BY: PAMELA SCHAEFFER, Ph.D.
As we were putting the final touches on this issue, with its large special section on rural health care, I was reorganizing some memorabilia at home. In the process, I made a serendipitous find: an aging, long-forgotten snapshot of my grandparents. In the photo, my grandmother and grandfather, or step-grandfather, to be precise — Emma and John — are posed outside their four-room frame house in a rural county outside St. Louis. The distance from downtown was probably less than 30 miles, yet it was a world away.
This photo, which sparks memories of many visits to their home, is iconic in its depiction of rural poverty. Emma is wearing a simple housedress, as worn and faded as her youthful beauty, which I know of from a second photo in my keeping. It shows her as a jaunty, fashionable young bride in the city, riding alongside her husband in a carriage.
My grandmother was raised in a prosperous German farm family. Her father, as the story goes, owned the first radio in the region. She attended high school in St. Louis, living with an urban family and helping out with childcare. She married an ambitious young German immigrant and was no doubt looking forward to a comfortable life. But he had health problems, and, according to family lore, doctors counseled a move to the country. He died young, apparently of pneumonia, leaving Emma to raise their five daughters alone. She was hired as a housekeeper at a country resort, where part of her pay was housing for her growing family.
A few years later, she met John, a gentle, hardworking man whose worldview was limited to a simple life sustained by the land and who had no use for the city. No doubt he saved my grandmother from loneliness, but not from poverty. Except we didn't call it poverty then. I never heard my grandparents referred to as "poor." But the differences between their lifestyle and that of Emma's five grown daughters — four living comfortable, middle-class lives in St. Louis — was stark.
To a kid, on our frequent Sunday afternoon visits to the country, the differences smacked of adventure. I looked forward to the freshly baked bread, to selecting stored produce from the musty cellar: beets, potatoes and onion in bins; tomatoes, beans, squash and pickled cucumbers "put up" in jars. I liked drawing water from the outdoor pump, scattering corn for the chickens and reaching underneath the squawking hens to capture their warm, brown eggs. I tolerated slopping the hogs. I didn't like the outhouse much, or the chamber pot, used only on overnight visits during summer. But I didn't complain. And I doubt that it occurred to any of the cousins on those longer visits, when we helped out with the laundry, watching grandmother stir the clothes in a kettle of water heated over an open outdoor fire, how hard this life must have been day after day.
I know now, from the perspective of my far more pampered later years, that it took its toll. Emma and John eventually got indoor plumbing when their children became prosperous enough to give it as a gift. But she didn't have long to enjoy it. She died a few years later, at home in bed, of a heart attack. She was in her early 60s. Her legs had become chronically achy, her movements slow. Although she saw a country doctor, travel to the city for health care was out of the question. She had grown to fear the city, frightened by the traffic and reports of crime.
It may be that many of you reading these pages have also had firsthand experiences of rural poverty in one or more of its various contours, and you, too, will be able to put faces to the statistics, shortages and hardships described. Let's use our collective experiences to keep our rural brothers and sisters in mind in the post-health-reform days ahead, as we struggle together to forge a better future for uninsured and underinsured Americans.
Correction: In the July-August 2010 issue of Health Progress, footnotes 7 through 9 were incorrect in an article by Jeff Thies titled "Cultural Competence, An Ongoing Quest." The footnotes were corrected for the online edition.