This month's cover photo and the image above feature the remarkable nurse-and mother-Lillian Carter, when she was a Peace Corps volunteer in India in the 1960s. She is the subject of President Jimmy Carter's latest book, A Remarkable Mother (Simon and Schuster, 2008). Her work as a nurse figures strongly in his tribute to his mother, as it did in their lives.
Born in Chattahoochee County, Georgia, in 1898, Bessie Lillian Gordy was the fourth of nine children in a family that sometimes struggled to make ends meet. She moved to Plains, Georgia, when she was 19 to attend the Wise Sanitarium's nurse training program.
In the 1930s and 40s segregation was formally institutionalized in the United States when the Supreme Court upheld the "separate but equal" doctrine. Miss Lillian refused to embrace that convention. After marrying James Earl Carter, Sr., and becoming an RN, she worked in the operating room at Wise Sanitarium in Plains, Georgia, where she was held in high esteem as a nurse. When she had children and her husband became more affluent, she went to work as a private duty nurse in people's homes-black people's homes. If the patient was the mother of the house, Miss Lillian took over the responsibilities of cooking, cleaning, and getting the children off to school. She worked 20-hour days for $6 a day. But most of her patients were too poor to pay her with money. Instead they gave her eggs, chickens, hogs, firewood, and other goods that she and her family could use.
President Carter spoke with me about his mother in June. "We knew the families with whom she was spending 20 hours a day," he said. "Mother was immersed totally in their culture and life and saw their worth as human beings, [even though they] were scorned or denigrated[horizontal ellipsis]. She talked to all of us children about nursing. When I was growing up, she had to explain to us the reason for her long absences, and she would give sometimes an emotional presentation of what she felt was her life's calling-to serve other people.
"She would come home at night after we were in bed at 10," he recalled. "She only had four hours off each day, and she would go back on duty at two in the morning. She would come home and wash her clothes and uniform [horizontal ellipsis] and would leave a note in the front room on a black desk [telling us] what she expected us to do the next day-sweep the floor, feed the chickens, bring in stove wood, chores. And sometimes we'd go a week or so without seeing our mama. So she had to explain a basic philosophy of life that was alien to children-why she was gone and why she was working without pay."
Decades later when she was in her late 60s, Lillian Carter joined the Peace Corps and was assigned to Vikhroli, India, an industrial town near Mumbai that was owned by the Godrej family, one of the country's wealthiest. Prime Minister Indira Ghandi had started a family-planning program, and the Godrejs offered Vikhroli as a test of the most stringent application of the program. Lilly, as she was known in India, was to teach women about contraception and men about vasectomy. She hated the work, having an "aversion to the strict family-planning regimen," as President Carter writes in his book.
In her off-duty hours, she found solace in volunteering for a clinic that served the factory workers. President Carter told me that the physician, Ghanshyam Bhatia, initially treated her in a demeaning manner. "Mother was assigned to deal with those workers who were considered untouchables; Mother was considered an untouchable, too, because she dealt with human feces and blood and things of that kind, she took care of her own cooking, and she washed pots and she mopped floors. It was only when Hubert Humphrey came over there that Mrs. Godrej came to Mama and said, 'So, Lilly, who the hell are you anyway?'" As vice president of the United States, Humphrey was the most famous American in India at the time; he had met Jimmy Carter and made it a point to ask about how his mother was faring.
Lillian Carter understood that social justice is the key to greatness in nursing practice. She had the strength of character that allowed her to defy conventions in the United States and in India. For example, when she went to the home of a Hindu couple, the woman prepared tea for Lilly and the husband, but Lilly refused to drink the tea without the woman. For the first time, the husband and wife had tea together and vowed to continue to eat together unless someone else was around. President Carter described his mother as "tough," with "an extraordinary degree of self-confidence and ambition. She never hesitated to use her influence to accomplish whatever goal she had in mind. She wasn't timid at all."
In recent months, whenever I have seen or heard him in interviews as he promotes his book, he has talked proudly of his mother's work as a nurse. "Part of my reason for being proud of my mother is that she was a nurse," he told me. "The Carter Center and I personally are dealing directly with nursing every day." Of his own life, he said: "We understood from the beginning that Mother was dedicated to nursing as a life obligation to help other people who were in need and she never considered it to be a sacrifice. She always considered it to be a source of gratification and pride that she was able to do it."
He is carrying on his mother's legacy by dedicating the Lillian Carter Center for International Nursing at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta and by coleading a conference on the global nursing shortage with United Nations secretary-general Ban Ki-moon. As "Lilly" would have wanted, the conference included discussions of the challenges poor countries face in retaining nurses being recruited to address nursing shortages in wealthy nations. And he proudly described to me a program he started in Ethiopia for the training of thousands of caregivers, including nurses, and that's headed by a nurse from the school of nursing at Emory. He also spoke of his wife's organization, the Rosalyn Carter Institute for Caregiving at Georgia Southwestern State University, which focuses on supporting caregivers, and how important nurses are to the institute's mission.
When I asked President Carter what message he had for today's nurses, he spoke of the importance of the contributions that nurses can make "to the most destitute and deprived and suffering and hopeless and fearful people on earth-and that involves not only the care that a nurse can give to a mother who sees her children starving to death[horizontal ellipsis]. The intimacy with which nurses deal with those deprived and desperate people is unique." Lillian Carter was just such a nurse.
Diana J. Mason, PhD, RN, FAAN, editor-in-chief