Socioeconomic Status and Healthcare in Welty's "A Worn Path"

Introduction

The Office of Disease Prevention and Health Promotion has shown that access to care is absolutely necessary in order to promote health in communities. And yet, even today in the 21st century, access to healthcare remains a serious problem for people of low socioeconomic status. The Affordable Care Act was meant to help address this gap (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 in impoverished communities seek out ways to self-medicate, which can lead to drug addiction and related problems (Nicks; Szabo).

On the one hand, the problem of access to care for low socioeconomic communities is one that could be addressed if nurses were 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 independently but must work under a physician — even when 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 socioeconomic communities, especially Black communities. There is a long history of suspicion between the Black community and the healthcare system, stemming from the Tuskegee experiments and the story of Henrietta Lacks, whose cells were taken and used for experimentation and study around the world without her knowledge or consent (Skloot). People of low socioeconomic backgrounds have historically felt exploited by those in medicine, as Skloot demonstrates — so even if the Institute of Medicine got its way and APRNs were allowed to practice independently, would people in poor communities actually seek care? Or would they remain distrustful of the healthcare industry?

This paper aims to answer that question by examining Eudora Welty's short story "A Worn Path." It will analyze Welty's story and show how, even though it is over 80 years old, its meaning still echoes in modern healthcare — where new technologies like telemedicine and drone delivery could be explored as possibilities to address the issues Welty raises. The paper first describes the story, then shows how the plight of the impoverished affects healthcare today and what healthcare workers can do about it. It then discusses the tension between Skloot's argument and the Institute of Medicine's position on whether a trust problem or an access problem is most fundamental. Finally, it argues that by integrating new technologies alongside improvements in access to care, healthcare workers can positively impact low socioeconomic communities.

A Worn Path: Summary and Social Context

Eudora Welty's short story "A Worn Path" first appeared in The Atlantic in 1941. It tells the story of an elderly grandmother making a long trek through the countryside into town to receive throat medicine for her young grandson, who swallowed lye two years earlier. Whenever his throat seizes up, she makes the long, arduous journey on foot to receive medicine provided through the hospital's charity toward poor people. She has nothing to give — but the doctor told her long ago that if the health issues persisted, and as 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 willing to go to such lengths to care for another.

The problem for many people of low socioeconomic status today is that they do not have someone as devoted and caring as the old woman is toward her young grandson. Today's families have changed dramatically (Lamont): the nature of communities in poor regions has worsened, becoming more dangerous due to violence and drugs, so that elderly 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 toward helping them.

The scene is set in winter. The Grandmother is a Black woman who must travel on foot across the countryside into town to get medicine for her grandson. It is not an easy journey even for a young person, but the Grandmother makes it routinely. Welty shows just how difficult it is for a person of low socioeconomic status to access healthcare — and the sad reality is that not much has changed in the more than 80 years since the story was published. Some circumstances have changed, however. The environment is entirely different: a grandmother in the 1940s might have made this trek alone, but in the 21st century it would be ill-advised. There is far more crime, more drugs and gang activity on the streets, and a much greater risk of danger. All of these factors explain why people of low socioeconomic status do not risk their lives to receive healthcare: for them it is not worth it. They would rather self-medicate with whatever is most accessible — such as drugs or alcohol.

The Grandmother will not take such an option. She knows what her grandson needs and sets out to get it from the hospital. She will not risk his health because she loves him and is willing to sacrifice herself to help him. Does such sacrifice still exist today? Eighty years have passed and the family dynamic has changed substantially, as Lamont has shown. Throughout those years, Black communities like the one the Grandmother comes from have endured repeated abuses at the hands of the healthcare establishment.

There is even skepticism among the healthcare workers toward the Grandmother. They look at her distrustfully, as though she herself might be an addict making up the story of a grandson in order to obtain medicine for her own use. The story makes clear, of course, that the medicine really is for her grandson — but the suspicion is real and telling. This two-way street of suspicion is firmly rooted in historical reality.

The plight of the impoverished is real, and to receive care they must overcome not only physical barriers — such as navigating dangerous neighborhoods or traveling long distances — but also social barriers of suspicion from others. It is a social fact that people who are not of a low socioeconomic background tend to look down upon those of lower classes, often viewing them with wariness because the stereotype of the lower class as untrustworthy persists to this day. In Welty's story, this dynamic is on full display as the Grandmother travels all day to reach the hospital, only to be treated with suspicion by nurses who do not know her. Those who do know her treat her condescendingly but with charity, and she is grateful. In reality, nurses can harbor prejudice and bias rooted in their cultural upbringing — and that is something the profession must actively confront.

Trust, Mistrust, and the Need for Access to Care

As the Institute of Medicine points out, there is a clear and pressing need for improvements in access to care so that communities everywhere can receive better healthcare. The problem is that nurses are not permitted to practice autonomously to the fullest extent of their training in many states. However, as Skloot demonstrates, it is far from certain that the Black community or other low socioeconomic communities would even trust healthcare workers if facilities expanded their operations and opened closer to those neighborhoods.

Trust is so central to the healthcare experience that the industry cannot function without it. Patients must be able to trust that their nurses and doctors will treat them fairly and genuinely have their best interests in mind. If that trust is absent, no patient will seek assistance. The story of the Tuskegee syphilis experiments illustrates just how devastating the consequences can be when healthcare workers abuse their authority — and why that mistrust lingers across generations.

Building trust requires understanding, and Welty illustrates this dynamic in her story. The Grandmother covers a great deal of ground, and because she is so old and exhausted, she momentarily forgets why she made the journey. She must sit and rest, and one of the nurses who knows her and understands her situation is kind enough to invite her to do so. Even though that nurse grows somewhat impatient while the old woman waits for her memory to return so she can answer the nurse's questions, the crucial point is that the nurse takes the time to engage with her rather than dismissing her as the other nurses do.

This dynamic is important because the tension between the Institute of Medicine's argument and Skloot's argument can only be resolved through a balance between the two perspectives. That balance requires a genuine meeting of the minds on both sides: healthcare workers must engage with low socioeconomic communities, and those communities must be given reasons to engage in return. They must come to know one another and develop meaningful relationships. Only then will expanded access to care produce the results it promises — because the trust those relationships cultivate will encourage people from the community to actually seek care, just as the Grandmother does. She trusts the people at the hospital, and they know her. It is a two-way street that, when it runs well, runs in a positive direction.

Conclusion

Eudora Welty's short story "A Worn Path" shows just how difficult it is for low socioeconomic communities to gain access to healthcare. The Grandmother in the story must travel through the countryside on foot to reach a town where she then relies on the charity of the hospital to receive the medicine her grandson needs. And even then, she encounters a degree of impatience and suspicion from the nurses around her — as though they harbor a bias toward her people and her community, in spite of their professional obligation to provide healthcare to all.

The fact of the matter is that in many communities across America today, the situation is not much different — even 80 years later. The same biases and prejudices persist. The same barriers to healthcare for the same impoverished communities remain. The Institute of Medicine suggests that the solution is to grant greater autonomy to APRNs so they can practice to the full extent of their training, thereby increasing access to care for these communities. The problem, as Skloot shows, is that these communities are not necessarily inclined to trust the healthcare system given the history of abuses they have endured. To resolve this dispute, it is possible to find a middle ground where the healthcare community demonstrates greater transparency and understanding of the communities it serves, and where those communities can gradually learn to trust healthcare providers through relationship-building and familiarity.

Understanding is key to addressing this problem — and another valuable tool is the integration of advanced technologies available today, such as telemedicine, which allows healthcare providers to connect with patients remotely so that patients do not have to leave their homes to receive care. This approach would demonstrate to communities that providers genuinely care about their wellbeing — and would help alleviate the burden that people like the Grandmother in Welty's story still face every day.

Works Cited

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Skloot, R. The Immortal Life of Henrietta Lacks. NY: Random House, 2010.

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/