Introduction

Archie Daniel, a resident in a rural community, found his mother dead in her bed during his childhood. He shares how she never went to the doctor except to take her kids, and how she would suffer intense stomach pains and then keep working. These conceptions of simply dealing with pain held by Daniel’s mother tend to fit into broader thought processes in entire rural communities. Stigmas and thought processes, rooted in rural culture, often seem to act as a barrier between rural communities and their access to healthcare and modern medicine. This paper seeks to document cultural influences such as social attitudes and religion and their relation to healthcare-seeking activities and healthy behaviors in individuals in rural areas.

Prioritization of Work and Defining Health

People in rural communities seem to define being healthy in a distinct way compared to the so-called “standard” in mainstream culture today. When thinking of staying healthy, one might bring up staying active or exercising, eating fresh foods with lots of nutrients, or getting the right amount of sleep. According to Leslie Rummage, however, a member of a rural community in Stanly County, North Carolina, residents in her area may think differently. When asked if she thinks her community is a healthy one, she goes on to state, “I do, but in a rural area, people, like I said, are more focused on physical labor and not as much on exercise” (Rummage 17)[1]. She continues to discuss how these working conditions have caused harm to even her father, but her main emphasis was on the prioritization of work overall in the lives of these individuals. This prioritization of labor is further evidenced in the article Vast Tracts of Land: Rural Healthcare Culture[2]. Klugman investigates the differences in notions of being healthy between urban and rural populations, and notes that people in rural areas do not define their health by lack of sickness, but “hardiness—ability to work and to be productive in their daily chores.” This research helps contextualize Rummage’s perspective on how people are focused on physical labor. When a rural man wakes up, possibly suffering from a variety of illnesses– take diabetes for example, as long as he can do his job, he considers himself healthy. He doesn’t try to stay healthy in other ways through exercise, for example, his primary concern is work. This idea that the ability to do work means one is healthy, shared through Rummage, can easily act as a barrier to health seeking behaviors. Prioritizing labor is a key part of the cultural mindset in these rural areas, and it very possibly could prevent people from seeking to better their health or recover when they are suffering.

Self Reliance and Perceptions Around Seeking Healthcare

Conceptions of hardiness have been established to be a key barrier to healthcare in rural communities, but fixed mentalities about actually seeking healthcare act as a barrier as well. Returning to Archie Daniel’s perspective for a moment, some background was given on his mother’s situation, but the level of depth of her pain has not yet been communicated. When describing his mother’s stomach pain, Daniel says in his interview “I would often go in the bedroom and find her crying, gripping her stomach and lying on the bed in pain” (Daniel 25)[3]. Daniel’s mother was clearly suffering, but even more shockingly, he said 30 minutes later she would be back working acting like nothing was happening. This dismissal of sickness seems to be a common theme in these rural communities and reflects back on the “hardiness” of rural residents. Despite this clearly life threatening condition Daniel’s mother was dealing with, she still only took her kids to the doctor. Aside from the monetary aspect of this situation, an entire rejection of healthcare with this severe of an illness suggests a stigma against even seeking a doctor. Research defines a hardy person as one that takes care of themselves. “Going to the healthcare provider is considered an option of last resort” (Klugman 2008)[4]. There are two primary factors behind this detailed by Klugman. One, it is an insult to hardiness. Two, taking the trip to a practitioner is equated to putting a burden on the family and not taking up the slack. In rural communities, that is a moral failing of its own, which in turn leads to the self-reliance we see in Daniel’s mother and the choice to suffer she felt she had to make. Many, like Daniel’s mom, have a negative stigma against the act of seeking healthcare that very well could have saved their lives.

The Role of Religion

Because rural communities are predicated on self-reliance and personal responsibility, healthcare seeking activities are neglected due to their cultural viewpoints. This means that instead of going to the doctor, the responsibility of healthcare falls back on the patient and their surrounding community, and religion often plays a part in this. An anonymous woman named Eleanor shares in her oral history interview that her mother was one of the people that looked after the entire village, not a doctor. This was due to the faith they had in community and in God, and she details how various members of the church would sit with a sick person. “They would go night after night, sitting up with the sick, taking care. That was the Christian duty” (Eleanor 10)[5]. Although religion and community support can be very helpful in these cases, certain illnesses require modern clinical treatment. Rejecting to acknowledge this can could cause serious suffering in these patients. In a research study from 2015, Thomas et al. found that in a focus group of 37, 14 did not view health as something an individual controls but as something that is controlled by a higher power[6]. When these people in rural communities seek higher powers over medical professionals, they are limiting their chances of getting better, which is a major cultural barrier and can cause a lot of harm within the community. Overall, it is necessary to address religion’s role in rural healthcare because it acts as an external influence, having positive support and health promotion benefits but also barring healthcare seeking activities by complicating people’s perceptions of when to seek healthcare and what controls their health.

Conclusion

It is important to address these cultural barriers to healthcare seeking activities because people are suffering in these rural communities and preexisting notions often hold them back from getting care. These notions include the ones covered in this paper, being the rural definition of health as hardiness, stigmas against seeking healthcare, and the thought process convolution that religious influences can produce. While there is nothing inherently wrong with the culture in rural communities, we need to work with the residents in these areas to place an emphasis on the value of healthcare—showing that it is okay to seek it, while attempting to offer it nearby and at an affordable price. While this is a large task to take on, a start is just listening to these oral histories as done in this text so we can seek to understand their perspective and morals surrounding medicine and therefore learn how to take action. These stories from people in these communities contextualize their experiences and clarify why they believe what they believe today. Through culture, we can improve the quality of life for those living in rural communities overall.

References

[1] Leslie Rummage. Interview with Caroline Efird. 15 June 2018. (Y-0046). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.

[2] Klugman, Craig M. “Vast Tracts of Land: Rural Healthcare Culture.” American Journal of Bioethics, vol. 8, no. 4, 2008, pp. 57-58. doi: 10.1080/15265160802147082

[3] Daniel, Archie. Interview with Chadwick Dunefsky. 2 August 2018. (Y-0019). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.

[4] Klugman, Craig M. “Vast Tracts of Land: Rural Healthcare Culture.” American Journal of Bioethics, vol. 8, no. 4, 2008, pp. 57-58. doi: 10.1080/15265160802147082

[5] Eleanor. Interview with Madelaine Katz. 30 July 2019. (Y-0111). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill

[6] Thomas, Tami R., et al. “The Influence of Religiosity and Spirituality on Rural Parents’ Health Decision-Making and Human Papillomavirus Vaccine Choices.” National Library of Medicine, 2015, 38(4): E1-E12. doi: 10.1097/ANS.0000000000000094