XIII

FIELD WORK WITH THE IMMIGRANT

THE evolution of the field agent, who in practice is either a visiting nurse, a social worker, or both, is a most significant recent development in medical organization. Fifteen years ago there were a few hundred visiting nurses in the United States; to-day there are probably over ten thousand.

The field agent has been the common denominator in the series of campaigns which have swept the country in the last twenty years, directed against some disease or group of more or less preventable diseases. Each of these has been initiated, guided, or pushed by national and by local organizations formed for the purpose. First in the field was the antituberculosis campaign. There followed in rapid succession national movements to reduce infant and maternal mortality, to control cancer, to control and prevent venereal disease, to promote school hygiene, dental hygiene, and mental hygiene. The striking fact, apparent after a slight survey of these various movements, is their common dependence for practical success upon the field agent. A similar development may be traced in the social-service departments of general hospitals and dispensaries.

Through the field agent the clinic or medical center reaches directly into the homes of the people. She does two things-she renders service and she educates.

Bedside service to sick people brings a response in gratitude and sympathy which lays the foundation for effective educational work. The field agent means the beginning of a closer relation between the objects of medical and health work, the people, and the agents of such work-the doctors and administrators; she means that medical and health work ceases to be passive and begins to seek out its subjects; she means the beginning of localization, making a democratic neighborhood relation possible between those who serve and those who are served.

The success of the visiting nurse and medical-social worker in various practical efforts in curative and preventive medicine illustrates our principle that successful service must include the study of people as well as of technique, and should be localized as thoroughly as possible in order to develop personal relations on a democratic basis.

Hence the experience of field agents is important in developing the technique of health work with the foreign born. What are the problems of militant health agencies in dealing with the immigrant? What special problems do the visiting nurses and hospital social workers meet in the immigrant's home? What methods have been most successful? What difficulties are still to be solved? These are some of the questions answered by nurses, social workers, and executives of some fifty social-service departments, and about two hundred tuberculosis and other health agencies.

THE PROBLEM OF APPROACH

The first necessity of the field worker is to establish contact with the foreign-born family. In many cases

these are recent immigrants who speak no English. Her object is to get them to do something or allow her to do something for them, for the good of their health. She must either convince them of the worth of her recommendations or inspire them with such confidence in herself that they will take her recommendations on faith. The nurse's most obvious difficulty is ignorance of the foreign language; a more fundamental difficulty is ignorance of the immigrant's social backgrounds and point of view.

The use of the nurse of foreign birth or parentage would seem on first consideration to solve both difficulties. One association writes:

We had a Polish nurse who was very helpful. She was Polish born, spoke German, French, Swedish, besides understanding a good many of the dialects.

Another statement comes from Denver, Colorado:

We have had only one nurse who was foreign born on our staff. She was Italian and of average ability, but very popular with her patients.

Further examination, however, discloses limitations to this service. Comparatively few foreign-born girls take nurse's training, either because they have not the prerequisite education or because other vocations take less preparation and yield a quicker return, or because national customs hold personal service in lower regard than clerical work or teaching. Among nationalities where marriage is considered the only respectable profession for women, any kind of paid work is regarded as demeaning.

Moreover, it seems to be a question whether foreign birth is in itself an advantage. It is the experience of

several associations that nurses of foreign birth do not possess American habits of personal and home hygiene to a sufficient extent to push them with their patients against the inertia of generations. They lack conviction in their message and confidence in their pupils' ability to change. Sometimes the conviction is present, but accompanied by contempt of, or impatience with, their compatriots. On the other hand, it seems logical that a family inclined to adopt American ways would prefer to learn directly from a native American. Testimony on these points was received from a number of places:

We have had one or two [foreign-born nurses] and our experience has been that the families did not care for them and I do not think the nurses are as patient with people of their own nationality as with others.

We have one Polish nurse and have had Italian nurses, but we have found that these women do not have so great an influence upon their own nationality as does an American

nurse.

The reason English-speaking nurses do better work than the Spanish-speaking is that their environment and training have given them an opportunity to see the advantage of their work.

Foreign-born nurses often have a very strong influence with their patients, but it is probable that they secure this, not through their foreign birth, but through their knowledge of the foreign tongue and customs.

BARRIER OF LANGUAGE

Native-born nurses, except for a relatively few, must overcome the language barrier by the use of interpreters and foreign-language literature. There is little

organized provision for interpreters in this country. Therefore, the nurse must depend upon whoever can be pressed into service at the moment. Most frequently this is a neighbor or a child of the household, rarely a paid interpreter. Interpretation demands so much understanding, conviction, and sympathy, besides mere translation, that it is not surprising to find differences of opinion as to whether children or adults prove more satisfactory.

The case against the adult relative, or neighbor, may be stated as follows:

The question of a paid interpreter has been the most difficult one, for it is almost impossible to obtain an adult who will not incorporate her own ideas into the interpretation. It is imperative that the nurse understand some of the language with which she is dealing, if she is to meet with the greatest possible success. (Detroit, Michigan.)

Of course the difficulty in using an interpreter is their tendency to put their own construction on the sentence to be translated. (Worcester, Massachusetts.)

An exception is stated as follows:

It has been my personal experience that when a young couple are living alone they are usually anxious and willing to learn from us and the man makes an interested and faithful interpreter.

When such an interpreter is found, the nurse can do no better than to make use of him.

In families where the children attend American schools, speaking English at school, and the mother tongue at home, they are often the most available translators. In so far as the child is relatively free from old-country traditions and from motives of selfinterest, he can truly render the message as spoken.