one region or of one asso-
ciation. In the New Haven discussions the importance was
stressed of an educational committee in each association to
consider methods and opportunities for the education of
its own board (as well as itself!) ; also the study of Miss
Gardner's Public Health Nursing and of current reading
in The Public Health Nurse, the various health magazines,
The Survey, and so on.

The essential importance of these meetings lay in their
expression of the recognition by board members of their
need for fitting themselves to meet their increasing responsi-
bilities, both inside their own associations and in their out-
side contacts with allied agencies in their communities. The
American tendency toward the development of large and
important voluntary associations, rendering public service
with private funds, demands a new and enlightened type of
administration from the volunteer servants who direct their
activities. The New Haven Institute has perhaps its message
for the public-spirited citizen in other fields of social activity.



Putting the Public into Public Health



By GEDDES SMITH



^"""F~"^AKE an American-born community of some 50,000
I souls, not much more than a generation from the
I pioneer stage; gregarious and cooperative, as indi-
M. cated by a host of little trading centers each
jammed full of lodges, clubs and churches; proud
of their growing berry patches and their virgin timber; in-
dividualistic enough to entertain a multitude of sects and
support a host of medical anomalies; reluctant to pay in-
creasing taxes and yet willing, when face to face with the
issue, to spend a million dollars on good roads; and, with
shining exceptions, almost wholly unacquainted with public
health. Arouse the interest of a few community leaders and
an exceedingly cooperative group of physicians in the
possibility of health progress. With their backing, try to
"demonstrate" public health, particularly as it affects chil-
dren, to the whole 50,000.

How would you go about it?

That was the problem faced by the Commonwealth
Fund Child Health Demonstration when it entered Marion
County, Oregon, in 1925. Its attempt to solve it amounts
to a spirited effort to put the public into public health.

While the main outline of procedure is uniform in all
the four centers where the Fund has placed demonstrations,
two of them, Athens and Clarke County, Georgia, and
Fargo, North Dakota, are urban and comparatively ad-
vanced in the organization of public services. Rutherford
County, Tennessee, and Marion County are both predom-
inantly rural ; neither had full-time county health service
before the demonstration ; and while the nature of the prob-
lem has permitted more rapid organization in Oregon than
in Tennessee, both should develop into valuable laboratories



of community relationship in a health program.

The purpose of each demonstration is to provide, in full
cooperation with local physicians and with public and priv-
ate agencies, a reasonably adequate set-up for promoting the
health of mothers and children as an integral part of a
consistent public health policy. A medical division, offer-
ing pediatric supervision of infants, pre-school and school
children; a health education division, stimulating and guid-
ing health teaching in the schools; and a nursing division,
giving generalized service and tying the whole demonstra-
tion to the individual family, have been arranged.

In Marion County a staff of nine nurses (one on night
and emergency service) are dealing with a territory which,
excluding a national forest, amounts perhaps to a thousand
square miles, and with a clientele of approximately 6,000
persons per nurse. This staff is four times as large as the
public health nursing staff before the demonstration began,
but it is clearly impossible to give intensive nursing care on
such a scale. The staff realized from the first that volunteer
cooperation must be built up to extend the reach of both
doctors and nurses. Moreover, the county had been accus-
tomed to thinking of public health service as a commodity
which could be bought much too cheaply and had invested
only in two or three part-time physicians and one full-time
nurse whose salary was hard enough to raise.

To persuade the public that public health service was
worth many times its pre-demonstration allowance of four-
teen cents per capita, it was necessary for the people not
only to understand what good health work meant but to
feel that it belonged to them. On both counts the need
of volunteer reinforcements and the need of popular par-



220



THE SURREY



May 15, 1927



ticipation there was an unmistakable need for a vigorous
plan of local organization.

This need has been met by a two-fold scheme of health
councils a set of local councils which assume responsibility
for local services, and a county council which keeps or-
ganized and unorganized towns and villages in touch with
each other and is prepared to deal with county agencies and
authorities on an equal footing. No less than twelve of the
local councils have been organized under tactful stimula-
tion from the nursing service in the last two years, and
in each of these communities, ranging from Scotts Mills
with 250 inhabitants to Salem with nearly 25,000, a local
group has provided and equipped its own health center and
maintains a cluster of services to make it more useful.

In the local council, representatives of all the permanent
groups of the town or city the churches, the lodges, the
women's clubs, the parent-teacher or community associations,
and so on have come together to form a body which is
primarily concerned with health but which also takes
responsibility for related matters, "social problems," for
instance. It rents, or finds rent-free, a room or rooms in
a store building, church, or school where health center ser-
vices can be given at regular intervals and which the nurse
can use as her local headquarters. It finds the money for
scales, furniture, decorations all the needed equipment
except that actually brought by the doctor and nurse. For
such purposes the twelve towns and cities raised last year a
sum estimated at $2,000 not large in the aggregate, but
large indeed when you stop to think how few American
towns of three or four hundred inhabitants have ever in-
vested even fifty dollars in a purely cooperative enterprise
like a health center.

Running the health center making appointments for



Marion

County

in

the

State

of

Oregon



Htilth



Courtesy of

the Child Health

Demonstration

Committee




examination, furnishing hostesses and recorders, and keep-
ing equipment ready and spotless is the task of a special
committee. Making surgical and maternity supplies is the
work of another. Finding cases needing nursing care and
putting the nurse in touch with them, transporting patients
to and from doctors' offices, popular health education, and
keeping the local archives, are other committee tasks. Local
physicians and dentists form an advisory group, and one com-
mittee takes responsibility for relief and personal service in a
fashion which amounts to rudimentary case-work. Not all of
these tasks are well done, needless to say, in all the councils,
nor all the time. But little by little they are done, and every
bit of local accomplishment is broadcasted by local pride
until the educational effect of the whole is unmeasurable.

TAKE, for example, a community which we may call
Quincy. Its population is a bit over a thousand, and like
most of its neighbors it is a trading center for the berry
growers, farmers, peppermint speculators, and other folk of
a rolling, prosperous, but still undeveloped countryside. Miss
Miller, the nurse in whose district Quincy lies, made her
first community contacts in July, 1925, by calling on the
leading local doctors. She found them both cordial and
ready to cooperate. Then, with the advice of the president
of the county health society, she began the hunt for a lay
leader. The first of the ladies interviewed was keenly inter-
ested, but felt that an old factional difficulty in the town
might flare up again if she took the chairmanship. She and
her husband suggested eight other desirable leaders. The
first of these was too busy, the second and third were away,
the fourth was helping to keep store and had no free time.
One was the wife of a chiropractor. Others were unavail-
able. Two more suggestions proved unfruitful. It was
nearly the end of August when a chairman was found a
man, a technical worker, exceedingly busy but a good organ-
izer and a "born peace-maker."

He and his wife took hold with vigor. In October he
reported to the nurse that he had everything "lined up
for the organization" and that his people were "r'arin" to go."
The pediatrician was then dated up so far ahead that a
school clinic could not be held for some months, and in
the meantime Miss Miller asked again that the chairman
read the health books she had left with him but which
he had been too busy to look at. The busy-ness increased
rather than diminished, and at the end of October the chair-
man sent the nurse an S.O.S. and told her he would have to
to give up his responsibility, because he didn't have time to
do the work "right." A couple of weeks later the presi-
dent of the Parent-Teacher Association consented to act
temporarily as chairman and to give demonstration speakers
a hearing at the Association's next meet-
ing. The nurse, meanwhile, was making
her routine calls not only in
Quincy but in a string of other
towns scattered far and wide.
Herserv-
ices are,
of course,
the foun-



Showing Health Centers, woods, waterfalls, sawmills,
Indians, hop trellises. Sublimity and other phenomena







May 15, 1927



THE SURVEY



dation on which local participation is based, and it is the
mothers and fathers whose children are the better for her
systematic visits, who spread understanding and give vitality
to the whole organization. On December 7 the director of
nursing service and other demonstration workers drove down
to Quincy for the P.T.A. meeting: the school house was
dark ; the president had made a mistake in the date !

The next week, however, speakers and hearers made
connections, and the P.T.A. -voted unanimously to
sponsor an organization meeting at which all local
groups would be represented. When the meeting was
held, under the nurse's watchful eye, a council was formed,
but each nominee for the chairmanship declined until some-
one had the happy thought of electing an absent business
man. Arrangements were made for the examination of
school children and though the number examined on this
first occasion was small 80 children out of a possible 300
the principal considered the findings exceedingly helpful. In
January the executive group in the council decided to use
a room in a school building for its health center, and started
listing possible chairmen for subcommittees. Late in the
month Miss Miller was startled to hear a mother declare
that her child would come in for the health center examina-
tions in March. Without troubling to make arrangements
with the demonstration staff, the local committee had pub-
lished a front-page story in the newspaper announcing the
entire personnel of the organization and promising a "clinic"
for a definite date.

With equal independence almost as embarrassing some-
times as inertia the council scheduled a meeting and
speakers for it, then, a few hours before it was to
happen, notified the speakers. Driving down from the
demonstration headquarters in Salem in a wild night, they
found "a group of people huddled together in the doorway,"
who had supposed nobody would come on such a night,
but went ahead nonetheless. The arbitrarily appointed com-
mittee chairmen were eager to know what it was all about.



221

and resigned. Their colleagues protested, and they con-
sented to hang on. "The meeting was well attended," the
nurse reported, "but there was a lack of enthusiasm; with
the exception of Mr. Black, who is the embodiment of it,
it was a minus quantity." So the work dragged on till
summer, when hop and berry picking and the heat tend to
suspend all public activities in Marion County.

One day the following October Miss Miller discovered
by chance that the council had held a meeting, that it had
been decided to transfer the health center to better quarters
in a public building, and that a new chairman had been
picked for the Education Committee. A discussion of pub-
licity seemed to arouse lagging interest, and the nurse
reported happily, "I believe the light has at last broken."
But there were still signs of factional feeling, and nobody,
from the chairman down, felt that things were going well.
In November the chairman again resigned, together with
the discouraged health center chairman, and the energetic
Mr. Black, who had caught the idea so early, became titu-
lar as well as actual leader of the group.

A HOMELY record, no doubt. The course of com-
munity organization never did run smooth. It took
a year and a half to find the right leader. But once he was
found, the riddle of community organization seemed to be
well on its way toward a solution. The reports from Quincy
now read like this:

Thursday afternoon the health officer came to Quincy and
gave toxin-antitoxin to 168. This was the third dose for 107.
A father of two little children and two high school boys came
asking for first dose. Truly, Quincy is awake! It was very
interesting to watch different people taking part in their local
council meeting last Monday evening. Everyone seemed happy
and willing to work. One woman, who has been one of the
best helpers I have had and who spoke several times at the
meeting, practically shut the door in my face the first time I
called on her. Truly, there is nothing as contagious as enthus-
iasm, if you can just get one germ.

Quincy has recently held the annual meeting of its health

U much inter-



but when the light did break, his enthusiasm knew no

"\V 7HY, this is a big thing for Marion County," he
Vv declared. "We just must get behind it and make
it a go."

"Interest increased as the evening wore on," Miss Miller
continues in her report, "and we were besieged with a rapid
fire volley of questions. We had a hard time tearing our-
selves away even at 11:15."

Next the nurse consulted the woman responsible for the
Health Center Committee, and made plain what service
she could give, and when babies and preschool children were
examined early in March the volunteers "gave excellent
service and put over a good clinic." Social problems came
up promptly, and Mr. Black took hold of his task eagerly.
The committee workers weren't very well satisfied with the
health center in the old school building, and decided to
renew their drive for a community house so the babies could
be properly cared for. Yet this good beginning was not
followed up: a health center consultation was scheduled
in April to which nobody came, and the nurse despairingly
reported that she didn't know "that it seemed possible for
Quincy people to get a health center consciousness/' In
May the executive chairman and the chairman of the Health
Center Committee both insisted they were too busy to go on,



ested in the

Each officer elected was not only willing

with the election. The vigorous chairman,

of his effort to persuade a woman to

the clinic. She met him at the door,

ested, and didn't have tin

children and knew more a_.

and she didn't want her children examined. hen

got sick, she'd take them to a doctor.

Black reported, "I decided that the need was quite obvio

for health education, and I sat down and talked for 1

an hour, and when I got up that woman would have brought

every child she had to the clinic that afternoon 1

bcen having a clinic. I tell you ladies and gentle

think the person who neglects his duty toward our childri



Online LibrarySurvey AssociatesThe Survey (Volume 58) → online text (page 50 of 130)