Posts tagged rural medicine

The Rural Imprint

After spending four weeks here, today marks the last day of my rural rotation. Through it all, I have seen patients with six different family physicians, done rounds with them in long-term care, and spent time with them at the hospital. It has been a month filled with experiences, stories, and memories. 

Rural medicine truly is something different. It has given me a new lens through which to see how medicine can be practiced. The continuity of care, the increased responsibilities, and the increased competency needed to practice have all been demonstrated by the doctors I have come in contact with. They have wowed me with their versatility and their mastery of the art of medicine.

A lot of that comes from the environment they work in. Rural medicine is a demanding area, one where resources are limited and the dependence of a community bears down heavily on the health care profession. After all, family physicians are the point of first contact. With those kinds of pressures, one naturally grows into the role. 

The past month has been a unique opportunity to see family medicine practiced in a more holistic way. It has been a privilege to work with these doctors who are as passionate about this form of medicine as they are dedicated to their craft. They have inspired me to do better and think bigger. This rural rotation is an experience that I shall carry with me for the rest of my career.

Now, it is time to say a long good bye as I depart this community for the metropolis, where new experiences await.

Long Winding Road by João Almeida.
In an under serviced rural setting, the issue of access is two-fold: there is a severe shortage of doctors available and also a longer travel distance for patients. The population in smaller communities has a tendency to be thinly distributed to small outlying areas, making health access difficult.
Today, at the recommendation of my preceptor, I took a drive out to one of these areas, as he sometimes does. As is common for some doctors in this community, there are courtesy house calls for some patients who are unable to make it to town. 
The drive took me deep into the heart of the land. Descending into a valley of thick foliage flanked by overpowering mountain ranges, I snaked my way along the valley edge through the low misty clouds down into the forest.
From paved asphalt to dirt roads, civilization faded further and further away into my rear view mirror. Beside myself, the road was empty. What was left was the land, the water, and the clouds.
I was awed and seduced by the beauty of my surroundings, seemingly untouched by the hand of man. Man, it would appear, was nearly two hours away by vehicle. Yet this same attractive quality was the root problem of those who lived at the end of the graveled path. Some people preferred these remote areas; others had lived there for generations. Regardless, the tradeoff was heavy.
The drive left me humbled both of the untouched beauty of the province and of the challenges these remote areas face in health care and beyond. It gave me a lot to think about. I looked across the still lake nearby one last time before drawing a breath.
"Time to go."

Long Winding Road by João Almeida.

In an under serviced rural setting, the issue of access is two-fold: there is a severe shortage of doctors available and also a longer travel distance for patients. The population in smaller communities has a tendency to be thinly distributed to small outlying areas, making health access difficult.

Today, at the recommendation of my preceptor, I took a drive out to one of these areas, as he sometimes does. As is common for some doctors in this community, there are courtesy house calls for some patients who are unable to make it to town. 

The drive took me deep into the heart of the land. Descending into a valley of thick foliage flanked by overpowering mountain ranges, I snaked my way along the valley edge through the low misty clouds down into the forest.

From paved asphalt to dirt roads, civilization faded further and further away into my rear view mirror. Beside myself, the road was empty. What was left was the land, the water, and the clouds.

I was awed and seduced by the beauty of my surroundings, seemingly untouched by the hand of man. Man, it would appear, was nearly two hours away by vehicle. Yet this same attractive quality was the root problem of those who lived at the end of the graveled path. Some people preferred these remote areas; others had lived there for generations. Regardless, the tradeoff was heavy.

The drive left me humbled both of the untouched beauty of the province and of the challenges these remote areas face in health care and beyond. It gave me a lot to think about. I looked across the still lake nearby one last time before drawing a breath.

"Time to go."

Access to Basic Healthcare in the United States, a Heat Map

This map, though it does not contain Canadian data, shows a very important point about rural medicine: there are not enough physicians. As the legend points out, Clark County, Mississippi had a population of over 17,000 but no doctor’s office, while Manhattan had a doctor’s office for every 500 residents. It is a stark contrast and a very important reminder of the dire situation a rural demographic faces. A physician may be alone in his practice with very little in the way of back-up support; a physician may not be present at all, and is instead hours away. This is the harsh reality of a physician shortage. The million dollar question of course is how to incentivize and promote rural medicine to support these marginalized populations.

Providing for Those Who Have Too Little by Dr. Margaret Seton

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.

An excerpt:

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.