Voices in Humanism

Nancy Smith, R.N.
Quality Improvement Coordinator, Ohio Reformatory for Women Physicians for Human Rights, OSU House Call Forum

“The Salt of the Earth”
“The salt of the earth” phrase has biblical origins that refer to the value of salt in those times as analogous to virtuous people. The message to the fishermen, shepherds, and laborers was that basic fundamental goodness is to be valued and that we are all of worth, not only the elevated classes.

The women receiving the COVID vaccine shots had tears in their eyes. They felt fortunate. “It gave me chills,” said Nurse Nancy Smith.

“They are so tired of being in quarantine having not seen their families in person for 10 months,” Nancy said. “I explained to them that the best and brightest in the world have given you this gift of the vaccine and that you are so brave to take it and help save millions of lives.”

The women Nancy is speaking of are the elderly inmates at the Ohio Reformatory for Women (ORW) in Marysville, Ohio, the first there to receive the vaccine. Their hospital treatment center is at Ohio State.

Nancy is also part of the ORW medical team, along with Warden Teri Baldauf, Warden’s Assistant Clara Golding-Kent, advisors, five inmates, and five released women who meet on a regular basis with the OSU medical students of the Physicians for Human Rights sub committee to discuss the health needs of incarcerated women. The group is called HOUSE CALL.

Nancy became a nurse in 1994 and has held a position at ORW for 24 years. She has moved up through the ranks at ORW to now being in charge of a mind boggling number of health related things, COVID being one of them, such as policies, standards, and resources, with the title, Quality Improvement Coordinator. “The staff calls me Google,” she said with a giggle. Nancy ‘knows the ropes.’

“When asked to join the OSU HOUSE CALL forums I thought that I did not need one more meeting to attend,” Nancy recalled. “But the forums have helped me to step outside my role and meet and listen to the medical students. It has such great value and it injects a sense of purpose into my work. It managed to invigorate my career.”

She is personally and professionally aware of what a toll the pandemic has taken. “We have a lot of resources for self-care but I can see it in the nurse’s eyes working those 12-16 hour shifts and dealing with PPE all day. Prison is not easy on a good day and with the pandemic it is a struggle. I know what is happening when a nurse goes to the bathroom and comes out with her eyes all red from crying.

Nancy credits the Ohio Department of Rehabilitation and Corrections Director Annette Chambers-Smith with her explicit instructions for immediate and expeditious inmate care when the pandemic struck, who ordered maximum clinical resources for the sickest people. Nancy said, “We restructured, eliminated what was not absolutely necessary, and made every appointment count.”

ORW, as of this writing, has had no fatalities in a prison population of about 2000. Across the other 26 Ohio prisons, there have been 132 deaths.

Nancy greatly appreciates OSU for their extraordinary expertise in saving a critically ill ORW COVID patient inmate.

“This inmate went to OSU, with multi organ failure and was in the ICU months. With the machines and skills of the technicians and nurses and physicians at OSU, she was saved. I was so afraid for her. We all worry over our patients when they are at the hospital from Warden Baldauf to the nurses on the floor. Covid took that worry to a much higher level” Nancy said. She also noted that before an ORW woman goes to the hospital a prison nurse must practice exemplary fine-tuned clinical skill and critical thinking skills.

“Being a nurse in a prison is almost like being a country doctor. You need to know about everything. Also, I’ve known some of these women for 20 years or so, and they trust me,” she said. Trust in sharing personal history by women inmates is a significant element, and can be a stumbling block, in their health care assessments and diagnoses. Without trust, many of the women develop feelings of being marginalized or have those already existing feelings magnified.

In addition, “Our nurses need to know all of the clinical fundamentals. We do EKG’s and draw blood. We cannot call another department for help. It is hands-on nursing at its finest. You have to be at the top of your game to be a nurse here,” Nancy said.

You also must possess compassion and perhaps, according to Nancy, the drive to serve in your DNA. Nancy grew up with both parents working in housekeeping at a hospital. Nancy was a “Candy Striper” and loved everything about the hospital environment, “with those white coated docs zooming by.”

For many of the inmates, prison has been their saving grace and as ORW Warden Baldauf often says, “We want the women to come out much healthier than when they came in.” As many women inmates report, “prison saved my life.”

Nancy recognizes the medicinal value of analyzing what the women have endured as part of their assessment. Reading some of their histories is sometimes so traumatic that Nancy needs to take a bit of time, drink a cup of tea, to recover from the horrors they endured and survived.

Some of the inmates have never had medical care. Nancy recalls one young woman in her mid 20s who will remain etched in her mind. “She came in with the complaint of vaginal bleeding. She appeared to be the picture of health in every way. This was a time when gang violence brought most of the women in, and now it is addiction. She was in tears, sobbing, and certain she had cancer and was dying. I asked about her menstrual history. Turns out she was the victim of human trafficking. Because of the stress, malnutrition, and the birth control pills she had been on from a young age, she had never had a period in her life. After six months in prison, her body had settled down and unbeknownst to her, her period began.”

When Nancy was considering taking a position at ORW, Ms. Mary Neal Miller, then the health care administrator, used that biblical reference regarding the “salt of the earth” to convince Nancy that we are called to add value to the world and to be a light to those who need it most. Nancy accepted the challenge.

“The first day on the job I was hooked,” said Nancy. “I am working at the best prison in the state. There is nothing like experiencing women’s health as we do here. God put me where I need to be. This is my place. This is my purpose.”

Patricia Wynn Brown
Writer and Performer
Medicine and the Arts Board
Author: ESSENTIAL STORIES: Medicine During COVID-19 and the Lives of Practitioners at The OSU Wexner Center