Welcome to part three of Three Trailblazing Hawaiian Nurses blog series – Alice Ting Hong Young – 1911- 1992: Hawaii’s First Nurse Midwife.
In honor of Asian American and Pacific Islander Heritage Month, Minority Nurse is republishing the Three Trailblazing Hawaiian Nurses blog series from October 2022.
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.
Alice Ting Hong Young – 1911- 1992: Hawaii’s first Nurse Midwife
Alice Ting Hong Young was born on October 24, 1911, in the Chinatown section of Honolulu. Her father, Wah Kam Young, was a Chinese immigrant and fish merchant. Her mother, Bow Ngan Sum, was of Chinese and Hawaiian descent. Mr. Young died when Alice was twelve, leaving her mother with nine young children to raise.
Alice’s hopes to attend medical school were dashed due to the family’s financial hardships. Instead, after graduating from McKinley High School in 1929, at age 18, Alice entered nursing school at the St. Luke’s Hospital School of Nursing in San Francisco. There, students exchanged their labor for tuition, making it possible for poor students like Young to become RNs. In 1932, Young graduated, passed the Registered Nurse examinations, and returned home. She quickly entered the one-year public health nursing course at the University of Hawaii that Mable Smyth had co-founded six years earlier.
The Palama Settlement hired young to provide various public health nursing services upon graduation. After two years, Smyth, then the Territorial Board of Health Nursing Director, hired Young to be a public health nurse with the Territorial Board of Health on the island of Molokai. Young worked in the maternal-child, school, home health, and tubercular nursing programs.
In 1900, the population of Hawaii was 154,001. Hawaii’s four most prominent ethnic groups listed in that year’s census (in round numbers) were Japanese – 61,000, Native Hawaiians – 38,000, Caucasians – 29,000, and Chinese – 26,000. By 1930, the Territory’s population had more than doubled to 368,336, and new ethnic groups appeared in the census.
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The 1930 Hawaiian Census listed 140,000 Japanese, 80,000 Caucasians, 63,000 Filipinos (none were listed in 1900), 51,000 Native Hawaiians, 27,000 Chinese, and 6,000 Koreans (also newly listed since 1900), while African Americans and Other groups combined made up fewer than 1,000 residents. This growth and change reflected the large number of Asians immigrating to Hawaii for work, primarily as plantation laborers. Among each ethnic group were educated and skilled midwives and untrained and dangerous midwives, all of whom attended home births.
In 1931 the Territorial Legislature passed Act 67, the first law to regulate the practice of midwifery in Hawaii. Midwives were required to register with the Board of Health. They were required to show proof of “being reasonably skilled and competent” in delivering babies and post-partum care, be of good moral character, and be at least 21 years old. In addition, they could only attend to women with no significant health problems and with no difficulties during their pregnancies.
Each registered midwife was issued a standard set of supplies and lengthy instructions by the Board of Health. In the first year, 168 midwives registered. Most were Japanese. Others were Filipino, Hawaiian, and Portuguese. During the 1930s, approximately a quarter of babies born in Hawaii were attended by midwives. While the law was generally successful in upgrading midwifery practice in Hawaii, there was no provision for supervision to ensure the regulations were being observed.
Young Becomes Hawaii’s First Nurse Midwife
In 1935, the U.S. Congress passed the Social Security Act, which provided funds to enhance maternal-child health services by expanding public health nurses’ skills and education. In 1936 the Hawaiian Territorial Board of Health selected Young to become the first Nurse Midwife and Midwife Supervisor for the Territory. It paid for her to go to the mainland for advanced education.
Young spent the academic year 1936-37 in New York City, earning a certificate in midwifery from a combined program sponsored by the Maternity Center Association of New York, Teacher’s College, Columbia University, and the Lobenstine Clinic in Harlem. In 1937, Young was awarded her Nurse-Midwife certificate and returned home to start her new duties.
Young visited every midwife in the Territory at least twice a year, observing and demonstrating new techniques. She inspected midwife bags to ensure all the necessary equipment was present and clean, and she followed up on reports of lay midwives practicing without a license. In addition, Young taught classes for midwives on each island. Although she spoke English, Cantonese, and Pidgin, she did not speak Japanese, so public health nurses fluent in Japanese taught the Japanese midwives. In 1940, Young wrote a manual for midwives, drawing on materials used in other states but adapting it to Hawaiian mores.
By 1940, maternal and infant mortality and morbidity rates were improving on the island, due in no small part to Young’s work. However, things changed drastically on December 7, 1941, when the Japanese attacked Pearl Harbor. Within hours, martial law was declared in the Territory; it stayed in effect until 1944. Travel was restricted, especially for Japanese residents. Because most midwives were Japanese, this forced many women to deliver babies without help or in a hospital. She told a reporter in a 1984 interview that World War II “wiped out” midwifery on the islands and that all births were mandated to occur in a hospital under martial law.
Soon after WWII began, Young met Lieutenant Commander Drew Kohler, a Caucasian from Minnesota working in naval intelligence stationed at Pearl Harbor. They fell in love and married on November 14, 1942. She continued her work with the Board of Health until she became pregnant in 1943. For several years she focused on being a new wife and mother of three small children.
Alice Ting Hong Young Kohler on left giving advice to another nurse circa 1950s
Although she was no longer with the Board of Health, Kohler’s pioneering work as a nurse midwife continued. As she documented in her 1953 article in Nursing Outlook, Kohler initiated and coordinated the first childbirth education classes in Hawaii with obstetricians in private practice. In 1949, she approached a busy obstetrical office in Honolulu and was hired to create a series of six two-hour classes about pregnancy, labor and delivery, and infant care. Attendance was always high. There was a morning and afternoon class, but soon an evening class was added to include expectant fathers.
In the first 30 months of the program, 1,338 people attended the sessions. Kohler used materials from the Board of Health and the Red Cross, but, as with the Midwife Manual a decade earlier, she adapted the information to meet the cultural needs of her patients. Kohler sought donations of materials and equipment, wrote the course curriculum, and recruited public health nurses to teach the classes.
Over the following decades, Lieutenant Commander Koher’s career took the family to Japan, Taiwan, and Washington, DC. While in Taiwan, Alice Kohler worked in the obstetrics ward at the U.S. Navy Hospital.
The Kohlers retired to Hawaii in the mid-1960s. In 1984, the University of Hawaii honored Kohler with the first Distinguished Alumna Award for her commitment to nursing and the people of Hawaii. She passed away in 1992 and is buried in Honolulu.
Mabel Isabel Wilcox, Mabel Leilani Smyth, and Alice Ting Hong Young are three pioneer nurses that broke new ground in a new profession to help the people of Hawaii. They freely gave their time, energy, money, and knowledge to ensure care for the most vulnerable. Their lives and careers illuminate the best of nursing. All nurses can benefit from their examples of extraordinary service.
Welcome to part one of Three Trailblazing Hawaiian Nurses blog series – Mabel Isabel Wilcox, First Registered Nurse in Hawaii.
In honor of Asian American and Pacific Islander Heritage Month, Minority Nurse is republishing the Three Trailblazing Hawaiian Nurses blog series from October 2022.
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.
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