xt7gb56d3f35 https://exploreuk.uky.edu/dips/xt7gb56d3f35/data/mets.xml The Frontier Nursing Service, Inc. 1990 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 Quarterly Bulletin, Vol. 65, No. 4, Spring 1990 text Frontier Nursing Service Quarterly Bulletin, Vol. 65, No. 4, Spring 1990 1990 2014 true xt7gb56d3f35 section xt7gb56d3f35 y4\JlSI~c
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US ISSN 0016-2116  
Table of Contents I
Frontier Nursing Futures - by Deanna Severance 1
FNS Welcomes Judith M. Treistman - Edited by Meriwether Wash 8
FNS Welcomes Charlie Wilson - by Meriwether Wash 9 I
Notes from the School - by Judith Treistman ll
FNS in the Virgin Islands —by Rhonda Johnson and Debbie Browning 13
Kate Ireland Honored 17
First at the County Fair - by Jean W. Byrne and J. Laurie Byrne 18
A Nurse Called Mitch - by Hannah Mitchell 22
Meet the Board of Governors - by Carl Severance 25
Beyond the Mountains - by Deanna Severance 30
Field Notes - by Cari Michaels 32
Courier News - by Cari Michaels 34
In Memoriam - by Ruth Morgan 35
Memorial Gifts - by Ruth Morgan 36
COVER: Deanna Severance, in the spirit of the history of FNS, prepares to mount horse
"Bill" at last year's Mary Breckinridge Festival. Until the mid—1960's horses were the
primary means of travel for FNS care providers.
1=‘RoNTn2R Ntmsmo s1;Rv1c12 QUARTERLY BULLETIN i
Us ISSN 0016-2116
Published at the end ofench quarter by the Frontier Nursing Service, ln:.
Wendover, Kentucky 41775
Subscription Price $5.00 a Year *
Ed|t0r's Omce, Wendover, Kentucky 41775
Second-class postage paid at Wendover, Ky. 41775 and at additional mailing offices.
POSTMASTER: Send address changes to Frontier Nursing Service, Wendover, Ky. 41775.
Copyright 1986, Frontier Nursing Service, Inc.

  The Past as a Vision of the Future
· The future:
J We fantasize about it.
l Anticipate it.
  Worry about it.
  Advance our education to try and plan for it.
I Stay with our jobs
Leave our jobs
Yet with all our planning, we are constantly surprised by it.
I don’t have a crystal ball. What I would like to do is talk about
blending our history with our present and our future.
Mary Breckin1idge’s desire was to improve the lives of children.
. As she began her work in the mountains of Kentucky, she came to believe
, this was accomplished best through providing health care to the entire
family. Hence, the creation of the philosophy of family-nurse mid-
wifery. Although FNS may be known for the school of family—nurse
midwifery, the school did not begin until 1939. FNS was created in 1925
as a health service for the people of Leslie County. Guided by both in-
1 tuition and insight, Mary Breckinridge created a public health care
system in the private sector which lends itself to replication in both the
private and public sectors today.
The future of health care in both rural and urban America may
mean getting back to basics. FNS has been demonstrating since its
i inception that the combination of well qualified family nurse practitio-
ners, caring for people in a holistic, comprehensive way, backed up by
competent physicians with links to secondary and tertiary care, reduces
“ the infant mortality rate and improves other health indicators.
{ The FNS system created by Mary Breckinridge had the follow-
la ing elements:
• It was based on the philosophy of family nurse midwifery.
• District outpost clinics were staffed by family nurse-mid-

• Physicians backed up the nurse midwives and were called in  
to provide care for high risk women. l
• Tertiary linkages were created and implemented with Cincin- I
nati Children’s Hospital and the University of Louisville. {
· Regardless of where the patient was referred, the family nurse-
midwife remained as the families’ link with these other systems.
We know that this kind of caring works. It has been documented.
Even knowing all this, we at FNS face challenges. We face barriers
established by ourselves, the legislature, credentialing bodies, universi-
ties, and other agencies and institutions. These barriers are not unique to
FNS. All providers face some or all of them,
 or,     i      
e     »   ."    gif? 
    w tf   F   t‘‘ S
A g  ·_  . __ ` _ ,
 T `  ‘   .._   ‘` `    I ’i“‘ *    
FNP examines infant at FNS's Community Health Center. *
Health Care—Cosmos or Microcosmos?
Do you think of health care as the Cosmos or as a microcosm of
a strong productive society? Do you believe that one symptom of a  
mediocre society or perhaps even a society in the throes of decay is the
unwillingness, lack of desire, or inability to care forthe less fortunate, the
most needy of that society? And within health care what is the cosmos

  and what is the microcosm?
l What is the relationship between the lack of health care during
if the preschool years and the fact that Johnny can’t read, can’t write. Forty
‘ million of the 280 million people in the United States are illiterate-
about one in five. Who are our future physicians, ARNP’s, RN’s,
_ nutritionists, dentists, pharmacists, social workers? We buy transporta-
tion, cars, engineering, steel, electronics, and nearly all the other trap-
pings of civilization from other countries. Would we, if we could, buy
health care from other countries? If a growing segment of our popula-
[ tion can’t read, can’t write who will provide not only our health care, but
the leadership of our country? I ask you again, what is the Cosmos and
what is the microcosm?
I I have been thinking about saving lives, and especially about the
. professionals who save lives. I have been trying to put myself in their
shoes. And when your world, day—in and day-out, is saving life, cheating
p death, then that becomes THE WORLD. That is the work of the tertiary
care centers, these centers of salvation for so many. These centers are
associated with our great universities, places of higher leaming and re-
search, institutions which attract the great minds of our industry, health
care. Hence, I have a glimmer of insight into that world. THE WORLD,
R as portrayed in our movies, on television, by newspapers. A complex
world of technology and caring. A difficult world where the technology
sometimes, oftentimes, has advanced beyond our society’s attention to
j the ethical questions which that technology raises.
I have been thinking about jogging, mineral water, and grain
A cereal. I have been thinking about the desperation of being homeless, of
, · being fifteen and pregnant, addicted to cocaine, sitting in the large and
  ever-crowded waiting room of the city health clinic. These public health
, ( clinics, these centers of prenatal care, attract nurses, physicians, nutri-
p tionists, social workers, etc. with a missionary zeal, dedication and com-
, p mitment to helping individuals. Individuals whose lives are often
  desperate and disorganized. Hence, I have insight into their world, THE
  I WORLD of day to day caring where no one dies in the office, people and
communities just seem to wither and die slowly. No miraculous cures
A occur in the office. THE WORLD where there are never adequate
i resources.

QF}, I»I_ I R   gr _ What is the gl;
p *     Q   future of this health  
  31%;,, & i I   system which saves Q
    ., A     # 'V   babies and then re- l
  j ;~— ., `;.Ie` » S- T ‘ N v  · ‘
eaI» ‘ ·’`‘,   ;,     < *     ¥       mms them “’ 3 S°°"
 i iIe—”e .         i_.<   I I   HY where adults
  -·s`‘ to   tit     can’t read, can’t ,
      *‘`‘   7 I   write? If one or ev-
  VL‘“   W     -  at    ·` »i`i   er f` eo l can’t
 I. ,t     g   __,,_ ,   _,_i .l  , y 1ve p p e
°   ‘ `»i      if       `` ` N read, how helpful are
 `V ; i   the pamphlets in the
    clinic? If 28 to 29
if  babies hom in Cin-
cinnati each month
The cry of a healthly FNS newbomi are bom to drug ad_
dicted mothers what is the likelihood that newborn clinic appointments
will be kept if that mother is the child’s primary caregiver? What is the
likelihood that this baby will have his diaper changed when wet, fed
when hungry, touched, stroked and smiled at when this baby signals now
is the time fortouching, stroking and smiling? What is the likelihood that
this baby will have the physical, social and emotional nourishment his
brain needs to develop optimally through the first two years of life? If
this baby does not encounter a life taking disease or injury, what is the
likelihood this baby will be able to read? If this child does not leam to
read, what is the likelihood that this adult will be able to obtain a job _
earning wages above the poverty level? What is the likelihood this adult X
will have children who can’t read? `
Courage and Barriers s
To restucture the health care system to meet the needs of the (
future will require courageous leadership. Courage is the "mental or f
moral strength to venture, persevere, and withstand danger, fear or
difficulty? Even minor restructuring of the health care system will  
require the strength to venture, persevere and withstand danger, fear and
What are the barriers to restructuring the health care system?

  There are many. I will discuss legislative and bureaucractic barriers, and
  related issues.
if Often, legislators are elected on platfomis reflecting their per-
i sonal beliefs about education and taxes. I have known people in the
health care community to become extremely frustrated because their
elected representatives "know nothing" about health care. What do they
` expect from legislators who have grown up on Marcus Welby and
Medical Center? And who have continued to be fed by Doogie Howser
and Nightingales? Many elected representatives, the men and women
who write the laws of our states, earn less than $20,000 a year. Who could
expect them to react in an enlightened way upon hearing that obstetri-
cians in someone else’s district will not accept women whose payment
source is Medicaid?
Maj or policy shifts occur when eitherlegislators are elected who
reflect a strong community belief, or when they are influenced by a group
of constituents organized around an issue. Of course, greatmen and great
women-—Florence Nightingale, Louis Pasteur, and on and on—have
influenced policy at critical times. People can change policy. Nurses and
others who expect to have credibility with legislators must provide
evidence that the expanded use of advanced registered nurse practitio-
ners will not lead to a second class of health care, but a better class of care.
When you hear the word bureaucrat, what image is conjured up
in your mind? The dictionary definition is: " a government official who
f follows a narrow rigid formal routine or who is established with great
‘ authority in his own department? Is your image of a bureaucrat a man
wearing a rumpled white shirt, sitting behind a desk at a city hall,
, . shuffling papers, thwarting community and individual projects and, in
  general building barriers, which prevent getting things done?
I I ask you to think of bureaucrats in terms of;
r • someone who doesn’t want to rock the boat.
P • someone who wants to retire from their position.
; • someone rigid and inflexible
I • someone who wants to protect the work they do
• someone satisfied
· someone who wants and tolerates no interference in doing their
job as they perceive it should be done

• someone who exercises tight control over their "piece of the
action". ,
If any or all of these definitions fit the image the word bureaucrat ,l
conjured up for you then I suggest the setting must be applicable to many '
institutions beyond the govemment-—to universities, private non-profit
agencies, professional organizations, credentialing bodies, and on and _
on. ,
If we are to meet the challenges of the future, we must have E
national leadership which rises to a higher plane. If we are going to carve  
out a new, future direction in health care delivery, the national leadership I
must communicate to the faculties, health officials, standard bearers,and l
credentialing bodies the expectation that barriers to quality health care
must be tom down and that new barriers—professional elitism and
educational turfism, to name two——will not be tolerated.
Who will influence the leadership? The funders? The policy
makers? We will. We can. We must.
Money, Rules, and Education
We can’t allow the hodgepodge of funding to continue. Link-
ages must be mandated before contracts are forged. For instance, should
anyone receive Title V, Medicaid, and/or state general revenue money
for prenatal care if delivery, postpartum and primary care linkages are not
in place?
But what, you may ask, about local autonomy? I am saying each »
state working with its local constituencies must have the right to forge
linkages in the unique fashions required by cultures, values, and popu- » I
lations. Butthe fact that the linkages must be forged is not up for debate.  
I also suggest serious consideration must be given to linking funding,
both federal and private, to standards of care. Finally, I am so bold as to (
recommend that our policy makers rethink and rebuild reimbursement ‘.
linked to levels of care. Perhaps we should call these levels: V
· Teaching everyone: Health Promotion/Education/First Aid/
· Primary care
· Secondary care

• Tertiary care.
§ There must be more creative ways to expand educational sys-
  tems. FNS, in cooperation with the Matemity Center Association, the
‘ National Association of Childbearing Centers, and the Frances Payne
Bolton School of Nursing at Case Western Reserve University, has made
a significant contribution in this direction. The Community-Based
I Nurse-Midwifery Education Program (CNEP) will prepare nurse-mid-
; wives primarily for birth center practice. Using a modular approach,
leaming will be individualized to permit most of the required course
p work to be completed through off—campus study. Clinical experience
  will be individually arranged in community-based nurse-midwifery
Technology and "   __ M" 3 Aiv`` W ywww
Toe Shoes   _ .  
l I am impressed .   ’     Oy  
that technology is exciting __ _   ·  A r   .
and fun. Iam also im- . ,.=:_*_ V   i`(_ we _  - 
pressed that no technology       ··   W Q  
can replace my daughter’s g °‘ . "'~ Q
grace and beauty and my   , l t‘’’ Q   1   C  
thrill as she dances in her .    ,_ _ ‘ .
firstpairoftoe shoes. Iam C .     ` ‘*°
A impressed that technology   i A.? U {
  must have a place, but a A      wk 
  place somewhere beside  $1 K ;; _w_; ii`1_=.`· _   ,,_.  
; human relationships--can  .. p  j p       (  
A p mg, compassion and thc           · rf ‘ .  
  f¤“h€““g of °i““Za¤°¤·  stl L   V Q    at  
`\ -Dganna     `      
Severance       . ’. ` ` 4 `
T , a     .  . .,·.. .,
Deanna Severance with daughter Sarah at last year's
Mary Breckinridge Festival parade.

Judith M. Treistman I
FNS is pleased to announce that Ju-
~   ~ __ dith Treistman has been appointed .
  ,,__V President of the Frontier Nursing ‘
    V.   Health and Education Corporation, {
  L the component of FNS that operates
Y '-»V . 3 --»t. the Frontier School of Midwifery and i
    ·   Family Nursing.
· .   Much like women every-
  where, Judith has had many "ca—
      reers". She first studied anthropology
  _   at Columbia University, where she
   J il received her PhD with a focus on the
    pyghjgtory of early Asia. She SD€m
" two years in Taiwan and Thailand
I researching indigenous cultures.
Judith Treistman President of the Frontier After more than ten Years Of graduate
Health and Education G¤rr><>ra¢i¤¤. teaching at Comell University and the
City University of New York she took
a slightly different tum and entered the Yale School of Nursing where she
eamed her MSN in Matemal and Newbom nursing and became certified
as a Nurse-Midwife. She never thought of anthropology and nursing as
contradictory or mutually exclusive but sees the two fields as remarkably
similar and enriching each other. ,
The next ten years saw more teaching, this time as Chair of the
Department of Parent Child Nursing at the State University of New York I
at Stony Brook. She was also very actively engaged in practice in the Suf-
folk County Department of Health Services where she superyised the
Prenatal and Family Planning programs. Judith and several other Cer-
tified Nurse-Midwives led a long but disappointing struggle to gain full-
scope midwifery privileges in New York's Suffolk county hospitals. The
midwives urged the legislature and physicians to allow them to practice
as they knew best - serving the mothers and babies of the community.

Even in New York the mission of Mary Breckinridge and the FNS is
Judith is well known on the national level, one of her peers
* comments:
{ "I am delighted to be able to report that Judith Treistman, PhD,
= CNM, has just come on board at the Frontier School of Midwifery and
Family Nursing and will be devoting a major portion of her time to the
Community-B ased Nurse-Midwifery Educational Program. She is very
excited about the CNEP and wants to play a major role in helping to test
the pilot and further develop the program. We are thrilled to have her ex-
; pertise as an experienced academic, international anthropologist and
nurse-midwife who just finished what she has called a 'vacation‘ with the
‘ Indian Health Service where she attended over 200 women at birth."
r -Edited by Meriwether Wash
Charlie Wilson
Frontier Nursing Service is pleased to announce the appoint-
ment of Charles Edward Wilson as administrator of Mary Breckinridge
Hospital. Charlie, as he is known, was bom at the old Pine Mountain
Hospital and is a lifelong resident of Leslie County. He graduated from
Leslie County High School, received his bachelor’s degree from Cum-
berland College in Williamsburg, Kentucky, and his master’s degree
from Union College in Barbourville, Kentucky. He did additional work
, at Eastem Kentucky University in Richmond, Kentucky.
Charlie brings to Mary Breckinridge varied personnel and
. human relations experiences. As an educator , he has been a teacher,
counselor, and vocational administrator at the local and regional level.
He also has administrative experience in the coal industry and has
worked as a social worker in Leslie County.
Charlie served a four-year term as Leslie County Judge Execu-
tive. Responsible for the management of county govemment services he
budgeted, planned, purchased and supervised personnel with a three

mation dollar annual budget.   ’ j=;,‘ ;I
He is pleased to note that `      _-   ; \__._° i _   I _
while the county was in the ` ·       E » p V (
red at the beginning of his f.     »—»—i -_,   I l,
term itwas tirmlyintheblack     if   I S   » » I
whenhe left. Charlie also has   "   p     g   sAs  E
broadcasting experience, X __I.   i _       I_\; . ;·;.gIJ °  V
which he considers fun, not _  1, ;,  ‘;" A `       
work. He has hosted a   p:`i ` i  I »»;`_ p    
weekly call-in talk show on a   Q J   I __  
Hazard, Kentuck radio sta-   _;_;;   ,= ’  
tion, and he is curiently doing   C      
a weekly commentary on l         i
WYMT-TV in Hazard. His . ..·/ Q
90—S€CO]']d commentary gen- Charlie Wilson atworkas new administratorof Mary .
ters on issues that affect East- Br°°ki""dg€ H°Sp'ta|‘ l*
em Kentuckians.  
Charlie says he took the job as administrator of Mary Breckin- {
ridge Hospital "because I care about Leslie County and I enjoy a chal-
Charlie is no stranger to the FNS and Mary Breckinridge
Hospital organization. He has served on the hospital’s Board of Direc-
tors in the past. One of the things that has always amazed him is the {
dedication of staff members that have worked for FNS for years. i
Charlie’s goals as administrator include building a stable medi- l
cal staff and building community confidence in the quality of care “
provided by a smaller facility such as Mary Breckinridge Hospital and »
the district clinics. He feels it is important to continue the mission as a
regional birthing center and a demonstration project as a prenatal care
and midwifery example for the world. °
Charlie looks forward to getting down to work. He is working I `
on a plan of action where Mary Breckinridge Healthcare staff will work
as a team under creative and aggressive leadership to move forward and
explore new altcmatives for quality care.
-Meriwether Wash

· Frontier Nursing Service to Have Pilot Class
i at University of New Mexico
i In a move termed "unusual and innovative," by many in the nursing
j education profession, the Frontier Nursing Service Board of Govemors
it authorized finalization of the agreement and approved implementation
Lil of a Pilot Rural Nurse—Midwifery Program at their quarterly meeting
I held at Wendover on June 15, 1990. This program will assign faculty
from the Frontier Nursing Service’s Hyden-based Frontier School of
  Midwifery and Family Nursing (FSMFN) to Albuquerque, New Mexico
i where they will initiate a midwifery training program in the College of
Nursing at the University of New Mexico. Eleven students, all from
* Southwestern states, have already been accepted to the class. The
qi program has recieved accreditation from the American College of Nurse-
i Midwifery and the approval of the Federal Division of Nursing.
y FNS will be there for one year, at the end of which the University
of New Mexico has the option of adopting the program as its own. In this
way, FNS will act as a spearhead, using the skills and "know—how"
developed over the years to help initiate midwifery education in an
underserved region.
The Frontier School of Midwifery and Family Nursing, the oldest
i continuously operating school of its kind in the United States, will
. remain headquartered at Hyden under the direction of Dr. Judith Treist-
man, newly appointed President of Frontier Nursing Service’s Health
! and Education Corporation.
In addition to basic midwifery instruction, FSMFN also offers a
’ Precertification Program for foreign-trained midwives, and a Commu-
nity Based Nurse Midwifery Program (CNEP) a revoluntionary ap-
, proach for training record numbers of nurse—midwives.
While it is true that for every nurse-midwife we graduate, there are
. A up to 30 positions to be Hlled, the future has never been brighter. Our
Precertihcation Program has been able to tap a source of practitioners
that until recently has been largely ignored. There have been many calls
from hospitals, birth centers and county health departments around the
country requesting us to give "on-site" programs for foreign-trained
midwives. The Frontier School just enrolled two groups of precertili—

 i R
cation students; one group in Hyden, Kentucky and one group in Miami,  
Florida. Both have six students. Our past group of six students sat for =
their certifying exams in June.
We are planning a feasibility study to look into expansion of the  
precertification program. When the current students pass the ACNM  
Board examinations, FNS will have placed thirty-tive newly certified i`
nurse—midwives in practice through the Precertification Program in only rl
two years!  
The forty—one students of the Hrst CNEP class are moving toward {
completion of the Levels I and II of the modular program. The students QI
will gather in Perkiomenville, Pemasylvania in June for Level lll, a two ,
week "on—campus" seminar and skills evaluation. As part of the x
transition to Hyden I will become course coordinator for one module and
will be faculty during the Level lll seminars. We are currently prepar- A
ing to undertake the Program Evaluation and I am developing a computer ‘
program to accomplish this task. The next step in preparing for the ,
relocation of CNEP to Hyden is to recruit and hire faculty and additional ;
support staff. '
The entire faculty attended the convention of the American
College of Nurse—Midwives in Atlanta, May 13-17, 1990. Administra-
tive Secretary, Jeanette Woods, and Registrar, Charleine Beatty, were
present for two CNEP workshops. Dr. Ernest Boyer, President of the i
Camegie Foundation highlighted the CNEP program in his keynote -
address "Innovation in Education" ,
-By Judith Treistman  

The Frontier School of Midwifery and Family Nursing
, (FSMFN) Precertitication Program, directed by Sr. Martha Walsh,
li MSN, CNM, remains unique in this country. It is the only program that
  prepares foreign-trained nurse—midwives to take the American College
  of Nurse Midwives (ACNM) certification examination. Since its incep-
I tion in March, 1988, it has attracted literally hundreds of inquiries from
I around the world,without advertisement.
I In March, 1990, and in true FNS pioneering tradition, this
if program took a step into the Caribbean world of nurse-midwifery. ln
” 1989, FSMFN was approached by the faculty of the University of the
' Virgin Islands stating their interest in collaborating with the Kentucky
, program to update their professional staff of nurse—midwives.
A Although St. Thomas, St. Croix and St. John are considered
  American territories, they have only recently considered requiring
I American certification for their nurse-midwives, most of whom are
trained in Great Britain or Jamaica. Thus, the nurse-midwives have years
of excellent training and experience in the British model while practicing
under an American flag; perhaps much like the original British nurse-
midwives on horseback in the mountains of southeastem Kentucky,
L recruited by Mary Breckinridge! These highly skilled women manage
- over half of all deliveries in the St. Thomas and St. Croix Hospitals. They
I also coordinate the prenatal, postnatal, and family planning services
  provided by the Division of Health on St. Thomas, St. Croix, and St.
  John. Despite their efforts, and because of many complex sociopolitical
` factors, infant mortality statistics within the territory of the Virgin
. Islands remain about twice as high as the U.S. average. Obviously,
efforts to improve pregnancy outcomes may be logically directed toward
` the nurse-midwives who are willing and eagerto share their expertise and
? sharpen existing clinical skills.
After initial discussions between Sr. Walsh and representatives
of the many concerned parties in the Virgin Islands, coordinated by Dr.
Judy Grybowski of the College of Nursing there, it was decided that a
three-week Physical Assessment course be offered on the Islands by
FSMFN faculty would be a reasonable pilot project to set the stage for

* ‘»;&__»               I
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  `:V_ ,   AV   I      la;     ` _ U
        ’ I       .
      I *     IIZ [  
.< E         I::v·   4   4`` i `R?`   II-   °I,. S ».S. 1.
I     A  é   III   .. .    III   
  ·· zr wl · ‘*’., 7   K  ` K  
..· t.   `  '`` 'Y ` *   ’ .   ‘ " "   `°`>§li°Z.e·r»;’§a
FSMFN Faculty members Flhonda Johnson and Debbie Browning with St. Thomas
further collaboration. It would also provide a first opportunity for
FSMFN faculty and the Virgin Islands nurse-midwives to work together.
On March 18, Debra Browning, MSN, CFNP and I (Rhonda Johnson, i
CFNP) left for St. Thomas and St. Croix to teach the Physical Assessment
course--which is normally conducted within the first six weeks of our
precertihcation course in Hyden. Post-Hurricane Hugo communication
difficulties (it was not uncommon to lose electricity or telephone contact)
made it difficult to estimate the actual numbers of participants prior to I
departure. Early estimates indicated that perhaps ten of the twenty-two ,
eligible nurse-midwives would take the course. Course materials were 5
planned for that number. Dr. Grybowski indicated we should bring `
opthalmoscopes and otoscopes but other medical supplies would be ·
available. S
Dr. Grybowski opened her home to us for three weeks, even 3
though a portion of her roof had been lost to Hunicane Hugo and had only .
recently been replaced. A local car dealership, Bayard Motors, provided
a complimentary car to us because its owner, Mr. Danny Bayard,
strongly supported this opportunity provided for their nurse-midwives.

The vehicle proved invaluable by greatly easing long daily commutes
and adding the essential flexibility to meet a harried schedule. It did take
a while to adjust to driving on the left side of the road and to the winding
island roads!
Upon arrival, we leamed that interest in this course had greatly
exceeded initial estimates and we would have ten students on St. Thomas
" and eleven on St. Croix. We were pleased at the interest but also wary
as this course is nomially limited to six or seven full-time students in
Kentucky and team taught for six weeks by three faculty members.
Debbie and I were about to teach three times that number of part—time
students with full-time jobs and family responsibilities the same material
in half the time in a totally new location. A REAL CHALLENGE. . .
Travel was an amazing undertaking. To fit the scheduling needs
of the nurse-midwives, it was decided to hold moming classes on St.
Croix and aftemoon classes on St. Thomas. This daily commute, once
made convenient by sea planes now defunct because of Hugo devasta-
tion, was accomplished via a small commuter flight between Island
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S  m mlgijhonda Johnson and Bebbie Browning with St. Croix students.

airports. Unfortunately, the airports were on opposite ends of the Island I
from the classroom sites which always added an extra hour onto the i
schedule. We truly relied on the kindness of strangers as each day we  
were met by one of the students and shuttled back and forth between K
airport and class. Q']
St. Croix was literally devastated by Hurricane Hugo and this
was grossly apparent as we flew across it each day. Although Hugo had k
passed six months previously, about half of all homes were still without .
roofs and huge piles of debris littered the landscape. Few in our class
were unaffected by Hugo and many had lost their homes. One nursing I
faculty member at St. Croix joked that her trailer site got the "Clean
Home Award" as everything had literally been swept from the founda-
tion with the exception of the toilet fixtures.
The nurse-midwives on St. Croix currently work out of MASH-
style tents provided by the National Guard. They are eerie, half
primitive, half space age contraptions that provide " temporary " housing
pending necessary repairs to the actual hospital which was judged unsafe
and unsuitable after Hugo. They hope to retum to the hospital within two
years. Their daily work is a struggle on top of dealing with the demands a
of rebuilding their own homes. Construction has replaced tourism as the I
number one industry on St. Croix. E
These are the women who chose to add a three- credit, 30-contact K
hour course to their burdens. The youngest was 39; the oldest 62 with L
an average age of 50. Most had graduated from England and Jamaica but .
a few graduated from Puerto Rico, St. Kitts, Trinidad and Tobago. The ‘
most recent graduate finished midwifery in 1985; one finished her `
training in 1958. All continued their work schedules during the course ,r
which included ten three-hour s