My Experience Part 4

Below are excerpts from an essay written by Marielle, Fall Courier 2009. She came through the Dartmouth Partner in Community Service at Dartmouth College. Names have been changed to protect identities.

Another thing I really enjoyed was tutoring at the Adult Learning Center. These were adults who were studying to earn their GEDs or get into selective programs in the local community college, aided by a new program funded with federal stimulus money. I ended up teaching a lot about math, even though I was initially a little afraid of the idea; how much did I remember my high school algebra and geometry? Yet I felt confident, when I realized that I did remember most of it quite well, and could tutor women in fractions and percents and factoring and word problems. Many of them had hard life stories also, often beginning with early marriage or pregnancy, and now with a return to school to earn a better livelihood. Some really tried hard, and wanted to be there; others wanted to play on the center’s computers and talk all day long. One woman struck me with her intelligence; she had graduated with a 4.0 from high school but had gotten married early and not gone on to further education because of caring for a child with special needs, and now she was so proud of her youngest daughter, who had earned the only full scholarship to University of Kentucky in the eighth grade.

I also truly explored the state that I was in. I went to Louisville to meet with my mentors and go to the Louisville Slugger museum, trendy Bardstown Road area, and the horse races at Churchill Downs. I went to Lexington, and saw a concert from a Tennessee band there. I went to Fort Knox and Elizabethtown and the Bourbon Trail. I went to the Natural Bridge State Park, and Daniel Boone National Forest, and the artisan centers of Berea. The Mary Breckinridge Festival, held annually in Hyden to celebrate Mary Breckinridge, founder of FNS and the third most famous nurse in history according to nursing students, took place the first weekend that I was in Kentucky. We served lunch at a community picnic, and quite literally the whole community turned up, a few bringing home food to feed the rest of their families, which was somewhat of a sobering thought. There was the parade through the streets of Hyden, with all sorts of quirky vehicles and participants, and a band, and fireworks, and food booths and monster trucks. It was an old fashioned but fun affair, although apparently I had just missed the Chicken and Black Gold festivals a few counties over.

All in all, I learned much from my time in Kentucky. I still have not been to the part of the state in the central time zone; I still have not been four-wheeling (although some of the other couriers did) or had any fried chicken here (although that is not likely to happen anytime soon). Yet I have gained much affection for a state I may otherwise have just overlooked on a map, with northern ignorance, as a flyover state and not worth my notice. I now have an attachment to the Bluegrass state, and bluegrass music has a place in my heart– and my playlist. I still feel like I could have done more for those people; or maybe my time was too short; but I did what I could in the time that I had, and I learned much that has furthered my interest in a career in nursing, and I guess in the end that is all one can hope for. I am looking forward to school again at Dartmouth, where I am preparing to take more nursing school prerequisites, explore more health and service-related extracurricular’s, and can hopefully bring my time in Kentucky to others by sharing my experience. I know that I will stop and think back on my experience every time I hear the song–

“A few more days for to tote the weary load,
No matter, 'twill never be light;
A few more days till we totter on the road,
Then my old Kentucky home, goodnight.” ~Stephen Foster

My Experience Part 3

Below are excerpts from an essay written by Marielle, Fall Courier 2009. She came through the Dartmouth Partner in Community Service at Dartmouth College. Names have been changed to protect identities.

I was somewhat nervous at first to volunteer with Hospice, but I ended up looking forward to it instead– the warmth of all the office staff, the genuine thankfulness of all the patients that we saw, and the nature of the work itself. I enjoyed my visits with one older patient under Hospice care. The patient reminded me of my grandparents, the patient was 89 but looked no older than 65. The patient was able-bodied though frail, still quite active, and had end-stage heart disease. I was shown family photographs and told about how they had sat beside their spouse who had had a stroke and was not able to move, not able to talk, or acknowledge their presence for three years– three whole years. That was devotion. I could not imagine how hard that must have been. And how unusual that seemed to me, in a world where people will sometimes leave fading relatives to the care of a nursing home or other facility.

The birth was a unique experience also; we received the call at 7:30 in the morning from Mary, one of the midwives, informing us that a woman one of the other couriers had visited in the hospital a few days earlier was in labor, and to come down to the hospital if we wanted to see a birth. Me and Katie (the other courier) got ready and were at the hospital by 8. “Sandra”, the first time mother, had just been given an epidural anesthetic. Apparently the labor had been going on since 11 pm the night before. In her birth plan she had not wanted any anesthetics at all, but after 8 hours of painful contractions, she had asked four times for an epidural and received it. She was smiling and cheerful when we entered the room, and her husband was asleep on the pull out chair by the window, having been up coal mining early the day before and up all night with his wife. I saw firsthand why FNS prefers to do noninvasive births, as natural as possible; once one interferes with the birthing process, one often has to continue interfering, and problems can arise. For example, because Sandra had been given the epidural so early, her contractions slowed down and she was only dilated to about 4 centimeters by one o’clock (a woman starts pushing once she is fully dilated and 100% effaced, meaning her cervix is 10 centimeters). Thus, the midwife Jane (who had taken over for Mary) had to break her water, and administer a small amount of the drug Pitocin, which makes the contractions come harder and faster. Luckily, this combination eventually worked, and Sandra's contractions came closer together, and her cervix became fully dilated at around 6 or 6:30 pm. Sometimes, however, a woman must have a c-section due to failure to progress with the labor, which can make a woman who had really wanted to have her baby the natural way feel like a failure or can do unnecessary harm to the woman’s body, and make it more complicated for her in future pregnancies.

Once Sandra was ready to push, the actually pushing part for her was so short! Maybe half an hour, but it felt shorter, especially in comparison to the long wait. She was a little over 5 feet tall and her baby was 9 lbs. 5 oz, a big baby boy. The midwife had to rush to put her gloves on in time. The head was there, you could see it coming, and then you could see the hair, and then boom! The midwife reached in at the next push and pulled him out, his head and shoulders and body all came at once, and they placed him on his mother’s belly so that they could each get their first looks at one another. He was adorable.

My Experience Part 2

Below are excerpts from an essay written by Marielle, Fall Courier 2009. She came through the Dartmouth Partner in Community Service at Dartmouth College. Names have been changed to protect identities.

My favorite part of my internship was the “Fit Club,” an after school program for primary school students that FNS and COLLY (County of Leslie Lifting Youth, a local nonprofit run by one of our Courier Program heads, Anna Carey) coordinated upon. The elementary schools in Leslie County had not had any nurse or clinic before COLLY installed them a few years ago, and they had no health education program until we started this pilot “Fit Club” for the students. Its purpose was to teach at a young age the basic concepts of exercise, nutrition and physical well-being; we also brought them healthy snacks to try, vegetables and fruits and granola bars. We taught them basic exercises that they could do on their own without much equipment or teammates necessary; jump roping and calisthenics and running. We taught them about calories and the food pyramid and dental hygiene. And one cold, sunny afternoon in October, while the World Series was on at night, we taught them how to play baseball. The smallest little kindergarten girl hit the biggest home run.
Me and the other couriers also went into the schools to teach dental lessons, how to brush and floss and take care of their teeth, and passed out toothbrushes and toothpaste and floss. We demonstrated the importance of flossing using peanut butter and gloves and read them stories about going to the dentist. It was important to encourage this healthy behavior early, because there is a high percentage of children in Leslie County who have urgent dental needs– 4 or more abscesses in their mouth– not to mention children who just had a few cavities or rotting teeth. I also went into the schools to mentor and tutor some of the children in reading. Tim and Tom were fifth graders who I read “Danger Guys” with, and practiced vocabulary and comprehension every week, while Mandy and Britney and I read “The Year of Miss Agnes”; they were so bright, and could recall the meaning of words, and summarize the story as though they had memorized it. They always remembered me, too. Some of the children probably relished the extra attention; some had problems at home.

In my time in Kentucky I witnessed the full range of human life and development– birth and death. I watched a mother give birth to her first child; I sat by the bedside of another mother, actively dying, to allow her middle-aged children who had come to see her a chance to grab something to eat. Both experiences were wonderful, in different ways; somewhat scary, in different ways; and beautiful, too. I remember a patient, in their nineties, small and frail, as they lay there on their deathbed; and yet the patient had served in the Marine Corps in WWII and had been a parent to 8or 9 children. The staff there called the patient a “spitfire” and a “wildcat.” The patient still had lovely eyelashes. The Hospice volunteer coordinator and I sat by for an hour, sitting by thier side, listening to the labored breathing. It was peaceful in that room, and country music was playing, and it was sad, but it was not so deeply sad as I had expected it to be. It somehow reminded me of a story I had read a long time ago, called “The Garden Party” by Katherine Mansfield. In the story, a little girl from a rich family goes to give the leftover food from her mother’s garden party to the poor family of a workman who has just died in a horseback riding accident. On her way out the door, the young man’s sister-in-law shows her the body of the young man who has just died, and somehow Mansfield’s description of death was the one that came vaguely to my mind, when I was sitting in that warm sunny room. I recently looked it up again-

There lay a young man, fast asleep - sleeping so soundly, so deeply, that he was far, far away from them both. Oh, so remote, so peaceful. He was dreaming. Never wake him up again. His head was sunk in the pillow, his eyes were closed; they were blind under the closed eyelids. He was given up to his dream. What did garden-parties and baskets and lace frocks matter to him? He was far from all those things. He was wonderful, beautiful. While they were laughing and while the band was playing, this marvel had come to the lane. Happy ... happy ... All is well, said that sleeping face. This is just as it should be. I am content. But all the same you had to cry, and she couldn't go out of the room without saying something to him.

My Experience Part 1

Below are excerpts from an essay written by Marielle, Fall Courier 2009. She came through the Dartmouth Partner in Community Service at Dartmouth College.


Before undertaking my Dartmouth Partners in Community Service internship in southeastern Appalachian Kentucky, I would have acknowledged myself to be relatively well-traveled. I had been to Niger, France, Italy, Japan– and so I was perhaps a little cocky about my imminent domestic journey. ‘Really, how different could another state be?’ I thought to myself on the long, 17+-hour drive over from my home in Rhode Island. I would still be in the U.S., and at least we would all speak the same language! Several people I spoke with in Leslie County, Kentucky had never been on a plane; my first plane was at the age of four months, when I flew with my mother to England. Yet unbeknownst to myself, I was in for a challenge, if not linguistic (although, at times even that was a struggle– my northern dialect against the strong eastern Kentucky accent).

Upon first arriving in Hyden, KY, the town in which Frontier Nursing Service, Inc., is based, I remember being somewhat surprised. The main drag of Hyden, KY, was– sparse– to say the least. There was a Dairy Queen, and a Subway. Oh, and a Hardee’s. Wendover Road, the road upon which the historical headquarters buildings of FNS are located, was full of potholes and nearly unnavigable the first day I drove over it (luckily it was repaved within the week). There were several other “hollers” and “spurs” (Kentuckian for “roads”) that were in worse condition. The Big House, and Garden House, wooden structures built by Mary Breckinridge and FNS in the 1920s, were both to be my living quarters for the next eight weeks. They were not drafty old buildings, however, but rather majestic and rustic in their age and quiet, understated beauty. Indeed my room in the Garden House was definitely nicer than my any of my dorm rooms at Dartmouth, and I didn’t have to share it with a roommate. Being a vegetarian was at first a tricky enterprise there–I certainly learned to love my green beans and mashed potatoes. But the Wendover evening cook, Carolyn, also bought me veggie burgers and frozen vegetables, and the whole cooking staff was very kind and attentive to my dietary differences.

My internship was different from some in which students live and commute from their homes, in that it was a live-there experience, and also not in a bustling big city. The nearest big city was Lexington, a two-hour drive away. Although Hanover is itself a rural area, the ruralness of Hyden was different than that of Dartmouth, and the people who lived there faced different problems day to day. I saw pregnant women who spoke of difficult living situations, which were completely foreign to me. One woman lived in a four-generation household, where her sister kicked her pregnant belly, both were on drugs, and she was constantly berated and harassed by her grandmother, mother, nieces, and nephews. Often, there were really no men in the picture. Matriarchs, often grandmothers reigned; although, there were instances where single fathers also took charge of their children after their partners decided they were not ready for motherhood and would rather act like teenagers again. And several of the mothers were teenagers– there were several fifteen year olds scheduled for deliveries at Mary Breckinridge Hospital within the time I was there.

Final Courier Frontier

After dinner on my last night as a courier, walking from the big house to pack up my little room everything sat in the right light. Rainbows of flowers in the gardens along the walkway seemed to sit perfectly on their stems. A late evening light glazed the heavy forested hillside in a golden hue. Down in the valley, fog laid on top of the river, skating down stream with the current.
Maybe that’s what it’s like when you realize you’re leaving a great place. All the pieces unite, matching up and playing off each other. As I ascended the stairs to the courier quarters, I relished in my experiences, acknowledging that it would never be the same again. I had come to rural Kentucky, made handfuls of friends, seen many births, spent countless hours in the women’s health halls, eaten poke sallet, celebrated a coon-on- log fourth of July, dug up potatoes with my hands, had a snake fall on my head, learned to sew, kicked open a piñata, - it’s endless.
As I my mind wandered through the piles of my courier experiences, I reached the top of the stairs. I look a final evening look into the wooded atmosphere. It was unmistakable, pronounced even - Wendover in all it’s glory and magic all the way to that final night.
-Amanda

Passages and roadways are frequent topics of conversation in the Appalachian Mountains of Kentucky. Whether the focus is on a washed out dirt road, the Parkway, the Spur, a path through the woods, a river, a holler, or the ATV trail, a constant reminder of the energy required to create this motion is ever present. Energy in these mountains is a limited resource. Yet it is a requirement for physical function, psychological awareness, and utility. The mountains, tall and worn, confine us to the small beautiful valleys between them.

I came to Kentucky knowing very little about midwifery, fried foods, rural health care, or Mrs. Breckinridge, and expected to learn many things related to each of these areas. This expectation was fulfilled, yet I have come away with something more: unanticipated knowledge. I now possess a deeper understanding of what a “modern’ or “scientific” 21st century birth entails. I have listened to stories of how this differs from the previous era. I have become more comfortable with the idea of cultural isolation. And I have witnessed illiteracy in America, a sight that caused my eyes to swell with tears.

I was initially startled by every toothless smile, saddened by the worn out faces of so many young women, and frustrated by the diet and lifestyle trends that have opened the flood gates of illness; particularly diabetes, hypertension, and obesity. Now however, I might not even notice the toothlessness of a smile. Instead, the focus has turned to the fog rising from the valleys, the savory taste of the terrible food, and the mysteriousness of coal mining.. I have learned what is meant by the term “strip job”, and that the definition of a house contains infinite possibilities, including once abandoned shacks and old buses, that a “toilet” can be many things, that even the most distracted students have something to give and gain, and that it is entirely possible for 13,000 people to be served by 6 emergency room beds. Not ideal, but possible.

As I sit here on Mrs. Breckinridge's front porch, listening to the rippling of the river below, I am filled with a sense of inspiration, to challenge my own expectations of comfort, and to offer service to those around me. I am moved by energy of Mrs. Breckinridge and will leave Kentucky with a small piece of the spirit Appalachia stitched into my heart.

-Elia

in retrospect

My summer at Wendover has ended and I am back in my home state of MA. This morning when I woke up I had the greatest impulse to throw on khaki and white, only to realize that a uniform is not required for this part of my summer. The lack of khaki and white left me standing awkwardly in front of my bureau, completely unable to dress myself.

This basic confusion may have subsided quickly, but it creates a nice metaphor for my departure from Wendover. I had such a schedule, such a daily goal, that without the structure of Frontier Nursing Service and the courier program, I find myself aimless.

I never could have imagined I would learn all that I did this summer. Of course, based on the literature regarding the service and the program, I knew I would be shadowing some health providers and doing some community service, and thus learning about healthcare and community building. But I had no idea of the magnitude of the learning, and the wide array of information I would accumulate through daily interactions, various chores, and specific circumstances.

I ended up seeing four births: three vaginal and one c-section, and each one was wildly different than the others. I was able to witness the different methods and tendencies of each midwife, as well as the varying birth plan of each mother. Obviously the c-section had very few similatrities to the other births, but even amongst the three vaginal births there were great discrepancies in the midwifery, the duration, the epidural, etc. I knew each birth would be its own, distinct moment of glory, but I didn't really know what that meant. Nor did I have any idea that I would begin to understand the delivery room lingo and jargon.

The experiences I had each day in town or in the clinics alone were enough to fill a whole summer. But the learning didn't stop there at all; the staff of FNS at Wendover provided me with a family of distinct and exceptional members. I will forever remember the converstations in the Garden House while signing out the service car, or the conversations in the kitchen over the steam from the massive dishwasher. I learned about poke sallet, about family function and dysfunction, about fondant cakes, and probably more about snakes than I'll ever (hopefully) need to know. Each person at Wendover brought to the table personality, stories and friendship. Living at Wendover was like being in a perpetual hug.

When I signed on to spend a summer in Southeastern Kentucky, I knew there would be a few other couriers there with me. And I knew, just because of the instinctual tendencies of young women, that we would beomce friendly and chatty. But I had no idea that my relationships with the other couriers would be as enjoyable as they were.

Everything I learned this summer seemed to come full circle -- things I learned from one area of my couriership frequently tied into something I was learning in another area, and lended to a greater understanding. With one birth, the midwife asked me to assit her by propping the mother's leg up and helping her through her contractions and periods of pushing. While I would have done this in the beginning of the summer, I felt much more well-equiped to do so after the Doula Training that we went through. Similarly, I began to see the same people around town or in different clinics, and it felt like we were succeeding at delivering well-rounded care and aid to the residents of Leslie County.

Not only could I take acquired knowledge from one task and apply it to another, but I started to be able to apply this acquired knowledge to my own life. On a smaller scale, I learned how to make butter at the Library camp, only to make some more at Wendover, and other such things. But on a greater scale, I learned from the people of Hyden and Leslie County. I learned the meaning of certain social graces, I learned the importance of kind interactions, I learned tolerance, I learned acceptance and I learned what 'southern comfort' really means.

-frances