Jurisdictional Boundaries and the Challenges of Providing Health Care in a Northern Landscape

Abstract

Professional nursing services were introduced into many rural and remote areas of Canada following World War II, especially Western Canada. At the time, the goal of governments was to provide health care to the previously neglected residents of the region, especially Aboriginal peoples.1 In the prairie provinces of Alberta, Saskatchewan, and Manitoba, small clinics and nursing outposts were created by both provincial health authorities and the federal Indian Health Services. These two types of health care facilities existed side by side; but they served different people because under the British North America Act in Canada's Constitution, were a federal responsibility. Jurisdiction over Indians and their health care was further deepened by the existence of federally negotiated treaties in these regions, some of which contained terms relating to health care. Thus, provinces did assume any responsibility for Indians. Provincial nurses were deemed responsible for the nonstatus, nontreaty Indian, Metis, and non-Aboriginal population, whereas federal Indian Health Services nurses attended the treaty status Indian population.Although these legal boundaries established distinct spheres of responsibility, inevitably duplication of services and confusion as to who was an Indian led to disputes over who should provide health care to whom. In Manitoba, Saskatchewan, and Alberta, federal and provincial governments often found themselves in a tug-of-war over patients and who should pay their fees because each division of government sought to minimize its health and welfare obligations in these regions. Ultimately, this jurisdictional wrangling interfered with the way nurses carried out their duties and put both patient health and professional nursing standards at risk.The provincial place that is the focus of this article is Northern Saskatchewan- not the Saskatchewan of wheat fields and grain elevators that exists in popular imagination but a treed place, clothed in boreal forest, rock, water, muskeg . . . and firmly situated in the geography and ethos of the north.2 For the most part, Northern Saskatchewan was ignored by both provincial and federal governments with an attitude that can be described as benign neglect. But after World War II, the region's relative isolation changed dramatically because of resource extraction projects and the proliferation of government institutions that affected every aspect of life for residents in the region.3When Northern Saskatchewan was formalized as a region in 1944, living conditions for the people there-many of Aboriginal descent-were appalling. Hospitals and schools were lacking. There was little decent housing, communication and transportation systems were inadequate, and there were virtually no government-run social services. Indeed, northern residents inhabited a landscape of hardship. It is into this landscape that small outpost nursing stations, operated by a lone provincial public health nurse, were introduced. But the nurses quickly encountered jurisdictional obstacles that, at times, impeded their efforts to provide much-needed health care services.Although it is possible here to explore the complex historical relationships that evolved between the state and Aboriginal people, suffice it to say the results were spatial and social boundaries that effectively split the population and landscape into different jurisdictional realms. Consequently, nursing practices and jurisdictional divisions contrasted sharply in the northern landscape-nursing was inclusive; jurisdiction was divisive. But the two were intertwined and, as this article will illustrate, profoundly affected how the nurses carried out their work. Sadly, the divisions became more entrenched over time and continue to plague health care delivery in the region.This research draws from an archival collection documenting the experiences of nurses working in Northern Saskatchewan between 1944 and the mid-1950s to late 1950s. …