Professional, Practice and Political Issues in the History of New Zealand's Remote Rural 'Backblocks' Nursing: The Case of Mokau, 1910-1940

By Wood, Pamela J. | Contemporary Nurse : a Journal for the Australian Nursing Profession, October 1, 2008 | Go to article overview

Professional, Practice and Political Issues in the History of New Zealand's Remote Rural 'Backblocks' Nursing: The Case of Mokau, 1910-1940


Wood, Pamela J., Contemporary Nurse : a Journal for the Australian Nursing Profession


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.The Department of Health oversaw her work.The nurse decided which level of fee, on a set scale, patients would pay for her service. She sent the fees to the hospital board where they offset the amount guaranteed by the community. Settlers paying a local subscription were charged less and the nurse could waive fees if patients could not afford to pay.

The backblocks scheme gave hospital boards the chance to meet their obligations to care for rural as well as urban people in their districts at minimal cost. It enabled settlers to take the initiative in obtaining a health service they needed and ensured them help in times of childbirth, sickness and accident, when distance made medical help inaccessible or too expensive to request. As farming was the basis of the country's economy, the scheme enabled the government to show settlers it valued their effort and contribution, and that it considered those in rural areas had the same right to a health service as their urban counterparts. In time, it gave the Department of Health a means to extend its public health agenda into rural New Zealand. The scheme offered the nursing profession an expanded role with a new direction for practice, as well as the opportunity to show its value to a health care system seeking to respond to increasing and changing health service needs. …

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