The Rural Household Production of Health Approach: Applying Lessons from Zambia to Rural Cancer Disparities in the U.S

Where there are no visitors: Improvising care in a pediatric hospital in Zambia

In hospitals in Zambia, family members carry out intimate and care procedures, run errands, and offer emotional and practical support to patients. However, their presence also creates challenges when they use resources, take up space dedicated to patients, and contribute to disease spread. The COVID-19 pandemic brought such tensions into view and drove hospital administrators, clinicians, and researchers to draw a bright line between family as caregivers (considered necessary) and family as visitors (considered extraneous). In this article, we ask: If caregivers are not visitors, then who are visitors? What is the work of visiting? From 2020 to 2021, we carried out research in a Zambian pediatric hospital when visitors were not allowed to enter the hospital, but a singular caregiver was required at the bedside of each child admitted. Our findings from interviews with 44 healthcare workers and 30 caregivers revealed several themes-that the care work required in hospitals surpasses the ability of a single caregiver; that ephemeral encounters between caregivers and visitors facilitate sympathy driven care; and that witnessing need could catalyze and exhibit support. We expand on these themes, focusing on one grandmother's months-long stay with her granddaughter in the hospital, to show how caregiver, visitor, and healthcare worker roles were improvised and reworked. Ultimately, this research breaks down binaries commonly cited in discussions of family caregiving, such as essential and non-essential, helpful and wasteful, caregiver and visitor. This has policy implications because ignoring or dismissing visitors as extraneous will further disadvantage caregivers and patients and disenfranchise families.

A Heart for the Care: Affect, Kin, and Care Work in a Zambian Hospital

At the only standalone pediatric hospital in Zambia, patient wellbeing often rests in the hands of bedsiders. Bedsiders are caregivers, often family, who sit at the patient's bedside, feeding, cleaning them, and running medical errands. Bedsiders are critical human infrastructure for the hospital and its staff. In our research, we heard repeatedly that bedsiders must have a "heart" for caregiving, taking on unremunerated and exhausting informal labor. We draw on Wendland's "heart for the work," a phrase commonly used among healthcare workers in Malawi and Zambia describing the medical profession, to explore what this metaphor reveals about care.

Distance and Transportation Barriers to Colorectal Cancer Screening in a Rural Community

Rural residents in underserved areas face many barriers to health services, including colonoscopies for colorectal cancer (CRC) screening, but rural healthcare providers may assist patients navigating these challenges due to familiarity with local contexts. In 2017 to 2018, we interviewed clinical practitioners and staff (n = 40) at 13 primary care and gastroenterology locations across rural Southern Illinois. We used a semi-structured interview guide that addressed system, provider, and patient levels including domains related to barriers, facilitators, and needs for intervention. This article focuses on 3 main elements related to distance and transportation that emerged from inductive coding. First, providers described long distance travel for care as normalized but not necessarily preferable. Second, they identified and described distance-related challenges specific to CRC screening, and third, providers discussed strategies, mostly related to transportation, they use to navigate those challenges. Finally, they suggested a variety of broader solutions to reduce distance and transportation barriers to screening. Overall, distance to care remains a challenge to increasing CRC screening and contributes to disparities in rural communities. To increase early detection and reduce rural cancer disparities, efforts to increase screening and follow-up must address ways to help patients and providers navigate this distance within their local communities and contexts.