Some easily-agreed tasks turn out to be challenges of a different order when eventually undertaken. Such has been my experience in reviewing the Rural Medical Education Guidebook, a herculean effort of the WONCA Working Party on Rural Practice, with support from the Northern Ontario School of Medicine, Memorial University of Newfoundland, and the Rockefeller Foundation. It is available for your reading pleasure at http://www.globalfamilydoctor.com/RMEG
A warning however: this is not a text with a beginning, middle, climax and an ending which neatly ties up all the loose ends like a classic murder mystery. It cannot be read in an evening. It is an encyclopaedia, a smorgasbord, a feast of insights and information about rural practice, rural education, rural life, and rural society, writ large. Although purporting (by its title) to be primarily a tool for rural educators and about rural education, it is in fact much more than this. Not only a text for preceptors and programs, but also a compendium of what we know and where we would like to go. Clearly education is where it all starts, but rural community is where it ends, and there is no shortage of stories that span this spectrum.
The editors have identified five themes, into which they have slotted the essays in logical clusters. Readers are free of course to follow the order of the essays as they are presented, but they may also dip in at will where they recognize a name or a theme with particular resonance. Either strategy invariably yields a pearl: from an historical description of surgery in remote Newfoundland, to an inside look at the challenges faced by women in rural practice, both written by those who have ‘been there, done that’.
It’s all there! The list of authors (over 80 of them) reads like a who’s who of the aristocracy of rural education, practice, academia, and advocacy, and by its very existence is testament to the vigour of the disciple and the breadth of its reach.
The ‘elephant in the room’ is the question: has this intimate knowledge of the history, dynamics, and social structures underlying the inequities in distribution of health and healthcare to rural populations begun to improve the situation? For surely this is the fundamental reason for this effort, and for the creation of this tool. Undoubtedly in some places things have improved. Equally as sure is the fact that in many it has not.
This collection of wisdom and insight and energy must therefore not be a static thing, but rather a process which invites new contributions as new practitioners bring their experience to bear on the problem. Aptly named a ‘guidebook’ this collection of essays should evolve as the landscape which it describes evolves. Its location on the web makes this technically possible, and the importance of the matter makes it imperative.
Happy reading, you won’t be disappointed.
John Wootton, MD, CM