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  • Writer's pictureDr. Clifford Brown

Rural Health Research

Research in this section is provided by the HRSA/FORHP-supported Rural Health Research Gateway.


Among the findings from the Rural and Minority Health Research Center: From 2010 to 2020, while the proportions of metropolitan and micropolitan hospitals offering specialized cardiac care substantially increased, there was no significant change in hospital-based cardiac services provided in rural (non core) counties.


This is only research validation of our Custer County experience. The millions of dollars designated to those providers who self-identified as rural health providers have done little o\r nothing to improve the access to rural health cardiovascular service availability. Pulmonary and cardiac specialists find it almost impossible to support a practice in sparsely populated regions due in major part to an insufficient referral system.

Many privately practicing general care providers located in very rural regions appear content to manage even the more complex health issues themselves. While this is totally legal, it does present a challenge for the specialist who depends upon referrals from generalist's referrals. Even though our elevation significantly impacts marginally functioning pulmonary and cardiovascular systems, the limited population still translates into conditions that do not adequately support the location of specialty care within our county.

Telehealth specialty care may offer a partial answer to our dilemma, but it also has its own set of limitations. Planned mobile clinics will support another partial answer. Traveling specialists and regional sharing of assets could speak to our deficits. But, although our local roadways have been improved drastically in quality, the costs of fuel and health care have so drastically increased within the past three years that many of our residents not only cannot afford to miss work, but also cannot afford the now extreme fuel costs to travel into the metropolitan centers (even when the weather allows a modicum of safe travel). So, while many of recent advent to our valley are not adversely affected by the gross inflation, there are certainly many residents who are.

A high percentage (percentages in our county are among the highest in the nation) of our valley residents are military veterans. Recently the Federal support promised to military veterans has been cut several times, leaving those of us who served our country _under the condition of promised post-service medical care for ourselves and our families_ effectively without that promised coverage. Even the care directed toward our service connected disabilities has been limited (see note below) by these Federal policies and the VA officials including those who determine our disability status.

Our Frontier County status is well-deserved, so the prevention aspect of health care in Custer County is significant. When preventive health approaches are insufficient, our medical care facilities must be depended upon to provide both basic and specialty care. The valley's medical clinic must receive as much support as we can give, but the clinic's services must be supplemented by specialty care that will be located in the major population centers. This challenge is not "going away."

Note: Historically, VA administrative personnel were financially rewarded for each denial of benefits to those who served our country. On the average, disability claims had to be submitted three times before any benefits were provided. These rewards amounted routinely to an additional six-digit annual income for those VA administrator "gate-keepers."

While this despicable practice has now been curtailed , increasing amounts of the medical care promised by President Lincoln to the veterans and their family members have been denied by the current administration. Veterans are seemingly supposed to just sacrifice further and in silence as the effects of old injuries and age upon our already challenged bodies continue to mount.


Respectfully, Clifford Brown, OD, MPH, FAAO(D) CAPT/USPHS (Ret) Director of Public Health Custer County

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