The harsh reality of social distancing in rural America

“They stole my shoes!” she told me with tears streaming down her face. It was 30 degrees Fahrenheit outside, and the woman in front of me at the food pantry only had the clothes on her back, walking around town barefoot.

In addition to taking her shoes, most of her items set up around her tent located in the Walmart parking lot had been stolen. She was here at the food pantry at 2 in the afternoon, but she had already visited the only homeless shelter in our community. Unfortunately, because of the rapidly changing circumstances, the shelter was unable to help right away. The morsel of stability she had savored for some time now had disappeared.

To reinforce social distancing, the food shelf had reorganized their donations from their usual model (a choice pantry) to where volunteers selected items for clients based on what they needed and packed it into boxes. As I went through the list of items, she told me she had no teeth and no way to heat up her food since all her belongings were gone. Her food options were severely limited, and the inability for one of the few community resources to provide for her left me with an unusual and gnawing sense of dread.

It was my first time volunteering at this particular pantry about two weeks ago, and the coordinator mentioned how this was not a typical day. The past few days really had not been typical, but neither are our current circumstances. Other clients told us that their local food pantry in a town 40 minutes away shut down and had instructed clients to drive down to our town because it was one of the few pantries still open.

We are currently seeing COVID-19 affecting thousands in major urban centers, such as New York and Detroit. The virus has only slowly emerged in rural communities, but will likely still have severe consequences. We know the best practice to mitigate spread is social distancing. However, it poses unique challenges in rural areas, like the northern New England community I live in.

The CDC published a series of studies about rural health in 2017, reporting that rural Americans are more likely to die from chronic diseases, such as heart disease or cancer, and unintentional injuries (i.e., motor vehicle crashes, opioid overdoses) as compared to Americans living in urban areas. At baseline, resources are limited and physically located far away from each other, so any shift in the wrong direction creates dire circumstances. Exacerbating an already persistent epidemic, people with substance use disorders or in recovery must adjust to a new normal that lacks social connection, one of the most crucial parts that aid in recovery. Some programs have transitioned to telephone recovery, which has helped mitigate the drastic change, but there are bound to be repercussions.

As a medical student, there are often times I feel helpless while in the clinical environment. I know I am there to learn, but many of us want to actively contribute to our teams. Because of my limited experience, I often feel as if I slow down the process of providing efficient medical care. Perhaps selfishly and naively, volunteering at the food pantry during this time when our clinical duties have been suspended, I thought that I would be able to more directly help the community. Providing someone with food is very tangible. However, handing someone a box of food when they have no home, no shoes, not even a can opener, filled me with the familiar sense of ineptitude and frustration.

There is an electronic traffic sign planted on the sidewalk as you enter the town my medical school is located. “Be Smart, Stay Home” flashes in bright orange light. In a town with a median family income greater than $150,000, home is guaranteed and assumed.

But what are you supposed to do when the only homeless shelter in town is trying as quickly as possible to adjust but is also limited with space and resources? What do you do if the home you had created in the Walmart parking lot is taken away from you? What do you if the only food pantry available is now 40 minutes away and you have no car or gas money? What do you when you know this will last for months?

COVID-19 and social distancing have exposed the fragility of our society and has caused further stress to the already underserved and underfunded populations in the United States. We are a society fraught with inequity, limited social resources, and a government that does not value bolstering the system. We were told over and over that we were prepared for a pandemic, and that we would not do as poorly as China or Italy in tackling this virus.  However, it is becoming clear with each passing day that people will die from the virus as well as the consequences of poverty and a neglectful government.

Meera Nagarajan is a medical student and can be reached on Twitter @meera_nagarajan.

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