B Y

Candace Higgins

and

Linda Lewln

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TIRRED by a strong desire for adventure and a unique S opportunity for learning, we three students, the authors and Judy Pinson, from Capital University in Columbus, Ohio, committed ourselves to spending seven weeks in the Delta region in Mississippi, enduring scorching temperatures and numerous stares.

It all began in March, 1969, when Public Health instructor Miss Olga Chernek received pamphlets and information de- scribing poverty-stricken Mound Bayou. She immediately realized the challenging experience that awaited any daring soul. Perhaps it was luck, although we now believe it was fate, that brought a positive response to our correspondence with the clinical director of the Tufts-Delta Health Center, Dr. David Weeks. Aware of what we could gain by becoming temporary members of the health team, Dr. Weeks agreed to our request for seven weeks of independent study at the Center.

All the planning, correspondence, and advance reading seemed very distant as we sped southward with Miss Chernek on Route 61. Could it be possible that the time had actually arrived when we could apply our nursing objectives and engage in the actual clinical experience? Rows of dilapidated shacks, sunshine privies, and half-clothed children penetrated our thoughts as we drew near our final destination. With spreading neurodermatitis and knocking knees, we cautiously set foot on the dusty land that would be our home. As Miss Chernek left us standing in the parking lot of the Tufts-Delta Health Center, our excitement mounted for we realized that no matter what fate befell us we were entirely on our own.

As twilight approached we threw our weary bodies on the dirty mattresses and prayed for sleep to claim us as we mentally relived that eventful first day. After leaving the

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health center we had slowly crawled out of the car to stare in total disbelief at what was to be our dwelling place. Our mouths hung open and tears threatened to spill as we viewed the accommodations. Broken windows, unhinged doors, and flies and crawling insects welcomed us to an abode that lacked plumbing and electricity. With wishful thoughts of hopping aboard the first northbound bus, we made a hasty retreat back to the health center and within hours found ourselves visiting Mound Bayou’s deserted funeral director’s home where

fortunately only dust, lumber, and dead mice were on hand to welcome us.

That evening at the local cafe as we tried to fight the homesickness and choke down our meal, we were hailed by the majority of the town’s male population. We soon learned that three white girls in all black Mound Bayou were bound to cause a few penetrating looks and would be the topic of conversation for days.

Our first day on duty will always be a memorable one. We

were assigned to make home visits with an experienced nurse. Without any warning or previous knowledge of what was in store for us, we pitched into our assignment. The weather was so unbearably hot to even stay hydrated was a problem. Most of the homes (literally sheds) we visited had been thrown together with pieces of decayed wood. The steps were an always present source of danger. The porches, full of holes, sagged with our weight. Garbage was strewn about the premises. Chickens and pigs roamed freely through the yards, accompanied by flies and mice.

The next day we were given a tour of the surrounding communities known as the target area and the co-op farm. As a bonus we viewed “Big Muddy,” and only then did we realize this winding river was the Mississippi. We were pro- vided with the background of the program, and puzzled over the outdated caste system that still prevailed in the South. For the first time in our lives we were confronted with feelings of being in the minority. However, we did not feel threatened, although we did feel conspicuous.

Initially, some of what we saw left us with a sense of despair and bewilderment. The Delta residents did not know a better way of life existed, but were forced to survive in extremely deprived conditions. Constant feelings of hunger and frustration, and conditions of filth filled their lives. In some homes, members of the family had to take turns eating because there was only one utensil for a fifteen-member household. The children had never been exposed to even the simplest of luxuries, and some of them even perceived a teddy bear as a large rat. Until the Tufts-Delta Health Center was established, these families could not afford to go to the segregated clinics so they had to suffer at home, treating themselves with home remedies.

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We spent our first three weeks rotating through the various departments, interviewing personnel, studying the agency, and meeting Delta families. On Friday afternoons we were actively involved in seminars on education and other problems con- fronting the black race. In many areas of the South, the blacks are constantly fighting unfair laws and striving just to keep their children in school. Often, children miss a school day because of inadequate clothing or lack of food, yet after 20 absences a child is forbidden to return to school. These seminars helped us to gain some insight into the defeating world of being black.

During the next few weeks we settled comfortably into the community and concentrated our efforts on working at the health center with the departments of social service, nutrition, sanitation, and the OB-GYN clinic. By following several families we learned to endure the frustrations of unsanitary conditions and the pervasive sense of hopelessness. We became appalled at the cruel reception these people en- countered and had learned to endure, and were disgusted with the total disregard for their relevant problems.

While working in the OB-GYN clinic we succeeded in con- vincing the administration of the need for pre-natal classes. The pregnant women were our prime concern. We threw ourselves enthusiastically into the project. The resources were limited, but even the small bit of knowledge available did prove helpful. One of our objectives was to design the class so that it would be meaningful and beneficial to those attending. Our efforts were rewarded when the shy women arrived and listened with exaggerated politeness. These gatherings were such a success that the health center has made plans to continue the classes.

After nearly a month of rotation among the various depart-

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ments, we were anxious to get out into the field and begin home visits. We had had a brief exposure to the families of the Delta through the social service and environmental im- provement departments, and observed severe health and en- vironmental problems. Our goals were to improve the health standards of families and encourage them to maintain these standards by using our suggestions and health instruction. Each of us was assigned to accompany either a health aide, a licensed practical nurse, or a registered nurse on home visits, and continue with them for the remainder of our three weeks in the South.

All three proved to be the best resource people we had encountered during our experience with the health center. They knew the area and they knew intimately most of the families, either through church or through relatives or friends. Their relationships were on a personal level and we found this to be most effective in identifying social problems and facili- tating communications. After all, aren’t human relations what nursing is all about? Their presence in a home also made the families feel less threatened by our visits, and we happily found that most of the families were very willing to accept our offering of health care. In the past, blacks of the Delta region were cautious in talking to whites about their impoverished conditions. A call from a white had meant investigation by the State Welfare Board or the Department of Aid to Dependent Children, or repossession of their only valuable household item, the television set.

We were each assigned to two families with the responsi- bility of their complete physical and social care. Compared to the cultural deprivation and environmental hazards, the fam- ilies’ health problems were of minor importance. This was impressed on us when we looked at the welfare applications

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and home survey sheets. We knew that our nursing care plans would have to encompass all facets of family living. A prime objective of our care plans was to help the poor discover resources within their own family unit. We realized that health teaching and counseling would, out of necessity, be a large part of our daily encounter with our families.

We knew that the poor thought more about their needs for food, jobs, and steady incomes than they thought of their health needs. It was going to be an overwhelming task to deal with these problems before we could even begin physical care. The task meant total involvement with our families and this added further impetus to the anticipation of our field work. But how were we to accomplish this? Perhaps the following family study of one of us will illustrate the problem.

Miss M was a 20-year-old mother of four. All her chil- dren were under the age of five, the youngest, only a month old. The problems I encountered were numerous, and at first they seemed to be too many to solve in the remaining three weeks. However, I took a deep breath before knocking on the door and told myself to do the best I could.

My initial visit was made in response to a referral to nursing service from an environmental survey of the home and its sanitation provisions. The referral problem was the general health of the baby. He had been six weeks premature, but had not been kept in the hospital nursery long enough to reach the standard five pounds. On questioning, the mother said that the baby had de- veloped severe diarrhea on two previous occasions and that each attack had lasted approximately two days. On examination, I found that the infant had developed diarrhea a third time. He exhibited little activity, had a very slight grasp, and emitted only a weak cry when

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stimulated. He weighed only four pounds, eight ounces. It was heartbreaking to see him, almost lost inside his soiled blanket, barely able to react. The mother did not have money for meat, much less money to pay for the infant’s hospitalization. She said she did not know what to do about her baby because all her other children had been so big and this one was so small. She really did not understand how much extra care a premature infant needed.

The nursing action for the first day was to obtain a doctor’s prescription to treat the diarrhea, request pre- mature bottle nipples from supplies along with baby blankets and diapers, and file for sanitation testing of the water supply. Two visits later, the diarrhea had stopped, the infant had become more active, his appetite had im- proved, and he had begun to gain weight. At that point it might have seemed that health care was no longer needed since the infant appeared to be recovering. How- ever, my responsibility to the family was just beginning.

The next two weeks I spent developing a care plan and giving suggestions to the health aide to continue the family’s care. In the remainder of the time, I helped with environmental improvements, health teaching, and health care to the other children. Also, I obtained household supplies and assisted with finances. Environmental im- provements included installation of window and door screens, replacement of window glass, porch repair, the drawing up of plans for privies, and the installation of a new water pump. In an effort to reduce the swarm of flies in the kitchen, Miss M was encouraged to throw the garbage into a large metal barrel to be burned. She was also encouraged to clean up the cans and glass that littered the place, because of the safety hazard they caused.

The other three children were sent to the clinic for immunization against communicable diseases and treat- ment for sores on their a r m and legs. Miss M was

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taught that a mattress and bed clothing could harbor harmful insects that could cause health problems for the children. When next I visited Miss M I found that she had pulled the mattress outside into the sun and was washing the outer covering. She also happily displayed a full clothesline of washed clothing, smiling with pride when I complimented her on the encouraging sight.

Another objective of my care plan was to arrange for financial assistance. The only income Miss M had was her field earnings of two to five dollars a day, but with the latest addition to the family even holding this job became an impossibility. She simpIy could not raise four children, provide a nutritional diet, and clothe them properly with this less-than-subsistence income. Miss M had applied for Aid to Dependent Children, but was refused because the children’s birth certificates had been lost in a fire. The state charged two dollars each to replace the certificates. Miss M could not stretch her budget to cover the cost. I requested that the social service department assume this cost and re-apply to A.D.C. for aid for Miss M’s children. Clothing and shoes were collected from the health center’s social service department to assist in defraying the cost of starting the children in school. The seeds had been planted; now if only continuing training and financial assistance would bring this family the minimum neces- sities of living.

Each of us left wondering if we had done enough. If only there had been more time, more funds, or more people in the field, could we have done more? Could we ever feel com- pletely comfortable in our northern, middle-class suburban homes again? Would we always be plagued with the memory of that first day, holding that dying infant? Had we really done anything to correct the Delta impoverishment and im- prove health standards?

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