Esther Conteh has enjoyed an extraordinary and varied healthcare and nursing career for over 25 years. She emigrated to New York City from Sierra Leone as a teenager and was inspired by her mother’s work as a midwife back home and decided to pursue a career in healthcare.
After working as a home health aide at VNS Health, she became an RN with the organization and moved quickly through the ranks, leading to her current leadership role, where she oversees a large and diverse team.
In everything she does, Esther works towards building a culture of inclusivity and family for her team. She is committed to providing top-notch care to the communities served by VNS Health Choice MAP and MLTC, many of whom come from vulnerable backgrounds.
I’m an Advanced Practice Nurse (APRN) and Associate Vice President at VNS Health, one of the nation’s largest nonprofit home and community-based healthcare organizations. I manage care for members of our Medicare Advantage and Medicaid Long Term Care health plans, which were developed specially for people with complex, chronic health conditions.
Please discuss your career path and how you ascended to that role.
I have been at VNS Health for 25 years—I started here as a home health aide working in Manhattan. I knew from the beginning that caring for people in their homes was what I wanted to do, so I got in on the ground floor, and it was a great beginning. As a home health aide, I absorbed the experience of what it was like for people to recover. I got a chance to see what people needed and their concerns. I learned how to reassure and help people as they regained strength or coped with changing health conditions. The empathy I found in those days still guides me today.
After working as an aide, I went on to train and become a nurse and graduated as an Advanced Practice Nurse (APRN) from NYU. I was eager to build my skills in home health nursing. As I expanded my education, I focused on home health–a specialty I’ve always been drawn to because you can interact with people, and education is a big component. There is always the potential to help people understand what they need to stay healthy.
Throughout it all, I am grateful for the support of my mentors and those I work alongside. For example, when I was just about to enter the field as a nurse, I was also in the middle of my first pregnancy. As you might imagine, balancing so many life changes at once can be challenging! Thankfully, I had a lot of flexibility in home care, but the job could still be intense when I first started. I’m immensely grateful for the support I received from the team I worked with and my managers. Those early relationships helped me get where I am now.
After several years working in the field and many changes in the healthcare system, I’ve moved into a new role that’s been exciting. The work I do today as an AVP of Care Management for our VNS Health Health Plans is very much informed by my field experience. When talking with a client on the phone, I can visualize their home and ask questions about their environment, lifestyle, companions, or caregivers at home. Every day is different, but each structure is similar in many ways. That’s one thing I love about this work. Working with our MLTC (Managed Long Term Care) and Medicare members requires skill, empathy, and patience. Our plans serve some of the most vulnerable communities in the city. Disabilities, diabetes, heart disease, cancer, dementia, arthritis, and other chronic illnesses all come with fears and potential complications for our members. We try to simplify things and help them navigate complex systems, so they feel more in control of their health and well-being. Working in a management role, I still feel like I am a nurse first, but I’m also part of a care team that needs to be agile and deliver care quickly. My experience helps me support others on the team, too—especially younger clinicians.
Why did you become a nurse?
Growing up in Sierra Leone, my parents were healthcare workers and educators, helping all the locals. It sparked my desire to work in health care and to help others as my parents did. The care they provided others shaped my thinking, and I have never swayed from my passion for working in health and helping others. I moved to New York when I was sixteen, and as I finished school, I started moving into a career in health care, starting first as a home health aide. That experience still informs my work today and has given me a valuable perspective on best serving different patients.
What are the most important attributes of today’s nursing leaders, and why?
The first word that comes to mind for me is integrity. As a nurse, you’re often with people at their most vulnerable and truly depend on you, so integrity is critically important. Another core value that makes a good leader is empathy. Next, you have to understand where people are in their life journey. And lastly, you need to be agile and flexible and be able to pivot when needed. Especially working in people’s homes, our nurses are always mindful of where our patients come from. Every day has the potential to bring something entirely unexpected or new.
What does being a nursing leader mean to you, and how are you making a difference?
Experience is so important. Leading others, whether that is guiding someone who needs care or a team member that supports them, as is the case with our health plan care managers, that both the members and my colleagues know they can trust me. Leading requires clarity and honesty. I use those skills every day. There’s a lot of urgency in the work we do. Precision is essential, and you must make decisions quickly sometimes—it can be stressful. Everyone experiences that, both members and our experts on the phone. We lead by example and communicate one step at a time so we can hear what our members are saying—we try to “meet them where they are.”
Those we serve are often facing multiple comorbidities and life challenges. So you must ask yourself, what can I do right now to ease some of the issues this person has to deal with? It’s about considering all their needs, not just nursing care, but do they have access to food? Are they safe? If not, we must prioritize those crucial basics for our members.
What is the most significant challenge facing nursing today?
As the aging adult population grows, so will the need for skilled home care nurses and caregivers. It’s an exciting time to be in this specialty, but it also means more nurses with skills in home health care will be needed.
I don’t think the solution is simply hiring more people. Instead, we must think carefully about where nursing is going and how to improve. It is about what we learn from those we care for and how that can transform nursing. It is about working smarter, not harder. Because we can all agree burnout is a prevalent issue across the industry, and it’s important to support both veteran and novice nurses that put their all into the work.
As a nursing leader, how are you working to overcome this challenge?
Technology has become a valuable tool and resource for our team. Throughout the pandemic, it’s been amazing to see how telemedicine has transformed how we communicate and deliver care. The pandemic brought people together through technology and made it easier to trust and feel a face-to-face connection, even if that was on a phone or computer screen. For many of us in nursing, I think it opened our eyes to new possibilities.
For example, with remote patient monitoring, you can recognize a problem before you are even there in person, enabling us to respond faster. From afar, we can manage our patient’s heart rates, blood pressure, blood sugar levels, and much more. With this data, we can spot emergencies and react immediately. At VNS Health, we created a sort of dashboard where we could track and monitor incidents with patients. This lets us monitor risk and work with different teams to determine which services or interventions are likely needed.
Technology encourages even the most seasoned nurses to think out of the box. Our world is changing, and that’s not necessarily a bad thing! Especially if it can help nurses excel, feel supported, and better serve their patients.
What nursing leader inspires you the most and why?
That’s a tricky question because there are so many who have been an inspiration to me! Someone who comes to my mind first is Susan Underwood, Director of Compliance Operations with VNS Health. I first met her in an entirely different capacity from the one I am now, as I had just graduated from another part of the organization, so it felt like I was starting somewhere new. However, she was incredibly supportive and recognized my potential, encouraging me to grow.
She approached me one day and said, “I think you are ready to take the next step. So let’s work together to find a role where you can grow your skillset and mature.” And she was right. Moving into a leadership/managerial role was daunting, but I’m glad I did it.
Looking back even further, I think the founder of our organization, America’s first public health nurse, Lillian Wald, was such a visionary figure. Her work 130 years ago still holds so much in common with what we do today. She looked around at the communities she worked in and saw significant issues that needed to be addressed. So, she took action. And that way of seeing the world, of instilling change, is very much a part of the culture here at VNS Health today.
In home health, as a nurse, you have the privilege and the challenge of being aware of so much. We watch family dynamics firsthand; we see the ins and outs of a patient’s life and understand the many unspoken things behind the scenes. Home health nurses must ask ourselves, “What help do I need to bring? Do they trust me in this relationship?” Home health nurses must consider all the factors that impact a patient when planning care.
What message would you like to share with the next generation of nurses?
It is so important to have a passion for this field, knowing that it can be tough sometimes. But nurses will find that sticking with this career is worth it if it is their passion. In nursing, as in every other career, there will always be challenges, and many of us face added hurdles because of race or ethnicity. However, one advantage I’ve seen is a better understanding of some health disparities because of my lived experience. That alone can play a powerful part in healing.
I would tell future nurses you have a significant role, especially when serving people who look like you and might share the same experience. Remind yourself that it’s important to implement a certain amount of selflessness, be there for them, and show up for them because you can make a real difference in their lives.
As you advance in your career, don’t let your fears hinder your growth. You are never truly alone in the journey; don’t be afraid to reach out to others for support. You will have so many people–to inspire you, encourage you, help you grow, and share their experiences with you. I have been so blessed to have people, all my leaders, all my bosses, and all the people I’ve encountered in this job, and I learn from them. So have a toolkit in place, be ready to be a sponge, and soak up new experiences. Education never ends when you’re a clinician; there’s always something new to learn.
As a Black woman, I want to tell other nurses that your contribution will speak for itself. Sometimes, you may feel like people don’t always tell you they appreciate you. But trust me; you will be rewarded. You may not see it immediately, and it may not be tangible, but there is a reward for all you do.
Is there anything else you’d like to share with our readers?
Nursing has always felt so natural to me. It could be because it brings me joy every day, and I chose a career that keeps me happy and smiling. As nurses, we may not have all the answers all the time, but if we do what we can at the moment to change somebody’s life and positively impact them, then we’ve done our job.
The real beauty of nursing is that there are so many ways to be a part of it, and you can find an outlet for your strengths. You could work in different environments or specialties like home health, hospice, or behavioral health. You can lead teams as a care manager or become an expert in analytics and data …you have so many options and choices. The sky’s the limit when you have a nursing career!
The fundamental mission of every healthcare provider is to first do no harm. Unfortunately, however, for far too long systemic inequities in the healthcare system have perpetrated and perpetuated harm.
Both implicit and explicit biases have strongly determined healthcare processes, including informing how patient pain is understood, diagnosed, and treated. Stereotypes relating to gender, race, and ethnicity have contributed to a pattern of delayed and erroneous diagnosis and inappropriate or insufficient palliative care. And as a result, untold numbers of female and minority patients have been consigned to suffer needlessly.
But there is hope, and nurses are helping to provide it. By prioritizing workforce diversity, qualified healthcare professionals enjoy greater career opportunities, and diverse patients increasingly receive the pain control they need. This article examines the importance of diversity in the healthcare industry and its implications for improving palliative care for diverse patients.
Biases and the Treatment of Pain
Generally, healthcare providers enter the field because they genuinely want to help people. Of course, financial security and social prestige are a perk, but no matter your particular role, the work is incredibly emotionally, cognitively, and physically demanding. Nevertheless, it is a profession you enter or remain in with a sense of a higher calling and a deeper purpose.
But, no matter how well-intentioned, healthcare providers are still very much human, and as such, they are shaped, both consciously and unconsciously, by the society in which they live. And that means that systemic biases have almost inevitably seeped into the care provider’s consciousness, contributing to the formation of false and dangerous stereotypes.
Research has shown, for example, that racial stereotypes concerning African-Americans have contributed strongly to the mismanagement of Black patients’ pain. These stereotypes are generally rooted in misperceptions of biological differences between African-American and Caucasian patients. This includes the false belief that Black patients have a higher pain tolerance than whites and the false presumption that Black patients are more likely to abuse drugs.
Implicit and explicit gender biases are also ubiquitous in modern medical practice. For example, female patients complaining of pain are more likely to experience treatment delays than male patients reporting the same or similar symptoms. Women’s pain symptoms, for instance, are significantly more likely to be attributed to emotional or psychological etiologies than men’s. This increases the likelihood that their pain will go untreated or under-treated, and severe disease symptoms will go unrecognized, thus delaying treatment.
Diversity and Cultural Competence in Healthcare
Nurses are at the front lines of patient care. They provide the majority of hands-on patient care, and, in general, their interactions with patients are more frequent and substantive than those of physicians.
For this reason, diversity in the nursing sector is particularly critical in redressing inequities in treating patients’ pain. Culturally competent patient care almost inevitably ensures that nurses derive from various ethnic, racial, socioeconomic, and gender backgrounds.
More specifically, this means that nurses with high cultural competence will better understand, recognize, and respond to culturally-specific manifestations of patient pain.
For instance, women or patients from specific cultural or religious backgrounds may feel reluctant or unable to express their symptoms, especially if these pertain to “taboo” areas. Nurses from similar backgrounds are more likely to have the cultural competence to identify and overcome these cultural taboos.
This enables them to formulate strategies that help patients express their concerns in more comfortable and culturally acceptable ways. In addition, by enhancing the dialogue with patients, nurses can provide physicians with more comprehensive and accurate case notes, increasing treatment efficacy.
Addressing Medical Anxiety
Promoting diversity in nursing doesn’t just equip healthcare teams to understand and address cultural differences among patient populations effectively. Diversity also enables healthcare teams to recognize and remediate systemic healthcare disparities’ profound and long-enduring impacts.
There is mounting evidence, for example, that minority patients are far less likely than Caucasians to be satisfied with their quality of medical care. Deficiencies in minority patient care can be linked to various factors, from the lack of healthcare access to a shortage of interpreters for patients who do not speak English.
These care deficiencies can instigate severe medical anxiety in patients, particularly for those who have experienced significant physical or emotional trauma in past medical encounters. Nurses from similar backgrounds may have also experienced such challenges in the healthcare system, whether for themselves or someone they love. And as such, they are more likely to be able to accurately anticipate or ascertain signs of medical anxiety in female and minority patients.
Equipped with such insight, diverse nurses can lend a measure of patient support and empathy that comes from understanding and experience. And, importantly, they can more effectively advocate for patients and their unique needs, particularly in treating pain.
The Takeaway
Disparities in the healthcare system have for too long led to deficiencies in palliative care for minority and female patients. By promoting diversity in the nursing profession, however, the needless suffering to which diverse patients have been subjected can finally end.
Structural and interpersonal racism is blocking aspiring midwives of color from joining the workforce at a critical time for the health of pregnant and birthing people.
The U.S. has alarming disparities in maternal health that will likely intensify following the erosion of reproductive health access in states across the country. Midwifery care and care from providers who share a racial and cultural identity with their patients are proven to improve outcomes for parents and babies. Yet an overwhelming majority of midwives in the U.S. identify as white.
People also frequently cited the lack of midwives of color to teach and mentor them. Barriers to becoming a midwife were greater among people with lower levels of income or education.
This survey of aspiring midwives of color across the U.S. is the first study exploring a wide range of barriers to entering midwifery education.
“Aspiring midwives of color are motivated to provide care in their communities to counteract the effects of racism on maternal and infant health,” says Renee Mehra, Ph.D., ACTIONS postdoctoral fellow and first author on the paper. “We need them in the workforce, yet the cost of midwifery education and the lack of racial and ethnic diversity in the profession are standing in their way.”
“We must act now to train, diversify and deploy a midwifery workforce that can tackle the persistent maternal morbidity and mortality that disproportionately plagues Black and marginalized people in the USA today,” says midwife Jennie Joseph, Founder and President of Commmonsense Childbirth.
The structural and interpersonal racism that impacts people’s ability to become midwives also motivated them to want to provide this care. The strongest motivating factors in the study were providing racially concordant care in their communities, reducing racial health disparities, and their own prior experiences of discrimination in healthcare settings.
To help aspiring midwives of color meet their goals, the researchers suggest solutions including providing funding for students of color for tuition and other living costs, creating a pipeline for midwives of color by enrolling more students of color, and supporting and hiring more teachers of color, and opening more midwifery schools, especially in Historically Black Colleges and Universities.
The VA knows that inclusion equals innovation. By ensuring that every Veteran receives care that matters to them and their whole health, VA providers and staff get to know each Veteran personally to provide better care tailored to the patient’s health and wellness goals.
All Veterans are different, and health care is not one-size-fits-all. However, diversity in VA personnel helps bridge the gap in health care disparities, an attitude adopted at the very top of their organization.
And the more diverse the VA workforce, the more tremendous success they’ll shareAnd the more diverse the VA workforce, the more tremendous success they’ll share
“To ensure a welcoming environment for Veterans, we must foster fair and inclusive VA workplaces where the experiences and perspectives of our diverse employees are valued,” says VA Secretary Denis McDonough. “The success of our mission depends on everyone being able to contribute their expertise, experience, talents, ideas, and perspectives.”
Investing in Inclusion
The Office of Academic Affiliations (OAA) plays a significant role in developing VA’s diverse workforce.
Healthcare professionals just starting in their careers can take advantage of health professions training and scholarship programs designed to increase job opportunities at VA for racial and ethnic minorities, improving healthcare experiences and outcomes for these groups.
OAA manages affiliations with more than 1,800 unique colleges and universities, including nearly 200 minority-serving institutions (MSIs). Approximately 20,000 health professions trainees from MSIs come to VA each year.
Additionally, the Veterans Healing Veterans Medical Access & Scholarship Program provides full scholarships to 12 Veteran medical students at Teague-Cranston Act and Historically Black Colleges and Universities in exchange for a four-year service obligation at VA.
Inclusion Leads to Innovation
The VA’s academic affiliations put them in a unique position to mentor and fund researchers from disadvantaged backgrounds who are motivated to make a difference in their communities, broadening career opportunities for those seeking to join the VA’s team.
Additionally, the VA recognizes that scientists and trainees from diverse backgrounds and life experiences bring different perspectives, creativity, and individual enterprise to address complex health-related problems. So the VA has developed funding opportunities in mentored research for junior VA investigators from underrepresented backgrounds. These research supplements pair early-career investigators with established VA researchers.
The supplements, supported by the VA’s Office of Research and Development (ORD), have led to research into virtual reality technology to help Veterans with mild cognitive impairment and repurposing existing drugs to treat substance use disorder, among others.
The Road Ahead
Supporting diversity, equity, and inclusion among the VA staff is an ongoing effort and a challenge that will continue in the future. As the VA celebrates its successes, they look ahead to further efforts that support and recruit a diverse workforce.
By integrating best practices into all the VA does to expand access to world-class healthcare services and to improve policies and procedures to reflect the diversity of those they serve, the VA continues to strengthen its efforts toward a safe and respectful workplace and healthcare environment.
Serving the most diverse group of Veterans in history, the VA reaffirms its commitment to hiring staff that reflects that diversity, ensuring that VA employees feel supported and providing equitable healthcare access for all.
Welcome to part two of Three Trailblazing Hawaiian Nurses blog series – Mabel Leilani Smyth,First Hawaiian Registered Nurse with Hawaiian ancestry, often referred to as “Hawaiʻi’s Florence Nightingale.”
Hawai’i’ is one of the most multicultural and ethnically diverse places on Earth. This rich blend is reflective of its nursing history. Pioneer Registered Nurses in Hawaii include nurses of Native Hawaiian, English, Chinese, Japanese, and Filipino heritage. Their lives and work create a beautiful kaleidoscope of service that has improved the lives of residents in this tropical paradise for over 100 years. The life stories of three groundbreaking Hawaiian RNs can inspire us all.
Mabel Leilani Smyth 1892 – 1936 First Hawaiian Registered Nurse with Hawaiian Ancestry “Hawaiʻi’s Florence Nightingale”
Mabel Leilani Smyth was born in Honolulu on September 1. 1892, to Julia Goo and Halford Hamill Smyth. Like many Hawai’ians, she had an ethnically mixed lineage. Smyth’s ancestors included people from Hawai’i, England, China, and Ireland. Smyth’s older sister Eva was born visually impaired, and from a young age, Mabel was Eva’s companion and guide while her mother tended to the three younger children and her father was at sea. Caring for her sister foreshadowed a lifetime of caring for others.
Smyth spent her childhood on her mother’s Kona coffee farm in Hawaii. All the Smyth children worked hard picking and cleaning coffee beans and cultivating and pounding taro root to make poi, a national dish of Hawai’i. Julia Smyth earned additional money weaving and selling lauhala hats. The family was trilingual, speaking Hawaiian, English, and Pidgin in the home. Being fluent in three languages helped her cross racial and ethnic boundaries and gain acceptance in multiple communities. After Smyth’s father died around 1907, the family moved to the Palama neighborhood, a suburb of Honolulu on the island of Oahu. In 1910, Smyth graduated from President William McKinley High School and began working as a nanny for the Rath family.
Mabel Smyth Begins Career as a Nurse
James and Ragna Rath, Caucasian social workers, moved from Massachusetts to Hawaii in 1905 for James to direct the Palama Settlement, a multifaceted community service agency. In 1900 at least five cases of bubonic plague were reported in the Chinatown section of Honolulu. To eradicate the threat, city officials decided to burn the homes of the plague victims. Unfortunately, the fire burned out of control, destroying at least four blocks of Chinatown. As a result, thousands of recent impoverished immigrants were homeless, and many lost their jobs and businesses. The Central Union Church created the Palama Settlement (PS) in response to these dire conditions. Church officials founded and supported many programs, including visiting nurses, a pure milk station, a day camp for children with tuberculosis, an adult night school where English lessons were taught, a day care center for working mothers, and a swimming pool with hot showers. James Rath was busy overseeing these efforts, and Regna Rath worked by his side. The Raths had five children and needed at-home childcare, so they hired Mabel Smyth.
In 1912 the Raths took their five children and Smyth to Massachusetts for a sabbatical. Before the Raths returned to Honolulu, they encouraged and arranged for payment for Smyth to attend the Springfield Hospital Training School for Nurses. Upon her graduation in 1915, Smyth returned to her family in Honolulu. She spent two years as the “agent” of the Hawaiian Humane Society. The Society had a mission to relieve suffering wherever it was found – among children, animals, and even battered wives. Smyth left the Society to become the first nursing supervisor at the PS. Organizationally, the PS divided the city of Honolulu into seven districts, with a nurse assigned to each. Each nurse was responsible for providing their district school nursing, home visiting, and clinic hours. At age 26, Smyth oversaw the entire nursing program.
Mabel Leilani Smyth was the first Hawaiian Registered Nurse with Hawaiian ancestry, often referred to as “Hawaiʻi’s Florence Nightingale”
Smyth is First Hawaiian Nurse to Earn Advanced Certificate in Nursing
Smyth took a year off from the PS, from August 1921 to August 1922, to pursue graduate work in public health nursing at Simmons College in Boston. She was the first Hawaiian nurse to earn an advanced certificate in nursing. After her year of graduate studies, she continued her supervisory work at PS until 1927, when she accepted a position with the Territorial Board of Health as the first Director of the Public Nursing Service for the Territory of Hawaii. Up to that time, the Board of Health had hired nurses in either tuberculosis work or maternal child health work. Under her leadership, these programs merged and expanded to create a generalized public health nursing program covering all the islands in the Territory. Two years later, the nurses at the PS came under the auspices of the Department of Public Health Nursing to better coordinate care and reduced duplication of services.
Smyth gave many lectures to community and professional groups on the islands to increase public understanding and support for public health nursing. She successfully strove to upgrade lay midwives’ skills and standards, instituted immunization drives against diphtheria, coordinated chest x-ray screenings for TB, organized well-baby clinics across the islands, and represented Hawaii at several national public health meetings on the mainland.
In addition to her work, Smyth was a leader in professional nursing organizations. She was a charter member of the Nurse Association of the Territory of Hawaii when it was formed in 1920 and then elected president of the organization in 1925 and 1932. Smyth was also president of the City and County of Honolulu Nurses Association, a leader of the Honolulu Chapter of the American Red Cross, and a member of the Board of Registration of Nurses from 1925 to 1935. In 1926, Smyth was a small group of nurses who created a public health nursing course at the University of Hawaii to prepare nurses who wanted to practice public health nursing.
Hawaiian Florence Nightingale
Sadly, Smyth’s life was cut short at the young age of 43 after spending half her life serving others. A sewing needle had been lodged in her chest since she was a child. On March 24, 1936, she underwent an operation to remove the needle and tragically died of a post-surgical embolism that same day.
Smyth was widely mourned both in Hawaii and in the nursing community. Her obituary in the American Journal of Nursing read in part:
Endowed with charm and a dynamic personality, she had attained a high position in the ranks of Hawaiian women of achievement. Through her devotion, sympathy, keen sense of community responsibility, spirit of cooperation, and intelligently directed energy, Miss Smyth was, at the time of her untimely death, at the very height of her powers, the outstanding leader in nursing in the Territory of Hawaii.
After her death, a committee was formed to establish a memorial to the “Hawaiian Florence Nightingale.” It raised over $110,000 for the Mabel Smyth Memorial Building, with over 4,000 people contributing. The building was dedicated on January 4, 1941, with Hawaiian chants and music. It housed offices of the medical and nursing professional organization on the island, classrooms, a library, and an auditorium. The building was a fitting memorial to a nurse who did so much for her family, neighbors, and all Hawaiians.
Check back next week for part 3 of the Three Trailblazing Hawaiian Nurses blog series – Alice Ting Hong Young, Hawaii’s First Nurse Midwife.
Welcome to part one of Three Trailblazing Hawaiian Nurses blog series – Mabel Isabel Wilcox, First Registered Nurse in Hawaii.
Hawai’i’ is one of the most multicultural and ethnically diverse places on Earth. This rich blend is reflective of its nursing history. Pioneer Registered Nurses in Hawaii include nurses of Native Hawaiian, English, Chinese, Japanese, and Filipino heritage. Their lives and work create a beautiful kaleidoscope of service that has improved the lives of residents in this tropical paradise for over 100 years. The life stories of three groundbreaking Hawaiian RNs can inspire us all.
Mabel Isabel Wilcox 1882-1978 First Registered Nurse in Hawaii
The first Registered Nurse in Hawaii was Mabel Isabel Wilcox. Her maternal (David and Sarah Lyman) and paternal (Abner and Lucy Wilcox) grandparents were Caucasian Christian missionaries who traveled from New England to the Kingdom of Hawaii in the 1830s to establish schools and preach the Gospel.
Mabel was born on the island of Kauai on November 4, 1882, to the Wilcox’s son Samuel and the Lyman’s daughter Emma. She remembered a carefree childhood in a family that valued religion, philanthropy, education, and public service. When Wilcox was in her teens, there were no college preparatory high schools in Hawaii, so her parents sent her to California to complete her high school education. However, she stayed on the mainland, and in 1911 she graduated from the Johns Hopkins School of Nursing in Baltimore and passed her Registered Nurse examinations. Soon after graduation, Wilcox returned to Hawaii and began her career as the resident school nurse at the Kawaiahao Seminary, a Congregational Church-sponsored girls’ school in Honolulu, becoming the first Registered Nurse in Hawaii.
An early photo of Mabel Wilcox Hawaii’s first Registered Nurse
Earned the Moniker “Kauku Wilikoki”
Wilcox missed her extended family on Kauai, so in 1913 she accepted an assignment to begin and head the Territorial Board of Health’s anti-tuberculosis (TB) campaign on the island. She was the only Board of Health nurse on the island and served approximately 5,000 people. Often on foot or horseback, she did case investigations, collected sputum samples, educated the community about the disease, and provided follow-up care to those diagnosed with TB. Wilcox quickly saw the need for a TB Hospital on Kauai. She convinced service clubs and business organizations on the island to support her idea and solicited most of the funds needed from her aunt and uncle, Emma and Albert Wilcox. After a year of construction, the Samuel Mahelona Memorial Hospital opened in 1917.
Although Wilcox was hired to reduce the number of tuberculosis cases on Kauai, in 1920, Hawaii reported a 25% infant mortality rate, double that of the mainland. In addition, there were no maternal/infant health nursing programs on Kauai, so Wilcox added education on nutrition, sanitation, and healthy birthing practices to her rounds when she encountered pregnant women and young children. As a result, she earned the moniker “Kauku Wilikoki” or Doctor Wilcox for her work.
As soon as the U.S entered WWI in April 1917, Wilcox was anxious to do her part. She wrote the American Red Cross nursing service requesting an overseas assignment. Her work with maternal/child health in Hawaii gave her knowledge and experiences she would draw on during her war years.
Nurse Behind the Lines During WWI
Beginning in the winter of 1918, Wilcox was the Head Nurse of a hospital and outpatient clinic for women and children in Le Havre, France. The facility was relatively safe miles from the battlefront lines when Wilcox arrived. After that, however, the fighting grew closer. In September of 1918, Wilcox was sent into nearby Belgium, directly behind the advancing Allied troops, to inspect maternal and child health conditions and conduct clinics. While there during the final Allied campaign, she wrote to her family: “One night we were bombed, crawled under the bed, two of us trying to get into one helmet. Scared.” After the war ended, Wilcox spent another year in France helping mothers and children, many of whom were orphaned or refugees. Once the French government was stable enough to take over her work, she returned to Hawaii. She was awarded medals from the Queen of Belgium and the mayor of Le Havre for her service.
Kauai’s First Territorial Maternity and Child Health Hygiene Nurse
In 1921 Congress passed the Sheppard-Towner Act providing funds for maternal-child health programs. With these new monies, Wilcox was hired as Kauai’s first Territorial Maternity and Child Health Hygiene Nurse to focus full-time on improving the health of women and children. As they began hiring more nurses, she became the Supervising Nurse, a position she held until her retirement in 1935. In the first year, public health nurses made nearly 1,000 home visits, and newly organized “demonstration clinics” recorded an attendance of 4,403 mothers. Infant mortality dropped by 14% in the first year of the program. The program successfully provided care to 8,398 mothers and infants in 1927.
Congress discontinued funding the Sheppard-Towner programs in 1929. Then in 1930, Wilcox became the supervisor of the new generalized public health nursing program on Kauai. She oversaw tuberculosis, maternal-child health, and school and home health nursing programs on the island. During this time, Wilcox was a leader in many professional associations. She launched the Kauai Nurses Association, served as its first president from 1932-1946, served as the first executive director of the Kauai TB Association, and was on the Board of the Mahelona Hospital.
G.N. Wilcox Memorial Hospital
On Kauai, many sugar plantations maintained small, often inadequate, hospitals for their workers and families. After Wilcox’s father and mother died (1929 and 1934, respectively), she and her siblings decided to build a new, modern general hospital in their memory. She retired in 1935 and spent her time and energy making the G.N. Wilcox Memorial Hospital a reality for the next few years. It was dedicated on November 1, 1938, with 96 beds in wards and semi-private private rooms, 17 physicians and 50 employees, and 14 graduate nurses. The hospital provided more than 10,000 days of care in the first year of operation.
Upon Wilcox’s retirement, Mabel Smyth, RN, the Head Nurse of the Territorial Board of Health, wrote a tribute to her in The Pacific Coast Journal of Nursing.
It read in part: “With clarity of purpose and wisdom in leadership Miss Wilcox has developed an unusual spirit of loyalty and devotion among her corps of nurses and superiors … every nurse … on the island turns to her for inspiration and leadership in matters pertaining to individual and community well-being.” (Smyth, M, “Public Health Nursing in Hawaii: A Tribute to Mabel I. Wilcox,” (1935) The Pacific Coast Journal of Nursing, 297-98).
Mabel Wilcox circa 1911 and 1951
Influence of Wilcox Lives On
In her late 50s and 60s, Wilcox stayed active with the Wilcox Hospital in an unpaid capacity. She served on the hospital board, raised money for expansions, and recruited nurses. During this time, Wilcox also became very interested in historic preservation. Because both sides of her family tree had been missionaries and plantation owners in Hawaii for over 125 years, she and her living siblings began restoration efforts to preserve their ancestral homes and papers. Today the Waiolo Mission House, the Lyman House Memorial, and Grove Farm all stand as testimonies to their efforts, as do many manuscripts, records, and correspondence housed at the Grove Farm library.
After years of declining health, Wilcox died on December 27, 1978, at age 96. Before her death, the Kauai Tuberculosis Society honored her with these words: Through the years, there has been little in the health and welfare fields on this island that does not owe its beginnings to Miss Wilcox’s vision and active support. Her scope has been not only island-wide but territorial and even national.
Wilcox is is buried on her beloved Kauai Island.
Check back next week for part 2 of the Three Trailblazing Hawaiian Nurses blog series – Mabel Leilani Smyth, First Hawaiian Registered Nurse with Hawaiian Ancestry.
