Appalachia: A Nurses’ Perspective
Cincinnati is assembled highly by the Appalachian community. Many communities within the Cincinnati area
are not considered Appalachian (geographically) but can be considered predominantly
Appalachian.
Vulnerability is a large subject in todays health care system. Many
factors contribute to a population’s vulnerability. These factors may be connected to a cultural
aspect, the nurse and health care provider(s), or the entire healthcare
system. The healthcare system is one of
the biggest contributers to this disparity.
Appalachian individuals face resource and access problems such as: fewer
physicians, clinics, and hospitals.
Furthermore, in most Appalachian communities, there is less or no public
transportation and, due to greater geographic isolation, many individuals
cannot obtain transportation. Because of
the lack of healthcare in many Appalachian regions, overuse of emergency rooms
becomes a problem. Many healthcare
providers are angered over this topic without understanding the true cause.
The overuse of ER rooms in these situations are many times due
to the lack of healthcare providers in a community. If healthcare providers are not available,
and emergency rooms are, emergency rooms become the primary source of care. To solve both the emergency
room overuse and healthcare disparity, healthcare facilities, including
physicians, clinics, and hospitals, must be brought into communities. Furthermore, to finish combatting this
situation, transportation must be acquired for individuals who do not have the
means to transportation on their own.
Culturally, the Appalachian people may add to their own vulnerability. Eating habits, substance abuse, and exercise habits play a large importance in the health of a community. Appalachia is well known for less than optimal life-style habits. Furthermore, many Appalachian individuals grow up in an area plagued with either drug or substance abuse. I myself grew up in Appalachia Ohio along the Ohio Valley. Growing up on a tobacco farm, it was never highly stressed that smoking was a negative. This is just one example how culture may make a difference in life decisions. However, it is important not to
discriminate because of this assumption. Blame only results in further mistrust of the medical system and culture may not be a choice.
Due to the culture and beliefs
of this people, Appalachians may be resistant to change and mistrust anyone who
is new (thought to be due to the long history of exploitation). This may be a problem, because many
healthcare providers and facilities either bring “outsiders” into the community
and they may suggest changes for patients.
Between the distrust and the change, compliance may be an issue. Furthermore, Appalachian regions are many
times very poor and the culture values independence and not asking for
help. Because of the independence and
refusal of assistance, financial situations often are linked to the greater
proportion of individuals reporting no health insurance or being underinsured
(some health insurance disparities have been taken care of federally). Culturally,
nurses and health professionals can be educated. Education can help ensure that, as health
professionals, we can deliver culture-appropriate care and work to take care of
issues like mistrust and fear of change.
Furthermore, we can work to ensure that patients have the means to
obtain healthcare and insurance and insure that we allow them to continue to
feel independent.
Nurses and health care providers may contribute to the
vulnerability through our attitudes, beliefs, biases and behaviors. As mentioned earlier, Appalachian individuals
often are too prideful to seek out care and many times wait to seek care until
it is absolutely necessary and many times too late. Also, many times individuals may not feel
welcome based off certain biases. Healthcare professionals may be biased off
income level, education level, or even geographical location which all add to
an unwelcome feeling. I believe that
healthcare professionals can build trust with these populations to make them
feel welcome and make it so they don’t feel that they are giving up their
independence or having to put their pride away.
By acting as one of the community, healthcare professionals can not only
promote taking care of one’s health, but they may be able to also encourage
patients to come to the doctor for preventative care and at the earliest sign
of trouble. I also believe that the
stigma of income follows this group. Lastly, health care professionals may also
make assumptions about an individual without knowing the circumstances. The regions, geographically and culturally,
are essentially the same, however, even within the population there is a large
diversity. As healthcare professionals,
we should not gauge socioeconomic levels, education levels, or health literacy
levels based off geographical location.
The Corporation for Ohio Appalachian Development (COAD) is
an organization that has many supportive care services for Appalachian
regions. They are a private, non-profit
and community based organization that serves most of the rural regions of
eastern and southern Ohio (30 counties). You can visit their website (coadinc.org) and select a region for more contact
information or to look into the programs they offer.
Works Cited
"Appalachian Culture." NAMB. N.p., n.d. Web. 15 Apr. 2017.
McGarvey, Elizabeth
L., MaGuadalupe Leon-Verdin, Lydia F. Killos, Thomas Guterbock, and Wendy F.
Cohn. "Health Disparities Between Appalachian and Non-Appalachian Counties
in Virginia USA." Journal
of Community Health. Springer US, June 2011. Web. 15 Apr. 2017.
Paskett, Electra
D., James L. Fisher, Eugene J. Lengerich, Nancy E. Schoenberg, Stephenie K.
Kennedy, Mary Ellen Conn, Karen A. Roberto, Sharon K. Dwyer, Darla Fickle, and
Mark Dignan. "Disparities in Underserved White Populations: The Case of
Cancer-Related Disparities in Appalachia." The Oncologist. AlphaMed Press, Aug. 2011. Web. 15 Apr. 2017.
I've read about some of the struggles Appalachian people face when trying to receive healthcare services. I think we all need to be more cognizant of our biases (even the implicit ones!) when interacting with others in any kind of setting, but ESPECIALLY as medical professionals. Nice job!
ReplyDeleteI have never looked into the particular medical struggles of a socioeconomic group. However, the problems you described seem to me to be not localized in Appalachia. I think you could find these problems in many communities and that they are prevalent in our medical system as a whole. They simply become more visible when certain factors are present.
ReplyDeleteYou're very right Caitlyn. This is not a problem that is solely localized in Appalachia. These problems are spread throughout the entire country in many cultural and ethnic groups. I chose to target Appalachia because Appalachia is where I am from. Furthermore, many future practitioners may care from individuals from "Appalachia" or even decide to serve in these underserved areas.
DeleteI really like how you mentioned that healthcare professionals often are angry by the overuse of emergency rooms without understanding the true cause. I know many people who, while not Appalachian, do not have access to healthcare and use emergency rooms for things that would be better treated by a regular physician at a doctor's office. I think that if hospitals in Appalachia were able to establish smaller clinics that were satellites of the hospital, they would. However, since they serve such a small population of under-represented people, state governments are not really concerned about trying to make that happen.
ReplyDeleteYou are very correct that the problem of ER overuse as primary care is a very prevalent problem in all areas. Many times, it is linked to socioeconomic groups or underserved groups.
DeleteFurthermore, I really liked your comments about small populations/under-represented peoples receiving less attention just because the concern is not there. I feel like this is a large problem in society today in general.
The isolation of Appalachian communities really has cut them off from many major resources and cultural changes. Unfortunately, many of these problems extend in other rural areas such as the lack of physicians, transportation to hospitals, and poverty associated conditions. We really do need to expand both access to primary care and education to make sure care is welcomed and put to use. It actually reminds me somewhat of the Tennessee Valley Authority in that the difficulties associated with distributing resources in rural, and particularly Appalachian areas was often cost prohibitive without a publicly supported effort to increase access.
ReplyDeleteYou summed it up perfectly! I grew up about 20 minutes from primary care physicians and a hospital. When I was in high school we lost our hospital due to loss of funding and many of our physicians leave the area once their commitment is served (they commit "x" amount of years in order to have loan compensation).
Delete