xt7bzk55g24z https://exploreuk.uky.edu/dips/xt7bzk55g24z/data/mets.xml The Frontier Nursing Service, Inc. 1993 bulletins  English The Frontier Nursing Service, Inc. Contact the Special Collections Research Center for information regarding rights and use of this collection. Frontier Nursing Service Quarterly Bulletins Frontier Nursing Service, Vol. 69, No. 1, Summer 1993 text Frontier Nursing Service, Vol. 69, No. 1, Summer 1993 1993 2014 true xt7bzk55g24z section xt7bzk55g24z FRONTIER NURSING SERVICE
  Volume 69 Number 1 Summer 1993
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US ISSN 0016-2116 T
Table of Contents
A Courier Experience - Tim Bratton 1
ln Recognition - Kate Ireland - Barb Gibson 4
Notes from the School - Penny Armstrong 5 /_
New Leadership at FSMFN - Leigh Powell, Ken Tuggle 6 `
FNS Plans for Birthing Center - Deanna Severance 7
A Horse called "Doc" - Mary E. Heisey 9
FNS Employees - Barb Gibson 10
Courier News - Susie Quinlan ll
Sayings of the Children - Barb Gibson 13
Field Notes - Susie Hudgins 13
Ruth Lubic wins MacArthur Foundation Grant - Barb Gibson 15
A Look at FNS Outpost Clinics - Barb Gibson 15
Sixty-Eighth Annual Report 18 V
ln Memoriam - Barb Gibson 37
In Honor Of — Barb Gibson 38
KNA Recognizes work of Mary Breckinridge - Barb Gibson 38
In Memoriam Contribution Cards 39
Urgent Needs — Barb Gibson inside back cover
Frontier Nursing Service Quarterly Bulletin i
Us ISSN 001e2116
Published at the end of each quarter by the Frontier Nursing Service, Inc.
Wendover, Kentucky 41775 {
Subscription Price S 5.00 a Year for Donors
Subscription Price $10.00 a Year for Institutions
Editor's Office, Wendovcr, Kmtucky 41775
VOLUME 69 NUMBER 1 Summer 1993
Second-class postage paid at Wcndover, KY 41775 and at additional mailing offices. _i
POS'l`MAS'l`ER: Send address changes to Frontier Nursing Service, Wendover, KY 41775.  
Copyright 1986, Frontier Nursing Service, Inc.  

A Courier Experience - Tim Bratton
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Tim Bratton and Alabam Morgan
Tim Bratton is a student at the University of Louisville and a
volunteer courier during his free time. This article is a reprint from
the University of Louisville Alumni Magazine, Summer 1993 issue.
In late July of 1991, I traveled down the Daniel Boone
Parkway in eastem Kentucky toward Hyden. I was headed to the
Frontier Nursing Service (FNS), where I was going to volunteer as a
courier for five weeks. As I approached the toll booth at the Hyden
Spur, I felt overwhelmed by the size of the Appalachian mountains.
I was apprehensive about whether or notl would be accepted in the
community. The outcome was that I volunteered for the summer of
1991, Christmas break of 1991, the summer of 1992, and the Christ-
mas break of 1992.
During my eighth grade at Kentucky Country Day School, I
learned about the crafts, 1ife—style, and culture of eastem Kentuckians
.1 by spending a week at the Pine Mountain Settlement School. Two
years later, the courier director of FNS spoke at Country Day about
the volunteer program. It struck me that there was a dire need for help
· in our state. People in the inner cities usually have health facilities
such as clinics and university hospitals, whereas in rural areas,
medical facilities are sparse. Kentuckians, and all Americans, should
I have adequate health care wherever they live.

The health system in Leslie County is run by the Frontier
Nursing Service, which was established by Mary Breckinridge in g
1925. She gave birth to two babies, who died at very young ages. (
These two deaths convinced her that rural health care needed to be
upgraded. Therefore, she traveled to England to be trained in ~
midwifery. When she came back to America, Mrs. Breckinridge (
decided that she would locate in a very underserved area. Her chosen ;
area was Leslie County, which is now served by FNS with one  
hospital and three outpost clinics. Mary Breckinridge Hospital is a §
40-bed hospital served by one intemist, one pediatrician, one OB/ J
GYN, one Emergency Room doctor, two full—time midwives, and two
family nurse practitioners. The three outpost clinics are located at l
Beechfork, Wooton and the Leslie—Clay County line. Each clinic is
served by a family nurse practitioner (FNP), who provides primary p
care and who has his or her prescriptions signed by the doctors.
The role of the FNP is critical in rural health care. With a
scarcity of doctors, FNPs are able to provide primary health care. The
FNPs are registered nurses, who have obtained their masters degrees
and who have been trained in diagnosing disease and practicing
techniques such as emergency medicine. However, in the state of
Kentucky FN Ps are not yet permitted to write prescriptions. Doctors
and FNPs together provide the primary care and preventive medicine
in rural communities.
The health care model of FNS is lcnown worldwide because
it promotes health care to all, and at the same time it promotes a
balance between doctors, FNPs, and midwives. People from all over _
the world, including Kenya, Columbia, and Russia come to Leslie ?
County to observe the model health system. Besides the relationship I
between the doctors and FNPs, there is a relationship between the ’
doctors and midwives. The midwives "catch" the babies instead of
delivering them. Most prenatal visits, deliveries, and post partum
visits are taken care of by midwives. Only during high risk procedures
does the OB/GYN become involved. This balance allows for the
midwives to coach the mothers through their pregnancies and for a . ·
much lower percentage of fetal and matemal deaths. Since 1925, ..
more than 22,477 children have been delivered by the Frontier  
Nursing Service, and only ll mothers have been lost in childbirth.  
Finally, the use of FNPs and midwives allows for a lower cost of  
medical service.  

f Besides the hi ghl y trained health care providers, there are the
couriers; this is where I fit in as a volunteer. When Mrs. Breckinridge
  founded FNS, the form of transportation was horses. The role of the
{ couriers was to feed and take care of the horses. The couriers also
.‘ traveled on long trips with the nurses. The nurses and midwives
2 would travel through the mountains and hollows ("hollers") to visit
. patients. A round trip might take days so the couriers helped the
t ` nurses on the trips. However, as modes of transportation changed, the
I . . . .
· role of the courier evolved. Present day couriers take medicines,
  prescriptions, medical supplies, and mail between the hospitals and
i clinics on Mondays and Thursdays. On another day, couriers travel
with nursing assistants to homes (home health), where homebound
j patients receive baths and have their vital signs and medicines
checked. During the remaining two days, couriers shadow doctors
and FNPs in the hospital and clinics and tutor adults and children in
A the schools about how to read proficiently and how to perform
Home health was the most rewarding experience of my
travels to Leslie County. On my excursions, I learned about the
culture of eastem Kentuckians. In the home I met a large majority of
people who emphasized religion. Most people are Baptists or Pente-
costals, and a majority of the homes have a picture of Jesus and a
picture of The Last Supper.
A large portion ofthe residents live in house trailers and have
coal burning stoves. Coal companies are the second largest employ-
ers in the county next to FNS. While many of the men work for coal
V companies, a large percentage of women rear children at home.
? On my home health rounds, I ate a wide variety of homemade
Q jams and garden raised vegetables. Talking with the patients I noticed
¤ a strong sense of family commitment. There are no homeless people
in Leslie County, and there are no anonymous crimes on the streets.
People take care of one another, and if a family member is hurting, the
. family takes the person into the home. More than once I found homes
- where relatives from other cities came to Leslie County to live with
. r relatives. Few Leslie Countains leave eastern Kentucky. There is a
jj deep sense of belonging and family commitment. Not only was I
  rewarded by meeting people, I was also able to participate in the care
  of patients, to take vital signs, and to bathe patients. I also discovered
  that the majority of illnesses relate to high blood pressure, high

cholesterol, obesity, emphysema, and depression; these are medical a
problems, which can be prevented as more doctors teach more people I
about their health and life—styles. Thus home health provides deep }
insight into patient life and care. V J
On weekends I went out into the community. On Friday
nights I went to Stinnett Hill to listen to a group of men playing their ’
fiddles, banjos, and guitars. The group allowed anyone to play with
them, and they played into the wee hours of the morning. It was ;
genuine bluegrass music with the drone and style of Bill Monroe. In  
the barn, there was fried chicken and hand picked com and green 5
beans. On weekends I would fish with the principal of an elementary i
school, andl also visited my friend Alabam Morgan, who lived down I
the road from me, where I lived in a remodeled barn. Alabam is a 70
year old woman, who quilts, gardens, and tells of the days of Mary ,
Breckinridge. We would talk long into the night about gardening and
how coal companies exploited the land. Talking to people in the
county allowed me to tmderstand the resentment the people feel about I
coal companies’ owning the mineral rights to land owned by others.
Each Sunday I would go to a different church with a different
denomination to experience the varieties of Christianity. My experi-
ence on the weekends allowed me to experience rural music, friends,
and religions.
After I finish college and attend medical school I plan to
practice medicine in a rural area. I feel the social obligation of
providing health care to areas, which have scarce medical facilities.
As human beings, we owe it to one another to meet everyone’s
inherent needs such as food, health, clothing, and shelter. Hopefully,
within the next few years I will be able to return to the mountains of ,
Kentucky to help meet these needs. -Tim Braxton  
In Recognition-Kate Ireland »
During Berea College's graduation in May, the President's `
Medallion was presented to Kate Ireland, former Chairman of the
FNS Board of Governors. Kate became a member of the Berea I ·
College Board of Trustees in 1971 and was chairman of the Board A
from 1987 to 1992. t,

A Notes From the School
} The Community Based Nurse Midwifery Education Pro-
V J gram of the Frontier School of Nursing recently admitted the 107 th
class. Fifty—five nurse-midwifery students gathered in Hyden for the
’ three day orientation known as Midwifery Bound. The opening
convocation was held at the Mary Breckinridge Hospital where Board
; members and administration greeted the incoming class.
{ It was a challenge to find enough beds for all the faculty and
5 students, but everyone enjoyed the "camp like" atmosphere in Haggin,
i Joy House, and Mardi Cottage. The gathering at Wendover was made
T especially enjoyable by the story telling of Dr. Arme Wasson. On the
student's evaluations of the weekend, many mentioned their pride in
_ being a part of the rich tradition of the nurse midwives on horseback.
(One student even suggested that we bring back the horses!). Every-
one at the school is looking forward to the next class of fifty tive which
T arrives in late August.
Just before Midwifery Bound many faculty and students
attended the annual convention of the American College of Nurse-
Midwives in Orlando. The presence of over one hundred CNEP
students and faculty confirmed that this program is making an impact
on both the supply and quality of nurse-midwives in America.
Several resolutions at the convention acknowledged the role of the
CNEP which has led the way in distance education and electronic
communication. The CNEP will be providing consultation to the
ACNM as they go "on line" for the first time. As CNEP Clinical
Director, I have also organized the rural nurse midwives into a group
A for the purpose of communicating electronically. This electronic
  communication gives the rural nurse-midwives a much needed link
T with infonnation and support, thereby enabling them to continue to
t work in isolated areas of high need.
_ The Development Director of the CNEP has submitted a
` grant to the PEW Foundation for evaluation of the program. The
PEW Foundation funded the initial startup of the CNEP, and is most
; · interested in looking at the outcome data from the tive years of the
A program.
L As the CNEP moves toward its one hundredth graduate we
Q. can join in celebrating the success of a program which is currently

educating one third of all the nurse midwives in the United States. i
While numbers are important, we can also celebrate the fact that the ,
spirit of the Frontier Nursing Service lives on in the work of these i
nurse midwives as they care for mothers and babies in cities and small 7
towns all over this country. -Penny Armstrong
New Leadership at FSMFN   A
After much thoughtful consideration and deliberation, the {
Frontier School of Midwifery and Family Nursing Board of Directors  
at its June 18th meeting decided it was time for a change in leadership  
at the Frontier School of Midwifery and Family Nursing. The search {
for a new Program Director has begun. The Board of Directors look 1
forward to working with new leadership and you for the continued _
growth of the Frontier School in content, quality and prosperity. p
During the search process for a Program Director, Penny  
Armstrong, Clinical Director, and Kate McHugh, Academic Direc-  
tor, have been named Program Co-Directors. They will be happy to  
answer any questions you may have regarding this position. Please i
feel free to call the CentraliOffice to locate either of them. Again,
thank you for your ongoing support.
Miss Jane Leigh Powell, Mr. Kenneth J. Tuggle  
National Chairman of the Chairman ofthe Frontier School l
Frontier Nursing Service, ofMidwy"ery and F amilyNursing,  
Board of Governors. Board of Directors i
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Penny Armstrong Kate McHugh  

1 FNS Plans for Birthing Center
I Two words best describe FN S‘s approach to healthcare;
. responsive and innovative. In today's healthcare environment, those
Q who do not embrace both of these concepts will falter.
J Responding to national and state mandates for cost-effective
{ I alternatives and an ever-increasing recognition of the value of mid-
  wives, FNS‘s Board of Govemors has decided to develop a free-
i standing nurse-midwifery birthing center in its service area.
{ Women and matemity care have been such an important part
E of our history. Mrs. Breckinridge sought to provide good, preventive
  healthcare to people of southeast Kentucky through nursing centers.
l It is interesting how that mission, and the role of nurse midwives in
1 meeting that mission, has not diminished over the years.
. In fact, nurse-midwifery has gained momentum in becoming
, the altemative of choice among many women, both urban and rural.
E Several factors have influenced this trend. First, the shortage of
y physicians to deliver babies is a serious problem in many areas.
¥ Second, the costof care in hospital settings has continued to rise. And,
i third, there is a reversal in philosophy back to previous notions that
women are not sick when giving birth, so, therefore, should not be
  hospitalized unless necessary due to risk.
i Midwifery is certainly not new to this region; FNS has
  offered it for the past 68 years. However, during the past thirty years,
’ nurse-midwives have worked within the Mary Breckinridge Hospi-
i tal. The primary objective of establishing a separate center is to
E provide patients with a more comfortable, home-like setting that is
  also more economical.
[ We will continue to offer a full range of services for women,
  including family planning, prenatal care, delivery, and follow-up
  examinations. In addition, this arrangement will allow our hospital-
g I based obstetrics program to focus solely on patients who prefer or
  require physician assisted births.
i Friends of FNS will be kept infonned as details of the center
  ` emerge from the special task force that was established to tum the
é concept into reality. Task force members include Board of Govemors
  members Bob Johnson and Joyce Fitzpatrick and managers, Dave
  Southem, Penny Armstrong, Kate McHugh and myself. In addition,

Kitty Ernst, executive director of the National Association of J
Childbearing Centers, and Mary Breckimidge Chair at the Frontier V
School of Midwifery and Family Nursing is a task force consultant.
We're pleased to come forward with a creative solution Q
which will improve service to our midwifery patients and open new
opportunities for the hospital-based obstetrics program. We see it as
a continuation of Mrs. Breckinridge's foresighted leadership. .
-Deanna Severance  
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A Horse called "Doc"
Whenl applied and was accepted to join a class of midwifery
I students, it was suggested I arrive at Hyden a week early to practice
driving a jeep and learn to ride a horse. I grew up on a farm and, as
a child, shared family appreciation for our white horse, Scottie. But
· our father died when I was only tive and we moved off the farm. I was
never very athletic, but used to wish to leam to swim, paddle a canoe
and ride horseback!
Our class found three horses in the barn at Hyden. We were
taken individually to be shown the care of equipment and introduced
to the horses —- all "Tennessee Walkers". But of Doc, the larger horse,
it was said he should have a "hulla skirt", for he "never saw a
Tennessee walk!" Each of us soon had a favorite andl fell in love with
Doc. He had a great disposition and was so friendly.
One of my vivid memories of Hyden days is riding to the
Clinic up over the mountain trail with I ane Fumas ahead of me. She
liked birds, as I did, and usually had a pair of binoculars with her. It
I seemed to me that Doc loved every flower and enjoyed every bird
song along the path through the woods!
It was a great privilege to ride Mary Breckir1ridge's horse.
Can you understand why it was a thrill to be able to identify Doc in
an old picture in the FNS Quarterly Bulletin'? He‘s the tall beauty, all
, black with a white spot on his forehead. He last appeared on the cover
of the Spring 1992 Bulletin, mounted by Kate Ireland as a 1951
t courier. -Mary E. Heisey
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  Helen Stone, Courier, riding "Diane" and leading "D0c"

FNS Employees Q
In this issue ofthe Quarterly Bulletin we would like to recognize two
of our dedicated employees. .
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Beech fork Clinic Stajf left to right back ro