Neighborhoods Breckenridge, Mary. (1981). Wide

¶ … Neighborhoods

Breckenridge, Mary. (1981). Wide neighborhoods: A story of the frontier nursing service.

Mary Breckenridge was born to a privileged family, and grew up amongst European aristocracy. Yet much like nursing founder Florence Nightingale, Breckenridge rejected a life of comfort for the rigors of medicine. As Florence Nightingale was drawn to serve soldiers during the Crimean War, Breckenridge felt compelled to bring healthcare services to rural communities in the American South. Wide neighborhoods: A story of the frontier nursing service is Breckenridge's 1954 autobiography and the story of her mission. It is compelling reading, partially because of the author's considerable accomplishments but also because it is rare to read firsthand soul-searching examinations, written by nurses in their own words.

Breckenridge clearly had a kind of calling: she could recall nursing a sick baby when she was still a child herself (Breckenridge 1954, p. 16). This event would later be a harbinger of her field of specialty, that of pediatrics and midwifery. She also spent time amongst the Native American population, which solidified her passion to help the underprivileged (Breckenridge 1954, p. 43). However, according to Mary, she was not born with a desire to become a nurse. Not until her husband died an untimely death did she put aside her old dreams of becoming an explorer, and instead became interested in the career of nursing (Breckenridge 1954, p. 51).

Because of her spotty education and her footloose childhood which lead her from Russia America, Breckenridge did not even have a high school education. It is a testimony to how far nursing has evolved as a scientific profession that a woman with little education in arithmetic could reach Breckenridge's level in the healthcare field! Even during her training, however, she was an advocate for the ailing and disabled children on the ward where she served, in an era where their needs were often ignored. After World War I, she worked to give aid to the people of France, particularly the children, who were often emotionally and physically shell-shocked because of what they had witnessed. This hardened her to living in difficult conditions. Even after she suffered a broken back, she was still determined to realize her goal of improving healthcare for the nation's poorest.

Breckenridge founded the Frontier Nursing Service in Kentucky. Previously, poor, rural women giving birth often had no skilled assistance whatsoever. Breckenridge reached women on horseback, and later in jeeps, because many of her patients did not live near paved roads. She established both a hospital and a school of midwifery, as well as worked as a trained nurse, often in harrowing conditions. She pioneered the concept of the 'nurse-midwife' -- a nurse who was trained in both medical science and in the traditional practices of midwifery. At the time of the first years of the Frontier Nursing Service, many trained physicians had left America due to the war effort, making Breckenridge's task even more formidable. However, the communities were welcoming, which made the efforts worthwhile -- most of the midwives who had served the population were so old that they "turned their practices over to us with sighs of relief" she wrote (Breckenridge 1954, p.256).

Breckenridge's story indicates the importance of access and availability of healthcare for rural populations. Specialists "came to the mountains" since their residents could not (Breckenridge 1954, 257). Many of Breckenridge's patients had illnesses, such as cataracts, that could be easily remedied by doctors, but could severely inhibit the life of the sufferer if they were left untreated. Medical, dental, and other clinics were created to ensure that healthcare appointments became a part of the community's life, not something extraordinary undertaken only in dire circumstances, after a treatable condition had become chronic.

Even today, many isolated areas of America lack access to even basic healthcare, including prenatal care. Navigating the logistics of healthcare delivery can be a challenge. Breckenridge used horses to reach her patients. Regardless of what means are deployed -- even electronic visits with patients via the Internet today -- it is essential that contact is maintained between locals and the healthcare profession. Although much has changed since Breckenridge's day, it is still particularly critical that gynecological information is transmitted to sexually active populations, about prenatal care, childbirth and the need for prevention of sexually transmitted diseases. In this area of medicine, misinformation still often abounds, as it did in Breckenridge's day.