As a young girl growing up on my family’s Minnesota dairy farm, my plastic ice cream pail held many types of eggs at the end of the day. One of my chores was to traipse all over our farm to scout out the location of nests. My daily bounty included brown, white, large doubles, tiny pullet eggs, banty eggs, and even the odd soft shell laid by a chicken that hadn’t eaten enough oyster shells. After looking at the clinical trials being conducted for those living in rural areas in recent years, I’ve happily collected another basket full of variety.
To name just a few, there are or have been clinical trials to assess:
- fungicide exposure among apple and peach farmers
- risk for rural methamphetamine dependence
- ways to help overweight adults from rural areas
- Internet intervention to improve rural diabetes care
- impact on rural middle schools health behavior including fruit and vegetable intake
- intervention using text messaging to improve HIV medication adherence in rural drug users
These trials take place despite challenges. Maintaining data integrity in a resource-poor setting can be difficult. Internet and cell phone access are taken for granted in suburban areas; in remote farmland areas these communication tools are not always dependable or affordable. People living in rural areas often have limited access to healthcare professionals due to travel distance to facilities.
All these challenges can create barriers for rural dwellers to participate in clinical trials. However, the higher rate of chronic disease and disability among rural communities requires more focus on those areas of the country. Thus, it’s heartening to see that there are many innovative tactics and technologies being developed. These include new web-based software programs that visually link specialists to rural patients (similar to Skype), home visits from community health workers, advanced point-of-care (bed-side testing) technology for diagnosis and assessment, and telemedicine. Using telemedicine applications such as two-way video, email, smart phones, and wireless tools, healthcare professionals can electronically exchange medical information from one site to improve a rural patient’s health.
In my youth a trip to a qualified doctor required a 30-45 minute drive and a parent missing a half day’s work. This meant that if we could stop the bleeding ourselves or the broken bone didn’t protrude, we’d skip the trip to a doctor and apply the money to a tractor repair or veterinary care for our profit- producing livestock. My toe that was cut to the bone after an unfortunate encounter with the spoke of bike wheel was wrapped with gauze and tape from the medicine cabinet, not stitched up by a medical professional.
However, as I examine rural clinical trials today, it is evident that attitudes of farmers and the health industry are both changing for the better. Farmers accept and value that technology can make healthcare more available, just as it improves their ability to produce a better yield per acreage or higher butterfat content in the milk. Likewise, the health industry recognizes and addresses that there are many specific diseases unique to a rural lifestyle and environment, such as respiratory exposures and illnesses, cancers related to agricultural chemical exposures, pesticide-related illnesses, and ergonomic issues that can be helped and addressed with clinical trials. This response to the needs of the small segment of the population that works hard to grow the food that feeds the world is something to crow about.