Just the other day, I called my mother to catch up - something I probably don’t do as often as I should. She let me know that earlier in the morning she had found my grandmother laying on the floor due to tripping over the edge of a rug. My grandmother is rapidly approaching 90, so any sort of fall is a big deal - concussions, high-risk contusions, and bone breakages become much more common with age. They had to go to the emergency room to get her checked out, a trip of about 35 minutes by car. Fortunately, she was okay - this time. Such is life in a rural area.
A little over 20 years ago, my family wasn't so lucky. In 1999, my grandfather had an aneurysm in his abdomen - a critical medical issue that required immediate care. Back then, the nearest emergency hospital was 45 minutes away. He was alive when the ambulance arrived. He was still alive when the ambulance got to the hospital... but, by a twist of terrible luck, part of the equipment needed was moved on that day to the new hospital built down the road. The new hospital unfortunately was not yet staffed and authorized to begin care, and so could not yet accept patients. So, the ambulance headed to the next nearest trauma hospital - over an hour away, even at peak ambulance speeds. He didn't survive the journey.
Distance makes the heart grow fonder, some people say - but the reality is that distance makes the trips get longer.
Today, I live in Berlin, Germany, a city of millions, with a robust network of public services. The nearest trauma-capable ER for me is about a five-minute drive down the street - and if I were in real critical trouble, I'm sure the military hospital a few blocks away would take me in a pinch. The level of access that I take for granted today is hard to imagine if you've always lived where I grew up.
The rural lifestyle, like those of the suburbs or the city, has its tradeoffs. The problem is that some of those tradeoffs - like easy access to food, education, and healthcare - are both significant and detrimental to those who need them. My goal in writing Sparse with Dana is in part to bring attention to these tradeoffs, and what is being or could be done to close the gaps.
Back to the example above - my family lives very far from the nearest emergency room. If there are multiple ambulances required to handle a car accident on their road, for example, the time from accident to emergency room will likely be well over an hour for some of the victims - assuming that someone is around to make the emergency call. This isn’t uncommon if you look at the US as a whole. Over half of the US by land area - mostly in the western half of the country and Alaska - is more than 30 minutes from the nearest “acute care and critical access” facility. The NY Times did an amazing infographic (paywall) on the topic, showing that about 8.6 million people live in this situation in the United States.
My grandmother is one of those 8.6 million, and - bonus - is both elderly and of a high-risk group. Being that far from a hospital is especially problematic for her, and people like her - outcomes get worse with distance and the combined age / risk profile, so I’m on edge any time there is a problem. The process engineer in me drives directly to optimization - pack grandma up and get her a house closer to the nearest hospital. Solved. Migrate the elderly and high-risk closer to capable medical facilities, reducing the logistics burden and increasing the likelihood of positive outcomes in case of emergency. Simple, right?
Not really, because we can’t just move people around without them having a say. Most of those people live where they do for a reason - either they can’t afford to move, or they have no interest in doing so. My grandmother has lived in the same house for the last six decades - no way will she move now.
We need to find a way to ensure that essential services can survive in sparse areas and that there's not a massive gulf of experience quality between rural services and urban services. A gap in services will always exist, as when a lot of capital is required to build service infrastructure (e.g. hospitals), but there may be opportunities to mitigate the gap in the right circumstances.
Through Sparse, and work done alongside it, I want to make life easier on my family, and families like mine, without asking them to give up their right to be in the great outdoors. We need scatterings of people to live in sparse areas, the same way we need concentrations of people to live in cities.
If you have thoughts on ways to do this, feel free to leave them in the comments!