The new role of 'backblocks' nursing, established in 1909 to provide a nursing, midwifery, emergency and public health service to New Zealand's remote rural regions, created opportunities and challenges for the profession. For three decades, the novel nature of the role also provided numerous stakeholders with the opportunity to contest their authority and influence.This article explores the professional, practice and political issues of backblocks nursing through a case study of Mokau, a remote rural community in the North Island of New Zealand, 1910-1940. In particular, it considers professional issues of recruitment and retention, practice issues in delivering the new service in a challenging environment with few resources, and political issues in defining the scope of nurses' practice and dealing with competing stakeholders keen to determine its potential and limits.These issues were exacerbated by the location of the Mokau district in two administrative health regions.
rural and remote
nursing; backblocks nursing;
Received 23 August 2007 Accepted 25 June 2008
British colonial settlers arrived in New Zealand in increasing numbers from the 1840s, as part of the planned settlement of the country at the farthest edge of the British Empire.When the colony became a Dominion in 1907, settlers were still opening up land in its remote, isolated regions. In 1909 the New Zealand government introduced a scheme to provide a health service for these settlers - the Backblocks Nursing Scheme. The general history of this service has already been described (McKegg 1991).This article, however, explores professional, practice and political issues in backblocks nursing through a case study of one specific area, Mokau, a remote rural community in the North Island of New Zealand, 1910-1940. It examines in particular the professional issues of recruiting and retaining nurses for this post, practice issues in delivering the new service, and political issues in defining the scope of nurses' practice and dealing with competing stakeholders keen to determine its potential and limits.
BACKBLOCKS NURSING SCHEME
The idea for a nursing service for settlers in remote rural areas was proposed by Dr THA Valintine, New Zealand's Inspector-General of Hospitals, at a hospital board conference in 1908. Although living in the country's capital, Wellington, he was familiar with backblocks settlers' needs from his previous role as a rural doctor in Taranaki, a region in the west of the North Island of New Zealand.What the country needed, he said, was a health system that would 'make itself felt in all parts of these Islands', not only in districts immediately surrounding towns, as was then the case, but also 'in the far remote country districts - the backblocks'. Government subsidies had been insufficient to persuade doctors to settle in these regions so he suggested the districts would be better served by a district nurse who could keep in telephone contact with 'a doctor at a distance'. Such a service would be a boon to settlers 'facing the discomforts and hardships of backblocks life' and the nurse would 'supply the link in the chain' between the base hospital and its remote region (Valintine 1908).
The Backblocks Nursing Scheme, established the following year, provided a nursing, midwifery, emergency and public health service to Pakeha (European, mostly British) settlers living in remote regions. A parallel Maori (or Native) Health Scheme was established for the mostly rural, Indigenous Maori population in 1911 (Mc- Kegg 1991; McKillop 1998). By the 1920s the boundaries between the services had blurred. The backblocks scheme enabled settlers' groups to ask their hospital board for a nurse to be appointed in their isolated community. If settlers promised to meet half the nurse's salary and expenses, the hospital board would employ the nurse and use a government subsidy to pay the remainder. …