HOW I FOUND MY RHYTHM WHEN THE MUSIC STOPPED

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.

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THE MAN IN A BLUE SARONG

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.

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PATIENT “OWNERSHIP”

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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Rural hospitals struggle with financial issues and decreased demand of inpatient services resulting in hospital closures, with reported widespread reductions in access to obstetric or emergency services, equating to increased patient travel distances for essential services. Technology is bridging the gap in distance by providing services in primary, specialized, and mental health care to remote patients. Promising advances have been made in telemedicine to expand healthcare access for rural populations. Transportation difficulties, along with patient time and cost to drive far distances, make telemedicine an appealing intervention to expand healthcare delivery and access. A study lead by UC Davis investigators found that telemedicine has decreased travel distances by 5 million miles leading to a $3 million dollars saving in travel costs over 9 years. Not only does telemedicine save money and time, these programs provide care to rural residents that may have forgone care, allowing symptoms to persist and progress to a more serious condition. Using telemedicine has also been implemented by specialists at urban centers, which allows them to consult on patient care and promote long-term capacity building with providers at smaller rural hospitals.


Shortages in physicians and trained healthcare workers further contribute to rural healthcare access issues. Clinicians are stretched thin, and specialists, including mental health and substance abuse providers, are rare at best, ultimately having negative effects on patients. Many medical schools, like the University of Kentucky College of Medicine, are preparing medical students to serve rural populations through rural rotations, supporting medical students from undeserved communities, and learning from faculty with experience in rural settings. Further supporting predoctoral and early career programs that invest in student doctors can retain student doctors from rural communities and attract physicians to rural, underserved areas. We can support national and state workforce development policies that provide incentives for providers who practice in rural communities and in primary care. Thus, maintaining a sustainable physician workforce committed to improving health outcomes in rural patients.


In the national discussion of healthcare spending and improving healthcare quality, rural populations have been left out of the conversation. We need to incorporate the voices of rural residents, policy makers, providers, and public health professionals. To improve patient access to quality healthcare services in rural America, we need to foster interventions and policies to assure rural communities receive high quality services. We need to support rural providers and address the barriers of rural Americans which keep them from receiving proper health care.

Throughout my childhood, I witnessed how my grandfather, who had a brain tumor, experienced a lack of access to cancer treatment. He had to drive many hours away, multiple times each week to receive radiation and chemotherapy treatments which made managing his condition a struggle. Growing up in an underserved, Health Professional Shortage Area, I saw how having little to no access to quality health care affects rural and underserved populations. It shocks me that many people are suffering and dying from complications of chronic diseases with insufficient action to combat the issue. No one should have to suffer due to preventable lapses in access to healthcare. Whether from lack of knowledge about these conditions, or being in a resource-poor setting with few doctors and health facilities, or a combination of factors, the truth is that rural populations experience disproportionately poor health outcomes. By prioritizing healthcare delivery in rural America, we can promote prevention instead of delayed care to reduce the number of patients, like my grandfather, that are presented with advanced stage cancer or other progressed chronic conditions.


One in five Americans, nearly 60 million people, live in rural America. The gap between urban and rural communities is widening with rural areas leading the top five causes of mortality. A combination of barriers influences the high mortality rate in rural communities: higher rates of poverty, more difficulty in traveling to healthcare services, higher proportion of un-insurance or under-insurance, healthcare workforce shortages, and limited access to reliable internet and healthcare information among other barriers to care.

BY NICOLE ROBERTSON

Since 2010, 87 rural hospitals have closed their doors, further exacerbating limited to no access to quality healthcare services. Rural Americans deserve innovative care models that address the multifaceted issue of rural healthcare delivery. This could be accomplished by incorporating disease prevention and non- communicable disease management that address the social determinants of health. Increased rural health data monitoring, telemedicine interventions, and rural physician recruitment and development offer unique solutions to improving patient access in rural communities.


While we understand that there are urban-rural disparities in healthcare delivery and outcomes, research with aggregated data can unintentionally disguise these health disparities. The CDC and National Cancer Institute have taken steps towards measuring rural and urban health outcomes and healthcare indicators in the U.S. By quantifying the magnitude of rural health issues, we can understand how and where to focus healthcare delivery interventions in the future. Increasing access to meaningful data will also strengthen efforts to achieve healthcare improvements by helping researchers develop a clearer understanding of cost and quality in rural areas relative to other geographic settings. This will enable us to assess the current state of rural healthcare and measure future progress. 

ABOUT THE AUTHOR

A first-year medical student at the University of Kentucky College of Medicine, Nicole first earned her bachelor’s degree in Public Health and Biology at the University of Louisville and her Master’s degree in Public Health at the University of Edinburgh in Scotland. Her passion to advance healthcare access in rural communities globally and ameliorate health inequities inspired this essay and her goal to work in an underserved community as a physician.