Making a Difference
Author: Alan M. Scarrow, MD, JD
This edition of the CNS Q is dedicated to diversity in neurosurgery. I suspect nearly all of us have become familiar with the types of diversity our profession rightly desires: cultural, racial, religious, gender, sexual orientation, age and disability. Selfishly, I believe there is another type of diversity that is also worthy of desire - urban and rural diversity.
I represent the rural end of that diversity spectrum. I was raised in the rural culture of the Midwest - a culture not unlike the one I have chosen to live and practice in since completing residency 16 years ago. Springfield, Missouri is by most measures a small town for a neurosurgeon to call home. It’s population of 160,000 is no larger than a suburb of most major cities and even though there’s way more than one stop light, a look down during a cross-country flight reveals it’s ruralness in the geographic sense.
There are challenges to practicing neurosurgery in a rural area. Patients are spread out among many small communities and some live in such sparsely populated areas that they may not see others for days at a time. This is a particular problem when treating time- dependent maladies like strokes or trauma since there are few people around to find an impaired patient and even then it may take several hours for them to reach a neurosurgeon.
There is also a perception by some that neurosurgery in a rural area might be, shall we say, lacking in certain cultural ways. Most of the remarks I have heard in that regard are in good humor but within them is a kernel of truth. There are real cultural differences to be found in rural areas of the U.S. Much of that cultural difference has been driven by globalization and an explosion of knowledge over the past 40 years. As our country has transformed from a nation of farmers, to factory workers, to consumers, and globalization has taken hold, much of the output from rural areas such as meat, dairy and grains has become commoditized in the world market. That transformation drove down prices and brought economic ruin to many rural communities. Simultaneously an explosion of knowledge across all industries created a need for bright and innovative minds in cities where most products are designed and made for a global market. This gutted many small towns of a generation of its best minds and left behind a population that is more insular and increasingly distrustful of corporations, universities and government that are perceived to be more problem than solution.
Still there are so many redeeming qualities of practicing neurosurgery in a rural area. People who are tied to the land have a daily reminder that much of what surrounds us is beyond our control. It will be hot, or cold. There will be drought, or floods. Some years crops will grow, in others they will not. There is a realization that the world around us is not entirely man-made and thus is incapable of being molded into some utopian dream. Tied to that realization is a tolerance and acceptance for what neurosurgeons are capable of delivering. The great majority of patients are genuinely grateful for our efforts to help them and there is an underlying resilience that steadies patients and their loved ones when the care we provide does not result in all that we hoped for. More practically, it is difficult to be angry at someone when you see them around town regularly.
Like other types of diversity, I submit that rural and urban diversity in neurosurgery is also desirable. It is the type of diversity that puts neurosurgeons in communities where they are needed, among people who are grateful for the care we can provide. Just like urban centers, our profession needs neurosurgeons in rural places where opportunities to make a difference in the lives of others also reside. And no matter how large or small the community is you choose to live in, surely that is what we are all here to do.