CHAPTER XVII
The Problem of Giving Relief—The Giver of Relief—Co-operation between Agent and Nurse—General Rules for Nurses and Agents—Conditions of Asking for Relief—Wrong Conditions of Relief-Giving—Incidental Assistance—Withdrawal of Relief—Supplying Milk and Eggs.
The Problem of Relief-Giving. Giving financial assistance or relief to patients on or below the poverty line is a question which sooner or later confronts the nurse who undertakes social work. Long hours, overwork, and low wages produce a class of people who offer little or no resistance to disease, and when tuberculosis once gets a foothold amongst them, it is passed on from one devitalized individual to another. This is why it is necessary to remove a disease-distributor from among a group of highly susceptible individuals. For example: let us take a family consisting of father, mother, and four children. The father contracts tuberculosis and stops work—his income also stops. Even at best, it was a pitifully inadequate income, and in consequence the entire family is undernourished, anæmic, and generally run down. With the income gone, their resistance is still further lowered, and their chances of infection are correspondingly increased. The result is a patient surrounded by a group of people able to offer but slight opposition to this insidious disease. The environment, bad as it was originally, grows worse. The family moves into smaller, fewer, cheaper rooms, and food, heat, clothing are all reduced to a minimum. This increasing poverty means diminished vitality, and heightened susceptibility to the threatening danger. In attempting to relieve this situation we are dealing not with a simple, but with a twofold problem—poverty, plus an infectious disease.
Because of its complex nature, the question of giving assistance is a difficult and delicate matter. In our efforts to relieve distress and want, we must be careful to do nothing which will result in spreading tuberculosis. The paramount consideration is the prevention of infection, and for this reason, relief should be made conditional upon the removal or reduction of the danger. If we keep this idea firmly before us, the problem will be much simplified.
In Baltimore, from one third to one half of the families under supervision are on or below the poverty line. This means that they are registered on the books of some charitable association, and are, or at times have been, dependent upon these organizations for food, rent, fuel, clothing, or other assistance. In other words, the gap between the income and the cost of living has needed to be bridged over by outside aid. In a new community when the nurse’s first patients are the “poor people” of the locality, she will find that nearly a hundred per cent. of her cases are on the poverty line. This was our experience in Baltimore, when the work was first organized, but now that it is well established the percentage is much reduced. The nurses are now working in homes where economic conditions are not acute, hence the number of those receiving or rather of those needing relief (the terms are not always synonymous) is less than a few years ago. Still, distressing poverty is found in from one half to one third of the families, which means that the problem of fighting tuberculosis is gravely complicated.
The Relief-Giver. When people need financial assistance, the question arises, by whom shall it be given? a point which provokes much discussion. Many people think that the nurse should give this relief, because of her intimate knowledge of the home conditions of the families under her charge—a knowledge far more extensive than that gained in any other way. Some think if she is socially trained, i.e., supplements her hospital training by a course in a school of philanthropy, that she can combine the duties of both nurse and charity organization agent, and become in this way a most effective social worker. By this combination, the family will be spared the infliction of two visitors, nurse and agent, a desirable result, since the advice given by these two workers is often flatly contradictory. Other people think that instead of having a nurse, it would be better to have a graduate from a school of philanthropy, with a training supplemented by a six months’ hospital course. The superficial nature of this course is sufficient commentary on its value. Moreover, more than one half of the patients with tuberculosis do not come within the reach of a relief-giving agency.
These two people, nurse and agent, are both specialists in their own lines, and they are equally needed. They have had a different training and are equally valuable in the field of social service. Even if it were possible, we should not like to see these two offices combined in one person—somewhere there would be a loss. It is difficult enough to get a first-class tuberculosis nurse, and it is equally difficult to find a first-class charity organization agent. How much more difficult to find these combined in one person. There is full warrant for saying that under no circumstances whatever should the nurse become a relief-giver, or even remotely identified as such. In the foregoing pages we have learned something of the extent and responsibility of her work, and if she concentrates her attention upon bringing it to the highest degree of efficiency, she will find time for nothing else. Moreover, if she becomes known as one able to give material assistance, her value as a public health nurse will decline. That she can give or withhold relief will become known to her patients, who will follow or reject advice according to what they receive from her. Her prestige as impartial, disinterested adviser will at once diminish, and the force and authority of her opinion be lost. Never, even by the gift of a five-cent piece, should she jeopardize her unique position. The well-to-do patients will scorn her services, and resent the implication of her visits, while the others will follow advice when they are bribed, so to speak, and do as they like when for any reason this bribe is withdrawn. And other patients will be disobedient or resentful if they cannot obtain what their neighbours have, or what they believe themselves entitled to.
Co-operation not Interference. To concentrate on one’s specialty is all we should ask of anyone. Any social agency which scatters instead of concentrates, produces superficial work, which is open to well-deserved criticism. As well expect a nurse to become a kindergarten teacher, because she sees the need for kindergartens, or to become a playground teacher or settlement worker, as to take upon herself the rôle of charity-organization agent. And the reverse of this is true. We should not expect a relief-giver to undertake a nurse’s duties. It is not the combination of various effective qualities in one person, but the co-operation of various effective persons or specialists, which counts in social service. Furthermore, each set of workers should recognize its own limitations. The line of demarcation should be sharply drawn between the work of one agency and that of another.
One sometimes encounters an intense zeal which causes one social worker to try to do her own, and everyone else’s work as well; or even worse than this, to neglect her own work in order to do that of another person. All social workers should learn where to stop—where to transfer the case to someone else better fitted to deal with another phase of it. We sometimes hesitate to call in other agencies, because they do not recognize their boundaries. Co-operation should be substituted for rivalry and interference; when this is brought about, petty bickerings and jealousies among the social agencies will cease.
To become an effective co-operator, instead of a critical interferer, the public health nurse must familiarize herself with all the agencies in the wide field of social service. She should try to understand the object and method of their work, and to know where her own work interlocks with theirs. In a way, they are all interdependent, one upon the other, and have the same object in view—to relieve distress and raise the sum total of human happiness. Whether their work is effective or superficial is not our concern. The nurse should understand what each of them has to offer, and by picking here and there among them, secure valuable assistance for the families under her charge. She can thus reinforce her own efforts, and supplement her own work in behalf of their well-being and security.