A continuation of the VNA of Boston story...

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From Rebecca...

In this posting, I continue to share the historical insights I’ve been gleaning from reading Annie M. Brainard’s 1922 book, The Evolution of Public Health Nursing. I briefly touch on the Middle Ages and the Protestant Reformation which I’m sure made my eyes glaze over in school, but it is amazing what a little personal interest and application of knowledge does for one’s motivation to learn history!

The Middle Ages and the Institutionalization of Care for the Poor and Sick

Europe in the Middle Ages experienced large differences between the rich and poor, and the progress towards civil society was slowed if not reversed. It was a violent and chaotic time as small groups battled for control of lands, wealth and power. Brainard also notes that there were several centuries of devastating weather patterns, floods and earthquakes resulting in famines and outbreaks of disease including frequent and ravaging epidemics of the Black Plague. It is said that possibly 1/3 to 1/2 of the population of Europe died in the plague of 1348.

It was a dangerous time to be out and about, and the work of visiting the sick poor was largely limited to what noble women could do for the peasants employed on the lands of their husbands. As the years passed, care of the sick poor was centralized to a greater degree and administered by organized institutions such as early hospitals and monasteries. Early hospitals accommodated a wide range of people in need; travelers, locals, the poor and the sick. I would imagine that the wealthy would have availed themselves of private care, perhaps provided by physicians, in their homes.

Brainard mentions a few wealthy women from this era who dedicated their lives to caring for the sick poor and their fortunes to founding hospitals for their care. She tells of Fabiola, a wealthy Roman woman who founded the first hospital in Rome around the year 380. She also writes of Radegund, Queen of France around 550 CE who used the revenues of the lands she was granted at her wedding to establish hospices and to perform other charitable work on behalf of the poor.

Independent Sisterhoods in the Middle Ages

Brainard then covers the advent of sisterhoods that were independent of the formal Church structure. She sees in them the thread of public health nursing that started with the early deaconesses and was carried through the Middle Ages, a time in which there was not much concern for the sick poor. The first of these sisterhoods was the Beguines, a non-monastic, loosely affiliated group started in the late 1100s. They sought to serve God without retiring from the world and resisted the attempts of the church to cloister them and limit their independence. They tended to live on the outskirts of town and made their life’s work caring for the poor. Eventually, larger groups of Beguines came together to live in communities called a Beguinage, where they also built hospitals but they never stopped caring for the sick poor in their homes. By the 1300s the number of Beguines was estimated to be about 200,000. At various times throughout the centuries the church attempted to repress the movement and curtail their independence, but the service they provided to the community, and their desire to perform this role independent of the church, was so strong that the movement persisted.

Brainard mentions several other similar groups in Europe, who, like the Beguines, consisted of women who banded together to serve God by caring for the sick poor in their homes independent of the church. Among them were the Sisters of Mercy, The Sisters of the Common Life, and several others that were aligned with the Protestant Church after the Reformation. However, Brainard points out a couple of weaknesses in the system of independent sisterhoods. There was no central organization overseeing their actions, such as there was in the days of the deaconesses and nursing care was provided by each individual as she saw fit. Also, all too often there was a self-serving element, as visiting the sick poor had become a popular form of penance.

Stay tuned for future installments...

VNABA Traveling Display in the Community at Grove Hall

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The VNABA Traveling Display recently appeared at the Grove Hall branch of the Boston Public Library. Our thanks to head librarian Paul Edwards, who graciously hosted the event.

I'm pictured next to two nursing students and then on their sides by two of our own nurses, Keren Diamond (far left) and Adele Pike (far right).  Carol Bourne, also of the VNA of Boston, is third from the right and librarian, Paul Edwards is next to Adele.

This is part of our effort to celebrate our 125 years of caring out in the community and near those whom we serve...

The "daunting prospect" - a report from the field...

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This is a guest post from Janice Sullivan, our VP of External Affairs.  As part of a management initiative to make sure we all stay well connected with the purpose and mission of our organization, those of us who tend to be tethered to our desks are making sure we go out on home visits with our clinicians on a regular basis.  Here's what Janice had to say:

I had the opportunity to go on home visits with Roberta Dillon, RN, on a hot, humid day last week. Roberta’s “neighborhood” is in the Mattapan area of Boston. As I trailed after her, up the stairs to yet another un-air conditioned apartment, watching as she lugged the tools of her trade, laptop, BP cuff, thermometers and whatever else was carefully packed in her black bag, it hit me again….our clinicians do amazing work and help people who really, really need their expertise.

And again, I wondered at all these initiatives the federal and state governments are putting out there to encourage providers and payers to “contain costs” by coordination of care in less expensive settings. Why not just support (you can read that as “pay fairly”) home health care agencies like the VNA of Boston who do this work and do it extremely well.

Roberta picked me up in the neighborhood and I rode around with her all morning. She knows her way around the community and is a whiz at balancing driving, taking calls (hands free of course, wink), taking notes and keeping it all together – and she doesn’t drive slowly either. Some visits were more complicated than others, watching Roberta work with an older women (96) with dementia, and who was not at all happy with us being in the house, was a tutorial in diplomacy as Roberta convinced her to get a dressing changed that absolutely had to done.

I know we take care of plenty of younger patients, but what struck me was that aging with failing health is a daunting prospect. Aging, and trying to manage the various aspects of the health care you need is an even more daunting prospect. And aging, perhaps with some dementia, and trying to figure out the myriad of caregivers and providers involved in your care looks like it could downright impossible. Even with a constant caregiver in the house, and I met two husbands who could not have been more protective and tender with their wives, those primary caregivers are often not in the best of health either.

That’s where I think the VNA of Boston comes in….Roberta, in more than setting, called the doctor, assessed fall risks, answered questions about the home health aide, reconciled the medications, organized the pharmacy delivery, you name it….she was the manager of the healthcare team. Transitions in care, reducing re-hospitalizations, care coordination, geriatric care management are all buzzwords these days. In my opinion, that wheel does not need to re-invented – it exists at the VNA of Boston and needs to be supported by payers, including the government, not duplicated with all the costs associated with developing new infrastructures. Clone Roberta and others like her -- that may save thousands in a day.

Make Way for...

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Ducklings, Bruins and Nurses.


"Make Way for Ducklings" is a fantastic children's picture book, first published in 1941 and written and illustrated by Robert McCloskey.  The book chronicles the story of a pair of mallard ducks who decide to raise their family on a small island in the pond at nearby Boston Public Garden.

In October of 1987, a bronze statue depicting Mrs. Mallard and her eight ducklings was placed nearby that same pond.  The work was by local artist, Nancy Schon.  I understand that there is a similar piece in Moscow (gift of Mrs. Bush to Raisa Gorbachev in 1991).

Through the years, some have had fun with the sculpture, including dressing them up to commemmorate the fact that our Boston Bruins (last night's loss... ugh) are in the Stanley Cup Finals for the first time in over 20 years.

The photo below is a clever photoshop version of the ducks in honor of our great nurses.

More of the VNA of Boston story...

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Here's the next installment of the story... from Rebecca:
In 1859, Liverpool was a well established port city pulsing with commerce and industry. The population exploded in the 200 years between 1700 and 1900 as immigrants and waves of workers from the countryside flocked to the city, drawn by the demand for labor created by the industrial revolution and trade of all sorts. Our interest is in the Rathbone family of Liverpool, a family of prominent businessmen and philanthropists, and in particular in William Rathbone VI who established the first modern District Nursing organization in 1859, upon which our agency was modeled after in 1886.
The original William Rathbone brought his family to Liverpool in the early 1700s to pursue opportunities for his family in this growing port city. Initially, he worked in a saw mill and in 1742, at the age of 46, he established his own timber business, Rathbone Brothers. Subsequent William Rathbones (there are 13 generations now) built on this foundation and grew the family business, expanding into the cotton trade, shipping, ship building and eventually merchant banking.
From the beginning, the Rathbone family had a high sense of social consciousness and each generation engaged in significant public service and philanthropy. The early Rathbones were Quakers and Nonconformists, meaning they rejected the governance of the Church of England and were advocates for religious freedom. They consistently opposed the slave trade, which was a major part of business in Liverpool. At its peak in 1799, 40% of the worlds’, and 80% of Britain’s slave trade passed through Liverpool’s ports.
William Rathbone V and his wife Elizabeth, the parents of the our William Rathbone, expanded on this work and were large supports of Kitty Wilkerson’s efforts to provide people with a place to wash their clothes and bedding during the cholera outbreak of 1832. (the result of which was the establishment of the first public baths and wash-houses in Liverpool) The famous American prison and mental health reformer Dorethea Dix spent a formative year living with the William Rathbone V and his wife in the late 1830s. While there, she met a group of men and women who advocated for government involvement in social welfare and learned about the British lunacy reform movement, whose methods of detailed investigation of madhouses and asylums she applied to her work on reform for the care of the insane poor upon her return to Massachusetts in 1840. At their deaths, obituaries said of William and Elizabeth Rathbone: "His name was a 'household word', synonymous with truth and honour and charity” and "Her life was one of constant, careful, conscientious helpfulness, on a scale that can have no record".
William Rathbone VI, the founder of modern District Nursing in Liverpool, was born in 1819 and was a partner in the family business, Rathbone Brothers and Co, from 1842 to 1885. Throughout his youth he was surrounded by the reform and philanthropy work undertaken and supported by his parents. Later in life he wrote that he regarded wealth and business success chiefly as a means to the achievement of public and philanthropic work and he wrote that after meeting the reasonable living expenses of himself and his family, a man’s wealth should be considered "a trust for which he owes an account to himself, to his fellow-men, and to God; it is not an absolute freehold which he may use solely for personal enjoyment and indulgence."

Next week, I will delve deeper into William Rathbone VI’s achievements and the Liverpool District Nursing organization, arguably his most far reaching effort that has had long term influence on nursing in England and the United States.