Wanted: Good Quality and Trustful Healthcare in Appalachia
Pictures from the Bristol Herald Courier.
Healthcare in Appalachia is severely lacking. Between lack of providers and specialists to choose from and offices being long distances away, there is also a huge reason Appalachian people do not have the same quality of healthcare as the rest of the nation. That reason is general distrust. There are several reasons for this distrust of the healthcare system in the Appalachian region. Many have experienced condescending medical providers and monopolized healthcare. Medical care in Appalachia has been an issue that has been looked over for generations and as healthcare in the nation is constantly shifting, Appalachia continues to have a strong distrust regarding healthcare.
To give a better understanding of the health crisis in Appalachia, the Appalachian Region Commission (ARC) stated in 2017 disparities in health outcomes and other health-related factors in the Appalachian Region when compared with the nation. It stated that Appalachia had higher mortality rates in seven of the nation’s leading causes of death due to heart disease, cancer, chronic obstructive pulmonary disease (COPD), injury, stroke, diabetes, and suicide. Obesity, smoking, and lack of physical activity are more prevalent in Appalachia than in the nation overall. Mortality due to poisoning, including drug overdoses, is markedly higher in Appalachia than in the nation as a whole, especially in rural and economically distressed areas. There are also less healthcare professionals per 100,000 population when compared with the nation as a whole. These included primary care physicians, mental health providers, specialists, and dentists.
With this overall picture of health issues and concerns that Appalachian people face daily, then why is there such a strong distrust? Primarily it comes down to rude and condescending behavior and monopolized healthcare.
According to a study titled Mistreatment in health care among women in Appalachia by Dr. Amy Alspaugh, a dually trained Certified Nurse-Midwife and Nurse Scientist with the University of Tennessee, when it came to seeking specialized healthcare in Appalachia, specifically reproductive healthcare, many Appalachian women reported negative experiences where medical providers would treat them poorly due such reasons as their weight, income, or other reasons. The most common negative experience was reported to be rude and condescending providers, not feeling listened to, and feeling uncomfortable with the provider.
“No one wants to be shamed or made to feel bad when they’re talking about intimate details of their life. I believe that poor treatment from health care providers is an unstudied barrier to health care, both within Appalachia and across the country. We’re seeing some of this conversation occurring nationally with Black maternal mortality, but I think the breadth and depth of this problem goes much deeper. It may not always result in a pregnant person dying, but it certainly impacts someone’s interactions with health care throughout their life and certainly impacts their health and wellness,” said Dr. Alspaugh.
There were also discussions on how religion came into the treatment rooms for female patients. Religion is common in the Appalachian region, but many female patients reported that providers used their personal religious beliefs to shame them for seeking certain types of medical care.
“Some of our participants talked about being slut-shamed by providers based on their sexual activity. Others had providers who gave them misinformation, like IUDs causing abortions. While these providers may not identify their faith as the root of this, pushing your worldview over what we know about contraception or treating people with(out) respect and dignity is not a great way to provide health care or support your community,” stated Dr. Alspaugh.
This type of poor treatment and medical provider behavior is not just focused on reproductive healthcare. It has also impacted those going through other various health conditions, such as cancer or conditions that cause chronic pain that require stronger medications, such the opioids Morphine or Fentanyl, and with the strong and painful history of the opioid still lurking in Appalachia receiving quality care for chronic pain or serious illnesses can be easily swept to side because they will be treated as drug addicts looking for their next hit.
However, in those cases where maybe a quality provider is not an issue, the overall healthcare systems available in the community are the next biggest issues. Monopolized healthcare is common throughout the Appalachian region.
Seeking care in eastern Tennessee, patients have Ballad Healthcare. In Virginia, there are Lewis Gale or Carilion Clinic as the most common healthcare systems. West Virginia is becoming a state with only one healthcare option of that being WVU Medicine, which has 23 hospitals already throughout the state and the largest healthcare system in the state. This does not leave much variety when it comes to healthcare options for those who might not like Ballad Health, Lewis Gale, or WVU Medicine. While some would argue that this is a positive for rural and remote mountain communities, it can come with challenges that can make getting healthcare harder for people.
Many people have been reporting long emergency room (ER) wait times with some monopolized healthcare systems. In ERs, people go to receive urgent, life-saving care in those situations where someone is having chest pains, they have been seriously injured while working a physically demanding job, or any other emergencies; however, some people are waiting more than 18 hours in the ER to receive care.
This leaves many people to wonder where they should plan to go if they are having a medical emergency. Should they go to the closest, but monopolized ER, where it could be over 10 hours before they receive care, or should they drive hours to go out of state to possibly receive faster care? Unfortunately, many people have experienced this situation firsthand, and many worry it will become a more common experience.
It is becoming common that the elderly, people with disabilities, the ill, and expectant mothers throughout Appalachia are having to ask themselves when the time comes for them to receive healthcare: Do I like the providers available to me? Do they treat me as a human being? What kind of treatments are going to be options for me? How long am I going to have to wait for healthcare? Will my family and I get the care they need and deserve?