Where Doctors Don't Reach

When Nurse Susan Stearly, 28, drove her '64 Valiant into the southern Colorado town of Trinidad, she knew that she was taking on a tough case. Trinidad, once a covered-wagon depot and later a bustling coal-mining center, has become the core of a "depressed area," and Nurse Stearly was there to deal with one of its most depressing problems: the appalling lack of medical care for thousands of indigents, and especially for their children. In all of the 4,800 square miles of Las Animas County, of which Trinidad is the seat, there are just seven doctors--roughly one for every 3,000 residents.

Trinidad's new nurse was the advance guard from a University of Colorado School of Medicine program designed to lighten the work loads of practicing physicians by training nurses to perform most of the duties of a pediatrician, and to carry medical care to the children of poverty-stricken laboring families, including many Spanish-Americans, who rarely consult a doctor except in dire emergencies. To its founder, Pediatrics Professor Henry Silver, 48, the program is immensely promising in every aspect except for the unwieldy name that has been hung on the new breed of nurses: "pediatric public-health nurse-practitioners."

Run-of-the-Mine Ills. The basic idea, says Dr. Silver, is to train a well-qualified nurse to diagnose and treat run-of-the-mine complaints, give vaccines, check sight and hearing, and recognize troubles serious enough to demand a doctor's attention. "She doesn't have to know the specific difficulty," says Silver. "She simply has to know enough to say to herself, 'Oh-oh, I've listened to 3,000 hearts, and this one isn't right. This one is for the doctor.' "

Dr. Silver set up his program with $253,998 from New York's Commonwealth Fund.* Only registered nurses with a master's degree in public-health nursing are eligible. (Nurse Stearly had also had two rugged Peace Corps years in Honduras.) Once accepted, they spend four months at the University of Colorado's medical center. They put in time at the well-baby clinics and the screening and emergency clinics; they get basic training in child psychiatry, pediatric neurology, pediatric orthopedics, mental retardation, eye, ear, nose and throat complaints--all of the countless ills that young flesh is heir to.

Always they watch the professionals in action; then, while the professionals watch them, they apply the basic treatments themselves. "We discuss boundaries constantly," says Dr. Silver, "the boundaries of what they can do and what they cannot do." Once the nurses know those boundaries, they go into the field, where they are regularly checked by the program's faculty for 20 months.

No Crisis Calls. Susan Stearly was the first. She arrived in Trinidad in April and was given an office in the district health department. She promptly set up a health station in a transplanted shingle house on a grade-school's grounds. She makes house calls every morning. In the afternoons she holds office hours at the health station--except Fridays, which she spends at the health department. At the start, despite the obvious need for her services, there were days when not a soul took advantage of her presence. Now parents, some of them grateful for her fluency in Spanish, are gradually recognizing her skill. She has 45 patients. There have been no "What do I do now?" calls to busy doctors, she says proudly, "but I have sent them a number of children as patients." Most such cases have involved deafness, from neglected middle-ear infections, and a variety of chest complaints.

So far Susan Stearly has run into none of the dangers predicted by doubters. There has been no hint of a malpractice suit, which some doctors feared such nurses could get embroiled in. And the local physicians, who might have muttered about leaving doctoring to doctors, have welcomed the much-needed help. By last week two more of Dr. Silver's nurse-practitioners had set up a similar operation in a housing project in Denver. Another graduate has joined Nurse Stearly in Trinidad, where townspeople are beginning to recognize the long, athletic stride of their first nurse-practitioner and a few of the children have even shyly started to call her Susan.

* Established in 1918 by the late Mrs. Stephen V. Harkness, widow of the oil tycoon. Most of its grants, which have totaled as much as $7,000,000 a year, are given for medical education and community health.

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