Patient, heal thyself

One hundred years ago, nurse Alice Bowen had a great idea: If you go into Detroit's neighborhoods preaching the gospel of good health, more people would escape the stress, pain and humiliation of debilitating disease.

It was 1898 when she decided that it was time to take medicine to the people. She began visiting homes, showing Detroiters how to take care of everything from their arthritic joints to their newborn children. She vowed, "I will establish (community) nursing (in Detroit) unless I starve in the attempt."

She didn't starve. Instead, she established the Visiting Nurses Association. In its first year, the VNA provided home care to 1,764 patients on a budget of $635.78. The service was supported largely through area churches and nursing associations, and partly through the 25-cent fee the nurses collected after each home visit -- but only from those who could afford it.

Those were the days when married women were fighting for the right to hold property. And although the newly emancipated African-American men could vote, women were still not afforded the same constitutional right. Gender politics swirled around the white, starched bonnets of the visiting nurses. But their immediate battle was with the very survival of poor women, many of whom were immigrants. They focused on prenatal care and the care of newborn babies, becoming a bridge between medicine and the people it was there to serve.

In 1918, a flu epidemic claimed 600,000 lives nationwide, and the VNA struggled to keep up with the overwhelming need in the community. When Bowen reflected on her vow to establish community-based nursing, she recalled, "I did not starve, but I went hungry a whole lot of times."

Although the VNA established Detroit's first tuberculosis clinic, Bowen died of TB in 1921. But she left behind an enduring legacy. Just a few years after her death, the VNA's budget swelled to almost $150,000. Medical breakthroughs such as the discovery of penicillin transformed in-home health care. The VNA began serving physical therapy patients -- especially children. By the 1930s, a VNA flyer sounded dangerously like Hillary Rodham Clinton's vision for universal health care: "There's a visiting nurse to fit your purse for every illness."

Bowen would not have been the least bit surprised to hear that her nurses were among the first women in Michigan to get driver's licenses, that the VNA helped establish the Wayne County Health Department in 1943 or that they were at the vanguard of home care for cancer patients in the '50s. She would have enjoyed the irony that, after spreading their charity to the needy in Detroit for 60 years, the organization became the beneficiary of the estate of lumber baron David Whitney. The organization moved into what is now the opulent Whitney restaurant in 1958.

In the 1980s, the VNA became the first group in the state to provide home health care for patients with HIV/AIDS. In 1991, it received a commendation from its accreditation agency, receiving a rare score of 99 out of 100. And when the newly elected Gov. John Engler saw fit to end welfare for thousands of single men in 1990, the VNA organized a grassroots effort to expand health care to Michigan's homeless.

Today Bowen's vision is still very much alive. The VNA has an annual budget of $24.5 million, makes more than 300,000 home visits yearly, and serves more than 9,000 patients from Monroe to Macomb. This month it will open the VNA Training Institute. The Institute will prepare welfare recipients to become certified home health aides -- a profession for which the demand is growing sharply.

A few weeks ago, I attended the VNA centennial celebration at Dearborn's Ritz-Carlton. The organization was honoring Isabelle Thomas who served as a VNA nurse and administrator for 27 years. During her tenure, she ran three storefront sites in Southwest Detroit to care for senior citizens. When the program began, Medicare and Medicaid had just been enacted, and the VNA signed hundreds of senior citizens up for those programs.

Isabelle Thomas threw around her considerable clout and got her sister, Helen, to deliver the keynote address. You know Helen Thomas, the outspoken dean of the White House press corps. While Helen is in the limelight daily (she confided to me before the luncheon that it caused her "great anxiety" to be away from Washington in the middle of Lewinskygate), that day was Isabelle's. Helen was there to honor her sister.

At my table was an elegant woman, Jean, who sat on the edge of her chair, full of expectation.

"Are you a nurse?" she asked me.

"No, I'm an editor at the Metro Times."

Her face, ringed with snow-white curls, fell in disappointment. One reason was that she knew of the Metro Times, and once had protected her apartment mates from its poison by throwing away the only copy she found in the lobby.

But the other reason was that she was hoping I'd be someone she knew.

"I keep thinking I'll see the nurse who took care of me for a year," she said. "She saved my life."

A visiting nurse had come to Jean's home every day for months, allowing her to recover at home rather than remaining in the hospital. The nurse started coming weekly after that, checking in on Jean's progress, keeping her on the road to good health. Last week, Jean had jumped at the chance to say "thank you" to the person who, like Alice Bowen, understood that healing is as much about compassion and friendship as it is about medicine.

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