A second opinion

Juris Graney
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Unwrapping the bandages on an alternate history of Newfoundland’s health system

MUN research assistant John Matchim (left) and husband-and-wife team Dr. Jennifer Conner and Dr. Jim Conner are turning back the clock on Newfoundland's pre-Confederation health system by studying a cache of patient records at Charles S. Curtis Memorial Hospital in St. Anthony.

St. Anthony — It’s a thankless task but a necessary one if historians are to get a clearer view of health care in Newfoundland, pre-Confederation.

For the past four months, John Matchim has squirreled himself away in a room in Charles S. Curtis Memorial Hospital, photographing patient records.

It may not be glamorous but the research assistant’s daily task of digitizing medical records from as far back as 1907 could reveal an alternative history of the province’s health-care system.

By the time the data collection part of the project ends next month, up to 5,000 cases will have been recorded. They will then be examined by a research group led by Memorial University’s Dr. Jim Conner.

The collective also includes his wife, Dr. Jennifer Conner, Dr. Maria Mathews, and Dr. Monica Kidd, who did part of her training in St. Anthony.

“There is a significant cache of archival documents here providing a wonderful untainted, undisturbed snapshot of health-care delivery,”  Jim Conner said on a recent visit to St. Anthony.

“They are very detailed. Doctors then were trained to record everything; they were very observant and were writing medical history. The records they’ve created are not just medical records but social records.

“A lot’s been written about the Grenfell phenomenon,” he added, “but surprisingly not a lot has been written about the health care on the ground, and we are looking at the big issues. We are looking at what it was like to be a practitioner, patient and so on.“

The region’s place in the history of Newfoundland health-care delivery can never be disputed, he said, but its place in the world view has never been properly investigated.

St. Anthony’s international connections with the likes of Massachusetts General Hospital, Harvard Medical School and luminaries like Dr. Charles Curtis have somewhat overshadowed the contributions of locally trained midwives and the decentralized cottage hospital system developed in the desolate Scottish highlands in the early 1920s.

“It’s the Newfoundland dichotomy — on the one hand it is isolated, but it is still so connected to the mainstream,” Conner said.

“On the one hand you could say that these places are insulated and isolated, but with the high turnover of doctors and practitioners there was tremendous rejuvenation of medical thought and continuing medical training going on with all the healthy young men and women coming here.

“The dominion pre-Confederation is a curious mixed history, there is a narrative of poverty and failure and so on but you look at health care and I think actually it’s one of the biggest success stories.

“It’s not a bad system … but what we are trying to figure out is just how good a job did it do, what its limitations were and what its successes were.”

Most of the people working in satellite units like St. Anthony had basic first aid, including the midwives and public health practitioners, he said, and they should be included in the dialogue as opposed to “just talking about Doctor X.”

“They had a string of midwives, someone like a grandmother who helped deliver 15 to 20 kids; they may not have been trained but they had a hell of a lot of experience, and these midwives were scattered in the outports,” Conner said.

“If you take a doctor approach it may look thin on the ground, but this model, you can actually see overlapping of health-care delivery.”

As for the actual documents, Matchim says after reading them he was intrigued by just how far health care has come.

“The thing that struck me about these records is how they are not very exacting in detail,” he said.

“If you go into a modern hospital, you have to present a MCP card or a government ID and all your medical information, your history, it’s all there right on a computer.

“But a hundred years ago you could come in from say Englee with a broken arm. You’d give your first name, your age could be ‘around 50,’ you could say that you’re from down the shore and that your arm hurts and it was good enough.

“It was a mass of people existing outside of St. John’s with no contact with the state unless people chose to send their kids to school or had an ailment and had to go to the hospital. But otherwise they were practically non-existent to the state.”

Jennifer Conner said the research group took many steps in negotiating access to the files to maintain patient confidentiality despite the fact that many of the people involved are now deceased. They accessed the patient files on an anonymous basis, but a separate complete data set, with names and ages all indexed, would be provided to Labrador Grenfell Health.

“We have no idea who the patients are,” she said.

“We are never going to see the names of patients, they are off-limits, but we are not interested in who, we are interested in relationships between occupation and their health and family issues and how they all start to connect, and given the wealth of details, you get a terrific snapshot of trends that are happening.”

The Northern Pen

Organizations: Charles S. Curtis Memorial Hospital, Massachusetts General Hospital, Harvard Medical School Labrador Grenfell Health

Geographic location: St. Anthony, Newfoundland

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