Nursing in Appalachia

allnurses Guide · May 24, 2017

I can tell you this...

I have a patient, right now as we speak... he had surgery at a large hospital here in Central KY... NOT Appalachia, but more prosperous area of KY... he ended up with a large wound. He then came to my hospital for rehab services, wound care and IV antibiotics.

He has a wound vac. He still needs either the wound vac, or daily wet to dry

dressing changes.

He is from deep in the mountains of KY, about three hours from here. We

**CANNOT** find anyone to take care of this man's wound when he goes

home. I guarantee you that if he lived around here, that it would not be

nearly as big of a problem, even with his insurance.

Oregon, My Oregon · May 24, 2017

I don't know how helpful this is because I was/am not a nurse, but I recently spent a couple years in Appalachia for my partner's job. It was heartbreaking how many people just had no access to even rudimentary health care, and most of them seemed to just take that as a matter of course. They do for themselves and each other as best they can, but they weren't expecting anyone to show up and take care of them.

My neighbor had a rotted molar which was just a giant black crater when I first saw it. I urged her to have it seen ASAP, but of course she didn't have any access to dental care, so it just continued to rot. Eventually the whole side of her jaw swelled like a grapefruit and someone then found someone else to take her to a dental school an hour or so away and they ended up hospitalizing her for a week at the associated teaching hospital. Just think about the cost of that both to the taxpayers and the cost in pain for her, vs. a routine cleaning and early intervention. It was awful.

KelRN215, BSN, RN · May 24, 2017

I have never worked professionally in that area of the country but I can offer two perspectives.

1. In college I did 4 spring break service trips to the Appalachian region. 3 to Virginia and 1 to South Carolina. I attended a Jesuit university and every night, we had group "reflections" on our experiences. On one particular service trip, the year that I had started my clinical rotations, I was feeling particularly reflective. I realized that I had taken for granted the access to medical care that I'd had my entire life. When I was diagnosed with a brain tumor in my senior year of high school, I had access to multiple academic medical centers, all within an hr of my home. I couldn't help but think how I, the daughter of a single mother who was a teacher in the public school system, would not have had the same access to care had I lived in rural Appalachia. I remember speaking with one of the community members who was helping to facilitate our work in the community. I asked him about the access to healthcare and where one would go if one was seriously ill. There were not many choices- the hospitals in Washington, DC and Duke were the closest major medical centers and both were hours away.

2. In my current job, I work for a national infusion pharmacy at a hospital that serves patients from around the country. I have taken care of many children that had to travel very far from their homes in Virginia, the Carolinas, Alabama, Louisiana, Tennessee, Georgia, etc because there was no care for them where they lived. I remember one particular case of a child from Appalachia who had a history of congenital heart disease. She happened to be at a wedding up north when she became critically ill with an infection in her Melody valve. Because she was at this wedding, she was less than an hour away from one of the best pediatric cardiac surgery centers in the country. She was going to need long term IV antibiotics at discharge and the only way to facilitate this was for her to stay with family members who lived nearby because there were no home care services for her in the area in which she lived. Even my office in her state would have relied on UPS or FedEx to get her IV antibiotics to her weekly because she lived so far from any major city. The Medical Center where she was normally treated and the closest place that could perform pediatric heart surgery was 4 hours from her home.

MunoRN, RN · May 24, 2017

This was an interesting story on how people living in Appalachia commonly get healthcare: On the road with the Health Wagon - CBS News

Oregon, My Oregon · May 24, 2017

Just think about the cost of that both to the taxpayers and the cost in pain for her, vs. a routine cleaning and early intervention. It was awful.

Just to clarify, in case it sounds like I was blaming her for those costs--I'm happy to live in a nation where we don't let people die out on the sidewalk for lack of insurance. I am thrilled a safety net exists... but I personally feel we'd be better off both fiscally and humanely if we organized to support routine basic care for all than funding totally preventable emergency interventions like this.

amartinm11 · May 24, 2017

Thank you so much for the replies so far. Lots of interesting information.

perfectbluebuildings, BSN, RN · May 25, 2017

There is a program called Remote Area Medical in which medical professionals set up basically an entire clinic in a high school or other similar building just for a weekend, and give free care to anyone who comes who needs it, for an entire weekend- medical, dental, vision (including free glasses if needed), preventative care like general physicals/women's health/diabetes screening, etc.; even sometimes veterinary. They are usually large clinics with lots of professional volunteers nurses, doctors, dentists, etc. (it's all volunteer) and they go to the different remote areas around here and around the country, and they help A LOT of people, they are sometimes the only medical or dental care the person can get in a year. That does help with basic needs. But in an emergency, many of these people have a very difficult time accessing needed care, or if it's specialized. I worked in a Children's Hospital in a "big city" that provided care for children from miles and miles away, very poor or remote areas; they broke my heart. Appalachia is a region that has so much poverty right here in our country, and so many people forget about it because the people are so stoic and silent, or because it's seen as "stupid hillbillies/rednecks" who somehow don't deserve outreach, or people just plain don't KNOW about it because these areas are so isolated, as compared to the difficult serious conditions in inner-city that many people know about and see every day. Remote Area Medical reaches out to these remote poor areas, as well as having clinics in larger poorer cities as well. It's a start; a little bit of hope for some people. But there are definitely still a lot of needs in this region. Sorry for rambling so much I hope I helped you a little bit.

Here's the website for Remote Area Medical (RAM); it's pretty user-friendly. Remote Area Medical â€“ and if you want to see the areas they are serving this year, Upcoming Events

OlivetheRN, ADN, BSN, RN · May 25, 2017

There is a program called Remote Area Medical in which medical professionals set up basically an entire clinic in a high school or other similar building just for a weekend, and give free care to anyone who comes who needs it, for an entire weekend- medical, dental, vision (including free glasses if needed), preventative care like general physicals/women's health/diabetes screening, etc.; even sometimes veterinary. They are usually large clinics with lots of professional volunteers nurses, doctors, dentists, etc. (it's all volunteer) and they go to the different remote areas around here and around the country, and they help A LOT of people, they are sometimes the only medical or dental care the person can get in a year. That does help with basic needs. But in an emergency, many of these people have a very difficult time accessing needed care, or if it's specialized. I worked in a Children's Hospital in a "big city" that provided care for children from miles and miles away, very poor or remote areas; they broke my heart. Appalachia is a region that has so much poverty right here in our country, and so many people forget about it because the people are so stoic and silent, or because it's seen as "stupid hillbillies/rednecks" who somehow don't deserve outreach, or people just plain don't KNOW about it because these areas are so isolated, as compared to the difficult serious conditions in inner-city that many people know about and see every day. Remote Area Medical reaches out to these remote poor areas, as well as having clinics in larger poorer cities as well. It's a start; a little bit of hope for some people. But there are definitely still a lot of needs in this region. Sorry for rambling so much I hope I helped you a little bit.
Here's the website for Remote Area Medical (RAM); it's pretty user-friendly. Remote Area Medical â€“ and if you want to see the areas they are serving this year, Upcoming Events

Thanks for posting this. I looked around the website and ended up signing up to volunteer with one of the clinics in the fall.

Mkakids · May 26, 2017

There is a program called Remote Area Medical in which medical professionals set up basically an entire clinic in a high school or other similar building just for a weekend, and give free care to anyone who comes who needs it, for an entire weekend- medical, dental, vision (including free glasses if needed), preventative care like general physicals/women's health/diabetes screening, etc.; even sometimes veterinary. They are usually large clinics with lots of professional volunteers nurses, doctors, dentists, etc. (it's all volunteer) and they go to the different remote areas around here and around the country, and they help A LOT of people, they are sometimes the only medical or dental care the person can get in a year. That does help with basic needs. But in an emergency, many of these people have a very difficult time accessing needed care, or if it's specialized. I worked in a Children's Hospital in a "big city" that provided care for children from miles and miles away, very poor or remote areas; they broke my heart. Appalachia is a region that has so much poverty right here in our country, and so many people forget about it because the people are so stoic and silent, or because it's seen as "stupid hillbillies/rednecks" who somehow don't deserve outreach, or people just plain don't KNOW about it because these areas are so isolated, as compared to the difficult serious conditions in inner-city that many people know about and see every day. Remote Area Medical reaches out to these remote poor areas, as well as having clinics in larger poorer cities as well. It's a start; a little bit of hope for some people. But there are definitely still a lot of needs in this region. Sorry for rambling so much I hope I helped you a little bit.
Here's the website for Remote Area Medical (RAM); it's pretty user-friendly. Remote Area Medical â€“ and if you want to see the areas they are serving this year, Upcoming Events

There is a Netflix documentary based on this organization. It's called "Remote Area Medical".

perfectbluebuildings, BSN, RN · May 28, 2017

Thanks for posting this. I looked around the website and ended up signing up to volunteer with one of the clinics in the fall.

AHHH yay that is so exciting!!!! You are awesome!!! :-D

There is a Netflix documentary based on this organization. It's called "Remote Area Medical".

Oh thank you for sharing this!!! I will have to watch it, that's so cool!!!