xt7nvx05zm2q https://exploreuk.uky.edu/dips/xt7nvx05zm2q/data/mets.xml The Frontier Nursing Service, Inc. 1991 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. 67, No. 1, Summer 1991 text Frontier Nursing Service Quarterly Bulletin, Vol. 67, No. 1, Summer 1991 1991 2014 true xt7nvx05zm2q section xt7nvx05zm2q ` `
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Table of Contents
Midwifery Bound - Dr. Judith Treistman 2   n'
Past Courier Tia Casertano Works in Guatemala - Catherine C raft 4   _
Interview With Dr. Comett and Terri Goheen - Deanna Severance 11 ` i
Big House Named National Landmark - Catherine C raft 15
Local Spotlight - Catherine C ra]? 16
FNS Welcomes David Southem - Catherine C raft 18
Mrs. Patterson Visits - Catherine C r0ft 19
FNS Welcomes International Visitors - Catherine C raft 20
Meet the Board - Catherine Cro]? 22
Beyond the Mountains - Deanna Severance 24  
Notes from the School- Dr. Judith Treistman 29 ;
Field Notes — Susie H udgins 31  
Courier News - Susie H udgins 32  
In Memoriam - Mae Irvin 33  
Memorial Gifts - Mae Irvin 33  
for the Fiscal Year May 1, 1990 to April 30, 1991 35-52  
Urgent Needs Inside Back Cover
COVER: CNEP students arriving at Wendover
Photo by Gabrielle Beasley 2
US ISSN 0016-2116  
Published at the end of each quarter by the Frontier Nursing Service, Inc. ' ·*,,
Wendover, Kentucky 41775 j [
Subscription Price S5.00 a Year 1
Edit0r's Office, Wendover, Kentucky 41775   "1
VOLUME 67 NUMBER1 Summer 1991 ·`.
Sec¤nd·c1ass postage paid at Wendover, KY 41775 and at additional mailing offices. ' ~
POSTMASTER: Send address changes to Frontier Nursing Service, Wendover, KY 41775. *1
Copyright 1986, Frontier Nursing Service, Inc. il

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Midwifery Bound A
FSMFN Students Arrive
Months of hard work and mounting excitement culmi- _
nated on August 23rd when two yellow Leslie County school ‘
buses rolled into Hyden carrying 92 newly admitted FSMFN _
students to Midwifery Bound. The students were greeted with a ,
banner strung across Main Street:
Welcome Future Midwives
to Hyden, Kentucky _»
10,000 by Z000! j
Purple balloons bearing the initials MCA, CWRU,
NACC, and FNS lined the street. These two symbols really told
the whole story: the people of Hyden and the Frontier Nursing
Service welcoming the largest class ever of nurse-midwifery
students to the Community—B ased Education Program, a program
created through the cooperation of Maternity Center Association,
Case Western Reserve University/Frances Payne Bolton School
of Nursing, the National Association of Childbearing Centers, and
FNS. .
The spirit and enthusiasm of the students spread rapidly  
to the faculty and staff and we quickly forgot the arduous hours of  
preparation. Long before the students arrived, the "facilitators",  
a group of eight dedicated women from Outward Bound in  
Minnesota began to plan the minute—by-minute logistics of a very  
full program of activities. Because of their experience with  
leadership training programs and careful attention to detail, we Q
were able to have a safe, successful weekend. There was a strong V
feeling of new "frontiers" as students arrived from places as far
away as Alaska, Hawaii and the U.S. Virgin Islands. The sense of J
adventure was highlighted by the two students who flew their tiny _  
airplane into the Hazard airport! N
Midwifery Bound was a three-day weekend of intense it
orientation to the CNEP and to FNS. Students received their `P
course notebooks and readings, leamed how the program works, ·
were initiated into the world of electronic communication through ‘

  the FSMFN Bulletin Board, met with the Registrar, faculty and
` advisors, and were counseled by the Financial Officer. And that
was only the beginning!
7 There was a barbecue provided by the Mary Breckinridge
Hospital dietary staff, a reception at Wendover   complete with
I local musicians, a welcoming dinner during which Deanna Sev-
erance, Kitty Ernst, and others spoke and I was surprised to be
1 given the "key" to the city of Hyden by the Chamber of Com-
p merce. Large group meetings were held in the Richard M. Nixon
Q Recreational Center and breakfasts were taken at the Tim Lee
I Carter Senior Citizens Center. A fmal Sunday breakfast was held
i on the walking track in the center of Hyden.
- Throughout the weekend students participated in small
group activities that fostered the networking that will enable them
to successfully complete their studies. Each student will now
return to her own community, but will always feel a part of the
i larger community that was built in Hyden during Midwifery
Faculty have come away from Midwifery Bound with
  new energy and a sense of rededication to the ideals of their
; profession. As one new faculty member expressed it, "I now
  remember why I became a midwife twenty years ago."
  A student commented "All the women.. .all these women!
  They are committed, strong, and I feel a sense of comiectedness!"
  Another said "I’ve known about FNS since I was a
Q teenager and now I’m here 20 years later and this experience has
’ rekindled that feeling of awe Ihad when I first leamed about Mary
We will never duplicate the "iirst-time" feeling of having
  over 100 nurse-midwives and students together in Hyden at once.
,4. It makes us humble and proud.
_ -by Judith Treistman

Tia Casertano
Past FNS Courier Begins Children’s Home in Guatemala
Tia Casertano, like Mary Breckinridge, wanted to serve V
children and mothers and provide them with a chance for a decent
life. But Tia’s dream was to open a children’s home that would
not only address the needs of children, but also work with mothers ·
who wanted to leam to take better care of their children and
themselves. Project Quetzaltenango was just an idea live years
ago, but is now a reality.
In [hc .. b l —   u  li ` ~—-..  
fall of 1984 `   { Z   A { *
Tia of Chesh- V E " .‘°
ire, CT spent . f  ‘   ‘ .
two months * I -     , l . I
withtheFr0n- l _   `° _ E   ,_ jr -.,
tier Nursing    . _` p _ l ,V , g _ ii"     
Sewicq as 3 r   . = if   lg J-N  A   
courier. ,     ·~r
While here,   *~ , , ` { T   E
she worked e   _ /   \
with expec-       gw 3    A `
tant mothers   . A   .~     ,` "¥?.¤»~» ` _
and assisted   /  
the H°;’m° Tia and Guatemalan children.
Health aides
in patient’s homes. At this point in Tia’s life, she was in-between
schools. She had graduated from Choate Rosemary Hall and de-
cided to take two years off before going to college. It was during
these two years that she spent some time in Bangladesh volunteer- ·
ing at an orphanage started by Sandra Simpson of Canada. "Then
it was just sort of an idea of mine fora long time," she said. In 1987
she traveled to Central America and spent a summerin Guatemala. ‘
That is how she chose Guatemala as the location for her project.
She made some friends from the school and they helped her fit in .
with the local people. "l traveled, studied, and made some ’
connections. I spent six weeks in Quetzaltenan go and decided that  

that was where I wanted to stay."
Tia and Aaron Pollack, co-founders of the home, spent
r much time researching and laying the groundwork for this project.
The two met at Middletown YMCA Youthshelter where both
were working with adolescent boys. ln 1989 they started the
_‘ official paperwork and fund raising to establish an orphanage in
the city of Quetzaltenango. It took a year to get the required
permits to operate the home and to be recognized as a social-
service agency. Now the project is in full swing with about sixteen
children, age 6 months - 9 years old.
Quetzaltenango is a small city located in the westem,
mountainous region about 120 miles from Guatemala City and has
a population of about 100,000. The city lies on a plain amidst
mountains at an elevation of 7,000 feet above sea level. The city
is surrounded by numerous small villages primarily populated by
indigenous people. The name given to the city by these people is
Xelaju, meaning the place of 10 tribes. The name comes from the
ten mountains around the city and the separate tribes who made
their homes there, each on their own mountain. Quetzaltenango
is named for the legendary Quetzal bird. The im age ofthe Quetzal
A is seen on many embroidered and woven crafts produced by the
people of Guatemala. The bird’s long, colorful plumage and place
in folklore have made it a fixture of the country’s artistic work.
The Quetzal is also the symbol of the country’s independence.
· Even the currency of Guatemala takes its name from the bird,
known as Quetzals.
All over the world there are children who are malnour-
ished, illiterate, and homeless. In Guatemala, a country about the
· geographical size of Tennessee but with a population of 8.3 mil-
~ lion, there are many broken families from which the children
‘ become silent victims. Up to 80 percent of the population is
‘l without housing, 75 percent over seven years of age are illiterate,
. . and about 200,000 children in the country are orphaned or aban-
_  doned. About 85 out of every 1,000 babies die at birth and 82
, percent of children under five years suffer malnutrition. Only 35
jj percent reach adulthood and 65 percent die before age 15.

HogarNuevos Horizontes (Place of New Begimiings), the
name of the old house that became the children’s shelter, is a place
where children live communally and leam to play and work
together. The house is a large one-floor building with five large ‘
bedrooms, a kitchen that opens onto a dining room, and two baths.
It is in the center of Quetzaltenango. More than ensuring that the
children receive adequate food, clothing, and shelter they previ- `
ously lacked, the project is committed to giving them all the
emotional and material support they need for full development.
This includes a comprehensive medical evaluation and treatment  
upon arrival and regular care thereafter. There is a local doctor  
who runs a clinic in the city who visits the home twice a week to  
provide needed medical care. lt also includes an evaluation of the  
child’s educational needs and placement in whichever appropriate  
schools and extracurricular activities the project can afford. And ,
finally, it includes giving back to the kids the fun of childhood, 1
books, toys, trips to the zoo, and other activities.  
While North American families tend to consist solely of i
the nuclear family and children are raised primarily by their  
individual parents, Guatemalan families are extended and chil-  
dren are often raised under the guidance of not only their parents  
but also grandparents, aunts, uncles, and other relatives. Still,  
within such a group of children there exists a strong sense of love ,
and family identity. The primary factor in creating this sense of  
family unity is in creating a home where all members are loved J
and valued. The ties of blood are strong and cannot be ignored, but .
the unity of purpose and the survival of the home and its members  
also play an enormous role in the making of a family. ·
As is written in the Project’s Operational Philosophy, g,.
Hogar Nuevos Horizontes attempts to function within the frame-  .
work of the social norms and the culture of Guatemala. In g -
research, discussion, and personal experiences, the governing  
body of the home found that for Guatemalans the strongest sense l
of permanence and stability centers around the home and the
family and that outside of the home and family, few other support _
systems are recognized as viable or trustworthy. Just as in many
Guatemalan homes, the Hogar Nuevos Horiontes "family" may

expand and primary care-givers may change over time, but the
security and permanence will exist in the knowledge that it is
"home" and through this, they will always have an "extended
· family member."
Tia’s goal was to create a place forthe children where they
could grow and leam in a healthy environment, plus hold on to
` their traditional culture. "The idea is to keep the kids in their own
communities and culture and give them opportunities they would
not otherwise have had. They already have cormections to people,
  relatives, and their village," Tia said. "The orphanage is their new
  home. It’s pretty much like a family. It’s a funny kind of family,
{ big and loud."
  a ’ `  4 . ¥ —· ... . ~ ‘
    ¤’ · it  · "  · .»\·z. ‘’.
f     ··. »   *" ¤;...  \ fi t   J ·
   l,   “ " " " . i git . ‘ , T - 
R »t'~ A ‘         E?  
‘ Project Quetzaltenango children.
T One thing that Tia really likes about Guatemala is the
C? diversity of the people. "Half the population is of Mayan descent,
  which means that there is an ancient culture that is still alive,
in which is amazing. The Maya culture is very much alive in their
dress, speech, and agriculture practices," she says. Many people
T speak in one of 22 Mayan dialects, as opposed to Spanish. In fact
it was this high indigenous population that drew Tia to Guatemala.
The Mayan roots run deep and the people haven't been as
acculturated as in many developing countries.

The shelter children come in under many circumstances.  
Some have lost their parents; some may be taken from their  
families because of violence in the home; and some have mothers I
who just can’t care for them. '
Recently Tia began to reach out to women in the commu-
nity. She helps them understand how to better care for their _
children and for themselves. She has also helped them find jobs
in the area. In a recent letter, May 1, 1991, from Tia to Helen  
Peterle, the Project’s treasurer and past FNS courier as well, she  
writes, "The plight of the single mom is about as bad as one can  
imagine. The majority of women with whom I have contact are E
widowed or abandoned. Their lives are a mess because of it. The E
history goes back to girlhood and socialization. Girls are taught to  
. be girls - to play house and then grow up and stay in the house and  
have babies. There is nothing else. Hence, the female child grows  
up thinking and believing that unification or marriage is what it is 1;
about - her destiny."  
"A very young woman, usually quite ignorant of her body  
and it’s reproductive capabilities, falls madly in love with some- `I
one who treats her well enough for long enough to get a family -
going — 2 or 3 or 4 kids at least. One common reason for  
abandonment of women and children is the overwhelming respon-  
sibility. Most men don’t make enough money to support a wife,  .
let alone a family."  I
"Alcoholism is also common - to the extent of extreme  =
domestic violence and complete financial ruin. Also common is  i
the "other woman." Men feel completely justified in seeking out  
a younger, better, female to replace the first one(s) when the family  ;
scene loses appeal. What does the woman get? Nothing. If she’s  
lucky, she has a 3rd-6th grade education. lf not, she’s illiterate.  I
With no education and no experience outside the home her alter-  .
natives are such things as becoming a maid (but what does she do  . *·
with her children if she has to live there) or selling things in the ·
street or living off the family for as long as possible. If she has a  
- mother she leaves the kids with her and tries to work 12-14 hours  
per day making QSO-120 per month (about $15-25 per month). If
there’s no mother or willing family member, the woman is driven

  to desperation. Sometimes she finds another man. Sometimes she
  leaves her kids alone for long periods of time so she can work.
T Sometimes she makes her kids work in order to pull their weight.
’ Her situation is disastrous. She is in the majority of Guatemalan
women. It is rare (I’d say never) that women join forces, work
together, live together, share childcare, etc. It is never that a single
` woman would choose to parent singly or say that she prefers the
{ solo route in raising her kids, even after much abuse from the man.
  It’s just too hard to do alone."
  In another recent letter, Tia describes some ofthe children
E at the shelter. Here are excerpts from it .... "Jose had his 7 month
I birthday on May 3rd. He’s adorable, but kind of goofy at times.
E He loves Gisela (staff member) so much. He only wants to be with
  her and gets mad if left alone. He insists on being with the group
  at meals, even if he’s not eating. He now eats bananas, mashed
I, potatoes, and vegetables, soup, rice, cereals for baby diets, milk
; (like big kids) and incaparina. He sits up in a high chair and looks
E around and plays with toys. He doesn’t have much hair, but what
Y he does have stands on end most of the time."
. "Javier is three years old. I’m a little worried about him
  because he wets the bed sometimes, and cries in his sleep some-
  times. During the day he asks a million questions about why,
 j when, where, how things are going to happen. He’s still pretty new
 I here and adjusting but I think it’s pretty hard on him. He doesn’t
Q go to school and spends his mornings with Alvaro and the babies.
 i He has a limited vocabulary, even for a three year old, and he is
  really funny in his tone of voice. Everything ends in a question.
 I But other than his rough nights he participates with the group. He
 [,_ plays mostly with Alvaro and Mario. He likes Legos, balls, trucks,
 A and some books - as long as they’re interesting and adventurous."
 . "Lidia is developing into quite a bossy little girl, always
 . ·· needs to be the center of attention or undermines the activity.
· She’s excellent at manipulating the staff, telling lies to get them
 S "in trouble" with me. She is also a great "hitter" — does it when no
  one is looking and then fabricates a story. She is a typical older
sister, very hard on Yomara and Mario and blubbers all over

Sergio. In school, she ’s doing very well academically and she does  
homework easily and without much help and is learning to read  
somewhat. Socially she tries to behave similarly to her behavior
here and it’ s not working so great. But overall she does understand ‘
what she’s doing and tries to use other methods to get attention.
This week we’re going to work a lot on how to treat other people.
She just started visits with hermother and thatmay be affecting her `
Tia’s perseverance and dedication to the children’s home  
is reminiscent of Mary Breckinridge sixty-six years ago. To run  
the shelter for one year, she needed to raise about $40,000. The ·
money went toward clothing for the children, medical supplies .
and food. About $25,000 of that was donated by private and
business contributions from the U.S. According to Helen Peterle, ‘
it costs $822 annually to provide for each child; $600 for food, $45  
for clothing, $20 for personal hygiene, $100 for medical, and $57 j
for school which includes supplies, uniforms and a $27 fee. One  ,
of Tia’s biggest concems is the fear of losing money to needless ‘
paperwork and needless bureaucracy and people’s salaries who  
don’t have a lot of direct contact with the children. “Seventy-five  .
percent of Project Quetza1tenango’s budget is going directly I
toward serving children." Through the assistance of many volun-  '
teers the project has been able to minimize expenses. Another of  J
Tia’s goals was to train local Guatemalans to work at the orphan- *
age. Currently they operate with about 10 Guatemalan staff. Tia  ·
would like to see the entire orphanage run by Guatemalans in the t
future.  g
Project Quetzaltenango is answering a great need for  ·
children and mothers in Guatemala. Tia’s vision and spirit are  
touching many lives by creating open doors and bridges for _ 0
women and children who had led very sheltered and lonely lives I
up until now. May the dream live on.  ..
For further information about Project Quetzaltenango, 2
write or call Helen Peterle, Treasurer, 1 16 Beaver Meadow Road,  ?
. Haddam, CT 06438, (203) 345-2870.  ,
-by Catherine Cr0ft 4

  An Interview with Dr. Anita Cornett and
L Gerontological Nurse Practitioner Terri Goheen
_ Dr. Anita Comett is an internist who came to work for the
Frontier Nursing Service in October, 1990. Anita’s parents and
grandparents are natives of Leslie County. She is the first
. physician from Leslie County to retum to the mountains of Leslie
County to practice. Anita attended the University of Kentucky
  Medical School and the William Beaumont Hospital Residency
2 Program. Anita knew stories from her childhood about the
if "Frontier Nurses", but she had not had the opportunity to work
_ with nurse practitioners while in medical school or during her
T residency. This spring Dr. Comett was named Chief of Staff for
Mary Breckinridge Healthcare, Inc.
‘ Gerontological Nurse Practitioner Terri Goheen came to
it work for the Frontier Nursing Service May 15, 1991. Terri is from
 . Ashland, Kentucky. Her mother is a nurse, and she helped move
 _ Terri into her new living quarters at "Aunt Hattie’s Barn" on
Hospital Hill. It was my pleasure to have dinner with Terri and her
mother at that time. Terri’s mother had long heard of Mary
* Breckinridge and the Frontier Nurses. Terri graduated from .
 , Vanderbilt University’s Gerontological Nurse Practitioner Pro-
- gram. Terri’s Bachelor of Arts Degree was in psychology. This
I  is Terri’s first job since graduating!
  I have been very impressed with both these women, and
. I knew of Dr. Comett’s interest and concem for the elderly. As I
 J interviewed Terri in the winter of 1990, I was struck with the idea
 . of getting Anita and Teni together in a collegial elderly practice.
 i Six weeks after Terri had begun employment, I decided to find out
 ~ how things were going. The following interview tells the story!
 . Mrs. Severance: "When I approached each of you about this
  collaborative practice, what was your initial reaction?"
  Dr. Anita Comett: "When you first approached me with this
 . idea, I wondered how it would be to work hand in hand with a
 ` nurse practitioner. Since coming to the Frontier Nursing Service
  I have been consulting with all the family nurse practitioners, but
, I had never had the opportunity to work side by side in a collegial

practice. I know thatl am very particular about having things done
"my way". How would the nurse practitioner feel about this
personality trait? On the other hand, I knew the patient load was
increasing every day. I needed help!" ·
GNP Terri Goheenz "From the outset I was excited about
coming to Frontier Nursing Service. I knew there were other K
family nurse practitioners at FNS. Remember, I am a new RN as
I V »_  well as a new nurse practi— I
. . ,__` ’   tioner. I felt I had alot to  
; · V . M g    r g leam all the way around. E
 _ jg   ‘           There would be COI-  
5        .5. leagues at FNS to teach  
        `      _    me andto be supportive of  
 R   I ’ ‘ \t{ ;   " me. That helped my level I
    ` ' x ;__ ` of insecurity which oc-  
Dr. Anita Cornett and Terri cms   Stmmg any lj
Goheen, GNP new JO ‘ §
Mrs. Severance: "You are now six weeks into the practice. How  
are things going?"  
Dr. Anita Cornett: "I tell Terri every day that I do not know how {
I practiced without her! It has been wonderful. Implementing this I
practice with Terri has gone so smoothly. My patients love her! ._
I was worried about that. Since beginning my practice at FNS in
October of 1990, many ofthe patients have become very attached “
to me and I to them. I have a relationship with them. I wondered l
how they would feel about being seen by Terri rather than me. I
Teni treats them just the way I do! She is warm, humorous, and  
competent. They love her!"   A
Mrs. Severance: "Describe the initial implementation of the i
practice." is
Dr. Anita Cornett: "Terri and I make rounds together in the  
morning. If we have many patients, then we split hospital rounds j

according to acuity. If we have few patients, we see them together.
In the clinic, we just split them up. After Terri sees patients, we go
over the plan of care. This gives me more time to do consults with
` the emergency room nurse practitioners and the other nurse
practitioners, and it allows me to spend more time with my patients
who need an internist."
GNP Terri Goheenz "Anita and I stay busy! The health problems
. of the people we serve here are interesting. The pathology is
. incredible. I have seen diseases that I had only read about in
  Dr. Anita Cornett: "On Wednesdays Terri goes to the Hyden
  Manor Nursing Home and rounds on our patients. I read EKGs
  and Holters at the clinic and then meet Terri at the nursing home
  after she has completed rounds. We discuss the I5 or so patients,
E and then Terri makes home visits."
  GNP Terri Goheenz "I started a remiriiscence group for the
  nursing home patients. Last week we talked about our first loves.
  We have talked about the square dances that once were held at
  Wendover and how we got our names. This is very therapeutic for
  older patients who are mentally alert and in the nursing home for
I physical health reasons. Their long term memory is very sharp,
  and reminiscing increases self-esteem by reliving times when one
{ was physically stronger."
  Mrs. Severance: "Where do you go from here?"
E Dr. Anita Cornettz "By August, Terri’s initial orientation will
  have ended, and she will have her own appointments and
  caseload. We are currently organizing our 'new' schedule. Terri
I will arrive at the clinic early and begin diabetes work ups. I will
  round on my acute care patients in the hospital. Additionally, I am
\= working with the Area Health Education Center of the University
g   of Kentucky in Hazard and have medical students rotating with me
_ in two week blocks. I love teaching. Terri frees me to do this."
, GNP Terri Goheenz "I have received only positive reinforce-
Y ment from Anita. She is a wonderiiil physician and a wonderful
I friend, very approachable. She likes to teach, and I greatly benefit

from this. Her teaching makes me want to go home and leam  
In Wide Nei h orhoods Mary Breckinridge wrote: "In a
service designed, like ours, for a remotely rural area, the hospital `
and medical director are like the palm of a hand from which fingers
radiate in several directions. It is possible, under this system, for _
a hardy physician to be responsible for the medical needs of some
nine thousand people annually, many of whom he does not meet, 2
whereas he could serve little more than a five—mile radius without  
his nurse—midwives." Education has changed. Terri is a geron-  
tological nurse practitioner. The roads are better, and Dr. Cornett g
can see people from more than a five-mile radius. The end result  
is the same...caring, committed, challenging and cost-effective  
care! Mary Breckinridge would be proud!  
-by Deanna Severance  
llllllllllllllllllllllllll 1
Severance Recognized in the Baylor Ling  
Director and CEO of the Frontier Nursing Service, I
Deanna Severance was recognized in the J uly/Au gust issue of the
Baylor Line, the Alumni magazine for Baylor University. The .
article recounted the history of the Frontier Nursing Service and
Mary Breckinridge and the current work of the service under the Y
direction of Deanna Severance. To quote from the article entitled, A
"Mountain Medicine" by Judy Henderson Prather, " The move to ‘
Frontier Nursing Service was a bold one for Severance, who had y
previously served as the manager of matemal-child health for the  
City of Dallas and director of m atemal, child, and family health for  
the Missouri Department of Health. Though much of her work had  
been done with mothers and children... she and her husband, Carl, f`
were used to a more urban lifestyle than that offered by Wendover, ’· __
Kentucky. But the move has been a rewarding one: Carl is .
enjoying his ‘mountain’ veterinary practice, their daughter Sarah
has found that she loves small-town life, and Deanna is enjoying _
the challenges of mral health car