Document 1gdoBaKdow8XEove3ELv0n87j

- tr-jj r Dec, 19,1921, fir, Lee Km rraaJcel, Dew Torfc City, Dear Dr.Frecfcelj I have Just gotten bade from Xhetford Bines and baaten to submit a brief report on my visit there. Probably more detailed information might be developed later, if yon fail that it la essential. Ion will find enclosed* 1, A memorandum with reference to my observations in Thatford Bines, covering also ny conversations with the provincial officials in Montreal, 2, An expense account covering part of this trip, I discussed the matter of expenses with Br,BatfieHtWhftieli. that the Demonstration might legitimately meet certainly portion of the trip* Consequently, I am planning to charge the Demonstration with the *goin* expenses, and 1 enclose an account covering disbursements on the tetorn trip. Sincerely years. fiBA:l2L Executive Officer, 1263 71313? TO KAgEBBITT CEHTHR AHD CHILI) HEAIffH SgATIQH U? THETFOHD tnTraK.qTTEMfl By Dr. B. B.Armstrong ' Preliminary to this visit considerable oorrespondenoe had taken plaoe with Hiss Ah.eern. numerous quest ions had been submitted with reference to population, death rates, sanitary conditions, etc., most of whioh had been answered. Inquiries not already covered by oorrespondenoe were fully discussed at the time of the visit. This was the firBt opportunity the writer had had to meet Hiaa Ahearn, and ha was very favorably impressed with her personality and adapta bility for this work. She apparently visualizes the program in a broad and far-reaching way, and evidently has an nxmsnal amount of taot, as well as exceptional professional and social training. Zt is evident that she has made an excellent impression, and it is also evident that she has organized the work in an efficient manner. Other individuals who were met lu Thetford Hines included the Mayor, the Metropolitan superintendent, one of the leading priests, an in fluential notary, the head of the local Blights of Columbus, and other private citizens. An excellent opportunity was provided to discuss matters with the Mayor. He is very much in favor of the woxk, and la desirous of helping in every way. Miss Ahearn apparently has the backing of the priests, the leading women of the eoamnnity, and part though not all of the medical profession. It was the Mayor*s feeling that gradually all agencies, including the public at large, would line up in back of the project and that eventually and before a great while ell of the doctors would have to come in. He seemed to feel that this method of en gulfing was superior to any other fora of "attaoV, and that it was progressing IUOO08Bftllly 1264' z- The gen ral appearance of the Child Welfare Station itself is quite attractive. While it iB in a basement off the main street, it is oentrally located and certainly accessible to the greater portion of the popula tion. The Interior ds attracti-rely and advantageously arranged and equipped. The ohief tiling that seems to be needed is more health literature in French. Very few of the people read English or speak English. Such French literature as she has is very poorly translated, including the Metropolitan bulletins (according to MIeb .Ahearn). Some excellent material has been supplied by the government in Ottawa. Through the kindness of the Metropolitan superintendent, an opportunity was provided to visit practioally all sections of the town by auto mobile. The oomaznity is crude though not particularly unhygienic in appearance. There is very little over buildlag and lot congestion, though apparently eonsid-" arable house and room congestion. This would be eapeeted in any case in view of the extremely large families. She town is scattered over a vide area end the parte are relatively Inaccessible. There la one long main street with cross streets reaching oat Into the count17. One has to oome baok to the ms in street each time in order to go In v.v'a different direction. Incidentally, this nekos it very difficult for Mies Ahearn to eover the town with her Btaff. Consequently, ehe is extremely desirous of securing an automobile if possible. The oosnxnlty is very badly off for general health work. There is no other health work of any kind, no medical sohool inspection, no eorreetion of physical defects, and no medical or nursing work in the mines. The schools are, of oourse, under Catholic Church control. Mias Ahearn is hopeful of induolug the priests to see the desirability of at least a minimum amount of school nursing later on. The situation is hopeful in this regard, sb the ehnroh leaden are apparently quite aware of the vaftse of the Child health work being oarrled out. 1265 -3- The hospital facilities are grossly inadequate, in particular there being no provision for maternity service. to whites a maternity cobs is mnateama. There is a hospital run by nuns General sanitary conditions in certain respects are good. The :miUc supply apparently is well protected, eo far as tuberculosis is concerned at least, as all milk is said to be tuberculin tested; also^a small amount is pasteurised, JTot only is there no public health nursing in the community, but there is no private nursing. Such a thing as a private norBe does not exist in Thetford Mines, although they can be imported from Quebeft and are in rare instances. Certain minor observations. In addition to the foregoing night be itemized bb followsi 1, Owing to the fact that the asbestos mines are now practically closed down, the population is decreasing. This decrease has amounted to about one thousand people in the last year. Extensive unemployment exists and considerable unrest, a riot recently having taken place, in connection with whlah the Ifayor acquired some unpopularity, which may affect hie ability favorably to influence the development of the health work. 2. Apparently the Station aa organized at present, measured on the prenatal basis, 1b covering abont hqlf of the problem. Biss Aheara supplied the writer with econrate and up-to-date statistics for 1919, 1920, and 1921 for the ttwo parishes, indicating births and deaths, infant and total, for the town and the suburbs. In cidentally, also,- a distribution of population by religion and race was given for eaeh pariah. 126u These figures indicate an average of about 420 births a year, or a birth rate of about 46 per thousand, four hundred and twenty births - a year indicate that there should be under observation at least 200 prenatal esses. At the present time the Station la reaching 120 mothers, 60 of which are prenatal. . These come from the main center of the town. An autemAhlle would help reach those -4- In the outlying distriotB. fairly 3* The present year Is apparently showing a wesgcfavorable tendency In infant mortality* On a basis of the figures supplied by Hiss nhearn and secured from tbs prlepta' records (which indidentally Beamed to be much more reliable than the official records at Montreal), it is indicated that the infant mortality rate for the last three years is as foilowet 1919 1920 -- 254. Per ShouBand Born -- 326*1 W 1921 -- 219.5 n n n She doclins in 1921 is incident to a saving in mortality from diarrheal disease and pneumonia* She chief difficulties in the situation seem to be as followsi 1* She aedloal profession is extremely crude sad anti-social. She doctors fear that any development of public health work will Interfere with their income, and do not see the advantages that would accrue to them from medical exam ination work, hygienic education among the people, etc. However, two or three of have become the doctors ouse tolerant if not cooperative, and it is hoped that the others may soon be brought to see the advantages of cooperation. 2* Some arrangement ought to be made for medical supervision at the olinio* Swo of the dootoxs are willing to undertake this at present, though the others threaten dire results if sqjr one of than is selected* She Meyor could probably force the manioipal doctor to undertake the wortc, but he is said to be extremely lazy and uninterested, as well as ignorant on infant hygiene* sequently, this does not seem to be a very desirable solution* Con 126 V She best physician in town, the nan with the widest practice -5- and moBt influence, is apparently beginning to^aee the advantages of having the work oarried out there. He iB using the nurses on his private oases, and is leas antagonistic, thanjvreviously. It was the hope of the hayor that he could ehortly be further interested, and perhaps Induced to take part in the clinic work. 8. Of course high mortality rateB are oharacteristic of French Canadian population Just how much this is due to Ignorance and environmental conditions, and how nmch it la flu* to raoe stock, it is difficult to Bay. Of course the latter factor would be hard to dufluenee. 4. So far as infirnt mortality is conoerned, the extremely high birth rate presents an obstacle of considerable importance. The married women have bablee yearly and almost automatically. A typical family seems to be 10 or 15 such children.^ Under/diffioult economic conditions as prevail at presrnt, this means that/the mothers prefer to have their children die than live. Where birth control is unmentionable and where to some degree at least "death control" is consciously even though passively substituted, the difficulties in the way of lower ing the infant mortality rate are considerable. The reooomendatlons which one might submit for consider ation are as follows* 1. That aa automobile for transportation be provided, if possible. It Is probable that the nurses oould cover three times as moh territory, and meet the prenatal and infant needs of the situation. Certain difficulties of course present themselves in this connection. For three or four mouths of the year the operation of automobiles, except on the Bain Street, is said to be Impossible^ A 2, While some form of medioal supervision for the child health clinics should be arranged for as soon ns possible, it seems advisable to continue on the 1268 present basis for a few weeks at least, pending certain other developments that may have an influence upon looal medical opinion* i S. lfr sconvei^aiipnwith the Hayor and Hiss iiheara, a tentative suggestion was made that an effort be undertaken to organlzd some form of local committee, to be responsible for certain aBpeota of the health program* The Mayor ctxrressed his willingness to call together representatives of the leading agencies in the oorannnity, the mines* including the medical profession, the church, ythe mens* and the woman's organizations, eto. An effort will be made at this time to get a olear picture of what is being planned before this representative group, and to encourage their interest In and support of the work* 4* It ve felt that this might lead to the development of a greater feeling of looal responsibility and autonomy* This might Involve to same degree ~ a gradual withdrawal of the Hatropolitaa label on record forms* eto*, so that, eventually the Station might oome to be recognized by the people in Thetford Hines, as the Thetford Hines Sfatamity Center, or Child Health Station* Such a development would certainly encourage looal interest and support* It was also suggested that in addition to a very simply organized group of community leaders to sot at least as an advisory oaancll for the Maternity Center, it might also be possible to get together informally a group of mothers who had benefited by the work, and who were enthusiastic regarding it* Such a group might constitute a sort of neighborhood comoittee,who oould be loosely organized for the promotion of the propaganda in their seotions. Both the Mayor and Hies Ahearn were favorably inclined toward an attempt of thiB sort* ___ ______ ______ _______ 1269 Dr. Pelletier, the Secretary of the Superior Provincial Board of Health,a$ Montreal, was very enthusiastic over Hiss Abeam* Be felt that she had made an excellent otart and that the situation was promising except for the - 7- medical men* fie believed in the development of a local committee, upon which the medical men should be Invited to be represented* He^felt, however, that the medical situation wus extremely difficult and that it might eventually turn out to be necessary to take another comminity* He suggested Three Hivers, though he said the Health Officer was of a very poor type is this coassinity* He also spoke in favor of Shawaaigpn Halls, and urged that if a change was made or a second Btation started, the proposition be put up to the town first, in order to enlist their Initial interest and to tie them up to an agreement with reference to certain types of support and aid* It is the feeling of the writer that Dr.Pslletier might be more somewhat/optimiBtio, Certainly a very promising start has bean made in view of the 01102*1 period of time covered* TShile the medical c matter are resale Itrant the and present/ohief difficulties, many of the. important factors in the community are behind the demonstration* If another consaonity were selected, and the doctors were aggressively in favor of the project (which would seem to be extremely unlikely anywhere), it la probable that the priests would be against it* Consequently, it would seem desirable to make every effort to eapltallse to a more extensive degree the excellent Btart that has bow been made, in Thatford Mines. *** * 1270