She may never know the impact she has had on health care in America. Her name is Gulina Brown; and, when she sought care for the pregnancy and delivery of her fourth child, Peter Christopher, she received that care directly from a nurse-midwifery student who is now reflecting on that experience. One would like to believe that Ms. Brown was not sensing the nervousness of the student, that she was not amused or annoyed by the compulsive thoroughness of this novice, or that she was not at all concerned about the student's inexperience. But, she most likely was. She had been here before. She was a woman using the public health care system, and she knew that along with this system came the trainees and the novices. Yet, she never expressed concern. She was patient with the apprentice's deliberateness; she was friendly in their interactions; and most effectively, she showed confidence in the ability of this novice to assist her in the care of herself and her baby. This student may have been helping her in some way, but more to the point, she was teaching the learner. She was, in the process of having her fourth child, actually giving birth twice—once to the newest member of her family and once to a young nurse-midwife about to launch into a career.

Ms. Brown is one of the thousands of individuals in the United States who each year have their health care delivered by a sea of novices. Whether it is nurse-midwifery students, junior surgical residents, medical-surgical nursing students, or third-year medical students, there are many individuals training for the health care professions who would not have a career were it not for Gulina Brown and people who, like her, willingly, or in many cases unknowingly, receive their care from those just starting in their careers. People receiving health care within the public system are, for the most part, the source of experience for professionals in training.

Certainly, this health care educational system is a two-way street. The people who receive care within this structure are for the most part receiving free care, and, arguably, some of the best care this world has to offer. At the same time, however, they are offering much to this system. They are the foundation on which health care in America stands. Yet, the credit they receive or the acknowledgment they garner is minimal. Indeed, these individuals are often criticized, admonished, or categorized, with expressions such as “welfare person” or “clinic patient” being tossed around with little thought to the implications of these labels. The respect and gratitude that clients in the public health care system should receive for their role in health care delivery in the United States seldom has been recognized or offered.

There are many issues that could arise from this reflection. When medical students are introduced as “Doctor So-and-So,” is that informed consent for the client receiving care? When whole clinic populations are enlisted into research studies without individual solicitations of consent, is that ethical? And when beginning practitioners take their first jobs in public health care systems so that they can gain the experience they perceive to be necessary before opening a private practice, is this fair and equal distribution of health care across society? Certainly, these questions need to be addressed; but answering them is less a tribute to those receiving public health care in America and more a critical assessment of the system as it currently exists. No matter what the structure, health care professionals need to reflect on those individuals upon whose collective back rests the system of health care delivery in America, and we need to respect and thank them for their contributions.

So thank you, Gulina Brown. I was the student who had the honor and pleasure to work with you and learn from you. Thank you for believing in me, for trusting me, for training me, and for doing this with so much on the line—the health of you and your baby. As we re-examine health care in this country, I can only hope that among the voices of political lobbyists, insurance and pharmaceutical companies, medical societies, nurses' associations, and the hospital industry, we hear your voice and the voices of those like you on whom so much of health care relies. For without you, midwifery care in America—indeed, health care in America—would not be recognized for all of the accomplishments in caring for others that have occurred.

Unlike the recipients of many editorial tributes, Gulina Brown is not being eulogized, but is very alive and quite well. She remains one of the individuals 1 respect most in the world. As is true with most midwives recalling their first few attended births, I will never forget Gulina and the experience we shared together. I could have had no better teacher. Today, she is the hard-working mother of six children and the grandmother of one. Her fourth child, Peter, is in school and doing great. Now that is the public health care system and nurse-midwifery education at their best.


  1. Acknowledgment is extended to Ms. Brown for granting permission to use her name for this writing and for all of the assistance that she has offered.