Stirring Northern Initiatives into Florida’s Backwaters, 1922 to 1930

Chapter 2 brings new information to Florida’s sparse historical record of the Sheppard-Towner Maternity and Infancy Protection Act, initiated from 1922 to 1929. To provide expert administration of the program, public health nurse Laurie Jean Reid arrived, armed with a reformer’s vision augmented by a large dose of cultural chauvinism. Reid soon declared bringing federal initiatives into the state would be an uphill climb when the intertwining problems of race and poverty mired the state in its backwardness. The task of establishing authority over the predominantly black midwives and bringing health improvements to mothers rested with Reid’s team of public health nurses. They found innovative ways to bridge the communities they served with policies that addressed the threats of infection and the high infant and maternal mortality levels. Meeting these cultural and environmental challenges became not only a test of Reid’s judgment, but also a trial of how well the nurses operating under the Sheppard-Towner Act effectively imposed rules and regulations to a mostly rural population without creating racial and class tension.

Waking Up Communities and Seeking Out the Sick in Town and Countryside, 1914 to 1917

Chapter 1 plants the roots of public health nursing in Jacksonville, home of the State Board of Health and the focal point for health reforms in the state. The chapter then defines the work of the new state nurses as they began to wake up Florida’s small towns and the neglected rural districts. When professionalization offered the nurses a means to make connections in communities, the Board’s choice of nurses became a lens to explore the problems of nursing outreach for both black and white women. The public health nurses’ connections with clubwomen and the black and white national nursing organizations offer contrasting stories of professionalization as the nurses illuminate their work to improve rural and black health. The state’s short-lived fledgling program lasted only through the fiscal years of 1914 to 1916, but public health nursing grew locally, sustained in part by the long reach of white and black national philanthropic organizations.

Reaching Out to Midwives and Country People, 1930 to 1947

Chapter 4 examines in greater depth the public health nurses’ interplay and interconnections with midwives and country people. Jule O. Graves was a significant presence during the Sheppard-Towner work. She took on leadership of the midwifery program in 1936 and continued working until she retired in 1947. By knowing and understanding the culture of Florida’s rural people, Graves imparted innovative ways to negotiate social barriers and environmental obstacles. Her first-person accounts are critical to understanding both the maternity issues facing Florida’s rural women before nurses could intervene and the methods the nurses employed to save mothers’ and infants’ lives. She imparted her skills to a new generation of public health nurses, including colleagues Ethel J. Kirkland and Lalla Mary Goggins. In black and white, Kirkland, Goggins and Graves offer perspectives that deepen insights into the midwife institutes and their professional relationships. Together, the nurses present a more complicated view than previously recorded.

Linking to Public Health Nursing the Red Cross Way, 1919 to 1930

This chapter explores the influence of the Red Cross Nursing Service in Florida after World War I when the American Red Cross focused on public health nursing. Central leadership from its Washington, DC headquarters directed policies and values that guided Red Cross nurses into the southernmost state. The policies and the nurses themselves illuminated the connections between the Red Cross, race, class, and a population in dire need of healthcare. Becuase the Red Cross was to some extentcolorblind with its policies and nurse recruitment, it paved the way for black public health nurses to forge new paths. From local Red Cross chapters, the white and few black nurses began to establish links with the communities. The Home Hygiene and Care of the Sick classes offered a particularly important means to serve all, regardless of race. The aftermath of Florida’s 1928 hurricane highlighted the more racially open policy towards the employment of African American nurses. Rosa Brown demonstrated the need for public health nurses to improve health in the neglected rural areas of Palm Beach County.

Conclusion

This study investigates the public health nurses who worked during Jim Crow seeking to alleviate many layers of disconnection and bring the promise of contemporary medicine to those who were left out. Race, custom, and innuendo complicated their reach, but they were the bridges that connected people physically, and just as importantly, mentally, by correcting misunderstandings, allaying fears, conducting community meetings, teaching home hygiene and care of the sick classes, educating midwives, holding clinics, and more. The nurses’ interplay and interconnections with the midwives, country people, and others illustrated their commitment to meet the cultural challenges of Florida. Their work is significant in contemporary America, where maintaining healthy lives for all Americans is a matter of meeting the nation’s deep-rooted cultural challenges. Some leaders in public health assert that today more than ever the sense of community and the goals of social justice will fall upon public health nurses—the community health nurses. This investigation can inform today’s community health nurses and add to their conversation as they work towards connecting their social action with health policy, a necessity in caring for Florida’s diverse and vulnerable population groups.

Battling On without Fanfare for Better Health Conditions, 1934 to 1964

Chapter 5 centers on a new era of public health nursing under the leadership of Ruth E. Mettinger. Her overall public health nursing experience along with her grasp of Florida’s environmental and cultural challenges served her well to become the public health nurses’ standard-bearer—for almost 30 years. Though racial and class underpinnings continually clouded the work of public health nurses, Mettinger recognized the nurses’ vital roles in bringing progressive change; they remained the link—often the only link— between policy and the citizens who required uplift and care. Through the institution of New Deal programs, the development of county health units, and the aftermath of World War II when new opportunities opened for black public health nurses, Mettinger’s tenure provides a nuanced meaning to the cultural construction of health in the lead up to the Civil Rights Era.

Introduction

The introduction provides a background of the first public health nurses to begin work for the State Board of Health under Jim Crow laws by highlighting the dire need for their outreach, particularly in the rural areas among both black and white folk who were out of reach of medical care. Public health nursing came of age in the Progressive era, but Florida was behind Northern public health initiatives. Once Florida’s new group of black and white professional nurses began work, they illuminated how attitudes among national, regional, and state nursing leaders, as well as medical and public health authorities, created a wide variety of opportunities for them to grow their profession and deliver a service. White and black public health nurses were active agents for change, but cultural mores informed their practices differently. Professional patterns and social customs influenced the manner they could exert power to improve health and literally save people’s lives.