Sci-fi, telemed and access for women

I am a huge fan of science fiction. I enjoy the gadgets and visions writers can come up with for the future and all of the promise they offer people in their stories. So imagine what went through my head when I was at the National Rural Health Association meeting last May and they were discussing health care being delivered via telemedicine and robots. It almost seemed surreal.

However, the struggle of access to health care for people in rural communities is far from fiction. Rural America struggles to find health care providers. As providers age and retire there is a real gap in the number of medical professionals who want to live and practice medicine in those regions. This is where the advances in technology can step in to fill in some of those gaps.

In light of the work I do I though, what does telemedicine offer to women, in rural communities? How could a technology like this improve the lives of women? What are some of the services that have been hard to access? As I have looked around and done some research a few things jumped out at me.

1.     Cervical Cancer Screening - Telecolposcopy  -  (tele WHAT?) A Colposcopy is a procedure that allows health care practitioners to take a closer look at the cervix to determine what may be the cause of an abnormal pap smear test. This is not a procedure that has been readily accessible for women in remote areas. Telemed technology has made it possible for women to be screened for HPV, cervical cancer and other infections in remote regions. This procedure can alert a woman to cancerous cells and save her life.

2.     High risk prenatal care – Telesonography - It is not unusual for women in rural regions to forgo prenatal care due to the vast distances they have to travel and the time that will take away from work and family. As I saw in the presentation at the NRHA conference, sonograms can be done via telemedicine with incredible accuracy and alert women to any problems or monitor high risk pregnancies. This kind of information can make it possible for women to have healthier pregnancies and births.

3.     Abortion and abortion after care – Women’s access to abortion in rural areas is severely limited. Most physicians who offer abortion services are located in urban regions and women are not always able to get good referrals and information.Telemedicine has allowed for women in rural areas to access medication abortion in a private and safe manner.

It is true that robots and interaction via video screens will never be the same as an in human contact. But if there is a way to deliver health care to people in remote areas of the country through technology then we can learn to use it. Telemedicine alone is no answer. It will still be subject to the rules of what it takes to make a healthy community – access, resources on the ground, and a willingness of the community to allow progress to happen. There is no way to escape the political landmines that will crop up when you are dealing with women’s healthcare. But there is way for us to be visionary and thoughtful as we work together towards better health care for women and families in rural America.

Link to check out:

Healthy Appalachia

It was WHERE THEY LIVED back then...

The struggles of women just two generations ago can seem foreign to post Baby Boomers like me. I never gave much thought to the fact that my paternal grandmother, Agnes, grew up in the rural area outside of a mill village community in Clifton, South Carolina. They were the kind of people who had to figure out a lot of their own health care. It was not a special skill or something they aspired to – they were farmers and mill workers, it was just something that people in the country did. They relied on each other and their neighbors to get through tough times and sickness. My grandmother’s first two children died as young infants. The family tells me that my truck driving grandfather, Big Red, never recovered even though they went on to have two healthy sons a few years later (my father and my uncle).

My mom’s mother, Mackey, had a different life. She lived in a small town and was the daughter of shopkeepers in Spartanburg, SC. She was married at 19 and had one healthy baby boy. During her second pregnancy she went into preterm labor, gave birth and the doctors were unable to control the bleeding. She died shortly after giving birth to my mother. The impact of her death still touches my family today.

These stories are not unusual for women in the late 1940’s. Women had limited access and choices in their health care due mostly to when they lived and where they lived. Without the ability to treat infections, virus and control bleeding many women and children died in those days, regardless of where they lived – we simply didn’t have the technology.

Today, we DO have the technology needed to fight infection and give women the choices they need when it comes to pregnancy. But the issue remains that for many women, WHERE THEY LIVE is the biggest indicator of their access to health care.

For rural women in America, this is especially true. The vast distances in the landscapes, physically and politically, leave women and their families in a situation where they may find no help available, no access to medical assistance when it comes to abortion, miscarriage and stillbirth. In many places, despite the expertise and technology that exists, there is simply no one around to help women and their families navigate pregnancy loss.

Rural health care providers do amazing work with the resources they do have. I have seen some creative, tenacious and bold answers to situations that would have made others give up. We know that providers who work in rural areas understand the needs of their community but are often limited by time, funds and lack of training. They can only do so much without the help of allies and partners who can fill in the gaps where needs are not being met.

Such as the one around pregnancy loss.

At AAP we have the resources to fill in some of those gaps that women experience around health care when it comes to access to abortion. Of course this is by no means the answer that will solve everything in a rural health care community. But it is a piece of the puzzle that is missing. Having health care providers trained and able to serve the women where they live is vital to maintain and build rural communities. Women need choices they can access close to home with people they can talk with and trust if families are going to thrive in those communities.

My grandmother Agnes eventually moved to the city to live across the street from the hospital where she sterilized surgical equipment for 37 years. However, she continued to rely on and support her neighbors in ways reminiscent of living in the country. I am reminded of her supporting her neighbors when I think about the partnerships AAP needs to get things done. At a time when things are financially tight for people and organizations, when demographics are changing and communities are unsure, when health care seems out of reach for so many – these are the times for new, creative alliances. And here I am boldy advocating for an alliance between the rural and reproductive health communities.

These two seemingly disparate communities have an opportunity to guarantee that services are available when women need to make choices. The resources are already here. AAP’s initial report on rural health care, reproductive health and abortion shows a promising beginning to the hard work ahead. We need to see both partnerships AND resources differently.  We need to listen to women and shift from a culture where decisions have to be made in silos because of distance, politics and money – not because of lack of technology. We can work together to ensure all women have access to ALL the choices surrounding pregnancy that they need , no matter where they live. 

Let’s get to it.