As the impacts of the coronavirus pandemic continue to unfold, much of the attention is focused on the effects on densely populated areas. But rural areas of the country are experiencing the pandemic in a different way than their urban counterparts. The pandemic has put a spotlight on a challenge that existed in rural areas prior to the coronavirus—limited access to healthcare.
“The challenges COVID-19 creates in the rural areas is really an extension of overall existing healthcare concerns,” said Dr. Kathleen Winston, dean of University of Phoenix’s College of Nursing. “The focus now is on how to address the challenge of access to healthcare differently.”
Before the pandemic, healthcare providers who offered non-essential, yet critical, medical services already provided limited access to their patients. Specialists typically travel to rural areas from other areas to provide preventative care appointments for dental, mental/behavioral health services, gynecological services and elective surgeries.
“The challenges COVID creates in the rural areas are really an extension of overall existing healthcare concerns. The focus now is on how to address the challenge of access to healthcare differently.”
— Dr. Kathleen Winston, dean of University of Phoenix’s College of Nursing
In response to social distancing, many providers reduced or stopped these visits, or are referring care to offices in more populated areas, creating a new barrier for rural residents, said Kathleen Conlon, who is currently employed by the inpatient (medical-surgical) unit for a 638 tribal facility, as well as a PRN nurse for the Arizona State Prison Systems in nearby Safford.
“[Coronavirus] is forcing our local residents to drive hours to seek care,” said Conlon, who is pursuing Masters in Family Nurse Practitioner at University of Phoenix. “Overall, it has placed a greater burden on a rural area, which already struggles with longstanding issues of barriers to access to care, particularly with behavioral health.”
Providers in rural communities have been encouraged to embrace emerging technologies, such as telehealth, Conlon said. But this introduces yet another barrier. The unexpected need to shift to virtual appointment options for non-emergent care is an obstacle for those who have limited or no access to internet in their homes. She said communities need to actively work on solutions to make telehealth an available option if travel isn’t an option.
Strained resources are also an issue for rural hospitals, exacerbated by the pandemic. Conlon noted that Emergency Medical Services responders, for example, were already stretched thin prior to the COVID-19 outbreak. Responders in rural areas often travel for hours to transport patients to seek a higher level of care that isn’t available locally.
Conlon shared that the Eastern Arizona region has been fortunate thus far, with limited positive cases. This has allowed for strategic planning, including concerns related to adequate resources, facilities and staffing. Conlon said decision makers focused on managing their supplies, listening to staff input and developing plans based on what they were seeing happening in larger facilities nationwide. Staff also received cross-training in different departments and roles and reviewed critical care management, correct swabbing techniques and mechanical ventilation.
Things are a little different at the 70- bed hospital where Lea Fernandez works in California. Fernandez, who is also assistant program director at UOPX and a full-time faculty lead in the pediatric program, said the biggest impact her hospital has experienced is the management of care for patients, which sometimes changes daily or even hourly as new and revised practices are put in place.
This has included canceling elective procedures to shift the resources and staff to be available for pandemic-related occurrences, including units specifically designated for COVID-19 patients. Unfortunately, this further limits the number of staff available for the rooms of patients who are questionable for the coronavirus but haven’t tested positive yet. It’s a matter of shifting resources to where they are needed and being nimble enough to shift them again, sometimes sooner than later.
“We are doing what we can for rearranging to provide patient care,” Fernandez said.
Fernandez’s smaller community hospital has had to carefully manage their supplies at times, including learning what items can be safely reused. While larger hospitals may have more available supplies, they also have more patients, so whether rural or urban—there isn’t a better situation for either, she said. Fernandez praised local vendors and community members who have “helped the helpers” through donated supplies and food.
Conlon said she, too, has seen the generosity of the community, and healthcare workers have joined in to support others outside of their medical needs. Staff members have proven to be flexible, compassionate and calm amid fears expressed by the community. They’ve supported the community by donating masks to the elderly and food to food banks, providing layman education to the public related to coronavirus concerns, delivered necessities to quarantined families, and worked extra hours when necessary.
“I believe that rural communities will be grateful for the services provided by their healthcare workers,” Conlon said. “The acts of kindness will have a meaningful impact for years to come.