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Saturday November 24, 2012

A decorated, celebrated, altruistic activist

She fought to revamp the health-care education system and led the charge that turned nursing from a vocation into a profession


Helen Mussallem graduated from nursing school at Vancouver General Hospital in 1937, a class that was remarkable because it was the first to be taught how to take a person's blood pressure - a high-tech innovation at the time. It was also the first to do clinical training, to work with patients before graduation.

But the greatest claim to fame of the class of 1937 is, without a doubt, Mussallem herself. She was a trailblazer, her storied career a microcosm of the evolution of modern nursing. And, along the way, she helped to reshape health care in Canada and nursing education around the world.

Mussallem died on Nov. 9 at Ottawa Hospital Civic Campus surrounded, fittingly, not only by family members, but nurses. She was 98 and suffering from congestive heart failure and pneumonia.

Helen Kathleen Mussallem was born during the First World War, on Jan. 7, 1915, in remote Prince Rupert, B.C. Her parents, Lebanese immigrants, later moved to what is now Maple Ridge, B.C., where her father was the long-time reeve and an entrepreneur.

A lively child who excelled in school and helped in the family business, an auto repair shop, she was keenly interested in politics and travelling the world but, at the time, career opportunities for women were limited and, during the Great Depression, money was scarce.

Mussallem enrolled in nursing school in 1934 and, as was the norm at the time, began to practise in the hospital where she was trained.

At the outset of the Second World War, she was quick to enlist, joining the No. 19 Royal Army Medical Corps as a lieutenant. Initially, Mussallem's job was to train medics in basic first aid, but she was keen to do hands-on work and spent the entirety of the war at the front, as a surgical nurse in battlefield hospitals.

"Our job was to patch soldiers up enough to get them back to Canada alive," she recalled in a 1995 interview. Life on the front was very different from staid, hierarchical institutions back home, where nurses in starched white had to stand when a doctor entered the room.

In the army, the work was treacherous and hard but nurses were respected and powerful, unlike their civilian counterparts. She recalled, with amazement, that army surgeons asked her opinion and appreciated her capabilities, and that experience shaped her career.

After the war, Mussallem used her veterans' points - credits that could be used for education and to purchase land - to study at McGill University in Montreal, where she completed a bachelor's degree in nursing. There were only 12 women in the program at the time and, in addition to their studies, they were responsible for training younger hospital nurses. That set Mussallem on a course of lifelong interest in nursing education.

She went on to do a master's degree in education at the University of Washington in Seattle and then did doctoral studies at Columbia University in New York. Mussallem was the first Canadian to get a PhD in nursing, and her thesis, fittingly, was about the need to improve nursing education.

In that period, to finance her studies and her travel, she returned regularly to Vancouver General Hospital, serving in a number of administrative and teaching roles over a decade. But in 1957, she accepted a contract with the Canadian Nurses Association that would change her career path - along with the nursing profession itself and the Canadian health system more broadly. In the postwar years, there were dramatic advances in medicine and massive changes in health-care delivery as the building blocks of medicare were being constructed. But there were no standards for teaching or clinical practice in the country's 25 nursing schools.

Mussallem conducted an exhaustive one-woman inquiry, travelling more than 90,000 kilometres and personally interviewing 2,000 nurses, educators and administrators. Her report, titled Spotlight on Nursing Education, was a bombshell when it was published in 1960. She concluded that education standards were disgraceful and nurses were little more than indentured labour who needed liberating. (Most hospitals trained nurses themselves and forced them to live on-site, guaranteeing themselves a cheap, captive workforce.)

"There was fire coming out of my pen when I was writing that report," Mussallem recalled. The recommendations - to revamp education from top to bottom - infuriated hospital administrators and inflamed nurses. Shortly after the report's publication, nurses at the VGH, her alma mater, walked off the job to demand better work conditions, the first strike by Canadian nurses. A massive unionization movement followed, as did a complete revamp of nursing education.

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