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US ISSN 0016-2116
FNS Begins only "Refresher" Program for
Nurse-Midwives in USA -by Sharon Hatfield and Angela Todd 2
Then and Now -by Edwin Harper, MD. 6
_ Barnard College Honors Ruth Watson Lubic -by Angela Todd 11
  The MBH Women's Auxiliary Honored as "Employees of the Month"
j —by Angela Todd 12
`R The John D. Archbold Memorial Hospital Nurse-Midwifery
I Program Celebrates 15 years of Service -reprinI 14
Beyond the Mountains -by Ron Hallman 16
Field Notes -by David Lee 17
FNS Bids Farewell to Two Devoted Friends:
Dr. Francis S. Hutchins and Mr. Norbert F. Stammer -by Ron Hallman 20
i In Memoriam -edited by Ruth Morgan 21
Memorial Gifts —edited by Ruth Morgan 22
` Form of Bequest 24
‘ Urgent Needs 25
i Staff Opportunities 25
l Family Nurse Practitioner Trudy Morgan perfomrs a well-child examination at FNS's Pine
. _ Mountain Clinic.
US ISSN 0016-2116
I Published at the end of each quarter by the Frontier Nursing Service, Inc.
I Wendover, Kentucky 41775
1 Subscription Price $5.00 a Year
Edit0r's Office, Wcndover, Kentucky 41775
Second-class postage paid at Wendover, Ky, 41775 and at additional mailing offices
1 POSTMASTER: Send address changes to Frontier Nursing Service, Wendover, Ky. 41775
‘ Copyright 1986, Frontier Nursing Service, Inc.
L-_ _

FNS Begins only "Refresher" Program
for Nurse-Midwives in USA
There is presently a serious shortage of nurse-midwives in the United States. In
the most recent issue of the ACNM publication Quickening, there were 55
agencies, (FNS included), advertising for CNM’s with 25% of them offering g
more than one job opening. New graduates from existing schools are not
sufficient to meet this need — indeed, enrollment in basic nurse-midwifery i
programs has declined in the past few years. Clearly, we cannot rely on basic  
midwifery programs to meet the growing national demand for midwifery
There is an altemative resource available to us in the large numbers of
inactive nurse-midwives - both American and foreign-trained - who, until
recently, had no way to activate their licensure except to matriculate into a basic
nurse—midwifery program and begin anew. Currently, tuition to basic nurse-
midwifery programs ranges from $4000 to $15,000 per year and they require
from 8 to 24 months to complete the course of study. This is clearly a time-
consuming, expensive and inefficient way to solve the problem of "up—dating"
these providers and moving them into the job market. Over the years, the Frontier
School has received numerous requests from our own graduates who are no
longer in current practice, and from foreign-prepared nurse-midwives, request-
ing that we provide the program they need to meet requirements to sit for the
American College of Nurse-Midwives (ACNM) certification examination.
Many asked, "Could FNS he1p?" The answer was "Yes!" and the Frontier I
School’s Refresher Program was bom. This new program will cost students 1
approximately $4000 and require only four months to complete. 1
It is important to note that the need for such a program reaches beyond
that of the desire of inactive midwives to return to practice. Health care ~
professionals express a mounting concem over the unfavorable rates of perinatal
and infant mortality in the United States. They relate this serious situation to poor  
access to prenatal care. An Institute of Medicine study done in 1985 recom- {
mended "that more reliance be placed on nurse-midwives and nurse-practi-  
tioners to increase access to prenatal care for hard-to-reach, often high—risk ,
groups." Another report by the American Nurses' Association identified the `
need to "develop educational programs for certified nurse-midwives and nurse I
practitioners that would increase flexibility for students and grant educational
credit for life experiences and post baccalaureate nursing education courses."
In 1975, the Salvation Army Booth Matemity Center in Philadelphia Q
offered a refresher program for foreign—trained and American prepared nurse-  

midwives who were no longer in current practice. Unfortunately, the closure of
that program in 1983, left a critical gap which has remained unfilled until the
Frontier School responded to the need and opened its Precertiiication (Re-
fresher) Program to students in 1988.
We were fortunate to recruit Sr. Martha Walsh to head the new program.
Sr. Martha was involved with the Booth refresher program and brought to us her
extensive experience in developing and teaching precertitication programs. She
# is assisted by existing faculty of the Frontier School of Midwifery and Family
t Nursing (FSMFN). The Frontier School is the oldest, continuously operated
school of midwifery in the United States. Its founder, Mary Breckinridge, began
  the school in 1939 because she believed that family care, begimiing with the
unborn, would someday play a critical role in the U.S. health care system.
Obviously her vision is today’s reality and it seems most fitting that the FSMFN
should once again rise to the occasion and provide the means to bring midwifery
services to those who want and need them.
The Refresher Program curriculum is based on the philosophy, purpose
and objectives of the Frontier School and the ACN M. Help in shaping the
curriculum was also gained from talking to faculty from the now discontinued
refresher programs at both Booth Maternity Center in Philadelphia and the
Simpson Center for Matemal and Child Health in Springfield, Ohio.
Holistic in approach, the curriculum focuses on preventive care and
health maintenance. In addition, it encourages collaborative relationships with
health team members and stresses the patient’s role in assuming responsibility
for their own health care. Emphasis is placed on providing students with a sound
. foundation in normal body function and health care management in order to
j provide them with a framework for the recognition of the abnormal and
~ management of common deviations from the normal. It takes into consideration
the student’s previous basic midwifery training and allows for the professional
background and maturity they bring to the experience. It is expected the student
will be able to fulfill many of the theoretical course objectives through indepen-
< dent study.
» Upon completion of the Refresher Program, the graduate will possess a
` sound theoretical base for nurse-midwifery practice allowing her to provide
° complete care to the low-risk woman during her childbearing years. She is also
` well equipped to provide primary health care in a variety of settings, with
. emphasis on underserved areas.
The pilot class of four, admitted in March, 1988, included students from
Washington, Tennessee and Michigan. It is gratifying to report that all
,3 graduates of this charter class have passed their ACNM boards and are currently
  enjoying active practice once again. The second class of six students has left for

their clinical training in Houston, Texas. Sr. Martha accompanied them and _
serves as clinical faculty and all round support person during this important I
phase of their training. In April, FSMFN faculty members Dean Nancy Clark ;
and Educational Coordinator Wendy Wagers, will join Sister Martha dining the
students' critical evaluation period. At that time, they will also provide selected `
classroom teaching.
The Frontier School of Midwifery and Family Nursing (FSMFN) t
celebrates its 50th anniversary this year - half a century old and still going }··
strong - graduating one quarter of the nation’s midwives and able to grow and
change to meet the needs of the future. In addition to the Precertification g
Program, the FSMFN offers both a Rural Primary Care Nurse Program that y
prepares family nurse practitioners in a 43 credit, 12 month educational program
and a 64 credit family nurse—midwife program which requires 20 months to
complete. Both of these basic programs are accredited by the American Nurses'
Association and the American College of N urse—Midwives.
The Frontier School’s basic rural care nursing programs receive finan- i
cial support from the Division of Nursing of the U.S. Department of Health and *
Human Services. There is no such support for the new Refresher Program.
However, if applications from suitable candidates remain strong and evaluations I
continue to indicate the program prepares successful practitioners, the Frontier t
Nursing Service will continue to offer the program using grant support when
possible, supplemented by the Frontier School’s endowment income and tuition.
All precertification students have expressed gratitude for the new
program. Claire Englander, a graduate of the first refresher class, shared some
of her thoughts in a recent letter:
"I arrived in Hyden with my seven year old daughter and a bit of b
resistance to being a student again - not the part of studentdom that  
means learning and soaking up, but the part of having to convince  
others and prove my capabilities. I was very suprised. The FNS I
midwives welcomed me and my classmates with respect and interest.
It was fascinating to witness the skills held collectively by the mid- ·:
wives as they juggled a large and diverse prenatal program with the ,
economic and nutritional challenges in most clients; a fluid back-up/ I I
referral OB and pediatrics practice; as well as the needs and whims of “
several levels of ever-changing students.
I wasn’t used to hearing "nurse-midwife"— to me a midwife is a
midwife. Ibristled the first few weeks, but once I was distracted enough
by the work and the schedules, I was able to forget my defensiveness I
and eventually to approach it directly. I researched and presented the i-
module "The History of Nurse-Midwifery" and finally the pieces  
began to fall together.  

L The FSMFN Refresher Program was extremely valuable to me. Fron-
tier Nursing Service, is, once again, a bridge as she has been so many
times in the past ..... bringing together mother, child and midwife."
J     T ·-    iis Ti ·*,.=. to   _,   1 W ;
W  sg? E V     i  ,, ,  
  ,       - ·-—_ _      
a·   r iii`     i;  
_. ~#   » \ ‘ "‘“T""“_   T- ——e»-· » ¥
    · {lx 5*   wi; N A ~
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First refresherclass with FrontierSchool faculty. From left to right: Sister Martha
Walsh, Coordinator; Dean Nancy Clark; Claire Englander, Joanne Peterson
and Ardith Hintzman.
i L

Dr. Edwin Harper graduated jrom Harvard Medical School in 1931.
Before starting his pediatric residency at Boston C hildren's Hospital
he spent three months as a volunteer physician with Frontier Nursing
Service. The following article is excerpted from a manuscript he wrote
comparing the practice of medicine in the 1930's to that ofthe 1980's
citing some of his experiences while with FNS. Dr. Harper retired from  
private practice in 1981, but still attends a children's clinic at a local t
health ojfce in Lynchburg, VA., where he resides.
Fifty years ago, in the fall after graduation from medical school, I was offered
an opportunity to practice medicine on horseback for a few months before my
hospital internship began. The offer came from the Frontier Nursing Service, an
organization started six years earlier by Mrs. Mary Breckinridge in Leslie
County, Kentucky. Leslie County was aptly described by the State Health Com-
missioner as the poorest in the state. The only paved road was a twenty mile
stretch from the mining town of Hazard to the county seat of Hyden, population
about 100. Travel was on foot or horseback. This was before the days of jeeps
or 4-wheel drive vehicles, but if such had been available, the rocky creek beds
would soon have shaken them apart.
Mrs. Breckinridge was a trained nurse who saw service in devastated
France after World War I. Later she was so impressed with the work of British
nurse-midwives that she completed a course in midwifery in London and after
observing how the system worked in Scotland and the Highlands she decided to
begin similar work in eastem Kentucky. The loss of her own two children was
one reason that the Frontier Nursing Service was at first devoted primarily to the
care of women and children.
By 1928 Mrs. Breckinridge had raised enough money from friends in I
Lexington, Louisville and several northem cities to build a small hospital in
Hyden. By 1931 six rustic nursing centers had been built 10 to 15 miles apart .
in the county, each center staffed by two nurse-midwives. The majority of the i
nurses were English or S_cottish women who were graduate R.N.’s with addi-
tional training in midwifery. At that time there were no schools of midwifery in _,
the United States. Our emphasis was on training doctors of medicine in obstet-
rics. There were among the nurses a few American girls who had gone to Great
Britain for the course in midwifery.
To back up the nurses Mrs. Breckinridge paid one-half ($1500.00) of the
salary of Dr. Capps, the health officer of Leslie County. For this Dr. Capps acted
as a general consultant to the nurses and treated patients brought to the hospital.
From time to time volunteer physicians spent varying lengths of time as 1

, t , _ assistants. I was offered board,
V     V room anda horsetoride,butof
,        course, no salary. For major
· ag" y   operations there were sur-
. lv   , -     geons in Hazard who could
 `   V   i‘‘' either operate in the FNS hos-
  J   . H pital in Hyden or in their hospi-
A   #.,1 L A   e ,   I tal in Hazard. Also, there were
  _ V A iir. f     , ·`4         A  physicians in towns surround-
I V ' * J J `' * A V y   # ‘  L  9 ing Leslie County who did a
lv p_   it _ p p  ‘,   S-;.} ~ certain amount of practice on
  , j  fm ’`/i  ,, 2*  ” patients from Leslie County.
Ejgg  i,“*   _ ~ .;      »i;;5·;i;    1 spent me tau of 1931
 g -Q  , -i    _   ‘ I in what proved to be a most
  {ff;}   » e, I rewarding experience. Part of
Dr. Harper seated on his horse, Penny. {ny tml° Wa? dcvotcd   mab
mg patients in the hospital and
in the clinics, but more time was spent riding up and down the rocky creek
bottoms and visiting patients, chiefly women and children, but a few men, seeing
disease at first hand and trying to bring modem medicine to bear on their
problems. I leamed much that I could not have found in a big city hospital.
In those early years all normal deliveries were conducted at home. The
nurses showed great ingenuity in overcoming the many obstacles that confronted
them in the primitive log cabins. There was no electricity, no rtmning water, a
cranky wood stove (often fueled with wet wood) and a swarm of small children
always in one’s way. The patient would be lying in a sagging bed on a mattress
of com shucks and the nurse would be expected to conduct an aseptic delivery,
resucitate the baby, cut the cord, deliver the placenta and stay until all were
settled. In spite of these and other problems the statistical record of FNS was
_ On several occasions I was present at a delivery - actually my appoint-
' ment was supposed to be a consultant to the nurses. Since my previous obstetric
experience was limited to the delivery of twelve babies - six in homes and six in
_p hospital - I performed better as an observer than as an active obstetrician. It was,
of course, impossible to conduct the delivery in a truly aseptic way. The nurse
washed her hands in water brought from a spring, the patient was sponged to a
degree with a solution of lysol. In spite of these difficulties, post-partum infec-
tions were rare.
During my stay we had several cases of low grade fever after delivery.
Treatment of the few we had was unsatisfactory, so that the fever lasted much

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Dr. Harper with FNS staff in front of the old hospital.
longer than it would at present with the antibiotics now at our disposal.
Remember that in 1931 there were no sulfa drugs, no penicillin, or no antibiotics
that we use today.
Treating patients was not entirely a matter of having the right drug or
lacking an effective treatment. One of our greatest problems and frustrations
came from the refusal of the independent mountaineers to follow our advice. I
Many times they would refuse to leave home for the hospital, or once in the ,
hospital, refuse an operation or procedure that we felt was indicated. A
As I rode about I carried in my saddle bags a few pills and solutions which i
I dispensed - usually at no charge. I had a sterile hypodermic syringe with which
I could give an injection of morphine for pain. Also I had a stethoscope, otoscope
and blood pressure instrument. I was thus equipped to do a routine physical
examination much as it would be done today. Specimens of blood or urine could i
be taken and later examined in the hospital laboratory. X-ray examinations -
much less sophisticated than at present - were available at our hospital or in _'
Hazard. Most treatment was palliative - make the patient as comfortable as
possible and hope that nature would work a cure.
One major problem encountered during my stay was that of patient
transport. If a patient needed hospital care and was too ill to walk or ride a horse, ,
the usual solution was a stretcher carried in turn by a series of volunteers. This i
was quite an operation if the patient lived ten or more miles from the hospital - p
strenuous for both the patient and the carriers! Think for a minute what carrying 1

a stretcher for tive or ten miles meant, Just to walk that distance in eastem
Kentucky - up and down hills, back and forth across creeks - represented hard
work. One of the creeks near my clinic station was called, "Hell-for-Sartin
Creek." And it deserved the name! The stretcher was carried sometimes by two
men - one fore and one aft - and sometimes by four men - one at each comer.
During my stay I remember only two instances when we had to resort to a
stretcher. On one other occasion a very ill woman was brought to the hospital
in the bed of a truck. Several times along the rough way a wheel of the truck had
’ to be bodily lifted over a rock.
’ To a certain degree we, the nurses and I, were in competition with the
,, local grannies and herb doctors. I was offered many recipes for mixtures that
were "sure to work." The mountain people accepted the nurses with some res-
ervation. Once an old grannie watched one of the nurses throughout a whole
delivery and then told her, "Yes, you did very well. We are right pleased with
you - but I don’t believe you can hoe com!"
Forty-nine years later, in the fall of 1980, I retumed to Leslie County for
the first time. There were many changes: a new, thoroughly modem 40-bed
hospital, tive or six full-time physicians in several specialties and the nurses
travelled by jeep as there were no longer any horses. Changes and progress in
the practice of medicine have come, at times gradually, but sometimes suddenly
~, S ¤ 4 t    
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Atypical road in Leslie County in 1931. Doctors and midwivestraveled such
roads to visit their patients.

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if 4‘*’ ”  , s .@ ’pg_ “i>     ..  
  '·               ’\,.    "    ,  
Redbird Clinic nurse returning from visiting patients.
- occasionally so suddenly that we do not realize all of the implications of the
change. If I treated patients now with the standards of 1931 I would often be
guilty of malpractice. Perhaps the biggest change in the present is the almost
total absence of many diseases that in 1931 took up much of my time. Several
times I rode my horse to a cabin where a child had died of diphtheria the day
before. I came with a supply of antitoxin to give injections to the exposed p
children in the family. Usually this was successful. Of course, even then death
from diphtheria was unnecessary. We tried to persuade all families to have their
children immunized against the disease. Such shots were given at no cost.
I feel that my time in Kentucky was well spent. I enjoyed meeting and
working with the mountain people and developed much respect for them. This ‘*
was a valuable leamin g time for me. If it did nothing else, it gave me the chance 5
to see the natural history of disease and the body’s ability to fight infection and '
come out ahead. When, in later years, patients recovered from their illnesses, I '
have been humble enough to realize that their recovery was not all a result of my g
efforts. J
Edit0r’s note: All photographs used in this article are from Dr. Harper’s private  

g Barnard College Honors Ruth Watson Lubic
_ Ruth Watson Lubic, C.N.M., Ed.D., will be a
    guest of honor at Bamard College’s Centennial
I dinner in April of this year. Dr. Lubic, General
  A:’_ V t__AA} Director of Matemity Center Association (MCA)
· —   and a pioneer in the development of family-
,    * `       centered matemity care, is one of 100 New York
» i     women the college wishes to applaud. She is a
p _._r        valuable member of the FNS Board of Govemors.
v __f·Qi‘,Y·f.-’ 4.‘` {@ 1 .; / In her nearly 30-year career as a nurse-
  2 i.V`-· QQ _-`_ F      ig , midwife, childbirth educator and parent advocate,
    Dr. Lubic has worked as a tireless champion for
*`·`` °° `'·’ I ·'4‘i   ‘°` °.· " '° ?°°`     matemity care that responds to the needs of fami-
lies and enhances their responsibility and self con-
fidence. Under Dr. Lubic’s aegis as General Director of the Matemity Center
Association, the Childbearing Center was created as an alternative to the con-
ventional in-hospital birth setting. This Center has served as a model for safe, sat-
. isfying, low-cost care for birth centers throughout the country.
I Dr. Lubic graduated from the University of Pennsylvania’s School of
g Nursing in 1955 with its two top awards, the Letitia White Award for highest
i academic average and the Florence Nightingale medal for excellence in nursing
“ practice. She holds both a B.S. and an M.A. in nursing as well as an Ed.D. in
applied anthropology from Columbia University. She received her midwifery
t training from MCA-SUNY Downstate Medical Center.
  A fellow of both the American Association for the Advancement of the
  Sciences and the American Academy of Nursing, Dr. Lubic has been a member
* of the Institute of Medicine of the National Academy of Sciences since 1971. She
has served on many public and private committees and commissions, including
past presidency of the American Association for World Health/U.S. Committee
for the World Health Organization. With Phyllis Farley, MCA's chairman, she
y received the Rockefeller Public Service Award in 1981. In 1986 she was awarded
yi Doctor of Science Honoris Causa from the University of Medicine and Dentistry
Q of New Jersey and the Distinguished Alumnus Award from the School of Nursing
fl of the University of Pennsylvania.
[ As Barnard College stated in its recent letter to her, "... we are proud of
{ the achievements of women in this century. We hope you will join us in our
l celebration because of your own accomplishments and as an example of what
  New York women have done for the city and the nation."

The MBH Women’s Auxiliary
Honored as Employees of the Month
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Members of the M H Women’s Aux i iary pictured in front of
the hospita|’s gift shop. From left to right: Jean Campbell,
Pearl Lewis, Lula Begley, Maude Fortney and Anna Lee
Hoskins. Auxiliary members not pictured are: Celia
Bowling, Mary K. Brashear, Alice Estridge, Faye Farmer,
Helen Green, Alberta Keen, Ulene Lewis, Daisy Mattingly,
and Clome Moore.
Bright and early every moming, a woman wearing ared coat and a cheerful smile
can be found working in the gift shop at the Mary Breckinridge Hospital. She
is one of a very special group of women who belong to the Mary Breckinridge
Hospital Women’s Auxiliary. Since it was founded in 1975, the auxiliary has
contributed irnmeasurably to the level of health care the hospital provides ,
through their gifts of money for much needed equipment, their ever ready `
assistance with a variety of projects and just by their friendly presence in the
hospital. ,
Why do these women give so much of their time and talent to the hospital
auxiliary? Anna Lee Hoskins, a member since 1976, explains, "When I was very
young, the Frontier Nursing Service clinic was the main source of care for our
family health needs. We depended on them primarily for medical attention,
prenatal and post natal care and delivery of the babies. We cannot give enough
honor and credit to Mrs. Mary Breckinridge and her staff for what they did for
us during those early days of development."

The president of the auxiliary, Mrs. Jean Campbell, echoed these
feelings and added, "Frontier Nursing Service has always been a focal point in
the community and my life. Voltmteering my time to the Mary Breckinridge
Hospital seems a natural thing to do. " When asked what the auxiliary would
like to accomplish in the future Mrs. Campbell responded, "We are looking to
expand, redecorate and restock the gift shop. We recently completed a renova-
tion project that replaced the heavy metal gates with an attractive glass enclosure
- a much needed improvement and one we are all happy with. More patient
_ contact is also a high priority...talking with patients regarding any needs they
I ` may have that we can fulfill. The auxiliary would like to have a mobile library
` for patient use. However, before these ideas can happen, the auxiliary has a real
Y need for more volunteers."
In 1988 the auxiliary lost Miss Betty Lester, one of its founding
members. "Miss Lester was our most devoted member," said president Jean
Campbell. "She was the hub of our wheel. Not only did she keep us going, she
also kept us in line. We lost a good friend and we all truly miss her. Miss Lester
cannot be replaced. Because she had the interest of the gift shop at heart, we will
dedicate it in her name."
The syndicated columnist, Erma Bombeck, once wrote, "Volunteers
don’t contribute to our civilization, they ARE civilization - at least the only part
worth talking about." Those of us at the Frontier Nursing Service heartily agree
with that thought. Recently, the C.A.R.E. (Courtesy, Attitude, Respect and
Enthusiasm) Committee voted unanimously to name our special volunteers, the
MBH Women’s Auxiliary, February’s Employee(s) of the Month. Even though
the women are not, strictly speaking, "employees", the committee felt they more
than deserved to be honored for their untiring and dedicated work. During the
past years, many items of much needed equipment have been purchased through
their contributions. In 1988 they donated funds that made the beautification of
the hospital grounds possible. In addition, they made a substantial contribution
to the Mary Breckinridge Hospital Community Capital Fund Drive.
Sonya Calhoun, the MBH administrative liaison person for the auxiliary,
, confirms the overall attitude of those at FNS toward the auxiliary and their work.
"The Women’s Auxiliary is a real inspiration to me and to other employees. All
of these women had full-time jobs before they retired and you would think they
4 would want to sit back and put their feet up - not these ladies. They all work so
hard for no reimbursement and we all are grateful for what they have done."
Indeed, it is inspiring to see such dedication to "volunteerism" and the
wonderful way in which the women’s auxiliary expresses its thanks to FNS for
its contribution to health care in the community. We at Frontier Nursing Service
are proud of the Mary Breckinridge Hospital Women’s Auxiliary. Our commu-
nity is a much better place for your presence. Thank you!

The John D. Archbold Memorial Hospital
Nurse-Midwifery Program
Celebrates 15 years of Service
The Nurse-Midwifery Service at Archbold Hospital, Thomasville, GA., serves
as an integration site (final nurse-midwifery clinical experience) for the Frontier
School of Midwifery and Family Nursing (F SMFN) students. While the Frontier
School already has sixteen integration sites that it uses on a rotating basis, »
sending students to Archbold Hospital is a particular pleasure. All four of the
nurse-midwives employed