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Nary a Hospital in Sight

Our plan was to travel from our home in Seattle, through southern Oregon, and into Nevada. We would stay overnight in the small city of Winnemucca, Nevada, before heading south to the town of Tonopah, where we would again stay overnight — this time in a hotel I have been waiting (not at all ever so patiently) to visit: The World-Famous Clown Motel. (Yes, a motel centered around the theme of scary clowns, which also just so happens to be situated next door to the town’s historic cemetery.) After that one amazing night living out my most haunted, clown-filled dreams, we would continue our trip south toward Las Vegas, introducing our son to all the glorious wonders comprising America’s most grandiose shitshow. Or, at least, whatever family-friendly wonders we could find in Sin City.


We planned for a memorable and somewhat unique, speedy trip through the Silver State.


Unfortunately, plans don’t always go exactly... well... as planned.


(Certainly, as a caregiving family, it happens quite often that we need to shift, pivot, and make last-minute adjustments to life-as-planned. Medical families are nothing if not adaptable. And so it goes….)


Our first day on the road led us to Prineville, Oregon — a small city in the center of the state. A second long drive took us through the vastly open and sparsely populated, high-desert of southern Oregon and northern Nevada.


It was an uneasy drive. We saw long distances — too long of distances — between gas stations and, also, far too few roadside rest stops. The land was beautiful in its own way — with valleys of flat scrub and open rangeland. We passed through a tiny town — barely a blip on the map — with just a few homes and a one-room schoolhouse. We were without phone service for a significant chunk of the drive.


(And still, none of this would have proven particularly concerning had it just been me and my husband. However, as a caregiving family, this degree of isolation, even if for a limited duration, is enough to cause a high degree of anxiety. As a caregiving family, you are always, in every situation, thinking: What if something happens here? How would I respond to a medical emergency in this situation? What would the emergency response look like? Those questions never really leave the back of your mind.)


Our arrival in Winnemucca, Nevada, was a relief.


Winnemucca is a small city in the midst of this vast open desert. Fun fact: It is the only incorporated city in the entire county of Humboldt, according to our trusty friend Wikipedia.


Most importantly, for the purposes of our brief stay in the area, the city of Winnemucca is home to Humboldt General Hospital, a small facility, certainly, but one that houses a basic emergency room.


Just in case — our common travel refrain.


Considering the day’s experience of driving those long single-lane highways through the open desert, out of touch with most basic community services, and even beyond the reach of cellular communication, we began to look ahead to the rest of our trip through Nevada with a good deal of apprehension. We knew the following day would lead us farther into the open range, and our planned stay at the Clown Motel in Tonopah would place us in a smaller town, in an even more remote area.


Some quick Googling showed that Tonopah, while economically reliant on local tourism, is lacking in essential medical care and hospital services. The local hospital shut its doors several years ago, leaving area residents up a healthcare creek with no paddle. Another victim of the rural medical care crisis in this country.


 

A quick aside on the issue of rural healthcare, or more truthfully, the lack thereof:


Did you know?


Small, rural hospitals represent over one-quarter of all short-term general hospitals in the US, but they receive only about 2% of total national hospital spending.


The majority of these hospitals lose money to deliver patient services. Most small, rural hospitals are paid less for services by insurance plans, including private policies. However, it regularly costs more for rural hospitals to provide the same services available in urban hospitals. So, care costs more, but hospitals are paid less, causing small, rural hospitals to operate in the red. Lower income from insurance payouts leaves small, rural hospitals more dependent on local taxes, public subsidies, and other government grants.


Where these small, rural hospitals exist, they provide most or all healthcare services. Many communities in their service area have no other service alternatives. Almost 2/3 of rural hospitals are over 20 miles from the next hospital; one-fourth of rural hospitals are 30 miles or more from the next nearest facility. (Compare this to urban hospitals where most are less than 5 miles from another hospital, and ~80% are within 15 miles.)


Small, rural hospitals across the country are shutting their doors, leaving communities without an emergency department and other basic healthcare services. When hospitals close, residents must travel farther distances to receive care, increasing the possibility of unnecessary death or injury. Diseases and illness can also go undiagnosed longer due to a lack of access to regular care.


The result of this rural hospital crisis:

  • Delayed emergency care;

  • Lack of essential non-emergency care such as maternity care;

  • Delayed or inaccurate diagnostic care;

  • Limited options to monitor and treat chronic conditions.


*** Data from Saving Rural Hospitals website, maintained by the Center for Healthcare Quality and Payment Reform (CHQPR), a national policy institute focused on healthcare payment and delivery systems with a mission “to increase awareness about the problems facing rural hospitals and their communities and to encourage successful solutions.” Website: ruralhospitals.chqpr.org.


*** Check out this case study from the Saving Rural Hospitals website on the closure of Nye Regional Medical Center, the emergency department that served Tonopah, Nevada, and the surrounding 18,000 square miles in Nye County. This is the hospital that would have provided support if we had needed emergency care during our stay in Tonopah, assuming, of course, it was still open and serving the community, which it is not. The hospital closed in 2015 due to financial issues, and now, the nearest hospitals are over two hours away in northern Nevada or California. It is a three-hour drive to reach major hospital care in Las Vegas. (Read more: ruralhospitals.chqpr.org/importance)


 

Anyway, back to our story: So, my husband and I sat in our miniature hotel room, working our way through our son’s morning medical cares and deliberating our plan of action.


We could continue on our planned route and head south toward Tonopah, where we would stay overnight in an isolated area with few options to seek immediate medical care, in the event it was needed. I would finally get to experience the Clown Motel, and then, the following two days, introduce our son to the odd beauty and flashing lights of Las Vegas. Obviously, that would be a fun route! And also, the route of higher risk.


Or, we could re-route ourselves, head east to Salt Lake City, where there are a number of top-tier medical facilities; then, turn ourselves south and head directly to our destination of Albuquerque, New Mexico. While we love Salt Lake City, a re-route would mean skipping two places we looked forward to visiting as a family. But, it would be safer from a caregiving perspective, and, at the end of the day, medical safety is always our first priority.


So, just like that, our plans changed.


Travel is fun and absolutely worth every minute. The memories, the experiences, and the education we pass on to our son through our travels are priceless.


Travel is also hard. With a medically-complex kid, travel requires more planning, more attention to detail, more thinking about “worst case” scenarios, more flexibility, more physical labor, and without question, more money to accommodate medical needs.


And still, it is worth it.


But invaluable experiences aside, access to basic medical care is a necessary element of traveling while caregiving.


As a medical family, we can absolutely venture into wide-open spaces. We can and we should experience the great yonder…. so long as we also keep our wits about us.

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