xt7j3t9d6c03 https://exploreuk.uky.edu/dips/xt7j3t9d6c03/data/mets.xml The Frontier Nursing Service, Inc. 1987 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. 63, No. 2, Autumn 1987 text Frontier Nursing Service Quarterly Bulletin, Vol. 63, No. 2, Autumn 1987 1987 2014 true xt7j3t9d6c03 section xt7j3t9d6c03 6, ¤UlSr~C
\’Ol.lll\’llZt>3 NUMHIERZ Al"lUM\ l9><7 Q i Q 5
  Z »•¤•-`L. L;
M , ¤
I F t-   N  ik        T$L      S
¥ rO n ler  *  it lr       
I N U rg i n   ;:L I =—.      
g   ¤$·      
· €    
    l ` World
I tg   
(~' K   kr   pg    K —
.,1   § .-,   ‘   I
{  W  ` ·    `
`  ,       Fi
“A tiny plant above the ground was the Frontier Nursing Service ....
Over the years the plant has grown, throwing out branches, as it has
sought to become a banyan of the forest, ‘yie|ding shade and fruit to
wide neighborhoods of men} " — Mary Breckinridge

US ISSN 0016-21 16  
Mary Breckinridges’ Neighborhood I
Editorial by Steve Hardman, Administrator, Mary Breckinridge Hospital 2
A Trip to Nigeria by Wendy Wagers 4
Health Care Belize Style — by Whitney Robbins 12 *
Greetings from Zambia — by Heidi Froemke 19 l
In Memoriam 23 r
Memorial Gifts 23
School Notes — by Ruth Beeman 25
In Brief 26 `
Beyond the Mountains — by Ron Hallman 27 ;
Field Notes - by Elizabeth Wilcox 28 I
Urgent Needs Inside Back Cover
Staff Opportunities Inside Back Cover
Photo Upper Right: FNS midwife Dr. Nancy Clark checks on a newly delivered
Photo Lower Left: Two children ofthe Ebo Tribe seek health care at the Nigerian
Christian Hospital.
US ISSN 0016-2116  
Published at the end of each quarter by the Frontier Nursing Service, Inc.
Wendover, Kentucky 41775
Subscription Price $5.00 a Year
Edit0r's Office, Wendover, 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 ' i
Copyright 1986, Frontier Nursing Service, Inc.   l
~ I
i 1
» I

; Frontier Nursing Service Has
  Spread Its Mission To The World
1   »s~R   L                 
,   _ ' _&_`i ;     riUiTU T,     [  ,a    ‘l .?§_Z/g ___,  ~ 4 _, ·s    
·   t -:·    ` ‘___        ,  i       3   _ g  
»  r   it ‘T`s  ,·     _ d ;§g» ~’*’  
‘ q °       ieoa             .   » ie   +‘ ; R _
. ,   -_  Q;    *-1* `   2** ";~’=2¤§,    
  34.   » ~ »1 ‘ .   M"  t  = ~ T ».  
i       » > " ’  ’ia`i    
T 2    d,~.       _ · —+··$~*i" ‘1‘“Ii?‘   
l I ` T ii;. " Tk ·   ‘·FT°L—i""`°"'-[ji  \  
P — —     . " ,    T? '.., 2   l     E '
; -— r Que  5,.;*;.:;   .      -¤· .» rg;  tz ..
g I/.4 j____  lis ·*   ;;, _`_   —
  ’ ‘ F "’’``         · *“ k__.i_.f"'
f .. ...;.Zbi‘;¥·h!.Q$'.I...»x¤¤.·¤ra..;.p P   “1~*   · ~ ink   ;·_,Y_ ,_ _ ;_,_ _ __ L __ _ _ __
l For sixty-two years the Frontier Nursing Service has distin-
I guished itselfin the field ofrural health care. Over the years, FNS
has grown —— as founder Mary Breckinridge hoped it would — into
i a health care model that has been observed, copied and utilized by
health care specialists all over the world. Many such health care
” providers come to Hyden each year to learn our methods and
return home to set up systems similar to ours in their countries.
By far the largest group carrying the FNS concept outward are
’ former FNS practitioners, most of whom are graduates of the
V; Frontier School of Midwifery and Family Nursing. At this time of
i S writing, we have FNSer’s working in 54 countries and 47 ofthe 50
` states. As Steve Hardman reminds us in his editorial, Mary
Breckinridge had a broad world view and today her vision —
through those trained here in the Kentucky mountains — has
, been expanded to include a very large neighborhood indeed.
  This issue of the Quarterly Bulletin is dedicated with respect
L; and gratitude, to all those who have — with spirit and courage —
I   chosen to share their skills with the wider community.

Mary Breckinridges’ Neighborhood  
Mary Breckinridge held a remarkable view of the world in which  
all of mankind are residents of one world—wide neighborhood. ,?
It is perhaps a useful exercise to pause occasionally and ask i
ourselves, "What kind of shape is the neighborhod in?" I
First, the neighborhood in which we all live is growing rapidly. i .
It took probably one million years for the earth’s population to ,
reach one billion; thirty—two more years to reach three billion;  
fifteen more years to reach four billion. We are currently at about pj
five billion people and, we will double the earth’s population — to I
ten billion — in approximately sixty years.  I
Nearly all of this projected increase, however, will come in the I
undeveloped nations ofthe world, whose populations will increase  it
from 3.5 billion to 8.5 billion. During this same period, the  Z
industrialized nations —— the United States, Europe and Japan  I
—will only increase from 1.3 billion to 1.5 billion. By the year 2050  
——with current trends — India will surpass China as the earth’s °
most populated nation; El Salvador will grow from 5 million to 1 7 i
million; Africa will expand six-fold; and Nigeria will surpass  .
several nations — including the United States and the Soviet  L
Union - to become the world’s third largest country in population. ¥
In the developed nations, the major health-care problems are  
environmental and life—style diseases such as heart disease,  
diabetes, also motor vehicle accidents and a host of illnesses  
resulting from drug, cigarette and alcohol use.  4
In the third world, however, infectious diseases are still .
rampant. According to the World Health Organization’s 1984 · 
report, throughout the tropics, half of all school-age children have I
malaria. In parts of Africa one child in five dies before the age of t·
six of malaria. More than half of the world’s population lives in ,
malaria—risk areas. And the most dangerous of malaria parasites I I
— Plasmodium Falciparum — has developed a resistance to . ‘
The building of dams and irrigation systems is contributing to
the spread of Schistosomiasis or "snail fever". The World Health
Organization has estimated that there are over 200 million cases
of this parasitic disease in the world, and, the incidence is
increasing. ?

_ There are over 100 million cases of filariasis, one form of which
  — onchocerciasis — causes blindness and another form attacks
  the lymphatic system.
I There are over 50 million people infected with Trypanosom-
{ iasis in the world. The African form of the disease — African
, sleeping sickness — is spread by the Tsetse fly. A South American
* form of the disease — called Chagas’ disease — is spread by the
§ bite of a small, blood-sucking bug, and causes irreversible internal
I organ damage.
il There are over 400,000 cases each year of Leishmaniasis, a
, potentially fatal illness caused by a protozoan.
_? And, believe it or not, there are over 11 million people in the
 } world today suffering from Leprosy — another disease which has
 Y recently developed resistance to medication.
 I As if these horrible and exotic tropical diseases were not
  enough, poor people from third-world countries are also more at
L risk from everyday illnesses than you and I are. Dysentary is a
” leading cause of death among third-world children, and a child in
 - an undeveloped country who catches the measles has a 20%
 , chance of dying from this disease.
  The World Health Organization has estimated that fully 50%
 _ of third-world people are either undernourished or frankly mal·
  nourished. And only 25% of the third-world residents have ready
  access to safe, potable water. It is not surprising that infant
 < mortality rates for underdeveloped lands are 10 to 20 times higher
, than for developed nations.
"  So, how is our "neighborhood" doing? Well, it has many
I serious problems just as it did during Mary Breckinridge’s day.
i' And there are many of our neighbors who need help, just as many
; people did during Mrs. Breckinridge’s day. The question — as I see
I , it — that our generation must answer is whether we are willing to
-_ ` roll up our sleeves and lend our neighbors a hand today as Mary
{ Breckinridge and the other pioneers of Frontier Nursing Service
did in their day.
(Much of this information is taken from an address by Val D.
McMurray, Ph.D. to the second annual meeting of Collegium
_ Aesculapium, Salt Lake City, Utah, 1985.)
' — Steve Hardman

A native of Los Angeles, Wendy Wagers moved to Eastern Kentucky in  
1966. After receiving her BS in Nursing from Eastern Kentucky Uni- I
versity, Wendy attended our Frontier School for her midwifery and
family nursing training and then earned her Masters in Nursing at the 5 I
University of Kentucky, graduating in 1981.  
Following graduation, Wendy worked for the Booth Maternity Center l
in Philadelphia where she started and coordinated Women’s Health Y
Associates, a private practice of nurse midwives. She returned to FNS in A l
late 1984. Since then she has served as faculty, actively practiced '
midwifery and in addition, works with FSMFN students as Educational
Coordinator. `
Active in the American College of Nurse Midwives, Wendy is a
current Chapter Chair, Chair of the State Nurse—Midwifery Peer Review  .
Committee and a member of the National ACNM Peer Review Com-  _
mittee. j
In the following article, Wendy tells us of her adventures and shares  ;
her impressions during her very first experience working as a nurse-  ·
midwife in Nigeria. `
In the last week of May, Nancy Clark, the Associate Dean of our  Q
Frontier School of Midwifery and Family Nursing and I left FNS  .
for Nigeria. We went with a group of eight BSN students from  
Harding University in Searcy, Arkansas and with a combined 5
student/faculty group from the Frances Payne Bolton School of  
Nursing at Case Western Reserve University.  »
Prior to coming to the FSMFN, Nancy taught at Harding and
participated in several of their overseas programs. Acting as a  _1
faculty member in all three schools, Nancy was able to arrange for .
us to spend six weeks at the Nigerian Christian Hospital, a j ‘
facility that primarily serves the Ebo Tribe in the same area that  .
was once called Biafra. ,
Our arrival in Lagos, the Nigerian capitol, was an adventure F  i
in itself. The presence of armed military police was very apparent,  _,
although we got through customs easily without ever being  *
searched. All over the airport men begged and fought to carry our  
bags, as did the taxi drivers out in front of the terminal.  `
We were supposed to stay in a local mission overnight and then
continue on to our destination the next day. However, overseas

  .  ~·           * r;§·        
    i ’   ‘      .       H    
  T     .    -    TVL E          
{ I   {     i t ; ( i`   T v»‘· "   ·v`· fil;-_ ’ -   gg; `’_` x  
lt    LL R     . H °   H   L E       ` E ?E  
.     F ` . r
Students and faculty stand in front of the Mary Slelssor Hospital. From left to right: Susan
v Block FNS alumni, Matilda Chevez, Mary Segal, Lynn McDonald and Wendy Wagers.
P mail to Nigeria is very unreliable, so no one at the mission knew
B that we were coming. Since telephones are all but non-existant, we
= ended up driving through Lagos via Taxi. There do not seem to be
many rules of the road there except that the fastest driver gets
. where he’s going first. Since there is a tremendous volume of
_  traffic and each driver determines on his own where the various
. lanes are, we wondered if we’d make it out of Lagos alive. People
sell all manner of things in the middle of the highway and must
, run along side of the cars to conduct their business. Not surpris-
ingly, many are killed or injured doing this every year.
After several hours of driving lost through Lagos, we found the
mission and all 14 of us were welcomed at an impromptu dinner.
T ‘ The missionary couple, Walter and Eddie Smith, were exceed-
V ingly gracious, as were almost all of the people we met in Nigeria.
T , We arrived on the last night of the holiday of Ramadan. Since
  ` Lagos is largely a Muslum city, the celebration was in full swing.
 —, All night mullahs called the faithful to prayer from the many
 _ minerettes in the area. There was also a great deal of chanting
 ` and singing with drums in the background. While it was quite
, exotic, we got very little sleep that first night.
i The next day we flew on to Port Harcourt and then were driven
‘ about 60 miles further to the Nigerian Christian Hospital (NCH).

NCH is in a rural area, right on the border of Imo state, the E
homeland ofthe Ebo Tribe and Cross River State, the homeland of
several different tribes. The border area is land claimed by both
states and therefore a place that has frequent political violence. It
was peaceful when we were there, but we were reminded of the ,
potential for hostilities every time we were on the road to Aba, the I
nearest town. Nine months before in a border clash, a bus had il
been fired upon and many passengers had been killed or wounded. .
Its shell remained by the roadside, a handy portable barricade to L
be used if the necessity arose. I ,
The hospital had separate units for maternity, pediatrics, and i
male and female medical/surgical. There was also a large out- _
patient department and a program of village outreach. Most of our .
group worked in the labor and delivery area of the hospital. Nancy
was there to serve as group coordinator and faculty for the BSN
students in the areas of Pediatrics and Maternity. I was there I
mainly as a relief person for the Nigerian midwives in the labor  E
and delivery area. Our visit allowed several of them to take some
needed days off. Lynn McDonald, a student nurse—midwife from
Case Western Reserve came to get initial delivery experience, and
Susan Block, a CNM and FNS alumni, was sent by Case to 1
supervise Lynn.
  *lC’·*‘*“  I `  ·  i ` p »,._,·.. :  Q          .
  ..iis     "··  ,.       A ·°1?"*X °
  s`t.     .  `    ¤£;;*  13—- . .
» »..·              \
      ~;,*€. ‘       it ` »;{  ' —
Q ,.  ;  . ·_,—*~_{   gf   
I  pf;  $@***2*    i., ier.   . 
     3    ”    . ~` ti     i
  ,..-r. ; ifrr. P     fi       l
          ,.s r     
A typical Nigerian woman waits in line for a well-baby check.

Mary Segal, RN, PhD and Matilda Chavez, RN, and MSN
student from Case Western Reserve, worked in the village out-
reach program. Their presence enabled the well-established pro-
gram at NCH to expand, at least temporarily, so that mobile
" health care could be offered to more villages.
Delivering babies in Imo State is quite a different cultural
i_ experience. Families place a great deal of stock in stoicism in
Q T labor. Some people believe that if a woman has a difficult labor, it
l is an indication that she might have been unfaithful to her
K, husband. Considering this, women don’t allow themselves to
R react too much to the pain oflabor, and the type oflabor support
, that we do in the U.S.A. is inappropriate. Most of the women
 , preferred to labor outside, either walking around or lying on grass
mats. Many times they would be walking outside and then just
come into the labor area and say, "the baby is coming nowI" The
majority of labors were rapid and easy.
2 { §  ij};  r .. ._§wf ¤ i; `  V R. • _’
 » `     ·   _ . , ‘
i '`’'      
  s trs s     sr·rsi ’
·Z· ~       ’3ii ·   i » =
` . 8- ·-   »·   _ · _ .¤ '
 .-_ * { L `
_ Nigerian nurses and a student tend a recent post partum patient and her newborn.
R  Most had already given birth to many children. Women
 ·_ frequently become pregnant twelve times or more. Couples feel
that they need to have many children because only about half of
these children live longer than five years. In a developing country
` such as Nigeria, children are the most vulnerable to the problems
l caused by poverty: poor sanitation, malnutrition and the lack of
A sufficient medical care.

' . _ ~»R—     Q4; ~
»   l - ‘‘—~     T    
TS   I »“_“   _V‘° ` »»·` ’ i
  .   -»;:   .»·‘ T é  »ir* » H
  ..   — `  2;**   Y  A_N— 3 i `
I   .    ”`?; I ’ =`   *` I N t
 QI ,ii»$   _f§é§i{;§i_z1; ` e   5  " Y =~’ `  ` E·‘°   ”` " “ .
. fi. "#    . ‘  wi 4.   `E`  ¥   ri
- "‘   *‘;‘ ·       ` »—-.   · »     ,
A new mother watches over her eight-hour old twins.
Nigeria has the highest percentage of multiple births in the
world, and we certainly saw our share ofthese. In our first week at
NCH, four sets of twins were born. Unfortunately, most Ebo are _
not very happy about multiple births. In the not too distant past i
twins were considered a curse and it was common for one of the z
twins to be killed or to die from neglect in early infancy. While this
is not the case anymore, frequently one twin is smaller than the ,
other, and may be identified as weaker by the parents, and thus
less favored. Negative feelings about multiple births are really not I
too hard to understand considering the fact that many people are ,
malnourished; breastfeeding is universal and mothers carry their Q
babies on their backs until they are big enough to walk. The
women in our area worked long and hard, mostly in the fields  
planting and harvesting with very primitive tools. Having more ‘
than one baby to feed and carry around must be very difficult, .
especially for the malnourished mother. ,
The birth center is an idea that has caught on in a big way in , i
Nigeria. Nurse-midwives run birth centers all over Imo State. We  .
had the opportunity to visit one and we found it to be exceptional, .
although the standards vary from place to place. As in America,  .
the nurse—midwives have agreements with back—up physicians in ·
hospitals. However, nurse-midwives in Nigeria take care of very  
serious obstetrical problems no matter where they practice. While .

. practitioners in birth centers frequently refer their more difficult
Q cases to hospitals, all nurse-midwives routinely deliver breeches
E and twins. Because technology is very limited, the physician role
  in labor and delivery is largely composed of the application of
  forceps or doing surgery. Nurse-midwives sometimes use vacuum
i extractors if they have them.
{ Many women go to traditional birth attendants in the villages
when they find that they are in labor. While we didn’t know the
g outcomes of the majority of these births, frequently, women came
; in to the hospital after long boughts of labor in the villages or with
3 complications. We had at least one case of a ruptured uterus and
several women hemorrhaging because of placenta previa, a
condition where the afterbirth blocks the opening of the uterus.
I The Ebo attitude about life and death is much different than
ours, and while I can not pretend to have gained much insight in
six short weeks, I think that I could safely say that their
philosophy takes into consideration the hard realities of life in a
poor and underdeveloped country. Life is difficult in Nigeria and
people must work very hard to feed, clothe and house themselves.
_ There is no such thing as government assistance to weak, poor or
disabled people, therefore if they cannot support themselves, they
I do not survive. This reality is exemplified in the fact that the Ebo
’ rarely, if ever, resuscitate someone that is near death. In the case
of premature babies or babies born in distress, there are no
I attempts made to resuscitate. While we certainly respected their
  cultural values, we found that we could not ignore ours either, and
. therefore resuscitated babies on several occasions. We may have
saved a few babies, at least for the short run.
I Even though life is hard in Nigeria, the people, at least in Imo
A State, were exceptionally friendly and gracious. While the
’ majority of people had very little in the way of material wealth,
j most seemed genuinely happy. The women were very beautiful,
§ lean and muscular. Some wore western clothing, but most wore
i l colorful wrappers with matching blouses and head coverings.
 i They also saved matching material in which to wrap their
L newborn babies. It was always possible to tell a married women
L  from one who was unmarried because the ummarried girls wore
¤  their hair in close-clipped naturals. The married women let their
  hair grow and then braid it in incredibly intricate styles with
; black thread intertwined.

The older Ebo women, the grandmothers, had a fair amount of
status in the tribe. They frequently came into the maternity ward
with their daughters or daughters—in-law so that they could attend
to their needs both before and after the birth of their babies. They ·
brought straw mats and slept under their daughter’s beds at I
night. On one particularly memorable occasion, several of the
young women had been in fairly inactive labor for a long time. I
Finally, one of them gave birth to her baby. There was great ,
jubliation, especially among the grandmothers. They danced  
through the ward and started responsive chanting and singing T;
among the expectant and already delivered mothers. The oldest of {
the women then took the newly delivered baby and unwrapped it.
She had all of the women who were trying to get into active labor
(five at that time), line up, and expose their abdomens. She then I
bounced the naked baby on each woman’s belly. By the next day
all of these women had delivered. V
One thing that impressed me very much was the industri-
ousness ofthe Ebo people. Everyone, even the small children, had
some job to do. Very early in the morning the women and their
small children were in the fields working. Older children are sent
out to gather firewood for the day. In the afternoon, women sell
produce by the side of the road. Everybody seems to have some
kind of business, no matter how small. Even with the heat and
humidity, the people persevere against great odds to make a living
and try to improve their living conditions.
.   __ 1;-, . #4* ·   *‘ ” ~
  i’*     "  I  "       S     _ if V
Q_,;;TZ·»   I  i 4,)  Z}   ‘ .·     i   _ — if —
  -           T   Y
  ·   . ., j  ,   wa   ,.1%    i   j‘é’ j  ‘     I
I         l          ‘·-=    
.           s..» J .--3           ` X
- . * ` A I I s   i  I? ;—— ·.     Q
‘t’`i`     i"     ‘   ·,..    A I        
Shopping on the road to Calabar at an open-air fish market.  

*   i*  z  ‘’111     .
  i.   111   ·, ’   {`LL  
.     ,1,» ”  I - · · .  
,  , ’·=’ 35 ;;<   `?'  
l ij.;] g U ,/’g»‘v     gc.; _,%,,/gx  `
l    .1tE1.1&   1» 22 ia  ,*~ I “*` I
_i Nancy Clark enjoys a relaxing moment with Nigerian trained physicians Dr. Zike lkeorha
 I and Dr. Wosu.
 ‘ Considering how hard people work for what they have, it is not
surprising that the society in Imo State is definitely "cash and
carry". Also, the concept of giving something away "for free" is
. quite different there. For instance, if someone gives something
 _ away to one person, then everybody else feels that they deserve to
h get the same thing. When providing medical care, knowledge of
. this concept is very important. When people are so poor, it is
tempting to treat them for free, or to pay for the services that they
receive. While in our culture that is often appropriate, it doesn’t
I work very well in Nigeria. At NCH people were expected to pay for
their services and they usually did. Although fees were very
’ reasonable, sometimes as low as 12.5 cents, people occasionally
. could not afford the services. It is very hard to turn away people
 , who need care, and usually arrangements or alternatives of one
Z type or another were worked out. What we had to keep in mind is
V that the people determined the rules of their culture, and we had to
_ respect them.
·` At the end of the six weeks, I felt that I had been given a great
_ deal both by the Nigerians who invited me to come to their
 I hospital, and by those who allowed me to offer them nurse-
. midwifery care. In an experience like this, it is the visitor who
; gains the most benefit. While I learned a great deal, it is obvious
 W that it would take many years to garner a real understanding of
j the Ebo culture. When one considers that the Ebo are only one
tribe of over a hundred in Nigeria alone, and that the language,
A customs and values of each tribe varies widely, the task is put into
perspective. I hope to be able to return to Nigeria again sometime
in the future.
—Wendy Wagers, RN, MSN, CFNM

Health Care Belize Style
. . . Have Clinic, Will Travel
Whitney Robbins lives in a lovely, old, historic home in Medfield,
Massachusetts with her husband and three daughters (one ofwhom was ,
an FNS courier in 1982). Shared family adventures include domestic and ·
international travel. . .hiking in Switzerland, England and the U.S. and
biking through Ireland and Canada. ,
A good friend to FNS, Whitney serves as Co—Chairman of the Boston i_
Committee and is an active member of the Board of Governors. 1*
A Registered Nurse, Whitney is, at present, a MPH candidate in '
Health Services at Boston University’s School of Public Health. Last
March she spent six weeks as a public health intern in the small, Central ;
American country of Belize. The following narrative lets us share I
Whitney’s latest, very special adventure. _
"Who Candelaria Choc?" The soft call of the young, rural health  
nurse was lost in the din of crying babies, chattering children, and  ,
laughing women. The dust was thick and the heat heavy inside  
the dimly lighted health post. Outside the mid—day temperature I
. was approaching 100 degrees. Scrawny dogs sought refuge in the r 
shadows cast by the overhang of the thatch roof or inside on the
cool dirt floor under the benches and long cotton skirts of breast-  A
feeding mothers waiting to be seen at the day-long MCH clinic.  
March in Massachusetts was the height of the "mud season".  
Here in southern Belize it was the dry season —the beginning of  A
the hottest time of the year. The rains would not offer much relief , 
for another three months. There was little water in the creeks for ,i 
bathing or washing dishes. Only one pump was functioning in  
this Mayan village of thirty-two families, and it was producing .
"bad" water. Most people were getting their drinking water from ,
the slow running stream where the pigs wallowed. 1
The community health worker encouraged her people to boil  A
their water, but felt frustrated that her pleas often fell on deaf — 
ears. It was too hot to collect firewood for additional cooking, and ,
too tempting to drink whatever liquid was at hand. She realized  
how essential her message was for the few mothers who were  
bottlefeeding. Many of them had already requested oral rehy- Q 
dration packets (ORT) to treat their infants’ diarrhea. 3

Only seven days before, I had arrived in Belize to begin a six
week public health internship, or what my three adult children
had fondly dubbed "Mom’s mid-life adventure". Although I’d
hoped, little did I expect, that I would actually find myself
traveling with the Toledo District Mobile Health Team, immuniz-
ing hundreds of Indian children and helping with prenatal
l, exams. Nor did I imagine that I would be the first white overnight
guest to stay with the community health worker and her un-
i suspecting family in a village that had no electricity, phones,
it running water or latrines. A rat falling into my hammock during
the night and an afternoon of hitchhiking with the malaria
· control team in their pick-up truck provided additional excite-
g ment. I had been looking for "third world experience" to complete
I my MPH studies and found it happily in this beautiful setting.
My Belize experience evolved from communications during the
 A previous year with Project Concern International (PCI) — a
2 California organization that in 1982 had initiated a pilot primary
 V health care project in the Toledo District. For five years now PCI
 ' and the government of Belize have collaborated in the training of
¥ community health workers, in order to increase the delivery of
 . basic health services to the 11,000 people living in the remote
 I Mayan villages scattered throughout the 2,000 square mile area.
 . Today 23 community health workers (CHWs) are functioning
, under the supervision of Public and Rural Health Nurses in 22
 . Government—sponsored Mobile MCH clinics are scheduled to
. stop at each ofthe inland villages every six weeks throughout the
 A year. However, because ofroad washouts during the rainy season
 . and vehicle breakdowns, visits to the more inaccessible areas tend
- to be irregular. PCI has provided six communities with two-way
j radios for emergency communication between CHWs and PCI
3 and the hospital in Punta Gorda, Toledo’s main town.
 . These community health workers are responsible for spreading
  word of the MCH mobile clinic dates to their fellow villagers.
K, Indeed, when we arrived on a specified day, there was often a
 if gathering of women and children outside the health post, church
  hall, or school where the clinic was to be held. Where there were
  known newborns or children needing immunizations, beyond
  walking distance of the nearest village, the familiar blue Ford van

`   it   R "   ` > ~‘r4M- Mug   _____ __ I
ej`.   ‘ ` * `   ‘ W »
*‘Qi"1  :4   I  R  · I     I   F   I W ·
INI I               p   l
·._ ‘ · . ` ’ if {
"There was often a gathering of women and children outside the health post, church l
hall, or school where the clinic was to be held."  
MENT PROJECT" emblem would honk its horn to announce our E
arrival at an isolated house or group of dwellings. These "Road- i
side" clinics, where babies were weighed in sheet slings (lepop)  
from scales rigged in the van door opening, where prenatal exams l
were performed on the back seats, and immunizations were given i
by the side ofthe road, were experiences I imagined as close to any I
that early FNS nurses might have had in the Kentucky moun·  
The Toledo North Mobile Health Team consists of two Public  
Health Nurses (RNs with midwifery training and a post—graduate  
year of public health experience), three Rural Health Nurses  
(LPNs who are certified midwives), a driver, and often one of the l
caretakers/ community health workers from the health center at  
either San Antonio or San Pedro Colombia, Mayan towns over 20  
miles from Punta Gorda with populations of approximately 2,000  
and 1,000, respectively.  
Of the many visits I made to the San Antonio health center,  
none was more memorable than the first. Only 48 hours after l
leaving the U.S. I found myself there awaiting the beginning of a  
village health committee meeting. While exploring the empty i

examining room, my eyes were drawn to a bright yellow book
pressed between a dusty collection of outdated nursing texts. To
my amazement it was none other than the very same edition of
FNS Medical Directives that sat upon my desk at home! Yes, the
, Indian Health Nurse had heard of the Frontier Nursing Service,
I because one of her predecessors had come from Kentucky. (I was
unable to discover her name while in Belize). But, what a likely
i’ place for a former FNS nurse-midwife to practice! I had already
noted many similarities between the hills and "hollers" of
K Appalachia and the short, steeply pitched limestone mountains
{ and valleys of Toledo. The need for maternal-child nursing care
$ was perhaps not unlike what Mary Breckinridge had found in
} Leslie county in the 1920s.
I v »  4 * 9  if     a *  +  .  ~· @     »   r  ei’     ·i# e ;z
    ..  .       Q           ”
,· q ·`~ ‘;s_§§!§};, _r' . ·- · ~ ·‘ L V
{   ·· ,»> ,   .·;pQ ..»’j._   ,_._
l 2 I ,.7- ‘   el ·~~