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  • Health Journey Through Rural Doors
  • Sarah Howe-Cobb

It has been 35 years since I became a public health nurse (PHN), and 31 of these years I have spent in a very small rural community along the Rocky Mountain Front in Montana where I married into a family. I applied for the part-time job as a PHN right out of college after I fell in love with it my senior year of nursing. Having no experience myself, a veteran RN of +30 years experience was chosen for the local job. I had the good fortune of the county health department hiring me in the county seat town. This opened up incredible learning experiences for me from newborn visits to immunization clinics to health education.

The PHN RN chosen from the small town I lived in retired after 4 years, and I reapplied for the local position and got it. This time I had an incredible support system of colleagues, experience and knowledge of the challenges of rural health.

When I arrived at my new job, there was no separate PHN office. I shared a space in the old ambulance hall with a few other entities, so the concept of privacy was unknown. I had to salvage this situation to protect my clients and their information. I learned to utilize my home visits as the main gateway for me to meet and work with my clients. Also, my car became a traveling clinic for many years.

One of my first obstacles was to offer my services to a Hutterite Colony in my district. Having grown up in New England, I was not familiar with the Hutterite’s customs and history, so I had to steep myself in literature and local experiences with this group. My anthropology degree helped out tremendously as did my own curiosity.

Through examining immunization records for the children to giving them shots, I got to know the colony members and their teacher. I visited monthly to bring the shots and do blood pressure checks for the adults. Over time, I became their school nurse too for +10 years (I stopped doing this when their pupil numbers went down, but I continued as the PHN and continue still to report the state immunization requirements yearly). One of my first lessons was not to scold the mothers for giving coffee to their very young children. I became a better listener as time went on and encouraged change with educational materials . . . some was effective and some not.

Now we have dentists from our county seat town volunteer yearly to come into our local schools to [End Page 106] do dental checks on the children, but 30 years ago, I was responsible for doing the dental checks. A few years into my job, my supervisor complimented me on the huge statistical decrease of cavities for the Hutterite colony. I just looked at her and told her how we finally got most of the children to a dentist, and many had their teeth pulled . . . she was sort of aghast at this, but it was the truth and dental remedy at that time. Today the parents bring their children to the dentist more routinely than in the past, and this has made a huge difference in dental health for these children.

In the past 10 years, I have witnessed the splitting of our local colony. This happens when a colony gets more than 80+ members, the existing colony goes and buys land to build a new colony. A lottery system is applied between two elders as to which colony they and their family and friends go to. What was fascinating about the situation here is that usually, the split is geographically far apart while this one was just 15 miles away from each other. I have contacts, schools and ties with both colonies now and each has developed its own unique personality.

Doing home visits in client’s homes has opened my eyes into the lives of my clients. I love that when I become the visitor, the client becomes empowered to remain relaxed in their environment, knowing they are in control of the discussion and the timing of the visit...


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pp. 106-108
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