Social Economic Status and Healthcare through the Lens of Eudora Welty’s “A Worn Path

Social Economic Status and Healthcare through the Lens of Eudora Welty’s “A Worn Path”: The Impact it has on the U.S. Healthcare System
Introduction
The Office of Disease Prevention and Health Promotion has shown that in order to promote health in communities access to care is absolutely necessary. And yet even today in the 21st century, access to healthcare remains a big problem for people of low socio-economic status. The Affordable Care Act was meant to help with that (Somanader), but as the Centers for Disease Control and Prevention point out, 17.3% of people between the ages of 18 and 64 are typically without access to a source of healthcare year over year. The result is that people of impoverished communities seek out ways to self-medicate, which can lead to drug addictions and problems (Nicks; Szabo).
On the one hand, the problem of access to care for low socio-economic communities is one that could be solved if nurses were actually allowed to practice to the fullest extent of their training, as the Institute of Medicine has called for. Yet, in many states, nurses cannot practice on their own but have to work under a physician—even though they have been trained as Advanced Practice Registered Nurses (APRNs). On the other hand, it is unclear whether this would even solve the problem of getting care to people in low socio-economic communities, especially black communities. There is a long history of suspicion between the black community and healthcare as a result of healthcare’s Tuskegee experiments and the story of Henrietta Lacks, whose cells were taken and used for experimentation and study all over the world without her ever knowing anything about it or giving her consent to their study (Skloot). People of low socio-economic backgrounds feel like they have traditionally been exploited by people in medicine, as Skloot shows—so even if the Institute of Medicine got its way and APRNs were allowed to practice on their own, would people in poor communities come? Or would they still live in distrust of the healthcare industry? This paper aims to answer that question by looking at Eudora Welty’s short story “A Worn Path.” This paper will analyze Welty’s short story, “A Worn Path,” and show how, even though it is 80 years old, its meaning still echoes in the halls of modern healthcare, where new technologies like telemedicine and drone delivery could be used as possibilities to address the issues that Welty raises in her story. First, it will describe the story, then it will show how the plight of the impoverished impacts healthcare today and what healthcare workers can do about it. Third, it will discuss the argument between Skloot and the Institute of Medicine over whether there is a trust problem or whether improving access to care can be enough to help communities. Finally, it will show that by integrating new technologies and improvements in access to care, healthcare workers can positively impact low socio-economic communities.
A Worn Path
Eudora Welty’s short story “A Worn Path” first appeared in The Atlantic in 1941. It tells the story of an old Grandmother making a long trek through the country into town to receive throat medicine for her young grandson who swallowed lye two years back. Whenever his throat seizes up, she makes the long, arduous voyage on foot to receive the medicine out of the hospital’s charity towards poor people. She has nothing to give—but the doctor told her long ago that if the health issues persisted and so long as she made the trek to the hospital she would be given medicine for her grandson. The story is one of deep humanity and shows how important it is to have someone in one’s life who is willing to go to such lengths to care for another. The problem for many people today who are of a low socio-economic status like the Grandmother in Welty’s story is that they do not have people who are as devoted and caring as the old woman is towards her young grandson. Today’s families have changed dramatically (Lamont): the nature of communities in poor regions have worsened and become more dangerous with violence and drugs so that old women like the Grandmother would scarcely set out alone on such an errand. And yet these people still exist and there are advocates within the healthcare industry who work towards helping them.
The scene is set in the winter. The old Grandmother is a Negro woman who must travel by foot across the country into town to get the medicine for her grandson. It is not an easy trek even for a young person, but the Grandmother makes it routinely. Welty shows just how hard it is for a person of low socio-economic status to get healthcare—and the sad reality is that not much has changed in the 80 years that have passed since the story was published. Some issues have changed, however—such as the fact that the environment is totally different: a Grandmother in the 1940s might have made this trek alone. In the 21st century it would be ill-advised. There is much more crime today, far more drugs and gangs on the street, and much greater risk of danger. All of those issues factor into reasons why people of a low socio-economic position do not risk their lives to receive healthcare: for them it is not worth it. They would rather self-medicate with whatever is handiest around them—such as drugs or alcohol.
The Grandmother will not take such an option. She knows what her grandson needs and she sets out to get it from the hospital. She is not going to risk his health because she loves him and is willing to sacrifice herself to help him. Does such sacrifice still exist today? 80 years have passed and the family dynamic has changed substantially as Lamont has shown. Throughout those years, black communities like the one the Grandmother is from have been abused by the healthcare community.
There is even some skepticism among the healthcare workers about the Grandmother. They look at her distrustfully as though she herself were some kind of addict who was making up the story of a grandson in order to get the medicine, which she might then take for herself. But of course the story makes it clear that the medicine really is for a Grandson—but the suspicion that exists is real. This two-way street of suspicion is rooted in reality, as well.
The plight of the impoverished is real, and to receive care they must not only overcome physical hurdles and barriers to care—such as navigating dangerous neighborhoods or trekking long distances—but they must also overcome social barriers of suspicion from others. It is a social fact that people who are not of a low socio-economic background tend to look down upon those of lower classes; they tend to be wary of them as the stereotype of the lower class being untrustworthy persists to this day. In Welty’s story, this plight is shown as the Grandmother travels all day to reach the hospital, and then when she gets there she is treated with suspicion by the nurses who do not know her. Those who do know her treat her condescendingly but with charity, so she is happy. In reality, nurses can harbor prejudice and bias because of their cultural upbringing, and that is something that has to be dealt with.
Trust vs. Mistrust and the Need for Access to Care
It is obvious as the Institute of Medicine points out that there is great need for improvements in access to care so that communities everywhere can receive better healthcare. The problem is that nurses are not allowed to practice autonomously to fullest extent of their training in many states. However, as Skloot points out, it is not at all clear that the black community or other low socio-economic communities would even trust health care workers did they actually expand operations and open up their own facilities.
Trust is such a big part of the health care experience that the industry cannot exist without it. Patients need to be able to trust that their nurses and doctors are going to treat them fairly and that they actually do have their best interests in mind. If they do not have them in mind, no patient is going to want to go them for assistance. The story of Henrietta Lacks shows this, and the story of the Tuskegee experiments shows just how bad it can get when health care workers abuse their authority.
To build trust, understanding is needed—and Welty shows this in her short story. The Grandmother covers a great deal of ground and because she is so old, she forgets why she came all that way. She is tired out and has to sit—and one of the nurses who knows her and understands her predicament is kind enough to ask her to sit. And even though the nurse gets somewhat snippy with the Grandmother as the old woman keeps her waiting while her memory returns to her and she can answer the questions the nurse is asking, the fact is that the nurse does take the time to consult with her and does not brush her off as the other nurses do.
This is an important that has to be made because the tension between the argument by the Institute of Medicine and the argument by Skloot is one that can only be solved by a balance between the two perspectives. That requires a meeting of the minds on both sides: healthcare workers must meet with the low socio-economic community and vice versa. They must come to know one another and develop good relationships. That is the only way the expansion of access to care will help: the good relationships will allow trust to blossom, which will encourage people from the community to seek health care just as the Grandmother does. She trusts them and they know her. It is a two-way street that runs in a positive direction.
Integrating New Technologies to Help
Integrating new technologies such as telemedicine can do a great deal of good in helping to build that positive relationship between the communities and the health care workers (Risling). Because the Digital Age has arrived, many people have some access to the Internet or computers. Nurses today can use telemedicine to communicate directly with patients using the Internet so that patients do not actually have to leave their homes to check in with health care workers. This opens up new possibilities for communities that are dangerous and not likely to be places where many people are willing to get outside and walk long distances to receive care.
If new nurses are allowed to practice on their own, they can integrate new technologies into their practice so that they become truly accommodating to the needs of those in the low socio-economic community. Other technologies, such as translation technology, can be used to assist with patients who speak a language other than English, which can often happen in such neighborhoods as well. The more willing and able health care facilities are able to integrate technological advancements into their practice, the better it will be for the communities they serve.
Conclusion
Eudora Welty’s short story “A Worn Path” shows just how hard it is for low socio-economic communities to gain access to healthcare. The Grandmother in the story must travel through the country on foot to get to town where she then relies on the charity of the hospital to receive the medicine for her grandson that he needs. And even still there is a slight degree of impatience and suspicion that the nurses show towards her. It is as though they maintain a bias towards her people and community, in spite of their oaths to provide healthcare to all.
The fact of the matter is that in many communities still in America, it is no different even 80 years later. The same biases and prejudices exist. The same barriers to healthcare for the same impoverished communities still exist. The Institute of Medicine suggests that the solution is to provide more autonomy to APRNs so that they can practice to the full extent of their training and therefore increase access to care for these communities. The problem, as Skloot shows, is that these communities are not necessarily inclined to trust the healthcare community considering the history of abuses that have existed in the past. To solve this dispute over how to address the issue, it is possible to find a middle-ground where the healthcare community can display more transparency and understanding of the community it serves and where the community can learn to trust the healthcare providers by getting to know them as well. Understanding is key to addressing this problem—and another help would be to integrate the advanced technologies that exist today—such as the use of telemedicine to allow healthcare providers to connect with patients from the community remotely so that patients do not actually have to leave their homes to check in with their care providers. This would show the community that the care providers do indeed care—and would help to alleviate the burden that people like the Grandmother still face.
Works Cited
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Lamont, Ellen. Shifting the Center: Understanding Contemporary Families. Thousand Oaks, 2019.
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Office of Disease Prevention and Health Promotion. “Access to health services.” HealthyPeople, 2017.
https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
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Somanader, T. “A look at six years of the affordable care act.” White House, 2016. https://obamawhitehouse.archives.gov/blog/2016/03/23/look-six-years-affordable-care-act
Szabo, L. “Cost of not caring: Nowhere to go.” USA Today, 2014. https://www.usatoday.com/story/news/nation/2014/05/12/mental-health-system-crisis/7746535/
Welty, Eudora. “A Worn Path.” The Atlantic, 1941. https://www.theatlantic.com/magazine/archive/1941/02/a-worn-path/376236/