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of quinine throughout the district is almost universal. Quinine is of extreme value for Russia at present though the drug cannot control the epidemic. The value of quinine is due to the fact that it breaks the vicious. circle of Malaria, resulting physical weakness. inability to plough and work the land, further physical debility, and then severer Malaria - a vicious circle which is being enacted in hundreds of thousands of peasants in Russia to-day.

The difficulties of the practical administration of quinine are very great. Patients in Hospital will hide the powders or tablets under their pillows and after a sufficient number has been accumulated, the invalid will discharge himself and sell the quinine in the market. Powders of quinine which consist of chalk or flour with the minutest trace of quinine to give a bitter taste are sold in thousands in all the markets at one shilling each. Further, as the number to be treated is so great and the quinine so little in quantity, practitioners are tempted to try to give quinine to all with the result that the amount given to each person is infinitesimal and useless. Another factor is the absence of microscopes resulting in a very large number of cases of tuberculosis, etc., being treated as Malaria with consequent waste of quinine. Finally the depletion of the numbers of doctors and the fact that patients are often as much as one hundred and fifty miles from a doctor make the distribution of quinine through local medical personnel impossible.



It was necessary therefore for the Relief Unit to organize and retain complete control of the whole of the malarial work. This has remained throughout entirely in English hands.

The first step taken was to order a complete bacteriological laboratory from England together with a supply of microscopes, stains etc., to form sub-laboratories. Into this central laboratory Russians are admitted as students and are trained for three months in the diagnosis of Malaria microscopically and the administration of a malarial clinic. As each student completes the course he is supplied with a microscope, stains, quinine etc. and is sent into the district to open a Malarial outpost. Each outpost is run on the same lines as the central laboratory and clinic and controlled from here. At this each patient is examined microscopically upon presenting himself. No patient is declared negative until after three negative examinations of blood taken during fever. If possible the patient is given an index Icard with the number of times and dates on which he must take quinine. All quinine is issued in solution (Quinine Bisulphate) and drunk in the clinic, each patient attending daily for a week and later twice a week for two months. The dose given to adults is 20 grs. daily for the first week and 15 grs. twice weekly for two months. If a patient misses an attendance he is not allowed to receive any more quinine. The fear of the disease is so great that very few dare to risk being without treatment and in consequence


the cases attend very regularly. The quinine used for the clinic is very largely given by the British Red Cross and consisted of the old Army stores sent to Russia (after selection) from Constantinople. An interesting fact is that little children of five and six years old voluntarily and unaccompanied present themselves for quinine treatment in large numbers realizing the great benefits they derive from the medicine. The number of relapses after two months' treatment is extraordinarily low; in a total of 5,738 treated in six unselected months, there were only 380 relapses.

With the aid of the students trained in the laboratory a network of Malaria outposts is gradually being established in the Buzuluk district (an area about the size of Wales) but this area is negligible when compared with the infected areas of Russia as a whole.

It is not claimed for quinine that it will rapidly control the new epidemic or prevent the degeneration from chronic malarial infection of the next generation, but quinine represents the only possible practicable line of attack on

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the disease, not with a view of stamping it out but of enabling peasants to plough and sow and consequently increase their physical stamina and resistance and also of reducing the number of reservoirs of the disease. The possibilities for such work through the Red Cross organizations are very great. I am of opinion from my experience that the Soviet organizations have not proved satisfactory for the work owing to their corruption, indolence and political interests, but that this should be undertaken by a combination of foreign Red Cross organizations. Such work would require to be controlled most carefully by responsible persons especially as far as the distribution of quinine is concerned for the reasons stated above otherwise there is great danger of the drug being either sold, wasted or used politically. Furthermore, such distribution must be controlled by laboratory diagnosis. Quinine is urgently required in Russia to-day, but in the present state of the country simply to send the quinine without a means of controlling its distribution is a waste of the drug.

The International Migration Service

At the World's Y. W. C. A. Conference at Champéry, in June 1920, the studies and experience which had been gradually evolving in the whole Association since 1912 crystallized into a definite plan of study, personal service for the benefit of emigrants and immigrants, and education for the general public.

Perhaps it was the great need that the United States Y. W. C. A. reported at that Conference for an especial type of assistance in Europe for women and children who had come to her shores from half around the world, with their stories of the need for friendliness and advice and protection on their long journey to a new land, which made the World's Committee feel that immediate action was imperative.

A preliminary survey was made by a trained expert who studied the migration conditions in five European countries and as an outcome of that survey there was started an international experiment which has since become known as the International Migration Service.

This Service has as its aims to extend personal service and friendliness, through its various Bureaux, at points where migrants congregate for the formalities of travel between countries; to seek to study problems of migration, particularly as affecting women and children; to work towards the international regulation and bettering of conditions under which they migrate, thus promoting international good-will.

Service is rendered without charge and without religious or political propaganda or bias, by trained social workers speaking several languages.

An example may perhaps best help to illustrate the methods of this Migration Service at work.

One day a letter arrives in a small village of Eastern Europe. It contains money from Mrs. Polski's husband, and brings news that he has found work in the new country and is eagerly awaiting his family. The time of waiting and anxious suspense are over and there. follows a week of feverish activity. There is the house to sell, clothes to get ready, a visit to the nearest town to procure passports and visas growing excitement mingled with anxiety at the anticipation of the long journey to the seaboard, emotional stress at the breaking up of the old home, the farewells. Then the long comfortless journey, the excited children, tired and peevish, the absence of hot food, the arrival in the strange city, the glaring lights, the bustle, instructions shouted in a strange tongue, and always the anxiety as to whether the money, which has sadly dwindled en route, will cover the cost of the steamship



It is little wonder that migrants reach the port of embarkation in an overwrought and disintegrated state of mind. The men and women grow irritable, seek someone whom they can blame for their misfortunes, or listen with helpless stoicism to instructions they cannot understand. The younger ones, freed from traditions and conventions and, if travelling alone, from all supervision, become intoxicated with the excitement and opportunities for enjoying life that the city affords.

To help migrants through this difficult period of transition is the work of the Migration Secretaries, and the International Migration Service insists that all its workers shall be trained. Social Workers, who bring to the work sympathy and kindliness, but also experience in


effecting adjustments between men and their social environment ". To do this it is necessary to understand thoroughly one's client, and to understand one must have the fullest knowledge. In most case-work the client's story is checked and amplified by information gained from home, relations, schools and workshops. In the case of the migrant these opportunities are lacking, and it is necessary to rely solely on the statement of the client. For this reason the Secretaries, wherever possible, talk to the client in her own language, and this not only helps to evoke the fullest confidence, but acts immediately as a sedative, and the woman grows calmer and more able to face the problem.


A refugee from the Near East has a ticket. that takes her only to the French port. She wants to go to the United States. What chance is there of her admittance ?

Before this question can be answered there are many facts the Migration Secretary must know the migrant's country of birth, how she will be affected by the United States of America quota regulations; her age, whether she is married or single, whether she has any physical defects, the name of the relations to whom she is going, the nearness of relationship, whether she possesses an affidavit or sufficient money, whether she has relatives with whom she can spend the time of waiting in port, whether she is literate.

The answers to all these questions are entered on the confidential Case Record Cards, which are of a standard pattern and used by all the secretaries of the I. M. S. With numbers of clients a day, it would be impossible to rely on memory to keep case distinct from case, and sometimes the Secretary is in touch with a particular migrant for a year or even two years. All that has taken place during their contact is recorded on the card. When the time comes to sail, the record card, with its history, long or short, is sent on to the Bureau in the country to which the migrant is going, and the new secretary is in possession of every

detail and knows exactly how to help the migrant through the next stage of the journey. Even when the migrant has reached her destination and the final entry has been made, the usefulness of the record card is not at an end.

Thus we have a chain of service around the world; there are Bureaux in Antwerp, Copenhagen, Athens, Constantinople, Cherbourg, Le Havre, Marseille, Paris, Prague, Warsaw, Kobe, New York City, San Francisco, Seattle, El Paso, Quebec, St. John, Halifax, Toronto, Montevideo, relaying stations whereby signals of distress are not only caught but passed along, and help assured at the next difficult point.


The Secretaries who man these stations are generally conversant with several languages, or have working with them those who are. They are fortified by groups of women who are of varying nationalities and confessions, and who bring different points of view to a work that knows no bias religious, political or racial and calls for intelligent, sane understanding of the problems that affect the migration of peoples. They are not satisfied to stop with the help that, though welcome, may be only palliative unless followed to its conclusion and traced back to its source.

The Migration Secretary must be well informed on the migration laws and regulations of various countries. She seeks the co-operation of Government and steamship officials and finds it most heartily extended; she depends on other organizations doing welfare work, and finds hospitals, hostels and homes open to those whose difficulties she is unravelling. She cables, telephones and writes. Sometimes to straighten out one migrant's difficulties necessitates twenty letters, a dozen telephone calls, several trips to consulates or steamship offices and a cable or two. Sometimes she knows the end of the human story in which she has played a part; more often she does not.

To whatever the trouble may be due-ignorance, demoralization, confusion, misunderstand ing, exposure to indignity, exploitation, disease

or anxiety - it is the human experience of migrants that has developped a new field of social service, a new outlet for Christian ideals put into practical terms, a new incentive to the spreading of goodwill and understanding between the nations.

This in brief and without any emphasis, is a summary of the work of the International Migration Service of the World's Y. W. C. A. It gives no idea of the untiring assistance extended and inexhaustible patience shown by the Migration Secretaries to those in trouble; no idea of the fellowship, understanding and cooperation that exists between the staff throughout the world; no idea of the amount of correspondence and personal conference necessary to keep such a vast programme going; no idea of the interviews with Government officials, Y. W. C. A. Committees, representatives of other organizations, newspaper and steamship officials, on the part of the International Migration Secretary, nor the correspondence and requests for information and advice each of the above brings in its wake.


In the period just following the war, the migration problem became confused with the more acute difficulties of hordes of refugees which crowded so many ports and swamped completely the ordinary agencies. The Y. W. C. A. had not yet undertaken the work, and at that time many of the national Red Cross societies were attempting to apply emergency remedies to the refugee situation. Out of this fact has grown a close relation between the Migration Service and the Home Service branches of the Red Cross societies. In Czecho-Slovakia, in fact, the migration service was begun under the joint auspices of the Czecho-Slovakian Red Cross, the Y. M. C. A., and the Y. W. C. A. In Poland, the World's Y. W. C. A. took over the whole operation of the Polish Red Cross Society's cases, although they were numerous and difficult, when the society found it necessary to turn its attention to other tasks. Many national societies have

established definite working agreements with the branches of the migration service, and many others refer incidental cases to the Y. W. C. A., when they come up.

The time will soon come, probably, when some agreement may be worked out by which the national societies of the Red Cross may wish to arrange for a definite understanding with the Migration Service of the Y. W. C. A. In this way the two institutions may aid each other in the diverse and perplexing problems to which migration constantly gives rise. In the development of its work, the International Migration Service has struggled for a

business-like and effective method. For that reason, they have kept uniform records which have been likened to the well-kept books of a business firm. But as important as those records are to an efficient and effective service rendered, and valuable as they are for the stories they tell of the need of international regulation, this world-wide service, after all, does its book-keeping in higher values. It values the migrants neither as " potential labour units nor a projection in foreign countries of the influence of the homeland, neither as purchasers of transportation nor possible carriers of disease, but as men and women.

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