The Story of the Nurse

by Linda Corey

In addition to being a portable bank, Grameen de la Frontera's centers are also opportunities to provide health screening and care. On my first ride in the bank's infamous white Bronco, I sit in the back seat with Julia who is the bank's nurse. I too am a nurse and am interested in how Julia conducts her practice.

The first thing I have to say about Julia is how truly beautiful she is. She might be in movies or a model or a rock star but she's not. She's sitting here in the back seat of a muddy bronco driving along roads that have obviously had bad cases of mud pox and she looks like a vision in startling bright white: pants, turtleneck, and shoes. Over the top she has donned a navy blue sweater because it's a chilly, gray day. It seems impossible that she can stay so bright given the mud and the gentle rains and the bumpy, splashing roads.

I learn that Julia has a university nursing education and also the equivalent of a Master's degree in family practice. She is no ordinary nurse but rather a nurse practitioner which means she can screen for all kinds of medical problems, treat many, and know when to refer people to the clinics. This is important because she is likely to be the people's first medical contact. In addition to screening for problems, she also educates the women about issues affecting their health. She does this individually and also in the center groups. Recently she presented what she had done in the past year to Nigel Biggar, Senior Program Officer with Grameen Foundation USA. He was very impressed with her program and could see what a difference hiring a person of Julia's caliber and education means for the health care of the women. He told Marshall that Grameen de la Frontera is a model for how to improve the health care of the women.

In addition to her general practice, Julia had also worked as a psychiatric nurse for three years in Ciudad Obregon. I know only too well how important that is for good health care delivery. She has finely honed interpersonal relationship skills. I am on the receiving end of those skills as she patiently helps me with my faltering Spanish. As we bump along toward the first center, we pass Julia's little childhood village. Later she will show Jean and me the exact house in the village where she grew up with nine brothers and sisters all of whom are university educated and living and working in Sonora as she is.

We arrive at the site of the first center meeting and Julia brings in her nurse's bag and sets up her stool. As the women arrive, she greets each one personally with the traditional "abrazo," the ritual Mexican hug. She socializes with people as she makes observations, determining who needs to be seen individually. She has brought a bathroom scale which she places on the tile floor. After all the women have assembled, she calls them one by one to get weighed. This reminds me of a Weight Watchers' meeting. The women are sometimes reluctant, sometimes eager to stand on the scales depending on what they think the outcome will be. Like all women everywhere they are a little nervous about it. Some make loud jokes and precipitate laughter in the whole group with their acts of bravado. Others shyly stand on the scale and wait for Julia to tell them the score. She writes the weights down on her list. After the weigh-in, she takes the blood pressure of some of the women.and again reports the result individually to each one. Then she addresses the whole group, delivering a short talk on nutrition and the importance of eating fruits and vegetables, drinking clean water, and avoiding soda which she explains is high in sugar and has no nutritional value whatsoever. No soda? No. Nada.

Following the group talk, Julia meets individually with five of the women in an enclosed and private room off the patio. One has a small child and the consultation seems to be about him. Another is pregnant and she does a quick prenatal check. She is efficient and in charge of the health care but always respectful and kind. She is soft spoken but can command their attention. The women like her and trust her.

On the way to the next center she tells me there are terrible problems with alcoholism among many of the men in the villages who drink up the money. The good thing about Grameen is that the women make their own money and aren't dependent on the husbands for access to money. Also they know they absolutely can not give the men their money because every two weeks they have to show up at the center meeting to make their loan and savings payments. But the women have to put up with the abuse that goes on wherever there are alcoholic men. So far the problem remains difficult to treat. Research in alcoholism among native peoples and its prevention are my area of specialty. I tell Julia about work that is beginning in San Diego that may have application in the villages. We will keep in touch about those. In addition to alcoholism, diabetes and malnutrition are major problems; also cervical cancer. I'm not sure how she screens for the cancer.

Grameen encourages the women to commit themselves to growing vegetables and fruits for their families and actually eating the produce rather than selling all of it. Julia reinforces this and reminds the women of the benefits to them and their families. She also does counseling for family planning. She said in her parents' generation, most people had large families like the one she comes from. But now, most people have two children, or three at the maximum. Later Jean and I will talk with a young couple who are expecting their third child and they will say emphatically that this third is the last. No mas.

Julia attends two center meetings each morning five days a week. After la comida, the mid-day meal, she makes individual visits to people who need attention in their homes. On this schedule she is able to rotate through all the centers once every two months. She has seen each and every one of the 1,875 current borrowers. She doesn't always remember all of their names all of the time but she knows their faces. She keeps records on all of them. She is their nurse – Nurse Julia. And standing near the Bronco after a long hard day in the rain, still sparkling white in her uniform, she makes me very proud of our profession.