TALLIES & TOLLS: The costs of rural health care

TALLIES & TOLLS: The costs of rural health care

It’s budget tally time.

Each month I do a TALLIES AND TOLLS. I review all my expenses to see how close I get in my attempt to live on the income of an average rural individual. To read the first post about why I’m doing this click here.

My tally this week: I’m still in the red but getting closer to being afloat again. 

For people just starting to follow me, this is an experiment. By living on a rural budget, I can be less of a voyeur and instead, a participant in the struggles faced by so many.

This post is particularly painful write. Lulu (on the left) and Phoebe (on the right) started my trip with me. They both died a few weeks ago. Yeah, they were old, 17 year old sisters, and had kidney disease but my heart still freezes a bit when I think how fast they tumbled.

After almost two decades with them in my life I miss their sweet, gentle companionship.

I wasn’t going to share it at all. It seemed so much easier just to pretend it didn’t happen. For a couple reasons, however, I am.

First, I want to honor  these two lovely old ladies. Second, I hope through their health tumble and the struggles I had getting them care, I can illuminate the immense health challenges rural people face.  

Firstly, it still boggles my mind that they lived so incredibly long. Friends would joke that they’d never die because my garden was such a paradise they believed were already in heaven. 

For over a year I worked to find them a new home. When my house sold and I still didn’t have a foster family I reached out to a couple of people in towns I was interested in researching. I was relieved when found a house-sitting gig in Coos Bay and then a house stay for three months in Roseburg. There was a one-week gap between the two. 

Off we went-

They were surprisingly easy travel companions. Phoebe settled into her wombat cushion just as she had a home. Lulu, the petting slut, climbed on me whenever she could for her lulu-love.

In preparation for a week-long gap between the house sitting in Coos Bay and the Roseburg home stay, I took one Sunday—while they were settled at the house—to find a place. A hotel owner shook his head and said, “People travel with cats? Is that really a thing?” 

“Of course,” I responded, trying to exude confidence.

He still said “Sorry, but I can’t”. 

The place I found overlooked the sea just south of Bandon. It was perfect! I’d take them on walks holding them in my arms. Phoebe loved these strolls. She’d lift her head and lean into the wind. I thought, “Wow, this just might work!”

When we traveled inland from the coast something switched.

They stopped eating or drinking. They’d stumble into the kitchen, ravenous, but then refuse any food or fluids. Five days later, as their health spiraled downward, I brought them to the vet. They went swiftly and gently. I walked their little boxes across the street to the cremation house. By mid afternoon their ashes were ready. Okay, I know, this next part is a very cat-lady thing to do. ~~~ That night I drove to the coast, where Phoebe and I had enjoyed our walks, and released half of their ashes over the sea. The other half? On my way to Montana, I’ll stop in Portland and spread them under the garbage can where they’d sit and watch the world.

Through their health spiral, I realized that their medical journey was emblematic of the health care issues that many rural families face, but with their human family. On my first weekend, when Ron Wyden came to speak, he stated health care as one of the top priorities in his mission as a senator.

Check out this article on the rural health care crisis to give you an idea just how dire the heath crisis is in rural regions.

This is a cat story. But it could easily be a human tragedy.

The day my cat’s health started failing, I called my vet in Portland. He wasn’t there, so I spoke with his vet tech. He promised to send me a prescription immediately. Long story short, he’s in the city and I’m here, not at the counter making sure the script gets sent immediately.

Minutes turned into hours. By the time the prescription came, the pharmacy was closed. I nursed my cats through the night. I prayed they’d make it until morning.

The next morning, Sunday, I was first at the pharmacy counter.

“We don’t carry this,” the pharmacist told me. “No pharmacy in town will.” Monday was a holiday. I knew if they didn’t get fluids immediately they would die. I started sobbing. The pharmacist called the vet hospital two hours away. She was told their hospital couldn’t accept the prescription. I’d have to drive my cat there. Even then, they most likely wouldn’t sell me a bag. Plus, the cost was prohibitive.

The young pharmacist was aghast. She started making phone calls while I searched Google for a local, mobile vet.

I can’t say this enough—this is the same health care crisis people face.

To the left are some statistics from an Association of American Medical Colleges article, Health Disparities Affect Millions in Rural U.S. Communities. Since January 2010 at least 80 rural hospitals in 26 states have closed.

Yesterday, as I was writing this post, an operations manager at a well-respected office in town shared her own story. Two weeks ago she took her preteen daughter to a doctor. The daughter seemed to have breathing issues while sleeping. She hoped he’d refer her to a sleep lab. Within minutes of examining her throat the doctor said, “She needs surgery immediately. Her enlarged adenoids and tonsils are stopping her from breathing.”

She went to schedule the emergency surgery. When the doctor’s office found out she had a $600 deductible, she was told she’d have to pay the copay before he would do the surgery.  

In a bigger city, she might have put out a FB post asking for help with her daughter’s emergency surgery. Here, in a county where people are barely getting by, it took two paychecks—a full month—before she could scrimp and save the money. She worried every night. “I just kept praying” she told me. “If she made it to twelve, she could make it for a few more weeks.”

Fortunately, time was on her side. Her daughter is doing well.

For me, once the pharmacist realized the desperation of my situation she connected me with a vet in town. Arrangements were made and within the hour I had picked up the bag fluids, paying dearly. My budget started going into the red.  I did what I had to do, just like the operations manager did and other families do when they’re in a health care crises. 

By the time the I got fluids it was just too late. The old ladies health scale had tipped too far. 

But what if this were my child, or my mother, or my grandmother?

When there is little medical care, the trauma can be both emotional and financial. Without a clinic nearby, a small issue can quickly escalate into life or death. And if the event is resolved, the financial burden can seem insurmountable.

As I looked at my over-budget spreadsheet, I wondered if this was a human medical emergency, where would that extra $500, $1000 or $10,000 come from? Where would I have turned to?

For me, this rural life experiment cut far too close to the bone.

I promise, there will be stories of light and hope. And I believe it’s vital to paint a candid picture of the challenges everyday people face in these rural communities. Perhaps if we understand their struggle to survive we can better understand the survival mentality of some, and craft a way to a forge greater understanding and solutions.


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