Working in a Rural Health Clinic on the Mexico-California Border
By Arlyn R. Duval, MSN, FNP-C, Family Nurse Practitioner, Rural Health Clinic: El Centro Outpatient Health Center

Friends ask "What's it like?"  Working down at the bottom of California, next to the Mexican Border Fence. In Imperial County - with the lowest per capita income in the entire State of California. "Why do you stay in such a place?" It's horrendously hot in the summer, the wind can blow a newly planted lawn right out of the ground, and it is 2 hours to San Diego over a mountain range that bears a weird resemblance to  a boulder strewn moonscape. "Why?"

It isn't as if there are no other choices -- there certainly are. Nurse Practitioners are in great demand - and many offers come my way. So why stay?

The work is difficult - the patients are medically complicated, with few resources and often lack basic education on their disease processes. They often need medications and treatments that are not available with their form of MediCal, requiring the completion of pages of paperwork and phone calls.

The building is old, with an awkward floor plan. There is scarcely room for all of us-- the patients, the providers, and the staff.

It's a small town -- everyone knows everyone. Hard to maintain distance.

Obviously, more money could be made elsewhere.

So why stay?

For the same reasons one might leave -- just seen under a different light.
The difficult, complicated medical problems are wonderful puzzles to put together daily.
Where else would one find "Zebras" but on the Border? Zebras?  Yes- in medical education, one is taught that "When Pounding Hoofs are heard approaching, one should think of Horses, not Zebras". In other words, the diagnosis is most likely to be an ordinary one, not an exotic one. Expect muscle spasm not Spinal Tuberculosis, arthritis not osteonecrosis (death of the bone for unknown reasons).  But not here on the Border!!!
Wonderful opportunities to apply all the medical and cultural knowledge one has to make a profound difference in a patient's life.

This rural area provides the same feeling of 'belonging" that many rural communities provide -- it is hard to go to a store or drive downtown without seeing someone you know.
There is a strength learned in areas where one must often 'make do' rather than simply expect it to be done. The streets are named after Pioneer families that still live here.
The Mexican community is wonderfully supportive - and always encouraging when one is learning to speak Spanish.

I stay because I make a difference. And because my efforts are both recognised and appreciated by those known as my patients.

Arlyn Duval can be reached at arlynd@sbcglobal.net

Article posted on 1/6/08