They were forging an emotional link established four
years earlier in the Hebrides
Whisky was Scotland's most notable export in America's prohibition years.
But
the nurses and midwives of the Highlands and Islands left a much longer
lasting legacy, inspiring colleagues around the world.
Their
exemplary care of mothers and babies in remote communities provided the
model for the Frontier Nursing Service in Kentucky whose nurse-midwives
famously covered the Appalachian Mountains on horseback.
It
is a remarkable story of truly remarkable women.
The
nurses and midwives were part of the Highlands and Islands Medical Service
(HIMS), a forerunner of the NHS set up 35 years earlier which provided
state-funded comprehensive care for more than 300,000 people across half
of Scotland's land mass.
Prior
to 1913, medical and nursing care in such remote communities was patchy
at best - and non-existent at worst.
Within
20 years, that had all changed. Resident surgeons and physicians had been
appointed to hospitals, the first air ambulances were taking patients
to the mainland.
Above
all, there was for the first time, a high quality service from family
doctors and district nurses and midwives. They worked closely together
proving a model for the future NHS.
Fees,
when charged, were minimal. Uniquely in pre-NHS Britain, there was affordable
treatment to women, children, the poor and others not covered by the existing
national insurance scheme.
Sir
Leslie Mackenzie was the main driving force behind the HIMS. A socialist
and friend of Beatrice and Sidney Webb, he was medical member of the Scottish
Board of Health (a post which later became Chief Medical Officer for Scotland).
He and his wife Helen, were leaders in promoting better nutrition and
care for mothers and young children.
It
was to the Mackenzies that the American pioneer Mary Breckinridge came
to in August 1924 to see for herself how nurses and midwives worked in
the Highlands and Islands Medical Service.
Breckinridge
was born into a rich and influential family. She suffered the tragedy
of losing both her children before they reached five. Trained as a nurse,
she went to France in 1918 working for the American Committee for Devastated
France.
Earlier
International aid by the women's suffrage movement had supported the Scottish
Women's Hospital Unit at Royaumont set up by Elsie Inglis, a close friend
of Helen Mackenzie.
In
France, Breckinridge recognised the value of trained midwives - then virtually
unknown in the United States. She qualified as a midwife at Woolwich in
London then fixed her sights on the journey north. It was to change her
life.
"Sometimes
an experience is so deeply creative that you respond to it with everything
that you have, not only in retrospect but at the time. When I went to
Scotland in mid-August of 1924 to make a study of the Highlands and Islands
Medical and Nursing Service, I knew that weeks of enchantment lay ahead
of me, but I could not know until it happened what it would be like to
enter a strange country and feel at once that I had come home" she
later wrote.
Sir
Leslie greeted her warmly in Edinburgh and gave her a letter of introduction
for her travels.
Her
next port of call was the Scottish Headquarters of Queen Victoria's Institute
for Nurses. "Queens Nurses" provided the backbone of the HIMS.
Highly trained in general nursing, many had additional qualifications
in midwifery.
Perthshire
was the next stop. Like Hertfordshire in England, it had a well developed
nursing association structure. Much of this was due to Kitty Murray, Duchess
of Atholl, a nurse and member of John Dewar's committee whose report in
1912 led to the establishment of the HIMS. Murray later became the first
female MP in Scotland and the first female minister in a Conservative
Government.
It
was called HIMS but the Scottish Board of Health which provided its administration
also embodied in HER. Unusually for that time, it purposely had a female
board member - Muriel Ritson, a high-flying civil servant.
Breckinridge
noted the high level of local autonomy and flexibility between the central
body at the Scottish Office in Edinburgh and local committees. Thus state
funding was much higher in the sparsely populated Outer Hebrides than
the more prosperous mainland counties.
On
her return to Kentucky, Breckinridge set about putting into practice what
she had seen in Scotland. She had taken meticulous notes - 11,000 words
in various notebooks.
She
was appalled at the number of American women who died in childbirth. Death
rates were four times as high as those looked after by the Queen's Nurses
in Britain.
America
had forged ahead in nurse education. The University of Texas had established
a chair of nursing in 1895. Glasgow Royal Infirmary had earlier set up
a nurse training school which itself inspired the school of nursing at
Yale.
But
in midwifery, there was strong resistance to the European model of midwives
being responsible for normal births with obstetric help at hand when required.
In the USA, the medical model not only prevailed but was enforced - all
births should be under the supervision of obstetricians.
Breckinridge
wanted to challenge this - particularly in remote areas where there were
no physicians, never mind obstetricians, to deliver babies.
What
became the Frontier Nursing Service held its first meeting in May 1925.
Scottish origins were evident in the choice where they would start - Leslie
County, one thousand square miles with 15,000 people and no doctor.
As
in parts of the Highlands, births and deaths had gone unrecorded for years.
To demonstrate what nurse midwives could do, they needed a statistical
base.
Breckinridge
contacted Sir Leslie and tracked down Miss Bertram Ireland, who had acted
as secretary to his inquiry on the Physical Welfare of Scottish Mothers
and Children.
Miss
Ireland had two further essential qualities. She could ride horseback
and she could take a nickname. The Frontier Nursing Service also pioneered
the now blokeish practice of pen names for their staff.
"Ireland
from Scotland" became the first of many. Riding from the nearest
railheads Krypton or Hazard was the first test for anyone - at least 20
miles across mountains and fording rivers and streams.
In
June 1925, Breckinridge noted: "She has begun her work on Hell-fer-Startin'
Creek and Devil's Jump Branch - really. She is blistered, sore, stiff,
and undaunted"
Others
followed in her wake. In some women, it offered an intoxicating challenge.
Riding was essential and the first test came in the initial journey from
the nearest railheads at Krypton or Hazard - at least 20 miles across
mountains and fording rivers and streams.
Most
were British or Irish. In the absence of any training in the USA, some
American nurses joined having taken midwifery courses in Britain.
Each
nurse-midwife had her own patients - desperately poor families scattered
off the mountain trails. As in the Highlands they offered a complete nursing
and public health service as well as midwifery.
Annie
P. Mackinnon from Skye was one of early recruits. She had served with
the French Flag Nursing Corps during World War One. She was awarded the
Croix de Guerre for continuing to care for the sick and wounded under
enemy fire during the retreat from Aisne in the early summer of 1918.
Inevitably,
she was given the name "Mac". She would joke with her Irish
colleague Hannah "Nancy" O'Driscoll from Skibboreen, when playing
Harry Lauder on the gramophone about what songs might be played in heaven.
The
work was punishing and hazardous. The first to die was Nancy. She had
ridden out to care for a mother but stayed with her despite taking ill
herself. By the time she got back, Nancy's appendix had ruptured. She
was only 35.
The
FNS modelled some of their equipment on that of the Royal Canadian Mounted
Police. The Mounties always got their man but the Frontier nurse-midwives
never left their woman once she had started labour. Others suffered serious
injury. Mary Breckinridge broke her back in a fall from her horse in 1931.
Equally
hard, particularly when the depression and drought hit Kentucky was the
constant need to raise funds. Unlike HIMS, there was no government money.
From the outset, Breckinridge used all her social networks to enlist.
Committees were established in major US cities to raise funds. Prominent
patrons show funded the clinics included Mrs Henry Ford.
Publicity
was essential to keep up FNS profile. Breckinridge's cousin, Marvin, was
the first FNS courier - young women who rode with the nurse midwives and
tended to basic tasks like building up the fire or looking after the other
children.
Marvin
later made a film of the service and became the first female colleague
of Ed Murrow (of Good Night and Good Luck fame) reporting the London Blitz
for the CBS network.
The
major early landmark was building the first FNS hospital - at Thousandsticks
Mountain in Hyden. There was only one choice to perform the opening ceremony
on June 26 1928.
Sir
Leslie, then 66, and Lady Helen Mackenzie were delighted to oblige. Neither
could ride and new buckboard was tested by "Mac" in advance.
It was well she did. The 22 mile journey from the railroad involved teetering
over precipices in a violent rain storm and fording the swollen Kentucky
River.
He
waxed lyrical in his address, later published in the Lancet.
"It
is a story full of adventure, sacrifice, passionate enthusiasm and splendid
initiative. When, some years ago, Mrs Mary Breckinridge came to us in
Scotland to see how we had faced a similar problem in medical service
and nursing, we were filled with a new sense of significance of the work
we had tried to do in the thinly peopled and difficult areas of Scotland.
"When,
therefore, I was invited by the Frontier Nursing Service of Kentucky to
give verbal form to the dedication of the hospital and nursing system
now established in these mountains, I felt indeed, a glow of supreme satisfaction
that our work in Scotland had found an echo in the great spaces and mountains
of an American Commonwealth. The invitation was a call of the Highlands
to the Highlands. It is a symbol of kinship in feeling and outlook. It
is the lightning spark that reveals the essential unity of our culture
..
"The
beacon lighted here today will find an answering flame wherever the human
hearts are touched with the same divine pity. Far in the future, men and
women, generation after generation, will arise to bless the name of the
Frontier Nursing Service"
The
FNS did develop attracting increasing interest from North America and
beyond.
By
1932, an external audit of its first 1000 births showed not a single maternal
death resulting in pregnancy or labour.
"This
study shows conclusively that has in fact been demonstrated before, that
the type of service rendered by the Frontier Nurses safeguards the life
of the mother and babe. If such service were available to the women of
the country generally, there would be a saving of 10,000 mothers' lives
a year in the United States, there would be 30,000 less still births and
30,000 more children alive at the end of the first month of life."
The
nurse-midwives in the Hebrides would have been very proud of them.
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