Over the past couple of years I have read a few articles about the importance of living in the community that one serves. I have seen articles championing volunteer organizations because “people like being cared for by their neighbors” or implying that those who do care for their neighbors would do a better job because of their proximity both physically and emotionally to a patient.
Other articles about fire based systems for example talk about how being part of a community can allow one to know the back roads and short cuts that might shave precious seconds off of response times thus saving countless lives. Further reading will reveal criticism of private EMS departments that come in from outside of the area and know little about the people that they are caring for. Some feel that not living in the area that one practices medicine in can result in them caring that much less about the people that they are providing medical care for.
Based on some personal experiences that I have had, I fail to see any of these as being an absolute that one should lead an argument with. My first EMS position was in the town that I grew up in. Island Heights, New Jersey is small, populated by maybe 1,200 people during the summer months. It was impossible for me to go into a house on a call and not either know the patient or one of their relatives. From there I moved some 250 miles away for college, and spent the first twelve years of my career in Springfield, Massachusetts. I was a transplant, and as a white kid from suburbia, I did not fit the cultural makeup of the city that I worked in at all. Neither did the vast majority of my coworkers. Much like the majority of the workforce in EMS, we were Caucasian and majority male.
Although I was not from the area I was able to learn the streets, and learn a lot about the culture as well. Working in Springfield pushed me to improve the quality of the Spanish that I spoke, and learn a little bit about the cultures that I was surrounded by. It took a little bit of time and work, but I was able to function without a problem, and my medicine grew to be pretty darn good too. Interestingly enough, I was more involved in the culture of Springfield when I was at work than I was when I was at home, where I mostly kept to myself. Living in the city that I worked in provided me with little advantage. Since leaving Springfield, I now live in another area that I am in no way indigenous to. My coverage area has more than tripled, and although I don’t know every back road and shortcut, I am able to function just fine.
The point that I am trying to make is let’s no sell short people’s ability to learn about a culture or to learn the main drags and back streets of their coverage areas. These things are a lot easier to perfect than providing good medicine. It is much easier to teach a paramedic about the cultural makeup of their populace than it is to teach someone from a specific neighborhood how to be a good paramedic. Furthermore, I have never once been turned away by someone in need because I was not part of their community, nor have I ever been asked where I lived or what my background was before being allowed to care for a patient.
Let’s focus on medical care. Let’s make sure that the people doing the assessments and providing treatment whether they are private EMTs, volunteer paramedics, or first responder firefighters, are as well trained as they possibly can be. Let’s make sure that they have a bar, a high bar, to reach for. And finally, let’s remember that there is more to EMS than where you park your car at the end of shift, or how quickly you can get from point A to point B.
So what say you? How important is culture? If a transplant can provide good medicine are the less valuable than somebody who was brought up in the community that they serve, or can they adapt and overcome?