Therese Zink - The Country Doctor Revisited: A Twenty-First Century Reader

In this collection we hear the voices of men and women who provide care and facilitate healing in modern rural settings: doctors, midwives, psychologists, nurses, emergency medical responders, and students, as diverse in ethnicity, gender, and age as those they serve. These storytellers, essayists, and poets live in small towns across the rural United States. They marvel, grumble, cry, grapple, and meditate on the beauty and challenges they encounter in their healing practices.

Today, rural health care encompasses more than the black bag of instruments and all the knowledge the doctor has in his head en route to a house call in the middle of the night. The stereotype of an elderly white-haired doctor and his predominately white, small-town clientele has imploded. The global age has reached rural America. House calls still occur, but the physician usually has a PDA or iPhone in her black bag. Although bartering medical care for a sack of potatoes or a few chickens may still occur, more common are the morass of the payment system and the alphabet soup of regulations.

The waiting room is increasingly heterogeneous too. Growing populations of new Americans as well as undocumented workers populate small, rural towns and create more business on Main Street and with it unfamiliar shops. Health practitioners are forced to accommodate languages besides English and to develop processes that oblige different cultural needs and expectations. Longtime rural residents have aged, challenging communities to develop social supports like Meals on Wheels and other programs for their elders. Troubled by many of the same problems as metropolitan areaspoverty, mental illness, addiction, and violencerural areas struggle because support services are limited and geographically more dispersed. Traditionally reclusive groups continue to reach out to an increasingly complex world for assistance with the health and life issues they cannot manage on their own.

Resources in rural America are enhanced and complicated by rapidly evolving telecommunication, computer, and air transport systems as well as expanding health care systems that link the mountains, hills, plains, and deserts with the high-tech services available at metro area hospitals. Patients and their families have more options for treatment and increased responsibility in managing their illnesses. These alternatives are often remarkably successful but are costly and raise numerous ethical issues as well.