Healthcare Across Cultures

8/2/2019 Healthcare Across Cultures

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r80 Cou6HrNc aND Sp,rrrNc rND NEw MFx'16 H,sr.nv15. see Dnetes afttle Ch.t' letet cA{4 t. rc.6 A%5), for a full account ofth.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 ofTelasand New Mexico," Pzllr Hzahh Re?o ',30 \rs1+ rc7t, 1066-67. Sweer foudthe highest concentration oftubercul.r patients in SihcrCiry where, he iudsed,afull 8o percent ofthe familis sheltered at least one TB parienr. H. concluded,"Were all the consuhptives to leale . . . Silver Criy would becone a nere spot in

17. Ibid-, roTr; and LeRoy Petere, what New Meli.o Needs Most inTuberculosis Legislation," Nrtu M.zi.o Mcdical Jounal, r5 (r915-r6): 23o.t8. Sp;.lle, Doctat of Medici,e, 99.t9. Selman waksman, Thc Conqrea of Tubddlot; (Berkeley and LosAnsles: Unilersity ofCalifo.nia Pre$, r964), r90,92.

za. Crft.it Th.nn \re8it t\2.a2. wlksma , Co"q"e! of Tubddlak, :,q'2.

ELEVENHEALTH CARE ACROSS CULTURES:PusLrc HeaLrH Nunsrs rr Hrsperrc aNoNerIve Aurnrc,rN CoMM uN rrrEs@

LATE in r9z: eugustine Stoll, Red Cro$ public Healrh nurse, began ayearJong assignment on the ficarilla Apache reservation in norrhern NewMexico Her 6rst monrhly report revealed some of the determination thatprompted her decision to take the position.I arrived in Dulce November r:, and so far my progress hrs beenso slow that I rhink it can be .ohpared to rhc walkins here in themud, you go forward one step aod slip brck two. There is somu.h to do and I have absolute farrh rhar sohe ofir can be done.This bliefmay ger a bir battered and hidden because everybodyfron the iannor up rells ne I can't do a thingt But I think r haveerhausred sobe ofrhei. probably well,founded pessimnm andthey are goina to ler he stop talking rnd get to work.lStoll and other women health workers in New Mexico were repre,scntative of well,intentioned, middle-clas Anglo women nationwidewhose efforts to cros ethnic bordere were part of a larger culturalrnovement in the early twentieth cenrury. As a public health reformer,Stoll understood her rask ro be "correcrive, preventive, and educationalw0rk." This ethnocentric :rpproach dovetailed wirh rh prevailing social

tLcorics thrr crDsid(crl rll nor-Angl


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r82 HEALr( C^RE Across Currunrstive or in need ofcorrection and improvement. Ofparamount concern tothe rlormers iD rhis era was the lack of health care among manyAmericans, a problem reflected in the narion's high infant monality rate.This chapter examines the role of women health care workers asagena ofchange in New Mexico in the 6rsr halfofthe twentieth cntury.In particular, it draws on the work ofpublic health workers among NewMexico's Pueblo, Navajo, and Hispanic communities ro show how theyserved as cultural conduits between rhe modern medical world andcultures in transrtion. The issue is one ofcomplexity on several levels. Thenurses themseh'es faced conflicts between their desire to ,,modernize,, theNative Amelican and Hispanic cultures and also to preserve traditions_They frequently faced prrsonal conflicts between their basic values andattitudes and thir willingness to suspend parts of their belief systems.Sometimes thre was a contradiction between what the heafth car agen-cies waDted and how rhe nurses met those goals. Finally, there was theeffect of the nurses' actions on their parients. From thei! letters andreports, we know how the nurses perceived their actions; hearing rheIndian and Hispanic voices would further enhance our understanding ofthe nurses'rol as agents ofchange. I suggest, however, that becaos theDurses were sensitive ro traditional ways, the changes were not as abruptor as intrusive as they might have been.The voices of the nurses whose accounts hav been preserved inagency reports or leners those of Augustine Stoll, Agnes Courtney,Louise Kuhrtz, Molly Reebel, and Elizabeth Forster-revealed a worldview that the nurees shared as middle-ctas Euro,Americans and asmembers of the health profession. All had aaended certified nursingprograms, trained in hospitals or clinics, aDd chosen to work in a publichealth setting. Some had servd as nurses overseas during World War Iand therefore saw adventure and challenge in a public health asignmentin the American West. Othrs wele drawn to New Mexico for its beautyand cultural diversity. Not wirhout prejudices aDd biases, these wornennevertheless wele abl to suspcnd judgment oftheir clients in a way rhatfostered harmony and cooperation. More importanr, they ser!d as facili,

'83tors ofchange toa popularion that was in transirion from a traditional toaThe nurses shared the late ninetenth-century viwof Native Amer-icans as a vaDishing race, and they believed that in some small wav thevcould impart knowledge and techniques that would halt that seeminglyinevitable process. They were atso products ofthe phitosophy ofprosrr.,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. drra of proeesr -hootchii;rcnweighed and measured and matched ro standarrlized charts: visits tohomes of midwives; number of hours given to ctass insrluction ofmid_wives; childreo treated for trachoma (a highly conragious eye disease)rand medical visits to Indian viilages. From this marrial. I have rried toreconstruct a picture of rhe nurses, wortd as they served in ethnic NewMexico communities.The ourses highlighted in this chapter stood outside mainstreamAmrica. Although ,hey ,hared mdn) ofrh. raturs rypi. at ofmiddte. ta,sreformers, they also displayed a willingnes to suspend cultural judgmentregardles ofrejection, haidship, or inconvenience. Later in this century,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 rhccustoms or beliefs ofthe peopte with whom they would be working. Inthe ethnocentric thinkjng ofthe progresive Era, health problems diJ nothave a cultural compooent. Some nurses had difficutty adiusting to " newsetting, as Sroll notesl

There is a Miss Reynotds up there lon the ]icarilta Apache reserva,tionl as field nurse. Between you and ne she: pathertc. This is herfirst Indian work and she can't drive a .ar or ride and she doesntlike the Indian and doesn,t want ro stay. She asked me to help herbut 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


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r84 HEALTH CaRE A.{oss C!LruREsMost nurses recognized the cultural chasm that separated them from theirpatients, and some were willing to question rheir assumptions of differ-rn.c in dn Jtrcmpr ro close Lhe gap. Ar rhc ,amc rimc. rn,irur) ,oditrerences was a necesary component to successful public health work.For xample, when explaioing maternity and infaDtcare to Nativ Americans. Stoll made cliar "that we dozor want to interfere with old customs-dances, religions [sic] observations."r

One ofthe driving forces behind the push for health care services inNew Mexico was the extremely high infanr mortality rate in the state. Inr929, rhe first year for which reliable statistics are available, the mortalityrate for infants under one yer ofage was r4o per r,ooo. This 6gure wasmore than twice the national rate of sixty-one per r,ooo; it conrinued tonse in the r93os before dropping to roo per r,ooo in r94o.a Several factorsaccounted for these disturbing statistics. The 6fth largest state at r22,ooosquare miles, New Mexico had 360,35rl citizens in r9:o, most ofrhem inrural areas and many in remote reaches where health care was scant ornonexistent. Lack ofgood roads made it difficult for physicians, nurses,and others to reach the ill. As a result. health care servicer fell to localaranden: \traditionalHispanic healers), medicine men and women, andmidwives. These health providers did notmeet AMA (American MedicalAssociarion) guidelines: they did not posess "formal" rraining, rhey didnot 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 sratedepartment of health began a concerted e{fort in the rgzos to raise irsstandard of health care. Although the eForts were direcred ar all NewMexicans, oflicials were especially interested in carrying rheir message roNative Americans and Spanish{peaking citizens.5 Acting on the beliefthat scieDtilic, rational medicine offered the best and safest rleatment,Anglo reformrrs began a campaigo against rraditional forms of healthcare. Included iD their campaigr were midwives, especially the Hispanicpartaas whom they characterized as superstitious, unclean, rnd un'n-tbrmcJ. In "nglrng our mrrwre'. rh. Anll,,..'rcqr\r'\ wi n .,r.rrt rrr

r85to alter cultural patterns among the Native American and Hispanicpopulations. They wenr among rhese commu.;ties with the highestconfi,dence that by teaching nutrition, cleanliness, and the importance oFgermtheory, they could efect change.Io many ways, according to Angio standards, rhce$ful.ln Indian communiries, they built dairies toprovid fresh milk forchildren, had wells dug, built laundries and bathhouses; thy screenedschoolchiidren for tuberculosis, treated trachoma, gave inoculations, andprovided pre- and postnatal care for mothers.6 In molt cases, rhese enter,prises were succesful because they did not conflict wirh tribal ceremonisor rituals. This was not the case, horvver, wirh childbirth which, in manycultures, n surrounded with ritual and secrecy. Here the nurses had rhes,ca'c., d,liiculty in bridging rhc , ul'ural bd'r'cr.Most Indian communities, willingty or cautiously, accepted thenurses and their Anglo ideas. Ooe exception, however, was Santo Do,mingo Pueblo, one ofthe mosr corservarive ofthe Rio crande publos. Inone ofher last reports from her makeshift home rhree miles outside rhepueblo in r926, Sroll mused over the traditional faction's reiction ofher

For some weeks I have been puzzling oler how one can change anattitude ofmind or a hlbir ofthinkins, pa.ri.ularly when one isheld distrusrfully and disapp.ovingly at arnt length. Ther. musrbe other averues ofapproach rhat we hare not foundr there mustbe some way ofwinning then, for one feels that rhey ar. veryworthwhile. 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.rossing a prickly cultural barrier when rhe remarked, "Our work is sovcry dillereot from anything that has ever been atrempred here thar in itsrlill-ercocc it is a bit puzzling and not to be rrusred. Somerimes rhe newestrtcrho(ls {rc.cc(l bccrusc of their novelty."i


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r86 HEALTH C^RE AcRoss CuLrunEsOne obstacle the health care refo.mers faced was rhe power andinfluence ofmedicine men and women. To the Bureau of lndian Aft'airs(tsIA), the agency responsible for the welfare ofNative Americans. rhesetradrtional healers represented all that was wrong in the pueblos an


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' 8li Hrrrrs Cere Across CuLruREsnizcd that they were outsiders and unless they were welcomed or invnedb tdke part, they respecrfully Lept their distance. yet they were pleasedwhen they were included in any part ofthe evenr. On one occasion, StoIreported that a SantoDomingo man invited her..to come tosee his sister,sbaby.It had attained theadvanced ageoftwodayst We weredelighted forir i! a rather rare invitation."r{ A few monthslater Stoll was told she mightattend a birrhin Cochiti and was disappointed when she missed theevent."I was so sorry for I have been told rhat the rires are very interesting.',rtl\ Den;zew ofthe Dere't, a rich collection ofletters Elizabeth Forsterwote while at Red Rock, she describes a Navajo birth to which she wasinyited inlune r932. When she and her interpreter arrived, the hogan was6lled with men, wornen, and children. They had missed the actualdelivery, but "the old woman who seemed mistress of ceremonies,, tookForster as a pupil and demonstrared how things should be done. Themother, looking "none roo comfortable," was held in a kneeling positionby means ofstraps extending from the ceiling and auached to each wrist.After the birrh, when the placenta was delivered, Forsrer was a owed rorelease the new mother, apply the umbitical dressing, and rub th babywith oil. She was thn totd to hold the baby over a trough ofsand on thehogan l1oor while an attendant poured 6rst cold then warm water overthe infant, rubbing vigorously all th white. Wrote Forster, ..you maybelieve it or not, but the result was a fresh pink-tan baby who was thendressed in swaddling bands wirh arms piniooed to its sides, as all goodNavaio babis are, and laid in its mother! arms." Meanwhile. otherassistants had prepared cedar tea from pungent foliage for the morher.Then, reported Forster, "We left peace in the little hogan in spite oftheremaining audience of ariends. I couldn't help wondering if there werestill 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 shknew it contribured to the Indians' acceptance of her and helped make herIes ofan outsider in their culture.

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

s|kdta s.Ao.4et r89birthing ceremonis. Among the Hopi, women ofthe household care forthe mother at birth; the baby is washed in warm water and rubbed wnhashes;then the child is laid in a cradle with one or more ears or corn. Linesof cornmeal or ashes :re made on each wall to mark rhe newborn,shome.r'In Picuris Pueblo, near Taos, an ear ofcorn is laid nexr to the childto acr as it! "corn mother" for thirty days, after which the mother takescorn meal to a shrine and offers prayers.rs At Acoma, a ..corn mother,,isplaced with the chjld for a fouLday lying in period after which thenaming ceremony takes place.i, A simitar rituat occurs ar Laguna, wherea medicjne man arrives on rhe fourth morning to o{Ier prayers to rheEarth Mother and to Father Sun, offering thm rhe child.,t)At Zuni Pueblo birrh is a family and clan matter in which rhemother's mothr atrends the delivery, unless complicatiom ensuer then amrdwife,' 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 itsmother. Naming takes place on the fourth day.), These and other ritualsnormally wre not part ofthe nurses'world, but the nurses accepted thesilence that surlounded the birth experience as part ofNative Americanculture that was not meant to be shard with outsiders. For those, who,like Forster, were invited inro private ceremonies on occasion. it was stillonly a partial experience.

, There was less silence surrounding the birthing experience amongSpanish-speaking New Mexicans. Most Hispanic women wanted andused midwives, women in rheir communities who had learned birthingskills from their mothers, grandmothers, or other femate relatives. Thseparteras were highly respected women who served as advisers, counselors.and confidantes.zr They were also targets ofthe state health system which,between rgzo and r95o, carried out many programs to resulare andlicense midwives as part of the targer goat of lowering the state,s intantmortality rate. When federal funds for infant and maternat health carebemme availabte to the states under the Sheppard-Towner Act of r9u r,New Mcxico was abte to hire threc public heatth nurses ro conductmaternity and infant care programs.,a By the end ofrhar decade, rwenty I


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l9o HE^LIH CArtr AcRoss CuLrlREspublic health worli.g in rhe state, even after the loss offederal lunding in reu8.Wiseln the New Mexico medical community recognized the needfor midwives in rural, isotated v;Uages where few physicians were avait,able. But there were reasons other rhan isolarion thar caused Hispaoicfamilies to prefer midwives. Counney noted that because ofthe .txpenseof such care and the povelty of some families a doctor would be calledonly as a last resource."rs Jusr as important was the Hispanic famities,longfamiliarity with and dependence on the parteras. Unlike in the nativeAmericao communities where the birth process was woven joto thereligious fabric, New Mexico Hispanics viewed birth within the targerframework of Western rradirion that accepred . science and reason,, aspart oftheir beljefsystem. Hence their views were not unlike those oFtheAnglo medical community, which made rhe nurses, task easier. Whilethey had to keep their distanc from the birrh expertence in the puebtos,the nurses were more readily accepted in the Hispanic villages when theyrrrivcd ro irJenLrry rnd ftJ,n Hi,pan( m,dsi\er.

Once she had the midwives located, the nurse arlanged for a series often clases to be held in a woman.s home, a school, or another centrallocation. Oral instructions combined with practical demonstrations al,lowed each woman the opporrunity to lepear rhe action being demonstrated. If the nurse did not speak Spanish, someone in the communitvwouu r d. in(e'pr.rer. The midqrve, were raugh, ranu,.d ob,Letri'cal techniques, procedures for dealing with the most common comptica-tions encouDtered iD deljvcry, and fuDdamentats in the care ofthe new_born. They were taught to recognize danger signals and iDstructed ro calla doctor at the 6rst sign oldificulty. Once the delivery was comptetett, themidwife was required to trll out the birth cerriFcate and mail it to rhecounty health omce.

The midwife clases clearly conrributed ro the steady decLine in rheinfant mortality rate which by r94o had dropped ro roo deaths per r,ooobirths.r" l)qually imporunt, the midwive s' willingDe $ ro accept;nsrruc-rr,n rr,,rn.,rh,r $,,m'.'r I,nl..,F..t rtr w.,t t.tr i tnl,r,r.nicti.,rxr ,,t

women physicians tarer, especially in theI9I

spcialties of obstetrics andThese successes did not come easily as rhe 'nnial.fforts to locare andlicense midwives in rhe r92os were tr:ughr wirh frustration. The Depar.

ment of Health could not afford the staff required lor the task, and theworL was hampered by inacce$ibiiity because many midwives tived inremote mountain vjllages or isolated rural areas. Since th state was alsotrving ro obtain an accurare counr of births and deaths ro mer federalcensus standards, the heatth care reformers sought out census registrarsand subregistrars (locat cidzens responsible for recording births anddeaths) to help jn identifying midwives. The midwjves were then in_structed in filling out 6irth aod death certiticates. Many of the womenwere illiterate, however and other arrangements had to be made toobtainthjs important informarion. Courrney related one experience i, Rio Arriba 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 leyeldrops. She does nor h.ow how to read or wrire so can not tilt ourbifth ceft;ficares bur she giles a blank to the fahily ofeach bahvdelivercd aod then .oilecrs them and retu.ns them ro the sub_registrar She is nearly blind.,i

This grassroots effort ro reach the midwives eventuallv succeederlBy Lhe mrd roao'. rr qr\ der.rmined rhat bcrueen *ven trundrcd andeight hundred mjdwives were pracrjcjng rhroughout rhe srate. mosr ofthm in the Hispanjc communities ofnorthern New ?vtexico.,, In r936,w;th federal funding, the state set up a rural demonstration unit in SanMiguel County in northeastern New Mexjco where rhat year m;dwivesattended 7or of97z b;ths. The project was highty succesfui, employingas many as ren nurses and engaging the cooperation of several womenphysicians, includiDg Nancy Campbe of Santa Fe, Gertflrde Light ofI{xn(hos (lc fios, Mary Lou Hickman of Las Vegas, and larer MariaD

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r92 H!aLrH CaRE AcRoss CuLruREsHotopp, Edirh Millican, and Mary Waddell. One of the mosr activemidwives in northern New Mexico, lesusna Aragon, was a graduate ofthe midwife clases and one of the last of the Hispanic midwives to belicensed as part of the state's demonstration project.ro

The project proved to be a valuable model for providing obstetricatcare during World-War II when many doctors were catted to the armedservices. The local midwife became increasingly important in areas thatlacked physicians or other medical professionals. Pubtic ofiicials noted inr94r that the demand for midwives was likely to increase as more phys!cians were called into the armed srvices. In r942,273 of678 ofmidwiveswere licensed through rhe state's midwifery program. The following yearthe Dpartment of Public Health acknowledged 'an awakened con-sciousnes among physicians" that recognized the ulue of training birthattendants in areas wherephysicians were not readily avaitable.r'Not ontywere the servjces ofthe midwife important in rhe birth expelince bur

Sincc she holds a key position in each little village or crossroadswhere she lives, the hidwife serves as a valuable heans of fufthFing the simple srories rold her regardinS nurririon, sanitarion, andwhat constitutes safe obstetrical care. .. . By passing on the lesonsshe learns she conrribures to thc overall heakh prdsran ofrhe

Still, the state was determined to reduce the numbers ofpracticingmidwives as part of the medical establishment's overalt pian to convincewomen to give birrh in hospitals. Although it seemed a contradiction, thestate belived that ifwomen were goiDg rocontinue to use midwives, thenthey should be licensed and regulated; at rhe sam rime, thy expecreddependnce on midwives to gradually decrease. In ry41 th. Nau MericoHuhh Oflcet smqgly prophesied that 'tlowly our problem with midwiaeservice will b solved, and what is now an essential service will in largemeasure be replaced by more sarisfacrory assistance ar chitdbirth."rr Sowhile the liccnsing program was succe$ful in locating anrJ training

r93midwives, the use of midwive! as birth artendanrs oonrheless gradualtydeclined.

Several factors played a rote in this decline, not the least of whichwas the narionwide movement to transfer birth from the private domainofwomen and homc inro rhe sre, itc and impe,sonat world oirhe horpitat.This movemenr affecrcd both \ative Amerrcan women and Hi,panicwomen, many ofwhom chose to take advantage ofthe improved medi-cat procedures and advanced technolog, that AMA medicine promised.With this form of progress came a loss ofautonomy for village panerasand Indian midwives. They no longer controlled the conditions;f rheirtrade; the state regulated midwifery by standardizing procedures, requir_ing examinarions, and issuing certiEcates. Gradualty, the numbers ofmidwives declined as the older partras died and th younger womenfailed to take up rhe profession. Not all midwives foltowed this route roprolessionalization nor did they replace rheir rrrdirronal hcrting practiccswith the new medical training, which they perceived ..as different frombut no more reliable than rheirs.,'ra Becaus of a shortage of both fundsand nurses, the practice of midwifery continued.The nurses who initiated marernity and infancy care in Indian andHispanic communities served as cLrttural agent! who hetped ase theirclients' transition from traditionai ro more modern methods of healthcare. We see rhe resutts in rwo ways: the decrease jn the infant andmatcrnity mortallty rates and the increase in the numbers of womengiving birth in hospitals port-Wo.ld War II. But rhere wre losses in thdiminished role of the parteras and in the deciining number ofpracticingmidwives. From a high ofeight hundred known midwives in 1945, thenumber fell to les than one hundred by 1965.15As agents of change, the nurses were abl to bridge culrurat difer-cnces because oftheir cmpathy and compassion for Hispanic and NativeAmerican practics. Yer rhey were unable to replace rraditjonal childbirihrituals with Anglo methods. UntiLe Hispanic women, Native Americanwomen resisted adopting middle_clas Anglo birthing methods, pre_


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r94 H!aLrs CaRx Acnoss Currrnrsferring to keep rhe bi.th xperience a private, clan_based matter. oneshrouded in religious symbohm. These women resisted the nurses,midwifery instructions unril afrer Wortd War II when rhey more readilyaccepted the Anglo preference for hospitat births.Why were H;spanic women more accepting of the nurses, instruc-tions rhan rheir Native American counterparts? One explanation is thatHispanics are a part ofthe larger framework ofWesrern fuadirion whileNatjve American culture has always enisted outside thi! framework.Hispanics, as Catholics, shared ideas an


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r96 HElLrH CiRE AcRoss CuLruREson and draw life f.om the corn as the child draws life from us mother." SeeLouN A. Hieb, Hopi worldview," i^ Hdkdb@4ofNotth An.i.dn lkdians, eol.9, Southwest (Washington, D.C.: Smithsonian Insriturion, ry7d,57918. Donald N. Brown, Picut;s Pvhlo,' in Handboo4af Not'h Anai.an

t9. Eeg n, W6En Puebl6,233.20. Eeg n, WaEn Pucbld, 264.2r. Edmund l. Ladd, Zuni Social and Pohi.al Reorganiz tion," inHdfltl-bao4 of Na/tA Atucncan lhdntu, !o1. 9, 488.22. Egg n, We$n Paeblot, t9t.,3. Fran Leeper Buss,L Paned: sto,r ofd Midtu;fc (Ann Arbor: Univer,sny of Mi.higan Pre$, r98o), r 15; Sarah Detrts.h, Nd Sepdnte R.fuse: cub'ft,Clz$, dnd Gcndd ok dk Aflglo-Hk?an;. Frent;d;" tAc An.t;.an SouthtuaL r88o-r91o (New York: Oxford University l,re$, 1987),46-48.:4. Social reformers nationwide had worked for nearly two decades forpa$ag of a federal bill to p.olide a national form ofhealth care for mothers andchildren, but their success was shortlived as the inlluenrial Ame.ican MedicalAssociation was able to brins pre$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 ofIllinois P.ess, r97l).25. Yearly Report, 1925 1926, Correspondence and Repo.rs Relating toP.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. Scott, "Twenry-Five Years of Public Health," r;-r+; also SchackeL,Suial Houte\eepos, ch. z.27. Btss, bPn qa, rr8.28. 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 (/'l6tguerque: Unive6,ty ofNew Mex;co Press, r962), r2,-23.jo. In, sixty-ye!r period, Arason deliveredover r2,ooobabies;n norrhernNew Mexico Schackel. Social Houte4ecPct, 5a,56.l!. Annurl Rcport, r94r,Ncw Mcxico Dcprrtnr.nr olPutrlic Hcahlr, in

r97Neu 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(M.rch r94j),26 28: and A.nual Report, 1941, New Mexico Depaftmenr ofPublic Health, in N./ McIto Hahh ofrcd 12 \March r9q4),49-5r.1,. A.nual Repo.t, 1941, New Mexico Deparrmenr ofHerlih,49 50.

ll. AnnuJ Report, r94r, New Mexico Department ofPublic Hedlrh, 19.,t4. Deutsch, No.trpalar. RefuAc, t86-87.35. Intrr!iew with Anne Fox,lanuary r4, r986, Oral Hisrory ofMedicineProiect, Unilersity ofNew Mexico Medical Libr.ry.36- Monthly Report, November 1924, Stoll Papers.

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Healthcare Across Cultures