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Back on the Tractor
UK nurse studies how farm amputees overcome their injuries

by Alicia P. Gregory

"When I was laying there in the hospital, it dawned on me that my cattle put on as many pounds last night as they did the night before, and the weeds grew just as tall in my tobacco as they did yesterday. Really, it's the same world. I just have to relate to it different."

This is what Ken Montgomery told his family and friends when he returned home to Lancaster, Kentucky, after losing his arm in a farming accident last June. "I don't think life's about what I can do -- life's about how I relate to whatever comes along," he says. That statement echoes the feelings of many injured farmers Deborah Reed encountered during her Ph.D. research at the University of Kentucky. She says her findings were born out of a personal desire to help farm families.

"I am a nurse, but I am a farm girl first," says Reed. Her family grew tobacco and raised beef cattle on a 200-acre farm in Woodford County. "Early on, I was given the choice to stay inside with my mom or go out with my father and brothers," she says. "I loved to be outside, so that's what I chose. I'd work hay in the summer and help with the tobacco, do a little veterinary work and feed the cattle."

Working with the farm animals was her first taste of nursing. Her second was working as a candy striper at Woodford Memorial Hospital. These experiences, in part, eventually led her to UK -- where she earned her bachelor's, master's, and Ph.D. in nursing, and master's in public health -- and eventually sent her back to the farm.

"Between 80,000 and 170,000 disabling injuries are sustained by farmers each year, but very little is known about the process of rehabilitation and reentry to work after an injury," says Reed, who is now a research assistant professor in the UK College of Medicine's preventive medicine and environmental health department. The variables involved in the rehabilitation process were the focus of her dissertation. Reed interviewed 16 farmers in six states with upper-extremity amputations in order to explore this question.

Reed's dissertation was related to a project called Kentucky AgrAbility, one of 18 programs nationwide providing rehabilitation resources to farmers with disabilities. AgrAbility offers farmers on-farm technical assistance, links them up with other disabled farmers, and helps them search for financial support for farm equipment modifications.

Last year Deborah Reed's disseration on occupational rehabilitation won the International Dissertation Award from Sigma Theta Tau,an international nursing honor society.

"I remember when I was growing up doing some pretty dangerous things because we didn't have all the safety features available now to farmers," Reed says. "In my work I urge farmers to put a roll bar on every tractor and wear a seat belt, keep equipment in good repair, and always closely supervise children. It only takes one time of being careless to be seriously injured.

"Every farmer I interviewed blamed himself for his injury. He'd say, 'It was my fault. I was careless, tired, in a hurry or chose to violate a safety rule I usually followed,'" Reed says.

In her study, she found the variables that had the most significant impact on farmers with permanent injuries were community and family support, a sense of retained personal control, and the bond to the farm.

Farmers are very independent, but they are also very community-oriented, Reed says. "When a disability occurs, the community comes in to help the family with the harvest and prepare the field for next season. This is always done with the expectation that the farmer will be back to work soon."

At one point in his hospital stay, Montgomery says he came to a personal realization that helped him to adjust after losing his right arm in a hay baling accident. "I decided that God would never again ask me to do a two-handed job, and I shouldn't expect anything of myself that God doesn't expect of me," he says. Reed says many injured farmers told her that they cope with their disability by relying on the faith they have in God and the faith they have in themselves. "Farmers with disabilities most often rehabilitate themselves. They don't go to physical or occupational therapy.

Most see returning to the fields as their therapy and, often, the first place they go when they get out of the hospital is back to the fields," Reed says.

"The first thing I did when I got home was got in my truck and went to Lincoln County and bought some tobacco sticks," Montgomery says.

On his 500-acre farm, Montgomery continues to buy and condition feeder steers as well as operate a lathe and milling business that makes parts for farmers and industry. With his son working the tobacco crop and two employees running the parts business, Montgomery focuses on other farm jobs like feeding the animals, and he does most of the driving. "I've got a one-ton truck with a stick shift that I can drive nicely because it steers real easy. I can steer it with the top side of my forearm while I'm changing gears."

Farmers with hand or arm amputations rarely use prosthetic devices, Reed says, mainly because of the risk of re-injury from getting them caught in equipment. "Most of the assistive devices on the market are not made to take the physical abuse of farming so the farmers invent their own," Reeds says.

Doing veterinary work on animals and repair work on machinery are two challenging areas for injured farmers. "Simple vice grips are indispensable to farmers with amputations," Reed says. "One farmer put a ring device on the terminal end of his full arm prosthesis and slides his pressure washer through it so he can wash his equipment and buildings."

Montgomery modified a tong originally used to carry concrete blocks in order to carry his own salt blocks. "When I saw the tong, I saw right off I could use it to carry the salt to the cattle," he says. "Just a short time before, I had dropped two blocks on the ground, and I finally just rolled them over to the feed trough and that took a while."

These simple modifications are part of what Reed termed "getting along," the final step in the adaptation process. "Farmers felt they were getting along when they could return to doing most of the things they did before the accident," she says.

"When I've talked to these injured farmers they all say 'farming is in my blood.' It's all they've ever wanted to do," Reed says. "Some will try another type of work, but they always seem to end up back on the farm."

Photo of Ken MontgomeryAfter losing his arm in a farming accident last June, Ken Montgomery says, "I don't think life's about what I can do; life's about how I relate to whatever comes along."

Montgomery says his strong bond to the farm and his dedication to hard work was passed down. His family has owned land in Garrard County for more than three generations. "My daddy has a little money by virtue of the fact he just liked to work hard. He worked until he was 88 years old. It made him happy," says Montgomery. "For me, the thought of sitting at a desk all the time is just depressing. I'd rather be out doing something."

Based on the information Reed has gathered, agricultural health professionals will be able to develop better vocational retraining programs to take to the farm site to help farmers and their families adjust after disabling injuries.

"The wife of one farmer came up to me after I talked to her husband and asked why everybody wanted to talk to him. She said, 'I have a story to tell, too. I'm part of this,'" Reed says. "I realized by focusing only on farmers, we were neglecting an important part of the farm -- the women. We are looking at developing a support system to meet the needs of these women who have had to assume more roles on the farm after a man is injured."

This system, however, may have to go beyond traditional support groups to really serve the needs of farm families, according to Montgomery.

"If I had a prosthesis, I think talking to somebody who's been there and done that would be a big help," he says. "But support groups -- they come up with some good stuff, but they keep the negative before you. I don't want to dwell on this condition. I don't feel any different now than I did before I lost my arm."

Reed agrees that most farmers want to be able to find the information they need after an injury, but they want to work through the challenges on their own. Providing farmers with information about the resources available to them is part of Reed's current clinical work.

Last year Reed's groundbreak-ing dissertation, titled "Occupational Rehabilitation of Farmers with Upper-Extremity Amputations," won international recognition, and her continued work is casting a fresh light on nursing.

Her study won the regional dissertation award and went on to win the 1997 International Dissertation Award from Sigma Theta Tau, an international nursing honor society. Reed's dissertation was chosen from 29 regional winners from around the world.

"It was pleasant to know that the people who nominated my dissertation at UK liked it. It was thrilling to receive the regional award, and it was awesome to win the international award," she says. "Traditionally, these dissertations focused on quantitative studies, and the fact that they chose this qualitative study on such a new area in nursing as the best says something.

"This is a new arena for nursing," Reed says. "There are very few agricultural health nurses in the country, and of these, most are clinical. They go to farms to do check-ups. Very few are involved in research."

Lynne Hall, associate professor and assistant dean for research in the UK College of Nursing, says Reed's work is opening up an important arena for future study. "Debbie's background in community health nursing and her personal background growing up on a farm, as well as her master's and doctoral training, has all blended together to influence her work, which is just the beginning of some excellent research with strong relevance for clinical nursing practice," says Hall.

"Debbie's work is unique in that her clinical arena is different than we typically think of because it's outside institutional walls," Hall says. "For Debbie, the community is her clinical arena."

Reed, who is a member of the research team in UK's Southeast Center for Agricultural Health and Injury Prevention (part of the Department of Preventive Medicine and Environmental Health), is continuing to work in the community on several new projects, including one aimed at preventing disabilities in farm youth.

Reed and co-investigator Pamela Kidd will teach 720 ninth graders in public schools in Kentucky, Iowa and Mississippi the consequences of and ways to prevent amputation, hearing loss, and long-term chemical exposure.

"Farming is the oldest occupation in the world. Man was given the responsibility to take care of the earth, and today it is our responsibility to take care of the farmers we've taken for granted for so long," Reed says. "Farming is an industry as well as a way of life, and my goal is to make it a healthy way of life."