Public Health Nursing in Constantinople

Kai Tiaki : the journal of the nurses of New Zealand, Volume XVII, Issue 4, 1 October 1924, Page 177

Public Health Nursing in Constantinople

Elizabeth Marshall

(By

R.N.)

Constantinople, a centre of so much that has been interesting for the past two years, was the spot chosen for a unique nursing venture. The American Hospital of Constantinople was founded m 1920, and m connection with it is a training school for nurses which draws its material from the many nationalities hovering m and around this great city of the Near East — Turks, Greeks, Armenians, Russians, Bulgarians. As a part of a thoroughly progressive curriculum three months of the student nurses' time m the course of twenty-eight months is devoted to training m public health nursing. Establishing a course m public health nursing m Constantinople was tinged with local colour as striking as a winter sunset over the Marmora. Fortunately excellent opportunities for its growth and development were supplied by the American Hospital. An active clinic was the seed from which our leading district grew. A baby clinic was started m charge of a Turkish children's specialist who has always appreciated the value of a nurse following the patient to the home. The medical clinic brought us tuberculosis and bedside nursing cases. Then an endowed maternity ward made possible a very good baby programme. Women who came for clinic^ examination during their pregnancy were gathered together as members of a pre-natal class which meets once a week, a class which began with two members, and had an average attendance during the month of .May, 1923, of 41 members. Undoubtedly the size of this class is affected by the fact that through it the applicants for free beds are heard; but nevertheless the regularity of attendance and the interest shown, women oi'ten coming from their fifth or sixth month, walking long distances over difficult, crowded streets — gives proof of the popularity of this class. The usual pre-natal instruction, including demonstration and urinalysis work, fill up the pre-natal hour. These women are also visited m the homes, and helped m every way possible to lay aside the old customs

dating back to barbaric days and to take up the new — offered by strangers whose ways are always to be suspected. But results have been forthcoming. In the way of dressing the babies, for instance, custom says they must be bound m swaddling clothes so that they are stiff like a stick, and the little loose head rolls around m a most distressing way. Comfortable clothes giving freedom for the baby's movements and growth, warm, clean clothes, have found favour with many of the young mothers. A purple blanket over a yellow dress over a rose shirt and pink diaper — but the baby free and happy. The great aid m driving home the instruction regarding the care of the baby is, of course, the perfect demonstration during the mother's stay m the hospital, for many of these women come to the hospital for delivery. After the return home, again the nurse visits to help the mother keep her baby well. There is a well babies' clinic to which she returns once a week for the weighing and the continuation of instruction. This class is a great joy, with all sorts of homely babies, lovely babies, fat babies, thin babies, litle Turks, little Tartars, little Greeks, little Arabs, little Kalmyks, little Armenians, little Russians. Gratitude comes from these mothers m ways touching and otherwise. There was the moth* r who came back after a year to give to the hospital for the care she had received 2 liras (about $1.25). A fat Kalmyk baby, because he was born m the American Hospital, is blessed with the name 'America/ The home visiting has met with most of the vicissitudes and joys of other cities. To no home has entrance ever been refused, although some have been rather cold at first. Some have grown cold when they found that no money, no food and no clothes could be begged; that it was only for health the nurse came. Nursing care m the homes is very difficult. Most of the beds are blankets or mattresses on the floor; frequently the water must be carried from the street fountain perhaps two blocks away; the one-room homes are

scantily equipped with even those things we think are essential, and this is not always due to poverty but to lack of knowledge or desire to live any other way. True it is that many of the people are wretchedly poor, but their wretchedness is often much less than we picture it, because they know nothing better and wish for notMng better. There was the case of Serpe, an Arab woman, whom we urged to clean up the room for the baby's birth. Finally she told us that this baby was blessed enough to be born under a roof, all her others had been born m the hills.

The visiting has taken us to the Russian refugee houses, to the old "hans," which are Constantinople's tenements; to homes that shelter a family m each corner; to more prosperous homes of two, three, four and five rooms. The Turkish family is private and sheltered, so that the nurse does not always find it easy to gain entrance there, but the young Turkish mother we have found receptive and responsive. The Greek and Armenian mothers usually learn quickly how to give the correct answers to questions on the babies' health, but they find it hard oftentimes to get out from under the influence of the old women who infest the home of a young infant. The open window question does not usually have to be emphasised — the houses are so poorly built, the difficulty lies not m keeping the air fresh, but m keeping it warm. The same troubles of irregularity of habits of life, hick of cleanliness and the pacific]* are found here as everywhere else. But the deepest difficulty seems to me to be the fatalistic philosophy of the people. Allah gives the babies, Allah takes them; the mothers accept a high mortality with their babies; babies have always died m great numbers. To them it is because babies arc weak and have not been given enough strength. The mother's and father's share m this they do not see. Takouhi is 32 years old, a member of our pre-natal class, pregnant for the eleventh time, and it was without the quiver of an eyelash that she told me that nine of her children had died before they reached the age of five. The tenth is still living.

"What is most satisfying, however, is the attitude of the pupil nurse towards public health nursing work, something most of them had not even heard of before they entered the hospital. Without exception they understand the opportunity that this work offers for their people. They feel that perhaps if they cannot establish hospitals or schools of nursing they can, even if working alone, give some good gift to their country. They see that hospital service, clinic service and home service are closely interwoven and interdependent. The value of their hospital training is understood so much more clearly, and frequently the nurses go back to hospital duties from their public health experience with a new determination to learn more definitely, more completely and more lastingly. It is a happy thought, too, to think of a nurse working m Anatolia with the babies and children, another returned to the new Russia establishing a training school which has public health nursing m its curriculum, and still others m Bulgaria, m Greece or right here m Constantinople — eacli taking up and carrying on the health problem of her community. — From the "American Journal of Nursing. n