In the New England Journal of Medicine, tucked away in the September 2011 issue, is a perspective piece by Dr. Margaret Seton. In it, she recounts her time as a student from Boston practicing a rural rotation in Arkansas. It vividly portrays the stark contrast between rural and urban care, the necessity for quick thinking, and the challenges of bridging a cultural gap. Things that may be taken for granted, such as MRI and CT scans, tests that are readily available in a larger urban centre, are absent or hard to access.
These differences are imposing to new doctors, especially those who have trained in a larger centre and she reflects on both the challenges and the rewards that have come from such an experience. I would highly recommend everyone to read it if they can.
…At other times, the biggest problems were not in diagnosis but in finding a farm truck that was free for a day to take a child into Little Rock for emergency surgery. Vaccinating the children born uncounted on the islands in the Mississippi, learning about “gigging” frogs by flashlight in the night, eating barbecued goat for the Fourth of July — such activities marked a time of transformation for us.
In the little houses clustered by the fields, there was a rural violence that I’d never seen before, bred by poverty and ignorance. Bullet holes pockmarked every signpost along the road. I learned to recognize the old black men who worked in the cotton gin by their missing fingers. I learned about hard lives and about children who died or disappeared. I hadn’t known that so many black Americans were still living without running water, that physicians could be on call every night, that one could eat squirrel, or that long, well-embroidered country stories could make one double over with laughter.