A Commitment for Two In September 2002, Brielle Jenson Stoyke's original contract with the CentraCare clinic was ending, and Philip Stoyke, M.D, her new husband of two months, was embarking on his own two-year National Health Service Corps (NHSC) commitment with the same clinic. Philip initially came to Long Prairie for his medical school rotation in a rural practice, having chosen the location "because it was the most rural of our options, and the residents who had served there before me had nothing but good things to say about it." There was no traffic and no worries of having his car stolen; plus, he would gain experience treating a much broader variety of medical issues than he would in a metropolitan area. The absence of ethnic restaurants and shopping are the downside he doesn't dwell on-hardly worth mentioning, he says, when he gets to work in a loving community alongside his partner and love of his life. Philip says he would have chosen to serve the Long Prairie community even if NHSC wasn't paying off some of his medical school loans. Loan repayment, however, has helped the young couple as they start their life together. Philip Stoyke plans on staying in Long Prairie for a long time, but it's not just up to him anymore. He notes: "My fate and Brielle's are tied together now." And Brielle doesn't have plans to call any place else home anytime soon.

A Nurse-Midwife's Labor of Love: A Letter From Rural Minnesota

For Brielle Jenson-Stoyke, women in labor have first dibs on her hours. There are unexpected night shifts, as well as 9-to-5 days of routine patient visits, including postpartum, prenatal, and annual clinical exams, followed sometimes by teaching prenatal classes in the evening. It's not unheard of, though, for a would-be lunch hour to become a noontime baby delivery. And on days when Stoyke is scheduled for some hard-earned relaxation at her lakeside home, or in her canoe, she can be interrupted by her cell phone's ring. "Then," says Stoyke, "I'll have to paddle back to shore-fast."

Her work at Long Prairie's CentraCare Clinic is a labor of love that has her feeling fulfilled and thankful. The National Health Service Corps (NHSC) Scholar recently wrote a telling letter to the NHSC about the demands and rewards of her work in the rural Minnesota health center. In pursuits both professional and personal, the 30-year-old clinician reports doing "pretty well" for herself.

[Below is an excerpt from Stoyke's letter to NHSC, describing the recent case of Jake, Iris, and their reluctant baby.] "Nothing's happening," husband Jake reported, "and my wife, Iris, has been in labor for 12 hours. This is our tenth child, and I've helped deliver the last nine at home, but it has never been this hard."

"Can you meet me at the hospital?" I asked.

"No, we really can't afford it. Isn't there something I can do here?" he pleaded.

I was just finishing with my morning clinic appointments a few hours later when Jake called again. "Iris is really tired and the contractions keep coming, but she hasn't dilated any farther." I convinced him to bring her in by promising we would try and keep the bill as low as we could.

I met them in the emergency room and Jake was right. By this time, she had been in labor almost 24 hours. Iris wanted to deliver the baby in bed, so we got her into position. Soon Jake and I could see the head crown. Iris was pushing hard. Less than a minute later, Iris and Jake met their healthy baby girl.

I have been a certified nurse-midwife (C.N.M.) for a year and a half in a rural Midwestern town. I joined Ruth Wingeier, also a C.N.M. who has been here since 1982. We share a practice in a town where the main employers are a printing company, meat packing plants, and many farms. In addition to farm families, we have a sizable Hispanic population and about 50 Amish families. That makes for diversity on clinic days.

I have had to learn Spanish. I have also learned to ask questions that I never asked during my training in the city. A dear friend, Susan Kroll, a C.N.M. who worked in the Long Prairie nurse-midwifery practice for 20 years, taught me to pay attention to the needs of farm wives. I never ask, "What kind of exercise do your get?" Instead I ask, "What kind of chores do you do?" and "When will you return to the barn after the baby is born?"

My partner, Ruth, had the vision that our hospital should get a birthing tub. It is now the most popular fixture in seven counties. The word has spread about how pleasant the process is, and women choose our hospital over others that may be closer to them. About 50-60 percent of our babies are now born under water. We use less medication, the births go smoother, and both parents seem to enjoy the process.

When I first started, the Hispanic women almost never used the birthing tub. The women we saw came from Mexico, and they felt that soaking in water during and after childbirth could lead to infections. Another difference that I noticed was that most of the Hispanic women we saw wanted the nurse-midwives to make the decisions. That has gradually changed. Even the use of the birthing tub has changed. One Hispanic mom who was new to the United States was willing to try it and she just loved it. She must have told her family and friends because now more of our Hispanic patients are willing to give it a try.

I also have had to polish up my rusty German because I do home health care visits with the Amish families in our area. And while the older Amish people speak English, the children only speak German until they go to school and start learning English.

The first winter I drove out to see an Amish family, I arrived at their driveway and realized they didn't have to plow the quarter-mile long stretch to the house for their horses. So I had to drive home to get a pair of boots in order to walk through the deep snow. In another Amish household, I was about to launch into an explanation about how to use a breast pump when I realized I only brought along the one that required electricity. Oops!

This is the three-quarter mark of my National Health Service Corps appointment, and I can truly say thank you. Thank you for the opportunity to serve in a rural area. Thank you for the chance to grow as a person and in my profession. Thank you for giving me the chance to give to others.

I have another thank you as well. Last April, a family practice resident, Philip Stoyke, arrived at our hospital for his two-month rotation in a rural setting. By May, we were dating and by August, we were engaged. Now, as I write this message to you, he has just decided to join me in the Long Prairie clinic as a family practice physician.

So, thank you, National Health Service Corps. Thanks for everything I have learned. Thanks for the barn dances and the hayrides and the picnics on the back forty. Thank you for the tears and the hugs. Thanks for the soon-to-be-husband.

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