1. Newland, Jamesetta A. PhD, APRN, BC, FNP, FAANP, FNAP

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Last summer, I traveled to rural southern Arkansas for a family reunion to honor my maternal great-grandfather. His descendants were responsible for planning Family Weekend 2005, which included a picnic and Sunday church service. The church in which my grandmother and mother grew up will celebrate its 100th anniversary this year. The small cemetery in the back holds the graves of my recent ancestors. The oldest headstone is that of my great-great grandfather, born in 1850. It was a wonderful weekend. I met relatives I had heard about but had never met and I experienced a taste of life in the rural South.

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A Picture of Rural Life

Isolation seemed to predominate in the small rural towns, but I later realized this was not the perception of the current residents.


The population in my mother's hometown is only 152. The populations of other nearby towns are not much larger. Can you imagine the size? Many residents now live on the highway after physically transporting their houses "from the back woods" to the "main road" in recent years. There is no "downtown", only a small country store at the intersection of two county roads, which you will miss if you blink. We got lost trying to find the park where the Saturday picnic was being held. We found ourselves driving on narrow red-clay dirt roads with deep ditches on either side, surrounded by endless fields and woods. My mother explained the purpose of the ditches-when two cars approached from opposite directions, one car had to carefully settle into the ditch to allow the other car to pass and then get out of the ditch. And where are the other cars when you need them? Modern technology came to the rescue; the rental car was equipped with a GPS navigation system, which guided us out of that maze of dirt roads (and many more incidents of misdirection).


Lives revolved around work, the church, and the occasional social event. The first Sunday in August (Family Reunion Day) is an event that draws a large crowd from miles around. It was important to attend, to see, and to be seen. While I listened to people talk about daily life, I realized that individuals in rural communities have an inner strength that sustains them through good times and bad times. Being a big-time city nurse, I was commissioned to hear numerous recitations about every ailment from head to toe. I observed that many looked much older than their stated years; many were obese and many had difficulty getting around.


Access to Care

Before leaving for Arkansas, I had called a cousin to order reunion t-shirts. When I expressed amazement that she had size choices of 3X and 4X, she reminded me that we had several obese relatives that were coming. Many health problems appeared to be directly related to environmental exposures, occupational hazards, and diets rich in fats. The residents of this small town are fortunate, however, to be only 30 miles from the nearest "big city" and 60 miles south of the state capital. There also is a public bus transportation system. I had to wonder though, about those persons living in even more remote rural areas. Quality healthcare does not exist without access.


This month, The Nurse Practitioner introduces a new column on rural health issues. I want to thank Carol Green-Hernandez, PhD, FNS, FNP-BC, for agreeing to coordinate it. I remember stories my grandmother related of how "country folk" dealt with health and illness without benefit of licensed professionals but with trust in "trained healers." Readers will be informed on topics in rural health and hear how nurse practitioners are working to improve the health of our nation's rural populations. Let us know what you think. Write to We look forward to your comments.