Negotiating Medical Encounters with the Grenfell Mission

By Heidi Coombs-Thorne

The Southern Inuit were the first Indigenous peoples of Labrador with whom the Grenfell Mission, or International Grenfell Association, came into contact. They traditionally lived along the Labrador coast south of Groswater Bay and practiced seasonal transhumance: fishing on islands and headlands during the summer; trapping through the interior and living in sheltered coves and bays during the winter. This settlement pattern was a survival strategy which ensured that Southern Inuit families had ready access to essential resources throughout the year – cod or salmon in summer, timber and trap lines in winter. However, it also made it difficult for Grenfell Mission medical and nursing personnel to reach Southern Inuit families at certain times of the year.

Spotted Islands c. 1930 (RPA, Fred C. Sears Photograph, IGA Collection, A 58-109)

Spotted Islands c. 1930 (RPA, Fred C. Sears Photograph, IGA Collection, A 58-109).

My current research explores the strategies that the Southern Inuit developed to meet their own health needs and to facilitate Grenfell Mission services in the region. This approach stems from my interest in the history of medicine from the people’s perspective of the medical encounter, rather than an institutional, organizational, or practitioner perspective. Although historian Roy Porter called for a patient-oriented history of medicine as early as 1985, this approach has been slow to gain momentum in the field. In his article, “The Patient’s View: Doing Medical History from Below,” Porter pointed out that “…in the past, managing and treating sickness remained very largely in the hands of the sufferers themselves and their circles, the intervention of doctors being only one weapon in the therapeutic arsenal.”[1] However, the history of medicine continues to be dominated by the practitioner lens.

According to Porter, when it came to sickness, some patients consulted doctors some of the time, some consulted doctors as a last resort when other therapeutic methods had failed, and others never called upon doctors at all. This construct applies to the Southern Inuit – they managed and treated their own sicknesses as much as possible; sometimes sought Grenfell services by contacting staff or bringing patients to hospitals/stations; sometimes facilitated Grenfell services by transporting staff to emergencies; and, sometimes negotiated their medial encounters with Grenfell personnel in the interests of their livelihoods. Two cases from the archival record illustrate this last point in particular.

The fishing season was vital to the survival of Southern Inuit families throughout the year. Until the early 1960s, the fishing industry in Newfoundland and Labrador operated through a truck or credit system. This was an arrangement in which merchants supplied fishing families with goods and supplies on credit and then tabulated the cost of those supplies at the end of the fishing season, after setting the value of the fish they bought from the families. Through this arrangement, merchants could assist families through poor fishing seasons and supply them with goods not otherwise available in the outports. But the merchants could also guarantee their own profits at the expense of potential wealth accumulation for fishing families. As a result, many families functioned at subsistence levels and in a continual state of indebtedness.[2] The summer fishing season was their best opportunity to earn the goods and supplies that would maintain them throughout the winter. With that in mind, it was crucial to Southern Inuit families that everyone was healthy enough throughout the summer to participate in the fishery.

It was for this reason that [S.] at Spotted Islands wrote to Medical Superintendent, Dr. Gordon Thomas, requesting to have her husband’s summer surgery postponed.[3] The operation was scheduled for August 1960, in the middle of the fishing season, and would require her husband leave Spotted Islands for an extended period of time and go to hospital in St. Anthony. Because of the importance of the fishing season, [S.] negotiated the circumstances of her husband’s medical services – the summer surgery would have forced an early end to the fishing season, which would have been disastrous for the family. As a result, [S.] asserted herself; and with Thomas she found a sympathetic ear – he rescheduled the surgery for the fall, the operation was not urgent and could be postponed.

There were also instances in which surgeries were more urgent and should not be postponed, but the seasonal movement of the people, combined with the seemingly random arrival of medical personnel, meant that doctors and patients kept missing each other. In October 1955, [A.] at Port Hope Simpson wrote to Thomas asking for a few days’ notice before the doctor arrived to remove a tumor on his neck. The last time a doctor was at Port Hope Simpson, [A.] missed him because he was in the woods working with Bowaters. The same was likely to happen again. In his letter, [A.]’s concern for his family was clear – if anything happened to him, if pain from the tumor became debilitating or if his life was at risk, his family of twelve would be destitute. And although he probably did not often write letters, he was concerned enough about his situation to reach out to Mission authorities.[4]

Labrador, pre-1940 (RPA, IGA Photograph Collection, VA 94-109.22)

Labrador, pre-1940 (RPA, IGA Photograph Collection, VA 94-109.22).

However, Thomas had no way to know exactly when the doctor would be at Port Hope Simpson. The community was visited periodically by a doctor from Cartwright or a nurse from Mary’s Harbour, and their trips depended on the medical circumstances of those centres at a given point in time – they could not leave their posts if there were no other staff members qualified to cover their absence. And they could not travel under certain weather conditions. As a result, there was often very little notice given to when the doctor or nurse would arrive in a community. In such cases, the people managed as well as possible until a doctor or nurse arrived and if a patient’s condition became critical, they would contact the Mission requesting emergency care or they would transport the patient themselves to a Grenfell station.

Despite the significant presence of the Grenfell Mission in Labrador throughout the twentieth-century, the nature of seasonal transhumance meant that the Southern Inuit exercised a significant amount of personal and proxy agency in advocating and balancing their health needs with the seasonal necessities of their livelihoods and the logistical realities of their settlement patterns. This was a pragmatic and proactive approach to meeting their own health needs under extraordinary circumstances – specifically, the distance from Grenfell Mission hospitals and nursing stations and the sporadic health visits of Grenfell personnel combined with the seasonal and often dispersed settlement pattern of the people. The result was a constant negotiation between the Southern Inuit and the Grenfell Mission to meet the health care needs of the people.

Heidi Coombs-Thorne is a research associate with the Faculty of Medicine at Memorial University of Newfoundland.


[1] Roy Porter, “The Patient’s View: Doing Medical History from Below,” Theory and Society, 14(2), p. 182.

[2] See, for example, David Alexander, “Newfoundland’s Traditional Economy and Development to 1934.” Newfoundland in the Nineteenth and Twentieth Centuries: Essays in Interpretation, James Hiller and Peter Neary, eds. (Toronto: University of Toronto Press, 1980): 17-39; James K. Hiller, “The Newfoundland Credit System: An Interpretation,” Merchant Credit and Labour Strategies in Historical Perspective. Rosemary E. Ommer, ed. (Fredericton: Acadiensis Press, 1990): 86-101; and Sean Cadigan, Hope and Deception in Conception Bay: Merchant-Settler Relations in Newfoundland, 1785-1855, (Toronto: University of Toronto Press, 1995).

[3] The Rooms Provincial Archives (RPA), International Grenfell Association Collection (MG 63), File 2965, [S.] (Spotted Islands) to Gordon Thomas (St. Anthony), 21 June 1960.

[4] RPA, MG 63, File 2965, A. […] (Port Hope Simpson) to Thomas (St. Anthony), 24 October [1955].

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