MD Recruits Face Culture Shock in Appalachia

[RamboLiberal]

For 25 years, Dr. David Avery has been practicing medicine "solo" in West Virginia -- the only state entirely situated in Appalachia, the heart of America's rural poor. Until recently his caseload was 4,000 to 5,000 families across 40 isolated towns.

But today, because of a campaign to recruit new primary care physicians, Avery has more help, working alongside a growing number of foreign doctors at the Ritchie County Primary Health Group in Parkersburg.

Lured by "exchange visitor" visas, these doctors -- hailing from Pakistan to the Philippines -- are often greeted as "rock stars," but in the isolated hollers ofAppalachia, they face a mountain of cultural and medical challenges.

"It's very hard," Avery told ABCNews.com. "These people don't want to trust anyone who hasn't lived here for years. It's hard enough for U.S.-trained physicians to come to a little town. They are very protective, and if you are not one of them, they can chase you out of town. You're not accepted."

With doctors like Avery, 54, who are approaching retirement, and medical students choosing lucrative specialties, the nation as a whole faces a shortage of primary doctors. In Appalachia, a federally declared Health Professionals Shortage Area, the need is particularly acute.

http://abcnews.go.com/Health/story?id=5922943&page=1

[tularetom]

1. Well I guess they can just fuckin die then

Don't want to accept help from somebody with a darker skin? Nobody else willing to come to their fallin down shack to take care of them? Looks to me like they gat a real problem.

Maybe Jeebus'll hep um.

[Warpy]

2. It's more complicated than that and has little to do with color

because Cherokee blood is still coursing through most veins there and some folks are quite brown.

It has a lot to do with the history of the region that has caused society there to be clannish and closed to outsiders. It also has to do with the longstanding poverty leading to exaggerated self reliance and a resistance to asking for help. Pneumonia is still treated with a mixture of moonshine and turpentine plus chest poultices. People in deep and grinding poverty just don't think of seeing a doctor and don't much trust the advice they get when they do.

That's what they're up against.

[Speck Tater]

3. Distrust does not have a very good survival value.

They have a choice: Get over it or die.

[Warpy]

4. Sounds like a lot of smokers I know

Read some of the history of the region to understand it. Trusting outsiders has not been conducive to their survival in the past.

[Mopar151]

5. Too true

Some immersion, and appreciation for the local culture will go a long way for the docs. Folks that have been ground down too much are sesnitive to a fault about being talked down to.
Some speech classes may help, too - some accents are very difficult for those with hearing loss.

[Lydia Leftcoast]

8. That was part of the plot of the movie The Song Catcher

It takes place in the early 1900s, but the people don't trust outsiders, because outsiders have never done anything but exploit them.

[endthewar]

7. I lived in Parkersburg, WV for a little over a year in the late 90s

and you have no clue as to what you're talking about. None.

[WVRevy]

9. I was born there...

...and raised in the southern part of the state (around Charleston), and I agree with you completely. People from outside the state have very little real knowledge of what it's like here.

[RamboLiberal]

6. I don't think its about the physicians coming to their towns

Its the poverty and the lack of health insurance. I'll never forget the 60 Minutes program of how people in these areas are lining up by the thousands for Remote Area Medical when they setup a weekend clinic. And RAM was originally designed to go to third-world countries not serve the US.

In a matter of hours, Remote Area Medical set up its massive clinic, for a weekend, in an exhibit hall in Knoxville, Tenn. Tools for dentists were laid out by the yard, optometrists prepared to make hundreds of pairs of glasses, general medical doctors set up for whatever might come though the door. Nearly everything is donated, and everyone is a volunteer. The care is free. But no one could say how many patients might show up.

The first clue came a little before midnight, when Stan Brock, the founder of Remote Area Medical, opened the gate outside. The clinic wouldn't open for seven hours, but people in pain didn't want to chance being left out. State guardsmen came in for crowd control. They handed out what would become precious slips of paper - numbered tickets to board what amounted to a medical lifeboat.

It was 27 degrees. The young and the old would spend the night in their cars, running the engine for heat, but not much - not at $3 a gallon. At 5 a.m., Pelley took a walk through the parking lot.

"We got up at three o’clock this morning and we got here about four. We’ve been out where a little while it's cold," Margaret Walls, a hopeful patient from Tennessee, told Pelley.

http://www.cbsnews.com/stories/2008/02/28/60minutes/main3889496.shtml

[varun]

10. Reminds me of the book "My Own Country"

about an Indian doctor who treated AIDS patients in Tennesee. This book was amazing:

http://www.amazon.com/My-Own-Country-Doctors-Story/dp/0679752927

From Publishers Weekly
Indian physician Verghese recalls his experience practicing in the remote, conservative town of Johnson City, Tenn., when HIV first emerged there in 1985.
Copyright 1995 Reed Business Information, Inc.

Product Description
Nestled in the Smoky Mountains of eastern Tennessee, the town of Johnson City saw its first AIDS patient in August 1985. Working in Johnson City was Abraham Verghese, a young Indian doctor specializing in infectious diseases who became, by necessity, the local AIDS expert. Out of his experience comes a startling, ultimately uplifting portrait of the American heartland.