ASHER, Ky. — People seldom say: "Who's your doctor?" Instead they ask: "Who's your nurse?" in the mountain river bottoms, valleys and hollows of four southeastern Kentucky counties.
Doctors have always been hard to come by in this slice of rural America. So nurse practitioners and nurse midwives take care of about 80% of the health needs. Only when complicated illnesses, serious injuries or the need for surgery arise are the few physicians in the area called upon.
In fact, many Kentuckians in Leslie, Clay, Harlan and Perry counties have never seen a doctor in their entire lives. They were delivered, and cared for as children and adults by family nurse midwives and family nurse practitioners from the Frontier Nursing Service, a unique 62-year-old Kentucky medical organization.
Sue Lazar, affectionately known by several hundred mountain people as "Nurse Sue" or "the nurse on the middle fork of the Kentucky River" has run the service's Beech Fork Outpost Clinic on the outskirts of the hamlet of Asher for seven years.
Lazar, 40, a curly-haired blonde, served a year in the thick of fighting in Vietnam as an Army nurse. A native of Lafayette, Ind., she came here from Denver "because I heard of the work of the Frontier Nurses and longed to work in Appalachia." She and four other women operate the service's Beech Fork Outpost Clinic serving families scattered for miles around, many living in modest cabins along dirt roads deep in the woods.
The clinic was filled with patients on a recent day--with pregnant women and crying babies, with coal miners suffering from black lung, with men, women and children being treated for diabetes, hypertension, common colds, wasp stings and other ailments.
"Nurse Sue" was in one of the examining rooms with Georgia Hoskins, 32, and her daughter, Tiffany, 5, who cried a river of tears as she received her booster shots and a physical in order to enter kindergarten. She wiped away her tears, smiled and said: "It's all over. I can go to school now."
Doyle Roberts, 22, was in the clinic with his pregnant wife, Polly, 18. They were both delivered by the service's nurses, as were their parents. Soon their child would be delivered in the same manner.
"I feel much more comfortable having a woman nurse than a man doctor delivering my baby," said Polly.
"We never see a doctor. All we have here is nurses. The nurses live close by. They have always taken care of our family. My granny remembers when they came to the house on horseback," Doyle said.
It was Mary Breckinridge who introduced nurses on horseback to Leslie County in 1925--a county with 10,000 residents at the time, without a road or an automobile, without one licensed physician, a county with the highest infant mortality rate in the nation.
Breckinridge was a wealthy woman who wanted to do something for the mountain people of Kentucky. Her great-great-grandfather was Thomas Jefferson's attorney general; her grandfather was John Cabell Breckinridge, vice president of the United States from 1857 to 1861, a Confederate general and Secretary of War for the Confederacy. Her father was U.S. Ambassador to Russia.
She was married to a college professor. They had two children, both of whom died in infancy. After the deaths of her daughter and son, she divorced, took back her maiden name, and decided while in her early 40s to dedicate her life to the children and families of Leslie County. There were no graduate midwifery schools in this country. So, Breckinridge went to England and studied at the British Hospital for Mothers and Babies in London. She returned to the United States, bringing with her the country's first professional nurse midwives.
"Women in childbirth suffer as much as men in war. Maternity is a young woman's battlefield. Her pain is terrible and her wounds are often mortal," she said when she founded Frontier Nursing Service. "It revolts my sense of decency that we should neglect our children and give 18th-Century care to women in childbirth in remotely rural America."
In 1925, Breckinridge built a large log cabin in the wilderness. It served as her home and headquarters for 40 years until her death at the age of 84 in 1965. She constructed a hospital and health center at nearby Hyden in 1928. Men in the area had raisings and built outpost clinics, the first at Beech Fork in 1926.
The horse and mule were the only means of transportation in this part of Kentucky through the 1940s, and the service's nurses, their saddlebags filled with medical kits, continued to reach the sick by horseback into the early '50s--when roads were finally pushed through and jeeps replaced the horse in the back country.
When mountain children asked where babies came from years ago they were told the nurses bring them in their saddlebags.
Kate Chieco , 38, program officer for the Alexander Fund of the New York Community Trust, was visiting the Beech Ford Outpost Clinic to see its operation firsthand. The New York Community Trust fund organizations in Appalachia.