Rural Reflections

Ellen Dearden, RN, BN

Reprinted from "Eating Disorders" issue of Visions Journal, 2002, No. 16, pp. 33-34

I stare at the empty pad of paper in front of me as I reflect on the challenges and joys of the past fourteen years working as the Eating Disorder Nurse/Therapist in rural ‘Small Town, BC’. I am in my parent’s empty home, sitting in my dad’s kitchen chair, my dad who passed away last June. I just finished watching the News Channel’s lead-up to the tributes planned in memory of the tragedies of September 11th, 2001, the same day my family buried my grandmother. These were all events I could not control, yet ‘control’ is the most commonly-used word in eating disorder treatment literature to describe the psychological/physical needs of eating disorder sufferers.

As the deaths of the last year demonstrate, none of us have total control over ourselves or of events around us. We need to learn to adapt to the challenges life brings us unbidden. Working as a small town eating disorder nurse has taught me to be adaptable. I learned and am still learning to deal with administrative isolation, lack of specialist services, especially psychiatric, public misconception (e.g., “Are eating disorders really a problem here?”), and of course the “Tyranny of the Urgent!” What should I focus my energies on, in my one-day-a-week job, within the context of what our regional funding allows. Do I see clients or a family, teach a prevention program at the local school or tackle administrative funding issues?

People appreciate my efforts and care, complain that funding is inadequate, and wonder about a referral to the ‘Big City’ eating disorder specialists. Going through periods of burnout for rural practitioners is not uncommon, as we deal with our own sense of inadequacy, of possibly not knowing or doing as good a job as our colleagues in the ‘Big City’; where seeing your client at church, at the gym, your daughter’s dance class or at the grocery store does not allow you the anonymity/privacy a larger community affords. Where you or your team (if you have one) are the only resource treating eating disorder clients, and therefore if you get sick or quit, there is no one to replace you or even anyone administratively who would oversee the responsibility of replacing you.

Despite these difficulties, many rural practitioners have stayed in their small communities, fighting to maintain their eating disorder programs. Why? Because there is a sense of satisfaction that one is contributing in some small way to groundbreaking work in rural eating disorder treatment. There is independence and yet a sense of professional community with the support and encouragement of other rural eating disorder practitioners in the province who are faced with the same challenges. Last, but not least, there are the women and girls I work with, who are bright, sensitive and unique. I am encouraged when I see them make improvements in their quality of life and when years later they return to thank me. Through helping them in their struggles, they teach me about myself, that I can’t control everything and that death may come unbidden, but I can learn to adapt and help make a difference by my presence, caring, support and prayers.

 
About the author
Ellen is the clinical nurse coordinator/therapist of the East Kootenay Eating Disorder Clinic located in Cranbrook, BC. She works with a very part-time team of a doctor, nutritionist and group therapist. She lives on a Christmas tree farm with a mountain-loving husband, three active teenage daughters, two German Shepard dogs and Oreo the Cat
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