Mary Burman: Passion And Dedication To Make A Difference In Healthcare

mary-burman

Mary Burman grew up in Laramie, Wyoming.

She earned a masters degree in Public Health and a doctoral degree in Nursing Science before returning to her home state to teach at the University of Wyoming.

Mary served on the advisory board of Albany County Public Health and has now retired from her role as a professor of nursing and family nurse practitioner.

She discusses why she works in preventative health, how to remove gender bias from healthcare, and the value of individual and societal policy intervention.

Emy: 00:08 Welcome to First, but Last brought to you by the Wyoming Humanities. I am your host, Emy diGrappa. Wyoming is called the equality state, because we were the first to give women the right to vote. 150 years later, we wonder what wailing women think about the progress towards equality now. Let's find out and thank you for listening. Today, we are talking to Mary Burman. She is a retired professor of nursing from the University of Wyoming. Welcome Mary.

Mary Burman: 00:44 Good to be here.

Emy: 00:45 I love having you. And I was just so intrigued because what we were just talking about, but the fact that you're retired nursing and just the whole realm of nursing is so intriguing anyway, because there's so many facets of it. But first, before we get started on that, tell me where you grew up.

Mary Burman: 01:05 I grew up in Laramie, Wyoming. I'm one the...

Emy: 01:08 What?

Mary Burman: 01:08 Yes. I'm a rare native. There's about five generations of Burmans that have been hanging around Wyoming. My great-grandfather was a Swedish immigrant farming in Nebraska, but I don't think dry land farming was all that financially lucrative. So he started coming and working part of the time on Union Pacific in Laramie. And then my grandfather ended up at the UPs Thai plant and worked there until he retired. Then my father was a professor at UW in engineering, and then me, and then my daughter is a graduate student at UW. So there've been about five generations of Burmans hanging around Wyoming. So I w- I was born in the old Evanson Hospital, which is now gone. It was torn down. I've had sort of a sense of loss ever since. (laughs).

Emy: 01:53 Wow, that is so fantastic. And, and you're right. Five generations, in Wyoming. Is probably the time when you can actually say you're a Wyomingite.

Mary Burman: 02:06 I think so. I think so.

Emy: 02:07 (laughs).

Mary Burman: 02:08 I can make the case that I, I am a true Wyomingite. (laughs).

Emy: 02:10 Yeah. I know. Cause a lot of people want to say that, but nope, you can't, unless you're just like born and raised in Wyoming, you can't say that.

Mary Burman: 02:21 It's in my blood. Yup.

Emy: 02:22 Good. I'm glad to hear that. So tell me about your, your journey into nursing and why was that important to you? How did you enter into the healthcare field?

Mary Burman: 02:32 Well, and, and this is going to sound sort of funny to say, because I've dedicated my career to it, but I think I sort of came into nursing sort of by accident. You know, when I was in high school, I didn't have a clue what I wanted to do. And my senior year, I signed up for this course, it was something, and I don't, I won't get the name quite right, but it was some sort of a health professions course. And you took the course and you spent part of the time working at the hospital. And I think we spent some time at the nursing home, and at the end of it were a CNA. So that summer I took a class and worked as a CNA and I liked it.

Mary Burman: 03:05 And so I just sorta decided, well, I'll just go into nursing. Now, had I thought more about it, you know, a lot of people will tell me, oh, they've known that they wanted to be a nurse since they were five years old or something. I just sort of fell into it to be quite honest with you. And it seems funny again, I've dedicated my career to it, but I'd love to tell some great story about how, you know, my mother became very ill and I helped take care of her or some lovely, wonderful story. No, I completely fell into it. That's, that's about all there was to say. And then once you get into that sort of field, you sort of stick with it. And, uh, and it was a very satisfying career on top of it as well, but I, I don't have a great story to tell. (laughs).

Emy: 03:45 No, but it sounds like you fell into it, but then you also fell in love with it.

Mary Burman: 03:50 No, it, it really became a part of who I am, caring for others, figuring out how to get access to care, figuring out how to educate really good nurses to provide that care, absolutely became the focus of my career here in Laramie and other places as well.

Emy: 04:08 Did you work in a hospital? Did you work in the emergency care? How did you get your training? Like what, what... Besides getting your nursing degree, what, what else did you do?

Mary Burman: 04:19 Yeah. So when I get out of nursing school, I worked in a hospital. Primarily I did a little bit of work in home health care, but mostly in the hospital setting. And it's interesting because I worked in critical care, which I loved. It's a very satisfying part of nursing. But you know, what, what really... I began to be uncomfortable with it because you realize there's a whole other side of this. Why? There's a, there's this metaphor about in healthcare that what we tend to do is pick up people who've been falling in the river, you know, three or four miles up the river, we're down at the bottom of the river pulling people out of the water so they don't drown.

Mary Burman: 04:53 And it becomes this idea about, well, why don't we go to the top of the river and stop these people from falling in the river so we don't have to pull them out down the river. And I, I loved critical care. I absolutely did. But you begin to have this uncomfortable sense of we're seeing these people who end up in the critical care unit, who we could have done something before to prevent them from ending up in the critical care unit, very, very ill and often in some cases dying. So I became more and more interested in public health and primary care.

Mary Burman: 05:23 And so after, I'd have to think back, but probably three or four years working in critical care units, I went back and got my master's degree and focused on public health and eventually got my doctoral degree and then came back to UW as a faculty member, um, and have focused on really primary care and public health in my career. I'm a family nurse practitioner on top of being a nurse, so I did a lot of primary care, was on the advisory board of Albany County Public Health.

Mary Burman: 05:50 So really focused on this idea of getting to the top of the river and trying to prevent people from falling in river rather than being at the bottom of the river, pulling people out. And the reality is of course you need both, but what felt more comfortable to me was be at the top of the river, um, with more of a prevention framework in mind.

Emy: 06:08 So critical care is, is that different than going to the emergency room?

Mary Burman: 06:14 Yeah. So these would be intensive care units.

Emy: 06:16 Mm-hmm (affirmative).

Mary Burman: 06:18 I've been in cardiovascular intensive care unit for quite a while. I worked in a general intensive care unit in Minneapolis. So these are places, the kind of clients that end up in those, uh, sort of settings are someone with a, who's having a heart attack for example.

Emy: 06:31 Uh-huh (affirmative).

Mary Burman: 06:31 Someone who's in cardiovascular surgery, somebody who's got terrible, terrible pneumonia and some liver failure and some renal failure. So these are very, very sick patients who are admitted to the hospital.

Emy: 06:44 Okay. So that's interesting your analogy about being upriver and downriver and what are the things that could be different if you were, you know, had a magic healthcare wand (laughs) and you could change things for people so that they're not at the bottom pulling them out, but you're there at the top, helping them figure stuff out.

Mary Burman: 07:08 Right. And if you think about it from a public health framework, we certainly can work with individuals. So probably one of the most classic things is to think about smoking. We know that smoking is a risk factor in a variety of things, not just lung cancer, but cardiovascular disease. So at an individual level, getting people to stop smoking becomes important. But if you put that in a public health context, there's also a systematic side of that too. There's changing the system or how we structure society so that we decrease smoking in a different way. So this is how things around, you know, again, not allowing children to buy cigarettes become important.

Mary Burman: 07:48 You, that's not an individual behavior, that's a societal mechanism to try and decrease exposure of children to smoking, for example. Looking at things, this is where legislation across, and ordinances across much of the country have resulted in things like you can't smoke. The University of Wyoming is one of those. You cannot smoke on the University of Wyoming property. So from a public health prevention framework, you look at the individual, but you also then look at society, and how can we through policy, through changes... One, and another really good example is thinking about exercise.

Mary Burman: 08:22 We know that a lot of people don't exercise because they don't feel safe. My brother used to live in Knoxville, Tennessee, and in his, the original neighborhood he moved into, there were no sidewalks anywhere. And the street was an old, probably an old street that had come out of the city into the country and was a farm road initially. Now it was a busy city, street in town. There wasn't a single sidewalk on it. I w- I wouldn't have walked on that street. So it's things like that where we change the environment in order to help people feel safe so that they then can can exercise. So if that makes sense, it's this idea of individual intervention, as well as a systematic structural society policy kind of intervention as well then.

Emy: 09:02 What did you learn becoming a professor at UW and working with students and, and helping them? Is everybody just born with an empathetic heart? Is this something you developed in order to help people? I mean, I hate getting shots, so I, I always think I would be a terrible nurse. I would be terrible. Like just the sight of blood, I'd be the one on the ground fainted. I mean, how do you develop the, dealing with all these different conditions?

Mary Burman: 09:35 Well, I think there are going to be some people who naturally, I mean, that's just life. Some people engineering's going to appeal to somebody else's construction. There are those who I think the desire to care for people, whether it's as a nurse or in other health professions is very, very strong. Some of it probably is innate. Some of it clearly is things that you can learn. I think I, the thing I would say about nursing is that nursing is very broad. So yeah, if you're a critical care nurse, you are inserting needles into people, putting tubes down people's nose, but let's step back a bit because if you think about from a public health perspective, public health nurses, aren't doing that.

Mary Burman: 10:15 They're actually working in the community. They're looking at ways again, if, if exercise is an issue, they're looking at ways that they could potentially restructure things in a community to get people out exercising. So they're not even, they're not sticking needles in anybody like that, or looking at blood. Psych mental health nursing, for example, a much, much, much needed area of health professions that we need in Wyoming. They're focused on something very, very different in terms of medication management, counseling, group work, things like that. So nursing is pretty broad. You don't actually, if you have an inclination to care for people, you don't, it doesn't have to be in the context of a hospital. It can be very different and very, very satisfying in a lot of ways.

Emy: 10:57 There's lots of ways to be a nurse.

Mary Burman: 10:59 Exactly. Some of which are the sort of stereotypical notion of being a nurse.

Emy: 11:03 Right.

Mary Burman: 11:04 Again, you're drawing somebody's blood or, you know, giving them a shot. And even in that context, that's not the core of nursing. It's not the tasks that you do, it's the critical thinking. It's the caring and that combination that you bring to that patient that is the core of nursing.

Emy: 11:20 Mm-hmm (affirmative).

Mary Burman: 11:21 The task happened to go with it, 'cause that's what you need to do to help that patient. But it's really how you think through this, how you bring in the family, how you connect pathophysiology and pharmacology within a context of caring. So that's really the core, not the tasks that we do in nursing.

Emy: 11:38 Well, how have you seen nursing change? Because I don't know if it's true, but just, and thinking about nurses, I've always thought nurses as females and have you seen a real big gender change in, in nurses?

Mary Burman: 11:54 It's happening. So if you think historically about nursing, it was a lot of women and, and very much to be honest with you, given the times it was white women. This is not just true of nursing, it was true of a number of healthcare professions. We have a, a history we've had to reckon with in which we didn't allow even women of color to come into the profession. That's why there were schools set up very separately for black women to become nurses, for example. So we've had to reckon, and again, this is not just nursing, this is true of other health professions. We've had to reckon with our own history along those lines.

Mary Burman: 12:29 But traditionally over time, if you think way back to Florence Nightingale, the traditional nurse was a woman who had a sense of caring, who then in Florence Nightingale's world, you gave this additional knowledge to. So it wasn't just, it wasn't just being a woman that was important, but it was also then this ability to think, to provide care, to be what became over time a professional nurse. But that's changing in fact at UW when I retired, we were now running 10% to 12% of our students being male up significantly from what it was. And you see that across the country, nursing is a profession that offers so many opportunities to people, and I think men are realizing that part of it.

Mary Burman: 13:12 And so you see the ranks of men going up significantly. The good news is we've also, again, reckoned with our past. It's not that we're probably there completely, but we've certainly reckoned with our past. And you see the number of women of color and men of color coming into nursing going up significantly as well. And so we've diversified a lot. That's one thing I'm really pleased to see, because I think you don't need to be a woman to be in nursing. Men are perfectly capable of those same sort of caring instincts combined with, again, that ability to critically think, to pull together knowledge about pharmacology pathophysiology, and do that within a caring context, just as well as women are.

Mary Burman: 13:53 So we're really seeing that changing. And I, for one I'm pleased to see it, because I think this is sort of an aside, but I think it's important because we, if you think about women, we know in Wyoming, we have a huge wage gap and women earn much, much less. And one of the things that we've talked about in, in responding to that is to get women to go into professions like engineering or construction, or working in one of the coal mines. Although that's becoming a little bit problematic now as our economy changes, but, but we've encouraged women to go in what were traditionally male areas of occupation. And that's good.

Mary Burman: 14:27 I don't have any problem with that. And these were typically areas where women then made more money, which is also good. But I think what we forget then is that there are a lot of things and certified nursing assistant. So these are the aides that take care of patients often in nursing homes, particularly in, also at home as well. And so we say, well, these are jobs in which an CNA would make maybe $15 an hour. That's probably a good average wage. That's not very much, if you think about a plumber who might be making $26, $27, it tells you a bit about our priorities and how we value work.

Mary Burman: 15:00 But if we encourage women to go into these, what have been traditionally male professions, that's fine, except for, we still have to have a workforce that's in these areas like nursing, teaching, CNA, certified nursing assistants. So the ability to make those fields attractive to all people, whether you're a male or a female becomes really, really important. Again, going back to CNAs, we de-value that work. These are people who work with our family members, our friends, our neighbors in really the most vulnerable times of their life and in the most intimate ways, bathing and feeding that loved one.

Mary Burman: 15:40 And yet we devalue that work. And now we tell women, well, don't go into, don't become a CNA, go be a truck driver, or why don't you do the prerequisites to go into engineering. And again, there's nothing wrong with that. But at a societal level, we have to address the fact that we need CNAs. We need to value that work, and we need to make them something that is appealing to all kinds of people, not just women, if that makes sense.

Emy: 16:05 Well, it does because I, and I still think there is the stigma that if someone says, well, I want to be a nurse, the next question is, well, why don't you want to be a doctor?

Mary Burman: 16:16 Exactly. Right. And I will be frank with you, there are vestiges of our history still present in nursing. So when you think about in the late 1800s, early 1900s as nursing became much more prominent was on this early stages of becoming a profession-

Emy: 16:32 Mm-hmm (affirmative).

Mary Burman: 16:33 ... the gender bias was stunning. I mean, you know, noted physicians would say things like, well, we don't need to teach those nurses anything about anatomy and physiology, they don't need to know. What, they're women anyway and they won't understand it. Again, that's a hundred years ago, but what, what started out in some respects as profound gender bias in a time when that was a societaly prominent, I mean, that we thought about women that way in general, not just in terms of nursing, those got built into hierarchical structures that are still relevant and here today. So when people think about, oh my goodness, we need to understand about the pandemic, we better go talk to a doctor.

Mary Burman: 17:12 There's nothing wrong with that, but there's a whole other group of health professions, nurses, pharmacists, in this case of COVID-19 respiratory therapists who actually know a heck of a lot too. And we don't, we don't think of them that same way, because of course, it's the doctors who were prominent all along hegemonic by the words of some people. That structure remains in place. I think in a lot of ways it's being torn down and that there's a lot of changes in nursing. Nurses are now in much more prominent administrative roles and, within hospitals. We have CEOs across the State of Wyoming who are nurses, whose background is in nursing.

Emy: 17:51 Mm-hmm (affirmative).

Mary Burman: 17:52 So you see that changing, but it is hard. Those what got started in a time of a lot of gender bias and got embedded into healthcare, it's difficult to get that removed from healthcare. We still have a lot of vestiges of our history 100 years ago.

Emy: 18:08 Well, and it always is interesting to me because my grandmother was one of the women... Well, and my great-grandmother, you know, because living out on a farm in rural America, the women were the ones who delivered babies.

Mary Burman: 18:24 Yeah. Oh yes. Midwives.

Emy: 18:26 Yeah. And that's what they did. They, they did everything a doctor could or would do.

Mary Burman: 18:33 Mm-hmm (affirmative).

Emy: 18:34 And they knew how to do it. And there was no stigma or whatever with that. But I just think that's really interesting how we entrusted women to deliver our babies, but in these other ways, we didn't give them that same reputation.

Mary Burman: 18:52 Right. And again, this idea that women really weren't smart enough to understand, that's not true at all. You look at modern nursing now, nurses have very sophisticated knowledge of pathophysiology, pharmacology, and are able then to combine that within the context of wherever they work in terms of caring, for example, where that's a hospital or a nursing home or something like that. But that got baked into our, the way we thought about nurses. Well, they, you know, they're just not really smart enough. They really don't know. They don't need to know that stuff. And that's not true. I remember a parent calling me who was concerned because her, her daughter did not get into nursing school.

Mary Burman: 19:28 The daughter did have some, I think academic challenges, but the mother said, "Well, I don't understand why on earth a nurse needs to know about math." Well, there's a lot of good reasons nurses need to know about math (laughs). And I talked to her about that. I, you know, I basically said in a, in nice way. I said, "Nursing is so much more." If I have a critically ill patient laying in a bed, it's not enough for me to hold my hand and watch them die. I have to make significant judgements. What's going on here? Do I need to titrate a medication so that, 'cause this person's blood pressure is dropping.

Mary Burman: 20:01 So yes, I have to be caring and I have to want that, you know, reach out and hold that person's hand and reassure that family member. But I have to make very astute judgment calls based on that person's treatment, their physical status at that time. Is this serious enough I need to call the team in because this is a person that's really, really very sick and I've got to call my team in to help address that person's need. Do I need again to titrate a medication? Do I need to call for something new? This is a new onset of something and we've got to now look at it differently.

Mary Burman: 20:31 You can't just care. There is a sophisticated set of knowledge and then critical thinking that go. And that's the core of nursing, that combination of critical thinking and caring and, and sophisticated knowledge that make a nurse.

Emy: 20:45 Well, I, I know you're retired, but you're serving in many ways still in Laramie. You're in the hospital board or what?

Mary Burman: 20:54 I'm on the board of directors of Ivinson Memorial Hospital. Yes.

Emy: 20:57 So how, how has COVID-19 changed healthcare in Wyoming?

Mary Burman: 21:03 You know, the first thing I would say, which I, 'cause I think it's so important to emphasize this piece of it, COVID-19 so much brought out the dysfunction in our healthcare system. And I can't emphasize that enough.

Emy: 21:18 Mm-hmm (affirmative).

Mary Burman: 21:19 The fact that we leave a certain portion of the population without insurance. So y- you just see that when you look at COVID-19, the problem with that. The fact that we've tied insurance to employment at a time in which people are losing employment, the way we have structured our healthcare system is broken, it doesn't work in a pandemic. And in many ways we're paying the price of that. We've been lucky in Laramie we've been able to maintain COVID rates at a fairly low level. We've been, we've not gotten to the point in which it overwhelmed our hospital. I'm also on the board of the downtown clinic, which is a free clinic here in Laramie.

Mary Burman: 21:57 We were able to quickly move into a tele-health mode. So in some ways we've been able to preserve our services and not get to the point of being overwhelmed, like other parts of the country, but it still shows the humongous gaps in our country. And these are significant for women. As we already talked, women tend to earn lower wages. They, because of family responsibilities often work part-time or have intermittent employment. They may have worked for a while, then left the workforce and then come back in again. So it creates huge challenges in terms of healthcare. Their insurance may come through a husband and if, if a divorce happens, they lose their insurance.

Mary Burman: 22:37 They may not be eligible for insurance if they're a single woman, but they're working, but their employer does not provide them insurance. So they may be a single mother and not able to provide insurance. Probably one of the clients that stuck with me the most that I took care of at the downtown clinic some years ago, her husband worked, and worked two or three jobs and he got insurance through one of his employers. Their three children, um, were eligible for kid care, which is the SCHIP program for the State of Wyoming. She was uninsured. She was a full-time student at a community college, but she didn't have access to an insurance.

Mary Burman: 23:10 Now, why do we do that to people and to families? And again, put that in the context of COVID-19, it presents huge barriers for people getting the care that they need. And it creates immense barriers for women, quite frankly, in the State of Wyoming and across the country to be truthful with you. So we certainly made significant changes moving into telehealth modes. The hospital went to great lengths to reevaluate care, how to respond to a surge, how to make certain, if we did get five patients on a ventilator, how we would be able to do that. And those were all good things.

Mary Burman: 23:46 But I think more important is that we need to take the lessons that COVID-19 has taught us about our broken healthcare system and do something about them. I will be completely blunt with you, the fact that at the ACA Obamacare is in front of the Supreme Court at the request of the Trump administration, in order to overturn it, is one of the, a horrible thing. We should all feel very angry about this. Whether you like Obamacare or not, it provided insurance for millions of people who are now losing it because of COVID-19.

Mary Burman: 24:22 They will really lose it if Obamacare goes away and we as a country need to stand up and say, this is unacceptable. We need this. In fact, we need to take Obamacare, tweak it and go even further, we still leave, with Obamacare, 10% of the population uninsured. This is unacceptable. It's morally reprehensible that we leave women particularly, but also men, uninsured without access to care. We're the superpower of the world and yet we leave people uninsured. It is morally reprehensible.

Emy: 24:54 I don't know enough about that to even respond because there's just been so many different opinions about Obamacare. And is it correct to have a government controlled healthcare system? It, does that weaken our healthcare system? I mean, just all these things that you hear people talk about that I can't really intelligently say, right, wrong, good or bad.

Mary Burman: 25:24 It, the irony of Obamacare. Do you know that the origin of Obamacare is based upon the Massachusetts system, which, which when Romney was governor of?

Emy: 25:33 Mm-hmm (affirmative). I do know that.

Mary Burman: 25:35 This is not... That's, that's the thing that's gotten somehow... The discourse about Obamacare is that it is a federal takeover of healthcare, which is ironic because it is actually not. Now it did expand Medicaid and Medicaid is a government program. That's, that is true. But if you think about it, the insurance exchange that came out of Obamacare is a private market mechanism. These are private insurance companies who offer insurance through the exchange, with a federal subsidy, for those who need specific income guidelines. And so it's one of the odd things that somehow got started, that Obamacare was socialized medicine.

Mary Burman: 26:15 It is [inaudible 00:26:16] removed from socialized medicine. It is nothing close to the British system, for example, which is probably in many ways, the most socialized system that we're familiar with in our country. There's certainly Scandinavian countries who do have socialized systems, but Obamacare is far, far, far removed from that. Again, it did expand Medicaid and there are public subsidies for those who buy insurance on an insurance market who cannot pay the premium. I think the thing that is so misunderstood in the United States is that, first of all, we have the highest cost of healthcare of any developed country.

Emy: 26:53 Mm-hmm (affirmative).

Mary Burman: 26:54 That we pay more, twice as much as most other countries in terms of our per capita healthcare expenditures. So our healthcare is way more costly. It is profoundly inequitably distributed. So as I said, we, even at the peak of Obamacare, we still had 9% to 10% of the population uninsured.

Emy: 27:13 Mm-hmm (affirmative).

Mary Burman: 27:14 And then finally we have poor outcomes than any other country in the world.

Emy: 27:18 Mm-hmm (affirmative).

Mary Burman: 27:19 A developed country. I shouldn't say any country, but developed countries are equivalent. Our outcomes are horrible.

Emy: 27:25 Mm-hmm (affirmative).

Mary Burman: 27:26 And I think we've lost that in our angst about healthcare reform that we do have profound problems. Our current, if you take away Obamacare, that system never served our purposes well, it did not. We left people uninsured. They didn't get the quality of care that they needed and it was expensive care. So without Obamacare, we had a dysfunctional system. Obamacare then increased access.

Mary Burman: 27:50 It was not a mechanism to decrease costs and it really didn't, but it did profoundly increase access to care. We went from running 17%, 18% uninsured down to about 9% or 10% uninsured. That was major, major gains. And the other piece of it was, it was not socialized healthcare. It wasn't a market mechanism through private insurances to increase access with the exception of the Medicaid expansion portion of the Obamacare.

Emy: 28:18 As a Dean at UW... How, how long were you a Dean at UW?

Mary Burman: 28:23 11 years.

Emy: 28:24 Wow. Did you specialize in an area of concern, like, like you were talking about healthcare coverage for all people, or hospital administration, or nurse training?

Mary Burman: 28:40 Yeah. In terms of practice, I was always a public health primary care person. In terms of my overall focus, it was on nursing education, how to educate nurses for a complex occupation career profession in a complex system. And healthcare is a very complex system.

Emy: 28:57 Yes, it is.

Mary Burman: 28:58 But I, like I said, access to healthcare was always, again, thinking about it from my perspective as a primary care provider and someone with a background in public health was always one of my main interests. I, I was a co-founder of the downtown clinic. We realized that there were people who were consistently falling through the cracks who did not have insurance. So we brought together a broad based coalition of people, educators, healthcare professionals, community leaders, and develop the clinic that provides free care to people who are uninsured. And it's been an operation for 20, almost, I think we're at 22 years now.

Mary Burman: 29:33 And we see very complicated patients who do not have insurance, do not have the financial resources. And they illustrate profoundly the gaps in our healthcare system. They should not... I love the downtown clinic and we provide amazing care. We provide primary care, we provide mental health services. We have a free pharmacy. We do COVID-19 testing. We do vaccines, adult vaccines. We have a healing garden in the back. We have a roof covered with solar panels. We are actually energy neutral. And yet as much as I love that place, people should not be getting their care through a free clinic. People should be insured and get their care through a system of care that is designed to help all Americans receive care.

Emy: 30:19 Well, my last parting question to you, Mary, is what kind of advice are you giving to young women today, or what would you be giving them to help them succeed? Not be part of the stereotypical nurse career path, but what do you say to them to, to help them see that the value of what they do is more than the stigma that society has put on the, the degree of a nurse?

Mary Burman: 30:48 You know, one of the things I often talk to the nursing students about when I would give, you know, I'd have to speak at various events. And I spoke about a woman who was one of my heroes. She was a, the sort of the founder of public health nursing, a woman named Lillian Wald. She worked in the lower East side of Manhattan. And her career is really interesting to look at. And one of the things that always struck me about Lillian Wald is that she, as a nurse, followed a very non-traditional path, she was a public health nurse. And I think the reason she did it is that she was very uncomfortable with what she saw happening to immigrants.

Mary Burman: 31:22 This was in the turn of the century. She was very uncomfortable with, uh, what she saw happening to immigrants in the lower East side of Manhattan. You know, living in large tenements with 12 people in a, in a, in two room apartment without any sewage system at all, using an outhouse five flights down that the entire tenement used. And she was fundamentally disturbed by this. And she didn't, she didn't ignore that that being disturbed, she embraced being disturbed by this and decided she had... She came from a reasonably wealthy Jewish family, she did not have to do this.

Mary Burman: 31:56 But she took it on and said, "I'm uncomfortable about this, I'm going to do something about it." And she embraced the discomfort that she felt in what she was seeing in the disparities in New York City at that time. She then I think committed to it and just showed up and did something about it. There wasn't really a model to follow. She developed what ultimately became what was called a Settlement House, Henry Street Settlement House like Jane Adams had done in Chicago. Lillian Wald did that. And so she sort of showed up and said, "I'm committed to this. I'ma do something about it." And the last thing that always struck me about her was that she, she maintained a compassion for humanity, no matter who you were.

Mary Burman: 32:36 You could be a Italian immigrant who looked down upon in our country at that time, but she still saw worth in you as a person. And I think maintaining a respect and a recognition of humanity, regardless of who that person is, at the time we were at now in our country, that becomes so much even more important. We need to have respect for humanity, no matter who that person is, their color, their shape, where they live, what their family history is, where they came from. We need to have that deep respect for humanity. And I think Lillian Wald illustrated that part of it in her life and her life's work.

Emy: 33:14 Wow. That's a great story. Thank you for talking to me, Mary.

Mary Burman: 33:18 Oh, I've enjoyed it. Thank you.

Emy: 33:20 Oh yeah. It's been great. Thank you for listening to First, but Last brought to you by the Wyoming Humanities. Please join us again next week, as we continue our conversations with women from around the state. You can also find us @thinkwy.org, where we continue the conversation on our blog about the history, journey, and the challenges of Wyoming's Intrepid women living in the equality state. And if you enjoyed this episode, please subscribe to the show and leave us a review on iTunes. Thank you for listening.