Place Matters More in Rural

People who live rural, and particularly those outside of town limits, have a unique relationship to place. For many their roots in a particular place run deep, across more than one generation. The people who live on the land in this way have watched the turn of the seasons all their lives and have developed a deep affinity for that specific place.
Those who live in small communities may have a slightly different relationship to place, but it can be just as strong. Some rural towns have residents who have lived in the same house for their entire life, and the home may also have a multi-generational legacy. Their sense of place is strongly interwoven with a complex network of long-term friendships and other relationships.

I am suggesting that for many if not most rural residents, their sense of place is tightly coupled with identity. I am also suggesting that much fewer urban or suburban residents have this dynamic present.

I grew up on 30 acres and though it has been nearly four decades since my family moved from there, our family had lived on that land for over 35 years and all five us were raised there. To this day, I can imagine every bit of the land, with all five senses, from the “big pasture” to the “canyon”, the “crick” and the maple tree that grew both vertical and horizontal, we called that maple the Rocket tree, as we took many space journeys seated on the horizontal trunk. My love for that land exists in me, and always will.

How does this relate to palliative care for serious illness? Foremost, healthcare teams need to understand the traumatic effects if someone is forced to leave their home. The wish to “age in place” and die close to family and friends is a high intensity desire for many. By offering palliative care in the community, patients are offered a strong alternative to transfers to tertiary care in urban settings, often for interventions that will not make a difference. This saves the family and patient stress, expense, and trauma.

The other important point I would like to make about rural sense of place, is that it belongs in conversation, in reminiscence and legacy work. I am suggesting that assessments should include some exploration of the patient’s sense of place, and the expression of emotional empathy when this evokes feelings. Place is so tightly held in the heart, when hearts are breaking place can be solace. 

 Pat Justis, Washington State Department of Health