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Intro From Medicine in the Remote and Rural North

Intro From Medicine in the Remote and Rural North

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Published by: Pickering and Chatto on Apr 14, 2011
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INTRODUCTION:CORES/PERIPHERIES – RURAL/REMOTE:MEDICINE, HEALTH-CARE DELIVERY ANDTHE NORTH
Stephan Curtis
T is collection o essays emerged rom a conerence held at Memorial Universityin St John’s, Newoundland, in 2007 in recognition o the Fourth InternationalPolar Year (IPY). One theme o the IPY was the investigation o the ‘cultural,historical and social processes that shape the resilience and sustainability o cir-cumpolar human societies, and to identiy their unique contributions to globalcultural diversity and citizenship’.
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T e maintenance o health and treatment o illness and accidents in locations such as northern Scotland, Scandinavia, Fin-land, Russia and northern Canada, and coastal regions such as Newoundlandand Labrador can certainly be easily linked to notions o human ‘resilience andsustainability’ (even i some o these northern locales are not circumpolar).O course climate, topography, cultural animosities or at least suspicionsbetween providers and recipients o health care, and the  nancial capacity o various governments in other remote areas o the world, all shaped what couldbe done just as they do today. T e essays in this volume ocus on northern, polarsocieties but the strength o this collection is best demonstrated by envisioning ‘the North’ not solely as a unique geographical part o the world. O course itis that but it also kindles in us images o numbing cold, and constant hardshipand isolation on the one hand, and o opportunity, excitement and welcomesolitude on the other. T inking about what the ‘North’ means or, better still,the images it evokes enables us to see the many similarities between the socie-ties studied in these papers and other parts o the world that were and are bestunderstood as rontier regions characterized by the obstacles, challenges andopportunities they present.Historians and others have modi ed Frederick Jackson urner’s concept o rontier and used it to rame studies in ar- ung regions o the world. Many early
 
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Medicine in the Remote and Rural North, 1800–2000 
works argued that rontiers were pushed back either because o the demands o domestic and/or export markets, or because o the initiative o adventurous peo-ple eager to carve out a livelihood or themselves. Neither case involved any greatconcern or people already living in these areas. More recently, Magnus Mörnerdemonstrates that this ‘policy o exclusion’ did not characterize all attempts tomove into new territories. Instead, he argues that Swedes who moved north-ward during the nineteenth century generally pursued a ‘policy o inclusion’that involved taking into account the needs and concerns o the local Sami. T isis not to say that there were no sources o contention or that the relationshipbetween the Sami and the new settlers was ree o con ict and suspicion.
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T e point here is that there are considerable advantages to envisioning ‘theNorth’ in a variety o ways that has little to do with its geographical location. T emost useul o these encourage us to ocus our attention on the way governmentof cials, new arrivals and local inhabitants perceived this area. It is also worthwhileto view this area as a  uid rontier best characterized as a region o compromise andnegotiation but also one where underlying sources o con ict were o en aroused.
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 Both approaches o er the opportunity to discover many regions in the world thatwere and are, in some way, similar to the northern societies studied here.
 
Numerous themes and topics are raised in these essays that are relevant notonly to a discussion o how medicine was practised in rural and remote areas o the recent past, but also to current attempts to improve medical care in moreisolated regions o the world in the twenty- rst century. For example, it is nosecret that many governments and NGOs are engaged in an ongoing struggleto improve maternal and inant health throughout much o the world. T eseorganizations and individual practitioners are conronting many o the samelogistical and cultural obstacles as did their counterparts in northern Europe andNorth America who are the subject o this volume. How can these governmentso today rationalize access to medicine and entice trained medical practitionersto work in remote areas? T ere has been a long history o opposition to outsid-ers attempting to impose new medical practices on local populations.
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How didthose doctors and midwives earn the trust and respect o their patients? Whatrole is there or traditional and unlicensed practitioners with the encroachmento more modern medical practices?T ere is obviously an argument or extending the geographical and temporalscope o any collection o essays that addresses such questions but those pre-sented here ocus on the various challenges and rewards o practising medicinein northern latitudes rom the second hal o the nineteenth century to the latetwentieth century. It would be impossible to overstate the hardships that doctors,nurses, midwives, olk healers and patients conronted in their pursuit o goodhealth or, at the very least, a little less discomort in their daily lives. Similarly, itwould be unair to belittle the e orts various governments have undertaken in
 
 
Introduction
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the past to improve the provision o health care or small and widely dispersedpopulations while being simultaneously constrained by very limited nancialresources. However, instead o dwelling solely on these ormidable obstaclesthat conronted practitioners and government of cials, these contributions alsomake a compelling case or highlighting the sense o duty, o responsibility, ando genuine care or the sick shared by all those charged with bringing medicalcare to those who needed it.In addition to providing a window on the development o medical practiceand health care delivery in remote areas and harsh environments, these papersalso augment our understanding o illness and health by complementing thenumerous historical studies dealing with more densely populated environments.People who lived and worked in remote northern settlements were subject toillness and injury just as were their southern or urban counterparts but perhapseven more so. Yet our understanding o the history o medicine and health carein these pockets o population remains spotty owing in part to a lack o interestby proessional historians and in part to the logistical dif culty o accessing andretrieving archival evidence rom such areas. T e ew existing studies that touchupon medicine in isolated areas are generally ocused on the United States o America and particularly the rural South. Many o these can be more accuratelydescribed as histories o rural medicine and small-town doctoring and are notparticularly germane to our northern project.
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Nonetheless, their concern witheveryday medicine’, race, class, gender and the role o the state in nation building and other related bureaucratic activities in under-populated and under-undedrural and remote areas provides additional context in which to ground this col-lection o essays.I it is wise to consider ‘the North’ in a way that downplays its geographicalcharacteristics, a similar case can be made in reassessing what we mean by ‘rural’.T ere are many reasons or de ning ‘rural medicine’ within larger social, cul-tural, political and even medical rameworks than simply using the geographicallocation in which that medical care occurred. One can, albeit unwisely, conjureup dichotomous images o rural, generally healthul environments with inhab-itants engaged in all manner o quaint olk cultures on the one hand, and thedisease inested urban centres with their more cosmopolitan and allegedly morescienti cally advanced populations on the other. Using simplistic spatial ordemographic de nitions to de ne rural and urban areas in the regions o theworld examined in this volume is bound to ail. One would be hard pressed toconsider the locales and regions examined here as being even remotely ‘urban’but they were all rural and remote in many di erent ways.
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T ese essays can certainly stand individually on their own merits or, as hasbeen done here, be organized into groups centring on various themes such asgender, proessionalization and the increasing role o the state in the provision

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