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Written by: Arlyn R Duval, MSN FNP-BC,
Family Nurse Practitioner
Rural Health Care, as we all are aware, primarily provides care for those with lesser fortunes. In the most rural sections of California, those with private insurance usually choose to travel to larger medical centers for their personal care. Many of us who work in the rural health system do likewise and think nothing of it.
So... Why do rural health centers really exist? And what is the primary argument for maintaining their existence? And why this particular discussion now?
We must discuss it now because rural health care is at great risk of loss of government support due to economic pressure. It is urgent that the rural health community pro-actively remind the public and politicians now why rural health must be maintained.
When a budget is already submitted, it will be too late to be convincing.
It is wonderful to think of rural health as a "calling” and that is frequently the truth. But to focus on this perspective ignores the underlying reason for the need for rural health care. Ethics, generosity, care of the indigent and elderly and those unable to care for themselves are all excellent reasons for doing what we do. But none of these perceived platitudes will stop an economics discussion that begins with "‘We must balance the budget, and rural health is too expensive.”
The real reason rural health care exists and is supported by the taxes of the middle and upper classes in the U.S. are self-preservation. Without good care for the poor and indigent, epidemics and infections cannot be avoided by those with prestige and power. This knowledge must be shared.
Cholera was perhaps the first epidemic disease to focus the attention of upper classes in England on the consequences of poor health of the poorer classes. Millions of people died in the Five Cholera Pandemics from 1816 to 1873, including two US Presidents, James K. Polk and Zachary Taylor, as well as the composer Tchaikovsky. Cholera is not particular about status and prestige.
In more modern times, a 1991- 1994 cholera epidemic in Peru claimed almost 10,000 deaths with more than one million other identified cases. It was attributed to discharge of a ship’s contaminated ballast into water near the shore.
Cholera is a severe bacterial infection caused by the bacteria Vibrio Cholerae. The primary symptom is profuse watery diarrhea. Rapid dehydration and death can occur within 6 hours. Transmission is primarily by the acquisition of the pathogen through contaminated drinking water or infected food. It wasn’t until 1853 that Dr. John Snow in England made a connection between clean drinking water and an absence of cholera. And it was another 50 years before that knowledge began to be applied routinely…when it was possible to do so. Peru’s experience demonstrates that pathogens such as cholera wait only for a people to let down their guard.
So what does cholera have to do with routine rural health care?
One of the best arguments for our existence is that Rural Health Centers are the principal "guard" against such epidemics. Working with County Health Departments, Medical Providers in Rural Health Clinics are in a unique position to intercept not just cholera, but also HIV and AIDS, Chlamydia, syphilis, gonorrhea and others - all the plagues of current and bygone times that wait only for us to ignore their certain presence. If Rural Health Clinics were not in place, many of the ‘routine’ diseases could gain a critical mass among the rural poor long before sufficient symptoms appeared in major centers to raise concerns.
Rural Health Clinics are the eyes and ears on the frontline of our nation’s health.
Discussions of ethics and justice often are brushed aside when hard economics must be addressed. We need to spread the word that Rural Health Clinics are the guardians of the health of the everyone - regardless of status, privilege and position. Diseases do not discriminate.
We need to share this information and the need for the continuation of Rural Health Clinics and Rural Hospitals to those who oversee the Budget in Sacramento.
We need to let them know how important Rural Health Care is in the protection of the general US population, and that dedicated people are in place through-out California.
About the Author:
Arlyn Duval has lived and worked in El Centro, California - down on the border with Mexico - for the past 13 years in a Rural Health Clinic owned and operated by a hospital - El Centro Regional Medical Center. She currently serves on the Board of Directors for El Centro Outpatient Center and The Cancer Resource Center of the Desert, previously served on Board of Directors for WomanHaven, Inc and Imperial Valley Desert Museum.
Comments or feedback? Email us at advocate@csrha.org. |
