r80

Cou6HrNc aND Sp,rrrNc rND NEw MFx'16 H,sr.nv ELEVEN

15. see Dnetes afttle Ch.t' letet cA{4 t. rc.6 A%5), for a full account of th.r inaugural gaihering. The enti.e issue was dedicated as a special r.ibure to the stale ofNew Mcxico." r6. Ernesr A. Swect, MD, "Inte6tate Misration ofTuberculous Persons,
Irs Bearing on the Public Health, with Special Reference ro rhe Srates ofTelas and New Mexico,"

Pzllr

Hzahh Re?o

the highest concentration oftubercul.r patients in SihcrCiry where, he iudsed,a full 8o percent ofthe familis sheltered at least one TB parienr. H. concluded,

',30

\rs1+ rc7t,

1066-67. Sweer

foud

HEALTH CARE ACROSS CULTURES: PusLrc HeaLrH Nunsrs rr Hrsperrc aNo

NerIve Aurnrc,rN CoMM uN rrrEs
@

"Were all the consuhptives to leale

...

Silver Criy would becone a nere spot in

Sarona

Sc

uac<

rl

roTr; and LeRoy Petere, what New Meli.o Needs Most in Tuberculosis Legislation," Nrtu M.zi.o Mcdical Jounal, r5 (r915-r6): 23o.

17. Ibid-,

t8. t9.

Sp;.lle, Doctat of Medici,e, 99.

Selman waksman, Thc Conqrea of

Tubddlot; (Berkeley and

Los

Ansles: Unilersity ofCalifo.nia Pre$, r964), r90,92.

za. Crft.it Th.nn \re8it t\2.

a2. wlksma , Co"q"e!
of

Tubddlak,

:,q'2.

in r9z: eugustine Stoll, Red Cro$ public Healrh nurse, began a yearJong assignment on the ficarilla Apache reservation in norrhern New Mexico Her 6rst monrhly report revealed some of the determination that
prompted her decision to take the position.

LATE

so

I arrived in Dulce November r:, and so far my progress hrs been slow that I rhink it can be .ohpared to rhc walkins here in the

mud, you go forward one step aod slip brck two. There is so mu.h to do and I have absolute farrh rhar sohe ofir can be done. This bliefmay ger a bir battered and hidden because everybody

fron the iannor up rells ne I can't do a thingt But I think r have erhausred sobe ofrhei. probably well,founded pessimnm and they are goina to ler he stop talking rnd get to work.l
Stoll and other women health workers in New Mexico were repre, scntative

of

well,intentioned, middle-clas Anglo women nationwide

whose efforts to cros ethnic bordere were part of a larger cultural rnovement in the early twentieth cenrury. As a public health reformer,

Stoll understood her rask ro be "correcrive, preventive, and educational w0rk." This ethnocentric :rpproach dovetailed wirh rh prevailing social
tLcorics thrr crDsid(crl

rll

nor-Angl<, Americans to be somchow ilefic

illl

r82

HEALr( C^RE Across Currunrs '83

tors ofchange toa popularion that was in transirion from
a

tive or in need ofcorrection and improvement. Ofparamount concern to

the rlormers iD rhis era was the lack of health care among many
Americans, a problem reflected in the narion's high infant monality rate. This chapter examines the role of women health care workers as agena ofchange in New Mexico in the 6rsr halfofthe twentieth cntury. In particular, it draws on the work ofpublic health workers among New Mexico's Pueblo, Navajo, and Hispanic communities ro show how they served as cultural conduits between rhe modern medical world and
cultures in transrtion. The issue is one ofcomplexity on several levels. The nurses themseh'es faced conflicts between their desire to ,,modernize,, the

traditional toa

The nurses shared the late ninetenth-century viwof Native Americans as a vaDishing race, and they believed that in some small wav thev could impart knowledge and techniques that would halt that seemingly inevitable process. They were atso products ofthe phitosophy

.,ve ,rfo,m in whi.h rhe concepr, of s.,ence. rJriondrry. a,d em.;".) were tools with which to reshape industrial America. Then resular ,epons $cre 6tted $irh rhe scirnri6. weighed and measured and matched ro standarrlized charts: visits to homes of midwives; number of hours given to ctass insrluction ofmid_ wives; childreo treated for trachoma (a highly conragious eye disease)r
and medical visits to Indian viilages. From this marrial. I have rried to reconstruct a picture of rhe nurses, wortd as they
served in ethnic New

ofprosrr

drra of proeesr -hootchii;rcn

Native Amelican and Hispanic cultures and also to preserve traditions_ They frequently faced prrsonal conflicts between their basic values and attitudes and thir willingness to suspend parts of their belief systems.
Sometimes thre was a contradiction between what the heafth car agencies waDted and how rhe nurses met those goals. Finally, there was the

effect of the nurses' actions on their parients. From thei! letters and reports, we know how the nurses perceived their actions; hearing rhe Indian and Hispanic voices would further enhance our understanding of

Mexico communities.

The ourses highlighted in this chapter stood outside mainstream Amrica. Although ,hey ,hared mdn) ofrh. raturs rypi. at ofmiddte.

ta,s

I suggest, however, that becaos the Durses were sensitive ro traditional ways, the changes were not as abrupt
the nurses'rol as agents ofchange.

or as intrusive as they might have been.

The voices of the nurses whose accounts hav been preserved in or leners those of Augustine Stoll, Agnes Courtney, Louise Kuhrtz, Molly Reebel, and Elizabeth Forster-revealed a world view that the nurees shared as middle-ctas Euro,Americans and as members of the health profession. All had aaended certified nursing programs, trained in hospitals or clinics, aDd chosen to work in a public
agency reports health setting. Some had servd as nurses overseas during World War I and therefore saw adventure and challenge in a public health asignment

crox-cultural training was provided to such heatth care workers. but r he.e q omen were ,enr direcrty rnro rhe 6eld with tirtle lnowlcdge oi rhc customs or beliefs ofthe peopte with whom they would be working. In the ethnocentric thinkjng ofthe progresive Era, health problems diJ not have a cultural compooent. Some nurses had difficutty adiusting to new " setting, as Sroll notesl

reformers, they also displayed a willingnes to suspend cultural judgment regardles ofrejection, haidship, or inconvenience. Later in this century,

in the American West. Othrs wele drawn to New Mexico for its beauty and cultural diversity. Not wirhout prejudices aDd biases, these wornen
nevertheless wele abl to suspcnd judgment oftheir clients in a way rhat fostered harmony and cooperation. More importanr, they ser!d as facili,

There is a Miss Reynotds up there lon the ]icarilta Apache reserva, tionl as field nurse. Between you and ne she: pathertc. This is her first Indian work and she can't drive a .ar or ride and she doesnt like the Indian and doesn,t want ro stay. She asked me to help her but I couldn'r do much for her spirit and conception ofthe work .re so wro^9. She s utterly Bosront And our ofpla.e. Bur I was so

r84

HEALTH CaRE A.{oss C!LruREs

r85

Most nurses recognized the cultural chasm that separated them from their

to alter cultural patterns among the Native American and Hispanic

populations. They wenr among rhese commu.;ties with the highestconfi, dence that by teaching nutrition, cleanliness, and the importance oFgerm theory, they could efect change.

willing to question rheir assumptions of differrn.c in dn Jtrcmpr ro close Lhe gap. Ar rhc ,amc rimc. rn,irur) ,o
patients, and some were ditrerences was a necesary component to successful public health work. For xample, when explaioing maternity and infaDtcare to Nativ
icans. Stoll made dances, religions [sic] observations."r

Amer

cliar "that we dozor want to interfere with old customs-

One ofthe driving forces behind the push for health care services in

Io many ways, according to Angio standards, rh ce$ful.ln Indian communiries, they built dairies toprovid fresh milk for children, had wells dug, built laundries and bathhouses; thy screened schoolchiidren for tuberculosis, treated trachoma, gave inoculations, and
provided pre- and postnatal care for mothers.6 In molt cases, rhese enter, prises were succesful because they did not conflict wirh tribal ceremonis
or rituals. This was not the case, horvver, wirh childbirth which, in many

New Mexico was the extremely high infanr mortality rate in the state. In r929, rhe first year for which reliable statistics are available, the mortality rate for infants under one yer ofage was r4o per r,ooo. This 6gure was more than twice the national rate of sixty-one per r,ooo; it conrinued to nse in the r93os before dropping to roo per r,ooo in r94o.a Several factors accounted for these disturbing statistics. The 6fth largest state at r22,ooo square miles, New Mexico had 360,35rl citizens in r9:o, most ofrhem in

cultures, n surrounded with ritual and secrecy. Here the nurses had rhe

rural areas and many in remote reaches where health care was scant or nonexistent. Lack ofgood roads made it difficult for physicians, nurses, and others to reach the ill. As a result. health care servicer fell to local aranden: \traditionalHispanic healers), medicine men and women, and
midwives. These health providers did notmeet AMA (American Medical Associarion) guidelines: they did not posess "formal" rraining, rhey did

s,ca'c., d,liiculty in bridging rhc , ul'ural bd'r'cr. Most Indian communities, willingty or cautiously, accepted the nurses and their Anglo ideas. Ooe exception, however, was Santo Do, mingo Pueblo, one ofthe mosr corservarive ofthe Rio crande publos. In one ofher last reports from her makeshift home rhree miles outside rhe pueblo in r926, Sroll mused over the traditional faction's reiction ofher

not practice "basic" health techniques, such as sterility and cleanliness; and they werc not pan ofthe nation's formal medical establishment. In response to the lack ofservices in much ofNew Mexico, the srate
department of health began a concerted e{fort in the rgzos to raise irs standard of health care. Although the eForts were direcred ar all New
Mexicans, oflicials were especially interested in carrying rheir message ro

For some weeks I have been puzzling oler how one can change an attitude ofmind or a hlbir ofthinkins, pa.ri.ularly when one is
held distrusrfully and disapp.ovingly at
be be some way

arnt

length. Ther. musr

other averues ofapproach rhat we hare not foundr there must ofwinning then, for one feels that rhey ar. very worthwhile. The village lies so near us, full ofcustoms, traditions, intricate religiotrs ceremo.ics ofwhich we know norhing.T Yet in the same report she speaks of the Indians at nearby Cochiti, who ''rre anxious to have us." As at Dulce earlie.. Sroll undersrood she w,s

Native Americans and Spanish{peaking citizens.5 Acting on the belief that scieDtilic, rational medicine offered the best and safest rleatment, Anglo reformrrs began a campaigo against rraditional forms of health care. Included iD their campaigr were midwives, especially the Hispanic partaas whom they characterized as superstitious, unclean, rnd un'ntbrmcJ. In our mrrwre'. rh. Anll,,..'rcqr\r'\ wi n .,r.rrt rrr

.rossing a prickly cultural barrier when rhe remarked, "Our work is so vcry dillereot from anything that has ever been atrempred here thar in its
rlill-ercocc it is a bit puzzling and not to be rrusred. Somerimes rhe newest rtcrho(ls {rc.cc(l bccrusc of their novelty."i

"nglrng

r86

HEALTH C^RE AcRoss CuLrunEs

t87

One obstacle the health care refo.mers faced was rhe power and influence ofmedicine men and women. To the Bureau of lndian Aft'airs
(tsIA), the agency responsible for the welfare ofNative Americans. rhese tradrtional healers represented all that was wrong in the pueblos an<l on
the reservations. The healers posed .: formidable barrier ro altering long held idea! regarding sickness and disease. Until th. ,96os agency oticials

Kuhrtz recognized that rhe practices of the medicine men were part of rheir religion and, therefore, did Dot ree rhem as competirors. As a result, she gained their support and her worL went ahead unimpeded. Her ability to Iisten and ro respond to Native American cultural prefereDces
was rhe key to a successful

regularly discounted the important role medicine men and women played in health mattrs and were unwilling to recognize rhe spiritual and
psychological aspects oftraditional Indian medicine. The agency attitude of resistance made the nurse's job hardtr and prolonged the process of health education. The most effective nurses had the cuhural sensitivity ro recognize thar they needed the sancrion and approvat of local heaters.

worling relarionship with the Isleta people. The Red Cross concurred, repeatedly renewing her assignment and
commending the "unusually good rapport between rhe nurse and the

lndians."'l
Elizabeth Forsrer, a public hralth nurse amons rhe Navaio in the early r93os, shared with Kuhrtz someofthe rraits thatallowed her to nt in

iocluding midwives. At the very least, they knew they must not altagonize the traditional belief structurc. Eva Wade Nickolds, worling at
Newcomb on the Navajo reservation, acknowledged this condirion when she noted that 'there has ben, as in most all pioneer work, all sorts of
obstacles to overcome and many

wll with her Navajo clierts. She roo remained empathetic and open to Navajo cusroms and was able to move comfbrtably between the two cultures. On several occasions Forsrer had been invited to healing ceremonies, then allowed to take rhe parient ro rhe hospital for further treatmenr. This practice, however, displeared rhe BtA superintendent in
so

thirgs to learn-mainly how to work

the region, who viewed rhe local heaters as an impediment to bringing

modern h.ahh

with the medicine man, rarher rhan againsr him.,,, One ofthe nost successful ar bridging this culturat gap was Louise Kuhnz, a Rcd Cross nurse who spelt thirty years (1926-56) ar Isleta
Pueblo south of Albuquerque. Unusualamongrhe nurses workingamong

trartic.\ ro rhe,^.rvarion. Mo{,g.".y

suspicious ofrraditionai medicine and saw tbemselves as competitors

".,,",, "..;

with

tnedicine men and wo'nen. In their view Forster was perpetuating prac tices that should be discredited and abolished. As a resutt,

the BIA

Native Americans, Kuh.tz grad ually Iearnd rheir tanguage and endeared herselfin many ways to the Istetans. ln r934 she counred the uccinatioos

of two ol the village

medicine

campaign. In a summary ofher work in r94o, she

in her immunization uote oflocal beliefs:

dismissed Forster after only eighteen months of service, and health care 1.or these Navaios in rhe remote north.asrern corner of the reservation came to a standstill. When Forster next visited tbe Red RocL regioD in the eariy r95os, she encountered many Navajo friends who had been without

mcdical care since her departu.e.iz The tack ofsensitivity on thc part of Anglo olicials had hindered and obstructed the exchange ofinformation rhat the best nurses, as culturat inrermediaries, hoped to promote. ()ne important lacet of the health reformers. work was infant and rn.terniry care, yer the topic of childbirth among Native Americans i! ,ni,rhcr, .)nd the dedicarion of the child to the clan.,r The nurses "r,l. recog

rheir supersridons aod srilt have their hedicine men. It is all more or ]es pertainins ro rhe; relision. The medr
cine men are

Yes, they have

til

pr;esrs. They all cooperare with

ne in

so many

ways aod they have cone to feel and know that

respect their

.ustons and beliefs

so

th.r rone ofit all ;nterteres wirh my hc.lth

i(,ticeably absnt or briefly treared in available sources. Amons Native 4,,,.fuJn\..rrrJn riruat ccrmonre, go,crn ch,tdbiflh. ,r,.."L

8li
'

Hrrrrs Cere

Across CuLruREs

s|kdta

s.Ao.4et

r89

nizcd that they were outsiders and unless they were welcomed or invned tdke part, they respecrfully Lept their distance. yet they were pleased when they were included in any part ofthe evenr. On one occasion, StoI

reported that

SantoDomingo man invited her..to come tosee his sister,s

baby.It had attained theadvanced ageoftwodayst We weredelighted for ir i! a rather rare invitation."r{ A few monthslater Stoll was told she might
attend

birrhin Cochiti and was disappointed when she missed theevent. "I was so sorry for I have been told rhat the rires are very interesting.',rt
a

l\

Den;zew ofthe Dere't, a rich collection ofletters Elizabeth Forster

birthing ceremonis. Among the Hopi, women ofthe household care for the mother at birth; the baby is washed in warm water and rubbed wnh ashes;then the child is laid in a cradle with one or more ears or corn. Lines of cornmeal or ashes :re made on each wall to mark rhe newborn,s home.r'In Picuris Pueblo, near Taos, an ear ofcorn is laid nexr to the child to acr as it! "corn mother" for thirty days, after which the mother takes corn meal to a shrine and offers prayers.rs At Acoma, ..corn a mother,,is placed with the chjld for a fouLday lying in period after which the
naming ceremony takes place.i, A simitar rituat occurs ar Laguna, where a medicjne man arrives on rhe fourth morning to o{Ier prayers to rhe Earth Mother and to Father Sun, offering thm rhe child.,t) At Zuni Pueblo birrh is a family and clan matter in which rhe mother's mothr atrends the delivery, unless complicatiom
ensuer then a

wote while at Red Rock, she describes a Navajo birth to which she was inyited inlune r932. When she and her interpreter arrived, the hogan was 6lled with men, wornen, and children. They had missed the actual
delivery, but "the old woman who seemed mistress of ceremonies,, took Forster as a pupil and demonstrared how things should be done. The mother, looking "none roo comfortable," was held in a kneeling position by means ofstraps extending from the ceiling and auached to each wrist. After the birrh, when the placenta was delivered, Forsrer was a owed ro
release the new mother, apply the umbitical dressing, and rub th baby with oil. She was thn totd to hold the baby over a trough ofsand on the

mrdwife,' cJlled in. I Afre, brrth. rhe faLher', morher bathes rhe chrtd, rubs is body with ashes, then places it in a bed ofwarm sand beside its
accepted the silence that surlounded the birth experience as part ofNative American culture that was not meant to be shard with outsiders. For those,

mother. Naming takes place on the fourth day.), These and other rituals normally wre not part ofthe nurses'world, but the nurses who,

hogan l1oor while an attendant poured 6rst cold then warm water over

the infant, rubbing vigorously all th white. Wrote Forster, ..you may believe it or not, but the result was a fresh pink-tan baby who was then
dressed in swaddling bands wirh arms piniooed to its sides, as all good Navaio babis are, and laid in its mother! arms." Meanwhile. other
assistants had prepared cedar tea

from pungent foliage for the morher.

Then, reported Forster, "We left peace in the little hogan in spite ofthe remaining audience of ariends. I couldn't help wondering if there were still rites to follow, but ifthere were,I was not invired."'6 Forstr appreci_
ated her inclusion in these private evenrs, even for parrial rituals, for sh knew it contribured to the Indians' acceptance of her and helped make her

among , Spanish-speaking New Mexicans. Most Hispanic women wanted and used midwives, women in rheir communities who had learned birthing skills from their mothers, grandmothers, or other femate relatives.

like Forster, were invited inro private ceremonies on occasion. it was still only a partial experience. There was less silence surrounding the birthing experience

Thse

parteras were highly respected women who served as advisers, counselors. and confidantes.zr They were also targets ofthe state health system which,

Ies ofan outsider in their culture.

Ethnographies done among the Rio Grande pueblos ofAcoma and Laguna and in the western pueblos of Zuni and Hopi describe simitar

mortality rate. When federal funds for infant and maternat health care bemme availabte to the states under the Sheppard-Towner Act of r9u r, New Mcxico was abte to hire threc public heatth nurses ro conduct maternity and infant care programs.,a By the end ofrhar decade, rwenty

r95o, carried out many programs to resulare and license midwives as part of the targer goat of lowering the state,s intant

between rgzo and

l9o
public

HE^LIH CArtr AcRoss CuLrlREs

health

I9I
women physicians tarer, especially

worli.g in

federal lunding in reu8.

rhe state, even after the loss of

in

the spcialties

of obstetrics

and

Wiseln the New Mexico medical community recognized the need for midwives in rural, isotated v;Uages where few physicians were avait, able. But there were reasons other rhan isolarion thar caused Hispaoic
families to prefer midwives. Counney noted that because ofthe .txpense of such care and the povelty of some families a doctor would be called only as a last resource."rs Jusr as important was the Hispanic famities,long

These successes did not come easily as rhe to locare and license midwives in rhe r92os were tr:ughr wirh'nnial.fforts frustration. The Depar.

ment of Health could not afford the staff required lor the task, and the worL was hampered by inacce$ibiiity because many midwives
remote mountain vjllages or isolated rural areas. Since th state was also trving ro obtain an accurare counr of births and deaths ro mer
census standards, the heatth care reformers sought out census registrars

tived in
federal

familiarity with and dependence on the parteras. Unlike in the native Americao communities where the birth process was woven joto the religious fabric, New Mexico Hispanics viewed birth within the targer framework of Western rradirion that accepred . science and reason,,
as

part oftheir beljefsystem. Hence their views were not unlike those oFthe Anglo medical community, which made rhe nurses, task easier. While they had to keep their distanc from the birrh expertence in the puebtos,
the nurses were more readily accepted in the Hispanic villages when they rrrivcd ro irJenLrry rnd ftJ,n Hi,pan( m,dsi\er.
Once she had the midwives located, the nurse arlanged for a series

and subregistrars (locat cidzens responsible for recording births and deaths) to help jn identifying midwives. The midwjves were then in_ structed in filling out 6irth aod death certiticates. Many of the women
were illiterate, however and other arrangements had to be made toobtain thjs important informarion. Courrney related one experience i, Rio Ar riba County in r928: The midwiles interviewed th;s week we.e sinply impossible. They wcre all very old and crippted up as s,.11 as isnorarr. I,rrs. Galtegos who lires ar Los B.azos Mys rhat shc s usi.g the
leyel drops. She does nor h.ow how to read or wrire so can not tilt our bifth ceft;ficares bur she giles a blank to the fahily ofeach bahv delivercd aod then .oilecrs them and retu.ns them ro the sub_ registrar She is nearly blind.,i

ten clases to be held in a woman.s home, a school, or another central location. Oral instructions combined with practical demonstrations al, lowed each woman the opporrunity to lepear rhe action being demon
strated.

of

If

wouu

the nurse did not speak Spanish, someone in the communitv d. in(e'pr.rer. The midqrve, were raugh, ranu,.d ob,Letri'

cal techniques, procedures for dealing with the most common comptications encouDtered iD deljvcry, and fuDdamentats in the care ofthe new_ born. They were taught to recognize danger signals and iDstructed ro call
a doctor at the 6rst sign

oldificulty. Once the delivery was comptetett, the midwife was required to trll out the birth cerriFcate and mail it to rhe
county health omce.

This grassroots effort ro reach the midwives eventuallv succeederl By Lhe mrd roao'. rr qr\ der.rmined rhat bcrueen *ven trundrcd and eight hundred mjdwives were pracrjcjng rhroughout rhe srate. mosr
thm in the Hispanjc communities ofnorthern New ?vtexico.,, In r936, w;th federal funding, the state set up a rural demonstration unit in San

of

l
I

The midwife clases clearly conrributed ro the steady decLine in rhe infant mortality rate which by r94o had dropped ro roo deaths per r,ooo births.r" l)qually imporunt, the midwive s' willingDe $ ro accept;nsrruc-

Miguel County in northeastern New Mexjco where rhat year m;dwives attended 7or of97z b;ths. The project was highty succesfui, employing
as many as ren nurses and engaging the cooperation of several women

rr,n rr,,rn.,rh,r $,,m'.'r I,nl..,F..t

rtr

w.,t t.tr

i tnl,r,r.nicti.,rxr

physicians, includiDg Nancy

,,t

I{xn(hos (lc

fios, Mary Lou Hickman of

Campbe of Santa Fe, Gertflrde Light of

Las Vegas, and larer MariaD

r92

H!aLrH

CaRE AcRoss CuLruREs

r93 midwives, the use of midwive! as birth artendanrs oonrheless gradualty

declined. Several factors played a rote in this decline, not the least of which was the narionwide movement to transfer birth from the private domain ofwomen and homc inro rhe sre, itc and impe,sonat world oirhe horpitat.

Hotopp, Edirh Millican, and Mary Waddell. One of the mosr active midwives in northern New Mexico, lesusna Aragon, was a graduate of the midwife clases and one of the last of the Hispanic midwives to be licensed as part of the state's demonstration project.ro The project proved to be a valuable model for providing obstetricat care during World-War II when many doctors were catted to the armed services. The local midwife became increasingly important in areas that
lacked physicians or other medical professionals. Pubtic ofiicials noted in r94r that the demand for midwives was likely to increase as more phys!
cians were called into the armed srvices. In r942,273 of678 ofmidwives were licensed through rhe state's midwifery program. The following year

This movemenr affecrcd both \ative Amerrcan women and Hi,panic women, many ofwhom chose to take advantage ofthe improved

the Dpartment of Public Health acknowledged 'an awakened consciousnes among physicians" that recognized the ulue of training birth
attendants in areas wherephysicians were not readily avaitable.r'Not onty were the servjces ofthe midwife important in rhe birth expelince bur
Sincc she holds a key position in each little village or crossroads

where she lives, the hidwife serves as a valuable heans of fufthF ing the simple srories rold her regardinS nurririon, sanitarion, and

route ro prolessionalization nor did they replace rheir rrrdirronal hcrting practiccs with the new medical training, which they perceived ..as different from but no more reliable than rheirs.,'ra Becaus of a shortage of both funds and nurses, the practice of midwifery continued.

midwives declined as the older partras died and th younger women failed to take up rhe profession. Not all midwives foltowed this

ing examinarions, and issuing certiEcates. Gradualty, the numbers of

cat procedures and advanced technolog, that AMA medicine promised. With this form of progress came a loss ofautonomy for village paneras and Indian midwives. They no longer controlled the conditions;f rheir trade; the state regulated midwifery by standardizing procedures, requir_

medi-

what constitutes safe obstetrical care. .. . By passing on the lesons

she learns she conrribures to thc overall heakh

prdsran ofrhe

The nurses who initiated marernity and infancy care in Indian and Hispanic communities served as cLrttural agent! who hetped ase their clients' transition from traditionai ro more modern

Still, the state was determined to reduce the numbers ofpracticing midwives as part of the medical establishment's overalt pian to convince women to give birrh in hospitals. Although it seemed a contradiction, the

ifwomen were goiDg rocontinue to use midwives, then they should be licensed and regulated; at rhe sam rime, thy expecred dependnce on midwives to gradually decrease. In ry41 th. Nau Merico Huhh Oflcet smqgly prophesied that 'tlowly our problem with midwiae service will b solved, and what is now an essential service will in large measure be replaced by more sarisfacrory assistance ar chitdbirth."rr So while the liccnsing program was succe$ful in locating anrJ training
state belived that

jn the infant and matcrnity mortallty rates and the increase in the numbers of women giving birth in hospitals port-Wo.ld War II. But rhere wre losses in th diminished role of the parteras and in the deciining number ofpracticing midwives. From a high ofeight hundred known midwives in 1945, the number fell to les than one hundred by 1965.15 As agents of change, the nurses were abl to bridge culrurat difercnces because oftheir cmpathy and compassion for Hispanic and Native American practics. Yer rhey were unable to replace rraditjonal childbirih rituals with Anglo methods. UntiLe Hispanic women, Native American women resisted adopting middle_clas Anglo birthing methods, pre_
ways: the decrease

care. We see rhe resutts

in rwo

methods of health

r94

H!aLrs

CaRx Acnoss

Currrnrs

t95

ferring to keep rhe bi.th xperience a private, clan_based matter. one shrouded in religious symbohm. These women resisted the nurses,mid wifery instructions unril afrer Wortd War II when rhey more readily accepted the Anglo preference for hospitat births. Why were H;spanic women more accepting of the nurses, instructions rhan rheir Native American counterparts? One explanation is that Hispanics are a part ofthe larger framework ofWesrern fuadirion while Natjve American culture has always enisted outside thi! framework.
Hispanics, as Catholics, shared ideas an<l attitudes toward birth, death. and other life experiences with rhe Anglo community. In contrast, Native

2.
lrom,nso

pu"hto\. {ueu{.n. \roti tupcr.. Mcdral Lrbrary, \tbuauerqur. N"w Me\ico

Aususrine Sro to Elizabeth C. Fox,November lo, re2s, fol.ler 2.Sanro

No hcrl

Univmi\ ofNrw Meri..

3. 4.

r9r9-t944," Nctu Mcxi.o Heabh Ofrct e (Decen;et ryaa), t3.14. 5. In rhe census of r92o, the sratet population was 60 per.ent Hispanic, r3.4 per.ent Anglo,5 perce't native Ahe.i.an, aD.l r.6 percembla.k. Fauten,A CeuatoftAe Uh;ted St,Er, r92o, lot.III, population (Washinsto., D.C.rcovern_ menL P,,aLrng Ofi,e. ro,r, cnd lohn t.. Anonor. .ofrp. . n,1 ed.. paputattua
AbJta.t of tle Unned Stat.s, vol. r, Tabtes.

Augustire Srotl to Anne Fox,lanuary 8, 1926, folder:, Sroll papen. .Twerry-Five years lanes R. Scoti, of public Healrh in New Mexico,

Americaff' views on these issues were very differenr. ID facr, Nariv Americans, from longexperienc, were cautious ofAnglo overtures. Stoll pu|r su,cinctll $hen,he wro,r in ,1,5 rhJr
Their fea. oflosi's rheir ra.iat culture and retigion ties at rhe bot_ toh ofthe; re'istance ro white mani ways. Ir would rale vast

6.
.h.j.

Sandra S.hackel, Soa; t Houc4ee?d,, Woden Shapi p

pabti.

Nru l.l.n.o. to,o. toaotAtbuquerqLe: Un,\rrnr\ otN"w Vexi..

poti.\) ;n

tr.*.

rss4,

tine and rare understanding to conp.ehend rheir anripathies and thought. I wonder if a white pe6on wilt eler do so. It nay hean thar one oftheir own race wil be thc true wo.k..,.

IfStoll

and orhers like her were not

in public bealth work, easiog the transition from tradirional medicine to moclern, and ultimately safer, forms of medical practice. Because of their empathy and sensirivitv to culrural bclrer' differenr f,om rhei, o$n. rh. nr,nc. wcre effrerwe in
agents

les were important cultural

rhe.lrue worker," rhey nonethe_

blinging marernity and infancy education to New Mexico! Hhpanic and Native Americancommunities. In retrospect,Sto ,s initialdetermination
to "stop

rr. Eric T Hagberg to Louise O. Kuh.tz, Sptember 6, 19{6 a.d February r8, r947i W;liiam A. Brophy ro Louise O. Kuhrtz, Seprember ro, 1949; and Reporr of cerr.ude F. Hosmer, Dsrricr Superliso.y Nu.se, n.d., all in rhe po$e$ion ofRobert Mayhew ofsanra Fe.
Mexico l,ress, 1988), 18.

l\4anu'cipr Librrry. Pnlceron Un,\rrn,y {rrh,ve. pnnrdon \.$ ler,c} ro. Ths quote is from a drafrofa synopsis ofher work in rslera. written in r94o, in possession ofher nephew, Robert Mayhew ofsanta Fe.

1926, folder 2, Sto papers. Monrhty Report, Novembcr r9,2, fol.ter r, stolt papers. Annual Report ofpublic Heahh Nursing fo. 1929, Northern pueblos. Pre r95o Annual Repo.h, Eastern A$o.iation on Indian AiTairs, bor r2l, folder Annual Reporr r9to, American Association on rndia. ,{trans, seelev c. Mu.ld

7. 8. 9.

Monthly Report, April

tdking and get to work', eventually reaped healthy dividends.

rz. Martha Sandweiss, ed., Dc"iza! of the Dcle : A Tate ;n Watd P;.t"re of L1f. Anahs the Na"ajo ridn"! (Albuquerquer Unilers,ty of
13. Monthly Repo.t, Nolenber r9:5, folder:, Stoll papers. 14. Monthly Report,lanua.y 1926, folder 2, Sro papers. 15. Monthly Repoft, April 1926, folder 2, Stoll papers. 16. Sandweiss, ,e,za ,/ the Dstt, s6.

ad

New

Norss
Monthly Repo(, November r9,,, folder r, licarilta Apache Rserla tion, Augusrine Srotl Papcrs, University ofNew Mexico Mc(tical t_itrr.ry, Albuqucrquc, Ncs M(xico

r.

Frcd Egsao, So,,i?/ Oryahiza,ion '7. (lhiclso vc 61ry of

ofthe Wcieth

p,c,l,r

(Chicago: UnF

l,.ess, , e5o). 46. To rhe Hopi, .o.n s their .,morhe. for thev rive

r96

HElLrH CiRE AcRoss CuLruREs

See

r97
Neu Mctica Hcahlj W.et rc (MarcE r94,), r9-,o. ,8i Annual Repoft, 1942, New Mexico Departhent of Public Health. ;n Neu Metie Hedbl' Ofr.a tt

on and draw life f.om the corn as the child draws life from us mother."
9, Southwest (Washington, D.C.: Smithsonian Insriturion, ry7d,579

LouN A. Hieb, Hopi worldview," i^ Hdkdb@4ofNotth An.i.dn lkdians, eol.

(M.rch r94j),26 28: and A.nual Report,

Public Health, in

1941, New Mexico Depaftmenr

12

of

18.

Donald N. Brown, Picut;s Pvhlo,' in Handboo4af Not'h Anai.an Eeg n, W6En Puebl6,233. Eeg n, WaEn Pucbld, 264.
Edmund l. Ladd, Zuni Social and Pohi.al Reorganiz tion," inHdfltl-

N./ McIto Hahh ofrcd

\March r9q4),49-5r.

t9.
20.

1,. ll.

A.nual Repo.t, 1941, New Mexico Deparrmenr ofHerlih,49 50. AnnuJ Report, r94r, New Mexico Department ofPublic Hedlrh, 19.
RefuAc, t86-87. Fox,lanuary r4, r986, Oral Hisrory ofMedicine

2r. ,3.

,t4. Deutsch, No.trpalar. 35. Intrr!iew with Anne 36-

bao4 of Na/tA Atucncan

lhdntu, !o1.
Paeblot,

9, 488.

Proiect, Unilersity ofNew Mexico Medical Libr.ry.

22. Egg n, We$n

t9t.

Monthly Report, November 1924, Stoll Papers.

Fran Leeper Buss,L Paned: sto,r ofd Midtu;fc (Ann Arbor: Univer,

sny of Mi.higan Pre$, r98o), r 15; Sarah Detrts.h, Nd Sepdnte R.fuse:

r91o (New York: Oxford University

cub'ft,

Clz$, dnd Gcndd ok dk Aflglo-Hk?an;. Frent;d;" tAc An.t;.an SouthtuaL r88o-

l,re$, 1987),46-48.

:4.

Social reformers nationwide had worked for nearly two decades for

pa$ag of a federal bill to p.olide a national form ofhealth care for mothers and

children, but their success was shortlived as the inlluenrial Ame.ican Medical Association was able to brins pre$u.e on Consre$ to discontinue funding by
,928. For a thorough discu$ion of the Sheppard-Towner Act, see Stanley l. Le1ons,The Wanan Cit;zc,: So.;dt Fcni in i" the t92al (Urbana: Unile6iry of

Illinois P.ess, r97l). 25. Yearly Report, 1925 1926, Correspondence and Repo.rs Relating to
P.ograms and Surveys, r9r7-r954, box 7o, foLder zo 95 5, Childrent Bureau, Record G.oup r02, Natio.al Archives and Records Adniniltration, Washington,

D.C.

26. 27. 28.

Scott, "Twenry-Five Years of Public Health,"

ch. z.

r;-r+;

also SchackeL,

Suial Houte\eepos,
Btss,

bPn qa,

rr8.

Weekly Report, October r928, folder 4-u-r-:-r, box ,66, Central File,

Children's Bureau, Record Group r02, National Archiles, washington, D.C.

:9.

Greenlield, Myftle,,4 H;'to,l of P"blic Hcahh in N.tu Metico

(/'l6t

guerque: Unive6,ty ofNew Mex;co Press, r962), r2,-23.

jo. In,

sixty-ye!r period, Arason deliveredover r2,ooobabies;n norrhern

New Mexico Schackel. Social Houte4ecPct, 5a,56. l!. Annurl Rcport, r94r,Ncw Mcxico Dcprrtnr.nr olPutrlic Hcahlr, in