Vol. IV, No. 1, Summer 1990

People Helping People

The Environment of Health Care

by Harold Bengsch

This edition of OzarksWatch is dedicated to the proposition that our environment is a fabric of situations and circumstances in which we live. One circumstance we have come to call "health care." The social, emotional, and economic well being of individuals and of whole communities is effected, for better or worse, by the nature of the health care that is available. Since I am familiar with the circumstances of health care in southwest Missouri, this article focuses on that part of the Ozarks.

Providing health care for the folks who live in the Ozarks has a long, rich tradition of caring, nurturing, and compassion. In time as well as technology it ranges from early physicians making house calls on horseback, to modern quick-response air lift vehicles equipped with space-age lifesaving equipment. But for all the technological advances, a hundred-year evolution from horse and buggy to high-tech has left intact that same ethic of compassion and care.

Health Care in the Ozarks

Springfield, with its "Medical Mile," is clearly the hub of medical services for the region. Major clinics and hospitals offer a range of medical specializations and a level of diagnosis and treatment equaled only at the largest urban medical centers of the United States. The result is patient referrals from all over the Ozarks, and beyond.

Significant health care services are also available to Ozarkers in settings closer to their homes. Private practitioners, both medical doctors and doctors of osteopathy, county health departments, home health agencies, community hospitals, and long-term care facilities combine with the available specialized care in Springfield to create an effective blend of services. Considered separately, the elements of this union may seem quite different from one another in form and function, yet they all focus on the common goal of providing top quality client care and service. This wedding of a variety of health care services in communities across the Ozarks provides an environment of care that is the envy of other rural regions of the United States.

S.R. Bergen was a turn-of-the-century Sulphur Springs, Arkansas doctor.
Photo from Shiloh Museum's Bobbie Kennard Collection.


Community Doctors

Whether medical doctors or doctors of osteopathy, small town physicians still possess the same caring qualities of their pioneering forerunners--traits which build patient relationships in which doctors are considered "like members of the family." Such close personal association not only establishes a high level of confidence between doctor and patient so desirable in the practice of good medicine, it also gives the physician an overall picture of other factors influencing the patient's health. The benefits of providing medical care for the entire family in a comprehensive setting has, in fact, given rise to a focused area of medicine known as "family practice." It is a specialty very well regarded in rural areas, and many communities in the Ozarks actively recruit new physicians with this training.

To help provide these doctors, the Lester E. Cox Medical Centers of Springfield has established a Family Practice Residency Program in which fourteen physicians are currently being trained in the medical treatment of family members of all ages. Physicians in this three-year residency program receive a broad spectrum of supervised hands-on instruction and experience in major areas of medicine including minor surgery, inpatient medical care, emergency medicine, and obstetrics and delivery. Their training also encourages timely and appropriate referrals to medical specialists.

While in training, the residents complete a rotation in the Springfield/Greene County Health Department. In this setting they see firsthand how local health departments provide an extension of community health care services in interaction with community physicians and other health care providers.

Residents in the Cox program come from Missouri, Arkansas, and surrounding states. Typically they come from small towns, and intend to practice in the Ozarks upon completion of their training.

County Health Departments

Children growing up in the rural Ozarks have for years had occasion to meet the county health nurse, through personal health education in the school, childhood immunizations, or some other facet of health service. The county health nurse continues to provide those proven services; but today the nurse's role is greatly expanded. Duties now include child health screenings, nutrition training and evaluation for both women and children, adult health screenings, home visits on doctor referrals, and follow-up of communicable disease reports such as tuberculosis, measles and other infectious illnesses.

Working in partnership with the county health nurse in most counties will be a specialist in environmental and community sanitation. The sanitarian is trained to provide expert counsel and guidance for residents who wish to drill a new well, build a septic tank, or solve a community environmental problem. In addition, the sanitarian is kept busy inspecting restaurants, campgrounds and commercial lodging establishments. With the growth of the tourist industry in the Ozarks and its importance to our economy, helping assure safe, sanitary food and facilities is a vital service of county health departments.

As a team, the county health nurse and sanitarian provide a powerful tool for community physicians in determining if certain illnesses which they see in their patients have a common and, more important, preventable cause. When this is the case, appropriate control measures can be implemented to reduce the spread of the illness.

Photo courtesy of St. John's Regional Health Center,
Springfield, Missouri
Home Health Agencies

Needless to say, a protracted hospital stay can become very expensive. Today, Medicaid and Medicare, and most private insurance companies, encourage the provision of health care in the home when such care is both medically desirable and economically feasible. To this end home health agencies provide Ozarkers valuable and beneficial services, ranging from skilled nursing services, physical therapy, and nutrition counseling, to home aid helpers who assist with certain domestic services. Such agencies may be housed in county health departments, in community hospitals or, in some cases, may be freestanding entities.

Often, especially in rural counties, home health providers are themselves longtime county residents who are well known to their clients. It is satisfying to see a return to the Ozarks tradition of neighbor helping neighbor during a time of illness.

Community Hospitals

The Ozarks is dotted with inpatient care facilities of varying sizes. Although the sophistication of these hospitals in terms of the surgery and diagnostic procedures performed may vary, providing caring and compassionate service to their patients is a thread common to all of them.

Several factors make community hospitals a viable and attractive alternative to a larger, distant regional facility. Transportation is often a critical difficulty, not only for the person being hospitalized, but for other family members wish-lng to visit the patient. In many cases simply being closer to home provides a psychological boost for the patient. Also, hospitalization in the community hospital often means the patient need not change doctors and can remain in the care of a familiar, Iongtime health care provider. The patient is afforded an emotional lift and the doctor remains close to the patient and the family.

The existence of a hospital and a professional staff is important when a community tries to attract new physicians. In a sense, the community hospital becomes the nucleus around which direct health care services are built. In addition, they provide employment and attract peripheral services, all helpful to the local economy.

When highly technical and sophisticated procedures are necessary, Springfield plays a regional role with its larger institutions, diagnostic clinics, and multiplicity of medical specialists. But even in big Springfield institutions, the Ozarks ethic for care and compassion is not lost.

Long-Term Care

Whenever illness and disability require long-term inpatient care, many facilities to provide it are to be found across the Ozarks. Long-term health care is a significant part of the continuum of health care services necessary for and available to the people of the Ozarks. The general reluctance of families to place a loved one in a long-term care facility often is tempered, may even disappear completely, once they see the quality of care and nurturing given the patient by the staff.

Other Services

The Ozarks region is fortunate to have the Missouri Rehabilitation Center, a major state institution located at Mt. Vernon, Missouri. First the Missouri Tuberculosis Sanatorium, then the Missouri Chest Hospital, its purpose has changed. With the use of powerful modern day antibiotics, few cases of tuberculosis require the long extended bed rest and isolation necessary in years past. Today Mt. Vernon's mission includes not only rehabilitation of people suffering from respiratory problems, but for those with head injuries and other traumas as well. Associated with the Missouri Rehabilitation Center is the recently-opened Gene Taylor Veterans Administration Outpatient Clinic, serving the region's veterans.


No reasonably informed person will hesitate to acknowledge that there are problems within our health care system which need to be addressed. They include an aging physician population now serving the rural Ozarks (will there be enough doctors to take their places?); community hospitals that are operating close to the financial edge; county health departments trying to fill the gap in health services on an antiquated and woefully inadequate tax base; an escalating population of persons on retirement income; rapidly increasing numbers of under-insured and uninsured workers; and increasing pressure on the environment of our beautiful yet fragile Ozarks, resulting in conditions conducive to illness and disease.

These are not minor problems. They need our urgent attention. But our people are not strangers to difficulties. In solving present and future problems, the caring and nurturing tradition of Ozarks people helping people will be carried forward.

Harold Bengsch is the Director of Public Health for Springfield and Greene County, Missouri.


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