Upgrading to Low Tech

When the 27-year-old man finally came to the free clinic, he had one eye shut and his jaw severely swollen from two abscessed teeth. He had had the toothache for two weeks, but without health insurance, he decided on home remedies.

First, he tried aspirin, then whiskey, then lukewarm saltwater. The pain persisted. He remembered his grandfather smearing WD-40 motor oil on his arthritic knees for relief. In desperation, he applied some WD-40 directly to the nerves near the teeth to kill the pain.

The clinic's nurse practitioner panicked after she heard the story. She knew the toxic substance could travel directly to the brain. Immediately she administered antibiotics to counter the infection. Then, with gentle words, she explained the danger to her patient, and with persuasive words, she talked a nearby dentist into a payment plan to pull the teeth.

This story of abscessed teeth points out an aspect of rural healthcare that frequently gets overlooked. Many health problems in rural areas can be addressed with modest expense, if healthcare is accessible locally, and patients can afford it and feel comfortable with its delivery.

Frequently rural healthcare systems strategically build regional hospitals, or clinics, featuring advanced medical technology. Highly trained personnel cluster around these medical centers, making available a full spectrum of medical services. But other rural areas go begging. The federal government has designated more than three-fourths of all rural counties as Health Professional Shortage Areas based on need and availability of healthcare professionals. In 2004, only 3 percent of doctors graduating from medical school entered rural practice.

Frequently medical facilities compete with one another by offering the same services requiring similar costly medical technology. This lack of networking produces an expensive overhead that demands large numbers of insured patients. Yet patients either with private insurance, Medicare, or Medicaid, feel depersonalized as they are efficiently run through the paperwork, their lab work and their brief visit with the doctor.

In 2001, the Census Bureau found that about 13 percent of rural residents lacked health insurance, approximately the same as urban dwellers. But that number jumped to 22 percent in remote rural counties where terrain and driving distances contribute a sense of isolation. The fear of an added financial burden for households without health insurance also causes many rural people to put off medical attention till the problem becomes acute. Without some sort of universal health insurance to cover primary care, small businesspeople, farmers and low-wage workers will face avoidable medical problems and possibly an early death.

The crisis in rural healthcare represents a social as well as financial problem. The system rewards health providers for efficiency, technical skill and measurable results, but bedside manner and medical counseling get undervalued. Yet rural patients respond to personalized care and sensitive treatment.

In the free clinics that dot several rural counties of Appalachia, health providers screen patients for serious and life-threatening conditions, then make appropriate referrals. Yet they can list the chronic illnesses they see on a daily basis: diabetes, hypertension, lung and heart diseases, and obesity. Some of these conditions need continual monitoring with pharmaceutical help. Other conditions require a change of lifestyle. The compassionate healthcare practiced in these non-profit clinics, many times run by nurse practitioners, represents a holistic approach to healing. It gently stresses fundamental rules of health: practice stress management, stop smoking, get more exercise and eat a healthy diet.

Better rural healthcare depends both on individuals making healthier lifestyle choices, and the healthcare system promoting preventive medicine while rediscovering a compassionate bedside manner.

Fr. Rausch is a Glenmary priest who lives, writes and organizes in Appalachia.

(This article courtesy of the Arlington Catholic Herald.)

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