Canadian Nurses Foundation

My relationship with the Canadian Nurses Foundation (CNF) was interesting and varied from great hope to despair as to its future and its goal of providing selected nurses with the opportunity to pursue graduate education. My commitment and dedication to this goal was another spin-off from my cross-Canada surveys of nursing education in both hospital and university schools of nursing. I knew that, if nursing service was to improve, the education of nurses for that service must, likewise, be improved. Along with many other “senior” nurses, I recognized that advanced education for nurses was imperative if nurses were to be accepted as an equal voice in the decision-making circles of the health care system. A personal note adds validity to this statement. As CNA’s Director of Special Studies (1960-63) I attended the CMA CHA CNA Committee meetings to report on the status of nursing education in Canada and to describe to the committee the projects undertaken by CNA which had been initiated as a result of the recommendations of my Pilot Project on the Evaluation of Schools of Nursing. The first meeting I attended was held at CMA headquarters in Toronto. The group from CNA entered the committee room through the side door. All other representatives seemed to come from somewhere else. At the next meeting, after I obtained my doctorate in 1962, I was met at the front door by the CMA General Secretary. I was astounded to be ushered in, to walk on the richly-carpeted hallway, and to be told that the CMA president would like to see me. Three times I was referred to as DOCTOR Mussallem. Then, I was taken to the committee room at the rear of the building. I was suspicious that my doctorate (the first earned by a nurse in Canada) might have been responsible for this unusual gesture and the CNA Executive Director, Penny Stiver, confirmed my suspicion.

In 1961, while I was Director of Special Studies, the CNA Executive Committee -influenced, perhaps, by the findings of the Pilot Project for Evaluation of Schools of Nursing –decided that “… the time had come when the Canadian Nurses Association should consider establishing a foundation”. A Special Committee, called the Canadian Nurses Association Foundation, was created in 1961 to work out the details necessary to establish such a foundation.

In February 1962, the Special Committee, Canadian Nurses’ Association Foundation, presented its report. The Executive Committee decided at this meeting that the Foundation would be known as the Canadian Nurses Foundation (CNF), and that its purposes would be: to provide financial support in the form of awards to nurses pursuing graduate studies at the masters and doctoral levels; to provide grants for nursing research; and to administer funds donated to the Foundation for the above purposes. CNF came into being in 1962 when the Kellogg Foundation awarded CNA a donation of $150,000 (U.S.). The preparation of the brief for the Kellogg Foundation requesting $150,000 (U.S.) for the establishment of CNF (and the accompanying strategies) and CNA’s success in obtaining these funds – to be spread over a five year period –was due primarily to the expert and scholarly work of Katherine MacLaggan. The CNA Executive Committee was preparing to have this Foundation set up within CNA but as the Kellogg Foundation required a receipt from a “charitable” agency for income tax purposes, a foundation was created by CNA to facilitate this request. In the early years of the Foundation, office space and administrative services were provided by CNA.

When the Kellogg grant arrived in Ottawa, CNF was advised that the amount allocated for 1962 scholarships must be awarded before the end of August 1962. Word of the new scholarships was disseminated and a number of applications were received at CNA headquarters. Then, I gather, a Selections Committee needed to be appointed. As it was early August, few staff or other suitable persons were available. I had just successfully defended my doctoral dissertation at Columbia and had returned to Ottawa, as promised. On arrival, I was advised that I was to work with Katherine MacLaggan to select the first “scholars”.

At the appointed time, I met with Katherine in her room at the Chateau Laurier. We worked very hard to develop criteria and to assess each application. A decision had to be made. Should all applications be ranked and scholarships awarded to only the top few, or should we ensure that each application was “worthy of an award” and spread the money over the qualified candidates? After assuring ourselves that each candidate merited an award, we chose the latter option. Two applications were rejected due to incomplete documentation. All the monies for 1962 were disseminated and, in retrospect, I believe we did an exceptional job.

In May of 1963, when I became CNA Executive Director, I inherited the responsibility for the administration of CNF. The monies from Kellogg were well used on fellowship and scholarship awards as, initially, CNA bore the entire administrative costs. However, the CNF Board, composed of half CNF members and half CNA members, had great ideas about CNF’s potential as a free-standing organization without CNA connections or controls. The CNF Board was appointed, and the part-time Executive Director (Lois Graham-Cumming) designated a member in each province as a CNF representative. The provincial associations were by-passed and, indeed, CNF attempted to set up an organization as “strong and powerful” as CNA. They would be free to solicit large sums of money for CNF and not “be hampered” by CNA. This “completely separate” organization did not survive for long and, in 1966, CNF became more closely allied with CNA while maintaining its separate identity as required by the Letters Patent. I later became Executive Secretary/Treasurer of CNF.

One of CNF’s perennial problems was always to find sufficient funds to maintain the scholarship program. The need was very great and hardly any other monies were available for nursing students studying at the masters or doctoral level. When the Kellogg money ran out, great efforts were made to obtain more funds but results were dismal. Each Selections Committee was faced with the problem of making awards with shrinking budgeted funds. One year, in the early 70s, when Glennis Zilm, Assistant Editor, was writing an article for The Canadian Nurse, she asked me what would be done at the next Selections Committee as funds were so low. I said, “Let’s go for broke!” She published my remark and, due to the efforts of provincial associations (some gave a yearly donation based on membership), the funds grew and then stabilized. It was a real roller coaster ride and I spent many of my precious “extra hours” doing CNF work. Often, I was asked why I worked so hard for CNF. My answer was honest and simple. When I studied for my masters and doctoral degrees with a very small income –having to decide between buying a book or eating dinner –I became dedicated to doing what I could, in my lifetime, to prevent others from facing similar circumstances.

WHO Expert Study Committee to Advice on the Program for the International School for Advanced Nursing Education (Edinburgh) – 1964

For me personally, and Canadian nursing generally, the three international I projects I completed in 1964 added to the beginning of CNA’s involvement in the world of health and gained for us some stature on the international scene. In addition to my responsibilities as CNA Executive Director, I completed the projects under the auspices of the World Health Organization.

The first assignment was as chairman of the WHO Expert Study Committee advising on the program for the International School of Advanced Nursing Education at the University of Edinburgh. The one-week project began 16 February 1964 and I can, to this day, recall how cold I was when I arrived at my room in the Bruntsfield Hotel in Edinburgh. I thought I would never be able to sleep that first night in my cold, damp room which was 10 feet wide by 24 feet long with a ceiling at least 14 feet high. My bed was a cot fitted with knitted nylon sheets top and bottom, and one comforter. At one end of the room was a very small hot water heater. When I got into bed, the cot was so small and the nylon sheet so tightly drawn that I just kept slipping out. In desperation, I pulled the one heavy chair in the room over to the side of the bed to at least keep me on the bed. The next morning, when I complained that my room was too cold and my bed too small, the management assured me that I had one of their best rooms!

The entire first four days in Edinburgh were spent on curriculum development for the yet to be established WHO International School for Advanced Nursing Education. After the first few days, although I was chair of the meeting, I had to intervene to support the North American model of developing aims and objectives based on philosophy. Miss Stevenson, Director of the School, was adamant in her resistance to our “stupid” proposals. She was of the school of thought where a syllabus was followed. The syllabus had no relation to the school’s philosophy (there was none in writing, but one did exist) and, certainly, aims, objectives and anticipated outcomes were never considered. Our meetings became a tense “we” and “they” struggle which I handled as tactfully as possible. Eventually, most of the University’s faculty “saw the light” and became enthusiastic and supportive. We all became such good friends, in fact, that I was invited out one evening to hear Andy Stewart, a favourite of mine. Due to pressures involved in writing the report each night, I regretfully declined but we did agree that Saturday was possible. We had a wonderful evening. One faculty member was assigned to sit next to me in our box seats “to interpret”. Despite the thick Scottish accent, no interpretation was necessary when he sang, “There was a soldier, a Scottish soldier….”

During my week in Edinburgh, I wrote in my room each night using the day’s discussions to gradually develop the curriculum in readiness for a final presentation. After the first day, Miss Stevenson would absent herself “to attend to pressing duties”. Writing in my room was a chilling challenge. It was so cold, I wrapped myself in my Newfoundland seal coat and wore lined gloves. Writing this way was very awkward so down I went to complain, again, to the hotel manager. I was told there would be more heat –there was none. After another hour of frigid room and cold, slippery bed, I complained again. This time, a maid brought me two hot stone pigs. A little better, but still tricky trying to sleep cuddled around the stone pigs. Despite the large chair I had placed next to the bed to restrain me, I kept slipping off my cot. After another hard day of meetings, I decided that enough was enough. I would not spend another night in my chilly room. Down I went, yet again, to see the manager. “If you don’t do something, I shall take a chill,” I warned. Those must have been magic words because, when I arrived back in my room, a large, electric heater had appeared. What bliss!

The final curriculum outline for the International School was completed Friday evening in readiness for presentation the next day to the Director of the School and others from the clinical setting from both inside the hospital and from the community (public health nursing). I remember that Saturday morning, seated at the head table in the Conference Room with Miss Stevenson, the Director on one side, and Lyle Creelman, WHO, on the other. I outlined the curriculum –starting with philosophy, aims and objectives as developed by the faculty of the school (minus Miss Stevenson) and the WHO consultants. Just before I commenced our presentation, Miss Stevenson said to me, “I disagree with everything you have done. ‘Noon’ will approve.” Facing a roomful of WHO personnel, staff of the university school, ward sisters in full uniform and public health nurses in their regalia, I started off with a full explanation of the project and how we had developed it. After 15 minutes or so, I began to outline the curriculum and our rationale for it. Then silence. Although Miss Stevenson chose not to speak, all the others were more supportive than I could have ever imagined. The chief public health nurse even said that it was the first time she actually knew what the program was all about. Two of the sisters, in their fetching bonnets agreed. Miss Stevenson, with palpable reluctance, agreed to “try it out”. She did and the program became a great success. Reports still refer to our work on the curriculum “way back in ’64”. It was, in fact, more than the development of a curriculum it was the establishment of the first English-language WHO nursing education program for post R.N. nurses world-wide: the very first program having been the French-language school for Advanced Nursing Education in Lyon, France.

When our presentation was complete, we were invited to explain our proposal for the School of Advanced Nursing (SAN) to the medical faculty. We proceeded to the faculty’s new and modern building and, although it was winter outside, it was a bright, warm day inside. All of the senior, rather imposing members of the medical faculty were seated at the head table, with Lyle Creelman at one end. I was seated at a side table. After the introductions, I was asked to make the presentation. The room was very warm and, when I was finished speaking, sweat poured down my face. I had worn an attractive, pink wool dress which was appropriate for the occasion but not for the heat in that sun-baked room. I eyed the raised Venetian blinds which were letting in the hot sun and decided to sidle, unobtrusively, to the window and lower the blinds. With everyone’s attention elsewhere, I pulled the cord to release the blinds. Unfortunately, it was the wrong cord and only half the blind released with the most awful clatter. I held on to the cord for dear life. The Dean of Medicine came to my rescue saying, “Steady, lass. Steady. What are you trying to do?” Although I thought my intentions were obvious, I hesitantly explained. Lyle looked away in agony but, with the blinds down, the room was somewhat cooler. All of the members of the medical faculty, except one, were not too impressed with our presentation and listened to us with polite disdain. One member of the faculty, however, spoke with great enthusiasm about our new approach to nursing education. After our presentation, we were invited to the office of the President, known in Scotland as Principal. We were offered sherry but I declined. At the urging of the President, who wanted to toast the completion of the project, I relented and hoped that, on an empty stomach, I would not feel the results too soon. The Principal was a fascinating man who, at that time, was one of the world’s top scientists in the field of space exploration. He asked if we had any questions and, of course, I had one. “Was it necessary,” I asked, “for the head of a university to have been an academic?” I was interested as, in Canada, the physician administrators of our hospitals were being replaced by “lay administrators” who were graduates of hospital or business administration programs. The President paused for about 10 seconds … it seemed forever … and replied in a Scottish brogue, “Yes, it is important to have been a professor in a discipline so that you can speak the language.” I have never forgotten his reply and have used it to advantage over the years.

Lebanon -May 1964

After intensive work at CNA following the project in Edinburgh, I was invited, by WHO, to conduct a survey of schools of nursing in Lebanon. I was also asked to give one major speech and to be a member of a panel discussion at the First Middle East Nurses Assembly to be held in Beirut, Lebanon. The CNA President approved these field trips saying that probably no one would notice that I was gone. I was excited to be visiting the land of my ancestors. When the initial correspondence came early in 1963, I shared it with my father. He was so pleased but, sadly, he died in June 1963 and never heard the great stories I could have told him about my visit. Although Dad rejected the land of his birth –he wanted to be a real Canadian and do his best for Canada –he was interested in Lebanon and so pleased that his daughter would see “the old land”.

Although there was a long lead time prior to my departure for Lebanon, communications were very poor. It was difficult to receive WHO authorization for my flight and to be informed about hotel reservations in Beirut. I did put together notes for my speech and preliminary plans for the survey of schools of nursing but the information I received was so slim that I felt ill-prepared. Despite telegrams, I did not even know the name of my hotel in Lebanon but I decided to go anyway.

The flight was long -Ottawa/Montreal/London, England -with a long wait for a connection to Beirut, via Frankfurt. The planes were slow so I slept most of the time after leaving London. I woke at one point and saw snow-covered mountains. For a moment, I thought I was crossing the Rockies on my way home to Vancouver. Then, I started to worry about how to find accommodation for the first night as we were arriving after dark. When the aircraft stairs were lowered, I was first off the plane. As I walked across the tarmac, I felt very lonely. Unexpectedly, I heard a faint, “Dr. Moo sell um” –the Arabic pronunciation of my name. Relieved, I approached the lady and gentleman and said, ”I’m Dr. Mussallem, from Canada.” A swarm of at least 20 men with flash cameras came out of the darkness and the night turned into a great, white flash of light. An elegant man approached and bowed from the waist saying, “Welcome to Lebanon, land of your father.” He was the Lebanon Minister of Tourism. Next came the Minister of External affairs, then Mme. Sultan, Director of the Red Cross School, and then other government officials. I was whisked into the VIP Lounge where arak and other liqueurs and wines were offered. My passport and luggage tags were handed over to airport officials while I sat with the welcoming delegation and talked, and talked. The Lounge was very warm and I had, as usual, travelled in a woollen suit. Eventually, a baggage handler appeared to announce that my luggage was not on the plane. “Find it!” shouted the ministers, clapping their hands in the typical Middle East clap command. We waited and waited but no luggage arrived. Finally, I was escorted to my hotel, The Orient Prince. A kindly nurse from the American University generously offered to lend me a night dress and slippers. Although she was about twice my size, I didn’t care. I slept soundly. In the morning, I was awakened by the sound of a jet overhead and then heard prayers from the Mosque, followed by the voices of vendors far below my window loudly extolling the virtues of their attractive1y-arranged carts.

At 6 a.m., a waiter, in fez, arrived with my breakfast. He knocked and, at my invitation, opened the door and stood there with my tray, screamed, put my breakfast on the floor — and ran. His startled eyes were as large as billiard halls. When I sat up, I did not realize that my night dress, miles too big, had slipped completely off.

My first day in Beirut was a busy one. Dressed in my now perspiration soaked suit (my luggage arrived two days later), I met with senior officials in the health department. Immediately after each introduction, the official would ask, “Are you Christian or Moslem?” In Lebanon, for every senior position in the entire government, there was always an equally ranking person of the other religion. I was also introduced to my national counterparts. The one that accompanied me everywhere was Christian but, when we went on distant trips to Tripoli and Tyre, my Moslem counterpart came along as well. Her English was limited as was my Arabic. My driver was Moslem. I recall so clearly the exciting ride back from Tripoli along the beautiful coast of Lebanon. There were no guardrails along the road despite the sheer drop into the Mediterranean on one side. I was especially frightened when the driver and my Christian guide got into a heated argument and several times, in his anger, the driver almost drove over the cliff.

There were many things my guides did in the name of my father. We visited the Cedars of Lebanon. “We take you there in the name of your father,” my guides said. On the drive to the coast, we visited the tomb of Kalil Gibran. At that stop, a Lebanese lady was asked to prepare chicken for us. She had just killed the chickens by wringing their necks and spices were rubbed into the meat with her bare hands. When we were ready to eat, I noted that the chicken was not well cooked and I feared that all the bacteria had not been killed. My counterparts and the driver, however, ate their portions – and mine, as I was “not hungry”.

I recall returning to my hotel that afternoon (work began at 8 a.m. and ended at 2 p.m.), to find the lobby filled with men in Arab headdress. The hotel manager said all of these men were relatives –all Mussallems.

My arrival had been reported, in English, French and Arabic, in the 30 daily newspapers. My “relatives” had read of my arrival and had come down from the mountains to welcome me. The oldest man spoke no English but, through an interpreter who accompanied him, told me how he was related to my father. I had no way of verifying this information but I thanked him, graciously, for coming. Likewise, when I was in Zahle, my counterpart called “a cousin” who took me to her home. In less than half an hour, every room in the house was filled with Mussallems or Moussallems (as it is spelled in French). They all claimed to be relatives. Mussallem, in Lebanon, is as common a name as Smith or Jones is in Canada.

The main reason for my visit to Lebanon was to conduct a survey of schools of nursing and hospitals as I had done in Canada for the PPESN. I started with the three main schools and hospitals in Beirut the Red Cross School of Nursing, The School of Nursing at AUB, and the Moslem School of Nursing –an Arabic School and Hospital. The entire survey process and techniques used were modified from those of the PPESN (see Report, p.94-137).

We then proceeded to Tyre, Sidon and Tripoli. In all, 11 schools of nursing were surveyed. Almost half of the schools were privately run by doctors and standards were very low. Survey results revealed that only two of the schools –AUB and Red Cross –met the desirable standards.

During our travels outside Beirut, tensions were mounting and there was a real threat of war. I remember, so vividly, sitting in the back of our car, alone, traveling to Beirut. My counterpart sat in the front with the driver. Six soldiers stopped the car and –three on each side –pointed their bayonets at us. Tremulously, I volunteered, “I have my Canadian passport.” “Shaddap!” said my companion. I understood Arabic well enough to surmise that my companions were attempting to explain our trip and tell the soldiers that we were all government officials. Apparently satisfied, the soldiers shoved a bayonet into the car as though to push us on –and off we sped.

There were, however, many pleasures in Beirut: looking out over the Mediterranean; sampling the best of Lebanese food; taking pleasure trips on Sunday to remote villages or casinos; and eating strawberries at the St. George’s Hotel patio. (As WHO personnel, I was forbidden to eat the strawberries but I did –only three times. They were worth dying for.) Many quaint items were sold on the streets of Beirut but I was particularly intrigued by the never-ending boxes of Chiclets offered for sale by grown boys. One night, at dusk, a very large boy approached me brandishing his Chiclets. I said “La” (no) but he kept following me, shoving the gum in my face. In desperation, I yelled “Rhou min hown”, the equivalent of “Get to h— away.” He really ran. I suppose he had never expected such language from a lady in European dress.

Leaving Beirut was another sad, if memorable, experience. We left the hotel at 3 a.m. to allow time for all the required clearances. On the way to the airport, we were again stopped by armed soldiers. They made us get out of our car, opened our suitcases and picked through everything — especially the negligees. We could do nothing but keep quiet and watch the charade. Later, as we approached the airport, the sun rose and bathed the beautiful hills of Lebanon with glorious light. Such a contrast from my noisy welcome: men dancing the Dabke in the streets; record players and radios blaring out music; and hordes of people lining the streets –some in Arabic costume, some in European.

After the Lebanon survey, I participated in the First Middle East Nurses Assembly where I presented a major address on Research in Nursing, chaired a panel, and gave many press interviews. These were unique events as they were conducted in three languages, English, French and Arabic, with volunteer interpreters. The equipment was rather primitive but, somehow we managed.