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Show Must all good thing come to an end1' Although (lie phra.se is a well worn lltche, its words fit the diqurtiirc from Tooele of Dr. David Carr and w ife IVb-ti- e Williamson. Tlie couple is leaving their practice with the Family Practice Group where Dr. Garr has lieen one of the physician since the group moved into its own building in 1975. Debbie, a certified nurse midwife, has headed the groups midwife program for the past four sear. In the short six sears since the Garr came to Tooele, they have lieen pari of some exciting new changes in health care provision in the community. During that six years, the Garr and their philosophy of health care have touched many lives. Although other physicians and a midwife will fill the positions left vacant by their leaving, this unusual couple have made a permanent niche for themselves in the history of health care in the community. They will tie missed by patients and friends. If Tooele will miss the Garrs, the Cam will miss Tooele. . . Teacher Debbie will lie teaching in the nurse midwifery program at the University of Colorado. This is only the second year of the project, and she sees it as an opportunity to help develop this program. As her duties call for teaching and working with the department of olistetrics and gynecology only 50 percent of the time, Debbie will also lie able to spend time practicing midwifery at Bose Hospital. She will lie working along with eight other midwives. The midwifery program will continue at Tooeles Family Practice group. Having a baby under the program has become the in thing to do, Debbie said, and the county feels it is important enough to continue. Right now there are only 2,000 certified midwives in the country. There are more positions than there are qualified nurses to fill them. Everyone who is licensed is working, she said. According to Debbie, there are only 23 schools offering nurse midwife degrees; it has become the most sought after program in nursing schools. The prospect of lieing in on the ground floor holds excitement and promise for Debbie. "The opportunity looked like a logical step," said Debbie. Having lieen in the vanguard of practicing midwives, she will now continue that rule in helping the practice to grow in this country. Training Residents Dr. Garr will lie teaching at Mercy Medical Center training residents in the specialty of family medicine. These will lie doctors who have finished medical schixil. Teaching doctors in the art of providing health care for families will not lie a new experience for Dr. Garr. He has been a part time member of the University of Utah faculty. He enjoys teaching. However, teaching will not leave much time for actual practice. "I know Im going to miss doing the amount of practice Ive had here in Tooele, he said, "hopefully the work 111 be doing in training family doctors will offset the sense of loss. Family practice became a specialty in 1967 Dr. Carr pointed out. There is a difference between the training of the general practitioner and that of the family doctor. General practitioners are most often trained in hospitals, taking care of people with all kinds of serious medical problems. The emphasis of the family doctor's training is on how to care for folks in the outpatient setting. There is emphasis on a lot of issues that people encounter and the effect it has on the family and its well being, he pointed out. The Family Practice Croup specialises in education and preventative medicine. "YVe try to keep people out of hospitals, Dr. Carr said. For example, in the past, everyone who had diabetes was put in the hospital to learn how to adjust to taking insulin. Nowadays, we rarely put them in a hospital to get them on insulin. We try not to make them feel sick lying around. Our training gives us some tools to help people choose the hospital only when the problem cant be managed on an outpatient basis. Birthing Centers The same concept carries over into the midwifery program. "There is a whole movement toward shorter stays in hospitals should such care become neces- sary, Debbie said. More and more health care provider offer places like birthing centers in which a mother may give birth and go home in six to twelve hour. . Caring for people outside of hospitals one way of managing health care in the most inexpensive way one of the aims of family doctors, Garr said. Since 1969 more and more medical students have become interested in becoming family doctors with its emphasis on community medicine. Board certified family doctors mast pass a special exam and meet certain requirements one of which may be a three year residency after they finish medical school. Dr. Garr is looking forward to being involved in teaching these relatively new concepts. I know I can do it, he said, and added, My main concern now is that it is going to lie difficult to leave the families Ive been working with here in is Tooele. When Debbie first received a letter from the University of Colorado offering her a position on the faculty, she didn't pay much attention; she dropped it into the waste basket. Later there was a phone call. It came at an opportune moment after she had been up all night fol- lowing an extra long day at work. Sounded Good At that m'oment the whole idea sounded good, and she agreed to go to Denver to take a look. As the only female health provider in the county, Debbie frequently gets calls on nights when she is not on call. It is difficult for her to say no to people. have an influence on the exciting changes, as a member of the faculty of the University of Colorado. Frequently to her detriment, said Dr. Garr. Debbie was quick to say that, although she often becomes exhausted, she loves her work. Often it is easier for women to talk to another woman about female problems. Teenagers especially seem to feel more confident. Debbie has worked with many teenagers. They are the group that needs the most support not only through pregnancy but beyond, she said. In the midwifery program the emphasis is placed on teaching and making the birth a shared experience for family members. It is better healthwise to start prenatal care to help avoid problems that might come up later on, Debbie pointed out. For instance, many have cut down or cut out smoking when they learned its possible effects. Patients are given information on psychological changes that come about as well as the physical changes. Fathers are encouraged to come to the 6 weeks of prenatal classes which include training in the LaMaze techniques, a relaxation type of breathing which helps the birth process whether the patient elects to use medication or not. Midwives handle only normal births, Debbie said. If there are any complications during the prenatal period or during the labor or delivery, a family physician is called in. Some patients elect to alternate between the midwife and their regular doctor. Changes The couple feels pleased about the changes that have come about since the inception of the Family Practice Group changes that did not happen .overnight according to Dr. Garr. Weve been successful at extending and improving the range of services we can provide, the doctor said. He said there are a lot more O.B. patients coming now. They have more opportunity to say what they want such as the length of stay in the hospital. Women can labor and deliver in the same room. We now have family centered maternity care. Studies are being done to see if there is less rivalry among siblings with this type of shared experience. Although the Famiy Practice Group started out as a group of family doctors (which still comprise the nucleus of the organization), other physicians have been added to broaden services, but the whole movement is still toward strengthening family relationships. Dr. Garr said. The exciting thing about this particular hospital, said Debbie, is that people are learning that things in large quantity dont always turn out as well. There is a movement toward decentralization, putting things in smaller units. There has been real progress in health care in the community, Dr. Garr said. He added that he has been really impressed with the interest people have shown in how to stay well. They have really taken advantage of health education. Not every community has a full time health educator. Debbie has done a lot of work in the school system, and all physicians have been involved in teaching courses and giving talks. Challenging Leaving all this behind and moving to Colorado is challenging for the couple, but the Garrs are used to challenges. We grew up in the 60s and went to school during the Great Society under Presidents Kennedy and Johnson, Dr. Garr said. We ended up remaining very idealistic. The Garrs share an interest in helping people get the care they need. David Garr grew up in Miami. A doctor was the only thing I ever wanted to be. Unlike other little kids, I never had any fantasies, he laughed. He went to medical school at Duke University in North Carolina, and filled his residency in Rochester, New York, in family practice. Debbie grew up in Savannah, Georgia and completed her nursing at Duke University. While working at a neighborhood health center in Rochester, she met a British midwife. I decided that was it for me, Debbie said. She was accepted at John Hopkins. David Garr and Debbie Williamson met at a poor peoples clinic in North Carolina. They were drawn together by their mutual interest in people, and medicine. The couple came to Tooele in 1975, Dave to practice as a family doctor, and Debbie to complete graduate work at the University of Utah, which at that time had the only nurse midwifery program in the west. Loves Tooele Debbie said she has qualms about moving to a big city. We love Tooele, and have really enjoyed working with all the people here, she said. It has been the perfect atmosphere for the midwifery program. The community is concerned about the family and children. People have been very supportive, she added. Both of us have an interest in rural health care in Utah as well as outside of Utah, Dr. Garr said. I suspect that some of those interests will have us end up in coming back to Tooele and Utah for meetings and trips. Future plans for the Garrs are fo- cused on going into developing countries to train nurse midwives and family doctors where they are in much greater need than here. They report to their new positions on Oct. 1. In the meantime, the couple will be enjoying a sort of postmans holiday in England where Debbies brother is being married. Debbie will also be attending an International Congress in Midwives, and Dr. Garr will be working with a physician who is director of train- ing programs for family doctors in Manchester, England. Britain has a whole system based on family physicians and midwives. It will be interesting to see how it all fits together, Debbie said. In the meantime, here in Tooele, we will be trying to fit the pieces together again now that the Garrs are gone. |
