At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.



I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.



I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.


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expect this conversation with someone like you” when I began discussing polymerase chain reactions with them. Another doctor insisted on getting me alone away from my football training staff, so they could “get the truth” about my drug and alcohol abuse, although I chose to do neither.

These divisions between physician and patient can also even be clearly illustrated by simple language. Every community has their own slang. I have witnessed in my own life how regional slang language can create barriers to healthcare.  All my life, I was taught that a “krilled” ankle meant a light sprain. However, I remember with a laugh the physician’s face when I told him during my first year at college that I had krilled my ankle. To my surprise, he didn’t understand language that had been perfectly normal to me my whole life.

Thus, a synergistic effect is born. Because of the division created between physicians and patients, a scarce yet essential commodity like healthcare for rural Kentuckians appears undesirable or unworthy of the strenuous effort required to seek it out unless truly necessary. Unfortunately, truly necessary often means when healthcare is absolutely required. In this scenario, patients seek healthcare only as a last resort. By the time a situation is deemed worthy of seeking care, the patient is in a much more dire predicament than if their ailment had been caught earlier. So, how does the healthcare system rectify this situation?  How can we overcome the division currently present between patients and physicians in rural healthcare areas?

I believe the answer lies in the sermon I woke up to in that small county church so long ago. How can we provide physicians who are close to home, who understand the patients whom they treat, and thereby circumvent the potentially deadly side effect of delaying treatment? Simply put, we need to train more students from these areas who look outside the door of their childhood home and see their mission field lying just outside it’s frame. You train these individuals to become doctors, thereby producing physicians who inherently believe and adhere to the same ideals as is engrained into the collective heart of the community they will serve.

I believe many of these individuals are not only able, but more than willing to return to the mission field known as their small towns to serve her and her people. I must look no further than my own parents as examples of this idea in action. My mother and father were both first generation college students from Russell County and the next county over respectively. They both worked their way through college and made it to professional school as a pharmacist and veterinarian. Upon completing their training, both immediately moved back to their hometowns to work where they still practice today. Similarly, I believe by recruiting and training more physicians from rural communities, we could overcome the lack of physicians. As these “local” physicians return home to practice, the hesitation to seek healthcare would be eliminated, providing an improved healthcare experience that will become more and more apparent for the future generations to come.

Along with the sheer number of physicians returning to these areas, they bring something so innate to the table for their patients that it cannot be taught by any textbook: understanding. This understanding does not come easily and is not learned in any medical class. It develops as the community sees you turn from a snotty-nosed kid into a man or woman. It is awarded like a badge of honor as you share the same foxhole known as our community and endure the same heartbreak and battles. It manifests as the community supports you throughout the entire time you are on this journey known as life. It is unconsciously taught as you are growing up and learning what “krilled” and other sayings mean. In this manner, healthcare is not delivered by a stranger from on high. Healthcare becomes individualized. It becomes as it should be: a mission of duty and pride to serve those whom they love and have an unparalleled intimacy with.

 In conclusion, the delivery of healthcare to rural Kentucky and America must improve. There is not only a lack of physicians, but an ever-growing divide of mistrust between physicians and rural patients built upon unfamiliarity, snap judgments, and misunderstanding. How do we combat both problems at the same time in order to improve delivery of healthcare to rural Kentucky and America?  You find students who have the same message of serving their rural community ingrained into their fiber as I have had through the words of my preacher, the example of my parents, and my previous experience with the current healthcare system. These individuals are not only more likely to return to their underserved areas than the average student, but these doctors will have already developed a strong bond with and understanding of the local culture that will help, if not eliminate, the divide between rural patient and physician. With this divide obliterated, the community will place more faith into the local healthcare community, which should result in more willingness to visit medical professionals and better compliance with treatments by patients. I believe the answer is simple and the likeminded students are out there. Some medical institutions have already had this realization and enacted many programs for greater opportunity to rural students, such as the University of Kentucky College of Medicine-Bowling Green campus that I am proudly a part of. However, I challenge them and other medical institutes across the nation to either follow suit or remain true to the course that they have embarked upon. Continue to find the rural students with the dreams of helping their home community. Educate and support them throughout medical school. Train them so that not only will their lives be improved, but the health of rural Kentucky and America as well!     

On the corner of Wilson Street and Lakeway Drive in Russell County, a small brick church sits on a sunny Sunday morning. The sun pours in through the stained glass window as a preacher concludes his fiery sermon. The preacher proclaims that, “You ain’t got to go on a far-off mission trip to spread the good word. Your mission field is outside them doors and in this town!” A young boy, who had been asleep only minutes before the crescendo of the sermon awakened him, would have this idea ring throughout the rest of his life.

The next day, the boy had an appointment with his pediatrician. He brought his coloring assignment, although he detested coloring. But he would have plenty of time to work, as he had an hour ride each way to get to his pediatrician’s office in Danville. He has made this trip many times before and will for various other medical procedures over the years, such as a large wart he had removed and the time he broke his arm riding a mechanical bull. In fact, he was even born in Danville because it was one of the closest places to home to see an OB/GYN.

However, Russell County is rather lucky as far as healthcare goes for the rural southcentral Kentucky area. They have a critical access care hospital, their own EMS service, and even a general surgery department. There are counties nearby that cannot say they have any of these services to this day. This lack of healthcare services, which starts with the lack of local physicians, makes healthcare access difficult to near impossible for the residents of these areas.  The lack of healthcare in rural Kentucky, along with compounding socioeconomic factors,


leads to what I have heard many attending physicians and residents call the “typical Kentucky patient” with long substance abuse histories, lack of compliance with treatment, and/or a spotty medical history at best.

Understandably, this ideology immediately puts a divide between the patient and physician. This results in the physician judging the “ignorant” patient from on high for the choices that he has made, and the patient becoming despondent and guarded against the healthcare system that lacks compassion, relatability, and understanding. Unfortunately, the doctor dismisses or ignores the realization that he, too, could be in a similar condition given the same circumstances. Although we hate to acknowledge it, as society becomes more individualistic, predisposition for certain behaviors are either passed down genetically or taught from generation to generation in a family. This means that a cycle of decisions beyond that of the patient’s own could have predisposed this individual to the life they live now, whether it be for the better or for the worse.

 I have seen this principal play out in my own life time and again. In college, I was a NCAA Division I football player. That position came with its own stereotypes of recklessness and stupidity. If you mix in a southern accent and customs, it makes for one nasty combination. I recall a doctor proclaiming to me that he “did not


Nicholas Coffey is a former Western Kentucky University football player and current University of Kentucky College of Medicine-Bowling Green Campus (UKCOMBG) first year medical student. He currently serves as the AHEC/outreach support for the UKCOMBG student ambassador program with a focus on rural Kentucky high school outreach. He hopes to be a general practitioner and serve southcentral Kentucky after completion of medical school.