Comments
Thank you for a great presentation! You mentioned the education / training these new midwives and nurses had got in the 1940s and I was thinking how this affected the ways they experienced their work. I would guess that it contained quite some ideological guidance as well, a kind of “script” to understand one’s caring work in national and collective terms. Probably the midwives and nurses were “trained in loneliness”, i.e. to be the sole representatives of the nation and the health profession in vast and distant territories. Maybe this had a sociomaterial aspect as well, being trained to use and introduce modern equipment and new practices? Education / training was also a collective experience for the midwives and nurses, although they were then separated from their colleagues. I wonder if you can include this training background to your analysis in some way? And maybe there were some annual regional conventions (“neuvottelupäivät”) where the experiences of loneliness etc. were shared and discussed?
Thank you again, Ville for this very important point. I absolutely agree that education and training were collectively experienced among the midwives and nurses. In the poster social on Tuesday, I mentioned that many midwives describe being shocked about the circumstances in the North and thus, I doubted that they were sufficiently trained for the loneliness/responsibility they encountered. However, I now think might have rushed a bit there. I only have a very preliminary understanding of what the educational curriculum contained, but I remember there being a heavy emphasis on the importance of midwifes’ and nurses’ role as an educator among the local people they worked with. Because their work involved a lot of home visits, nurses and midwives were thought to have closer relationships with the locals than the doctors that worked mostly in the clinic and this was also stressed to the students. The role of medicines in the treatment of illnesses increased during this period and the midwives (especially the older ones) seemed to have mixed feelings about this, but this is something that I have to take a closer look at. I would also assume that the war and postwar national spirit is something that affected the experiences of young professionals. I know that some of the midwives/nurses had been part of Lotta Svärd during the war and the vocation to serve the country was the reason some wanted to continue to study a profession in healthcare. Many of the midwife/nurse students were very young, in their twenties when they started their education and the training to become a midwife/nurse took two years at the time. Age must have been a big reason for the feelings of loneliness as well.
Midwives and nurses did have annual regional conventions, this is a good point as well when thinking about the sharing of experiences. I still have to do more archival searches on these.
Many thanks for your very interesting and “immersive” presentation, the addition of film clip and sounds was a nice touch. Regarding your discussion, I was wondering how the interior and materiality of the clinics was organized; i.e. was there a standard equipment for every clinic, and/or did the nurses and midwives have to order it according to their specific and local needs? Were there differences in the interior design of individual clinics, such as personal touches through colour schemes, decoration, patient-specific elements (regarding children, the Sami population, local languages…) that might be visible on photo material or talked about in written sources?
Hi Anna and thank you so much for your comment. Architecture and interior design are definitely interesting topics especially when it comes to the sociomateriality of experiencing and more precisely to the shared aspect of those experiences. Indeed, the clinics had a standard architectural design or a couple of standard models through which the after-war clinics were built. They had a certain number of patient rooms, sometimes a separate child health room, a room for a doctor’s reception, and a midwife’s reception. Some of the clinics also had a built-in midwife’s or nurse’s room, which was her home. If I have understood correctly, the clinics looked very much the same inside out. The municipal clinics were guided to have permanent educational boards in them to educate the patient about health and hygiene. I haven’t yet researched enough the details of photos and written materials that describe the interior of the clinics to say if local needs were somehow taken into consideration in the interior decoration per se. There were some educational leaflets on health/hygiene in the North Sámi language, but I haven’t seen any education boards on this. However, what I have come across, are the personal touches you mention. Because some midwives worked and lived in remote health lodges for long periods of time it is maybe no wonder that the spaces were also partly decorated to their taste. Midwife and a nurse Rita Berggren (who you can find in the first cover photo of my presentation) worked in the Outakoski health clinic for two decades and in her photos, you can find for example houseplants all around the clinic and self-made rugs on the floors. One interesting thing that doesn’t have to do with decoration but to the personal likings is that Berggren also had a dog and at least one cat in the clinic and the photos speak to her having a fond relationship with these animals.
Thank you for a very interesting presentation! As for your comment on loneliness as one of the most often shared experiences, I would like to add that I have come across similar shared experiences among the late nineteenth and early twentieth century poorhouse matrons, who often worked far away from their own home parishes and could be somewhat isolated from their new communities because of their status as both newcomers and professionals. In order to mitigate this, the state poor relief authorities actually suggested that municipal authorities should take the applicants’ backgrounds into consideration when appointing a new matron to the poorhouse: for example, from their point of view, it was not necessarily wise to choose a western Finnish candidate for a job in the eastern parts of the country. So, I was wondering whether you have come across similar attempts at regulating the emergence of a particular kind of (shared) experience among midwives in your source material.
Very interesting Johanna, thank you for sharing! I haven’t actually paid attention to this, but I will definitely take a look at my sources again through this lens. What this does bring into my mind are descriptions written by provincial midwives in annual reports about the poor housing conditions and inadequate means for traveling many of the midwives encountered when starting their job in the North after the war years. The provincial midwife tried to influence the decision-makers to make improvements on this as these points were listed as some of the reasons why the turnover rate of midwives and nurses was high in Lapland at the time. Often in these reports, the authorities hope to fill open positions by skilled professionals with both the qualifications of a nurse and a midwife, but this was usually hard because the need for professionals was high and professionals with both qualifications were scarce. So I would assume there is this type of regulation, you Johanna describe.
Thank you for your excellent poster ! Just a very small comment to continue Johanna’s thoughts: Leea Liuksiala’s research on Public health nurses and their “adjustment to rural social community” from 1954 has a regional comparative perspective, and it could open a perspective to how the circumstances in Lapland were different from other areas. Liuksiala points out that there was an aim to hire nurses from their home region to work at the remote areas of Finland especially.
Your starting point in analysing the new profession of midwifes and nurses in the most extreme circumstances in the north is excellent, as in such circumstances the different tensions that were linked to the sociomaterial practices of the profession were presumably most clearly visible.
Thank you Minna for this tip. I had heard about Liuksiala’s research before, but had already forgotten it. I will look for it now, for sure. Also, your words about the topic/starting point of my analysis really warm my hearth, coming from an expert as you are in the history of Finnish health care – your works have been extremely insightful for me. Your question in the poster social on Tuesday about the expectations vs. experiences of midwives and nurses in Lapland very much stuck with me. My answer wasn’t the most coherent one at the time: for example I wish I had talked about the image of the exotic Lapland that at least some of the midwives and nurses from Southern Finland had before arriving to their new position and which for sure influenced how they encountered the for them new environment in the North. It is a good point that the expectations also ushered the experiences, I have to look more carefully into this. Wish to continue discussion in the future with you Minna!
Thanks for your very interesting presentation! In light of your question about the limits of shared experience, I wonder if you could comment on patients’ sociomaterial experiences, especially those of the Sami? To what extent do you think their experience was shared with the midwives and non-Sami patients? What about the tension between traditional and “modern” healthcare practices/objects?
Hi Stephanie, thank you for your comment and important questions! The question of the Sámi experiences is something that I see as highly important, and the argument about inclusions and exclusions of shared experience that I pose in the presentation definitely has roots in thinking about how the Sámi were met in the health care institutions at the time. I’m afraid I am still hesitant to answer this question for many reasons. For now, I have mostly been concentrating on the experiences of the professionals and my research on the patients’ experiences is thus thin. I am also still searching for ways to conduct my research as ethically as possible considering that I am a Finnish researcher. But maybe there is something that I can say, however, based on the literature that I have read.
The wartime and especially the Lapland war had a great impact on the people living in the North – it was a material, cultural and mental catastrophe as historians Marja Tuominen and Mervi Löfgren have put it. Sámi professor Veli-Pekka Lehtola has written extensively on Sámi history and the encounters between the Sámi and Finns in the past and argues that reconstruction after the wars meant many conflicting things for the Sámi. It raised the standard of living, improved the road network, and brought the Finnish society closer. However, it was the Finnish society that held the power to define cultural values and ”right ways of acting”. The Sámi strived actively to adapt to the new situation and in part, this meant assimilation into Finnish society. Health care was of course part of this assimilation. Social services and security are often considered as an integral part of Northern welfare states. The Sámi were considered as Finnish citizens, and thus had equal rights and access to the same services as other Finns, but those rights were defined by the Finnish state. This meant for example that majority of the services were given in Finnish (not in the three Sámi languages spoken in Finland).
After the wars, the Sámi homeland in Finland was entirely built after the Finnish standardized house models and Lehtola has noted that many of the Sámi considered that living in a Finnish house meant also adapting to the Finnish lifestyle: clothing, farming, language, etc. So I think – or at least my hypothesis is – that the Sami experiences related to health care and its objects and places were also part of this bigger ”adaptation to the Finnish way of life”. (Here, I think it is important to note that the Sámi experiences of course also varied depending on for example where they were evacuated and how the war affected their home area).
I haven’t found extensive research on the history of health care or maternity care in Lapland that would take the Sámi people into account. Lehtola notes that the Sámi experiences related to the time after the wars stem from the same background as the experiences of other inhabitants of Lapland, though the Sámi of course had a different cultural background. The reconstruction of Lapland and as part of that the health and maternity clinic network built after the wars had a ”modernizing effect” on Northern Finland. The change was quick as in a couple of decades the place for giving birth changed from homes to clinics and all children now received monitoring from child health centers. The last question about traditional and ”modern” healthcare places/objects is an interesting one and something that I have to dig deeper into. However, I assume that the tension between these two had been highest already before the wars.
Returning to the question of shared experiences between midwives and patients, one interesting aspect comes across from former research on the midwives working in the North, that is, close relations between professional midwives and the mothers they worked with. In their reminiscences, midwives describe themselves as much more than only a person helping in the delivery of a baby. They shared life’s ups and downs with the mothers who in small communities became close to them. How the feelings of joy and sadness were related to the objects, places and bodily encounters is a fascinating question that deserves more attention. Also here again we run into the concern that the stories/reminiscences of midwives don’t necessarily tell the whole truth as it is possibly more likely that the midwives/nurses that had a positive overall experience of their work wrote about it.
I hope this provided at least some food for thought, if not clear answers to the questions Stephanie. Thank you again, hope to continue the discussion!
Thanks for a great presentation! You mention age, economic situation and background as elements in experiencing; but how is sociomaterial approach linked to construction of gender in your work?
Sari Katajala-Peltomaa
15.3.2022 11:21
Ah, what a beautiful question Sari, this is definitely one of my interests even if it didn’t show in this particular poster very well. There must be many examples on this but I’ll concentrate on a few here. The first thing that naturally comes to mind when thinking about sociomaterial experiences and gender is the professional clothing of midwives and nurses. They had similar dresses and now that I am thinking about this, I don’t think there ever was a professional uniform for a male nurse/midwife because there weren’t at least to my knowledge any. So gender is very highly linked to the profession of a midwife/nurse. I have also been interested to try to research for example expressions and gestures on photos and video material and these are also very much linked to the social gendered norms of the time and in addition affect experiencing.
One other sociomaterial aspect that comes into my mind is the interior decoration of small health clinics/maternity clinics that were run exclusively by midwives/nurses (in these clinics, there weren’t a doctor who at the time was usually male and who were mostly based in the bigger municipal clinics). Because the clinic often included the home of the midwife I have come across eg. pictures were you can see the personal touches the midwife has left there. In a health clinic in Outakoski, midwife Rita Berggren, who you saw in the presentation as well, had a lot of house plants in all of the windowsills and selfmade rugs covered the floors. I think that a sense of caring as a shared feeling can be find in these decorations. This feeling of taking care of others was a big part of a midwife’s and nurses’ vocation more generally and is of course a highly gendered aspect, as caring was something that was especially linked to women and their role in society at the time.
Jenni Räikkönen
17.3.2022 17:06