title: Nursing at the edge of the world: nurses on St Kilda.
abstract: In the early twenty-first century geographically isolated communities continue to experience unequal access to health care. The advent of new technologies such as telemedicine do not overcome the financial constraints of employing professionals such as health visitors or district nurses to meet the needs of these remote areas. In late nineteenth century Britain there were few more isolated communities than the St Kildans. Although it is 70 years since St Kilda was evacuated it continues to capture the popular imagination. This archipelago of islands lies less than 50 miles west of the Outer Hebrides yet remains inaccessible by sea except on the calmest of summer days. Isolation such as this may have been acceptable, even desirable, to the islanders for generations but became problematic with their increasing reliance on supply boats for food. As the population dwindled it became more difficult to be self-sufficient, with few able-bodied men to row to the nearby rocks and climb to harvest the seabirds that were their staple diet. The rocks, or stacs, as they are known, have sheer cliff faces rising spectacularly from the sea. It would be logical to assume that the population had difficulty expanding due to the high male mortality rate from accidents on the these pinnacles. But it was not the skillful rock climbers that were dying in large numbers, it was their babies. Sustained infant mortality rates of between 50-70 per cent during the nineteenth century contributed to the consistently low population levels which led to the eventual death of the community. It is surprising in this context to learn that the first nurses to serve the St Kildans were ostracised and rejected by the islanders.
authors.affiliation: Borders General Hospital, Scotland.
authors.forename: E
authors.initials: E
authors.lastname: Reid
mesh_terms: D003152:Community Health Nursing / Q000266:history*; D006363:Hebrides / Q000453:epidemiology; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008507:Medically Underserved Area; D009721:Nurse Midwives / Q000266:history; D012423:Rural Health / Q000266:history*; D013217:Starvation / Q000266:history