Journal of Rural Community Psychology, Vol. E2, No. 1, 1999 
 
Brief Commentary
 
 
Changing Frontiers of Health Care: Improving Rural and Remote
Practice through Professional Conferencing on the Internet
 
B. Hudnall Stamm, Ph.D. &
Joseph M. Rudolph, M.A.
Traumatic Stress Research Group
University of Alaska Anchorage
Anchorage, Alaska *
 
 
Sharing the Healing Arts
 
In both traditional and modern medicine, information about healing is passed from the elders to the students. In traditional medicine, a healer takes on students and brings them along, teaching them both about themselves and about the healing arts. In this bi-directional teaching style, students hear the elderís story and, in time, learn to ask questions appropriately. Modern health caretraining collects people into centralized facilities where the elders are concentrated based on their particular knowledge. In these settings, information about the healing arts is commonly passed in a more unidirectional manner to groups of students; orally through means such as lectures and grand rounds, or in print such as books and journals.
 
In either tradition, after the initial training period, most healers continue to learn and to help create new knowledge to pass to future generations. One difficulty with this is connecting the healer to other healers and knowing where and how to pass on the knowledge. In traditional medicine, healers generally share stories and remedies when they were able to come together face to face. In modern medicine, universities, journals, and professional conferences have taken their place at the fore of information sharing. However, access to these opportunities--either traditional or modern--is limited by a host of barriers including time, physical and professional proximity, and access to money to pay for travel. When one works in remote or isolated areas such as are common in the arctic, these constraints become more pronounced and are complicated by weather and geography.
 
Current telecommunication technology developments are offering bridges across traditional and modern training as well as the real-world constraints of time, location, and money. By creating electronic villages (Stamm & Pearce, 1995), we are able to expand our access to knowledge in a combined process in which elders and students can share their knowledge. Moreover, these new mediums take advantage of both unidirectional and bi-directional teaching by using the written word in an interactive oral-type way. Thus, the electronic tradition can confer the strength of both the oral and print traditions (Harnad, 1991). In comparison to the oral tradition, it can provide greater reliability in preservation of thoughts and words, while remaining a bi-directional medium of communication. In comparison to the unidirectional print tradition, it can provide information that is specific to the studentís question.
 
The Value of Information
 
Information makes us competent at our jobs. Information changes the things that we can offer to our patients and to our colleagues so that we can do our jobs better. This helps both the patient and the healer. The benefit to the patient is obvious--they are in better health. The benefit to the healer is less obvious. However, there is a very powerful effect of satisfaction for the healer when they are able to improve the quality of their patientís lives (Figley, 1995; Bills, 1995).
 
Accessing information
 
In our current health care system, when a healer lacks information, we move the patient where there is more information--that is to healers who possess more information. In the most extreme cases we send the patient to a place where the information is particularly concentrated--to our health care training facilities. While this can help patients, it disrupts their lives and it can lead to stagnation of knowledge for healers who are not at those places where information is concentrated. In effect, by not being in that group, we risk loosing access to the power of the body of knowledge of the group.
 
While the telephone and annual meetings can help overcome this "knowledge gap;" computers and the internet offer new possibilities for sharing knowledge. There are whole systems of people sharing questions and information via e-mail. One such system is InterPsych. InterPsych is a set of over 40 different electronic conferences devoted to various aspects of mental health, which serves over 7000 subscribers in 70 different countries. Via these conferences, experts in the field (elders) as well as students and everyone in between, can share information on literally anything that might be of interest to a subscriber. If a user has a question about mental health resources in rural settings, he or she might post a question to the Rural-Care conference. This conference has about 300 subscribers who could share their experiences and knowledge.
 
The technology is simple. Users subscribe to conferences of their choice by sending a subscription to the designated computer. Each time a person on that conference makes a post to the list, the computer sends a copy to each subscriber. If the user wishes to reply, he or she sends a response to the central computer and it redistributes the message to the other subscribers. The "conversation" can contain as few or as many people as wish to participate. All that is needed is access to the Internet via e-mail. Since these conferences are text-based, no elaborate computer systems or graphics capabilities to use them. They are especially useful in remote areas where the telecommunications lines do not support high speed modems required for the World Wide Web.
 
Professional advantages abound. Not only is there increased information, there is increased ability to approach colleagues. By corresponding with people we have met on the conferences, we maintain professional friendships with colleagues around the world. By drawing on the expertise of those we had met online, during a recent meeting, we were able to conference with both traditional an modern healers in New Zealand, KwaZulu-Natal, California, and Washington, DC Truly, oneís vision is expanded as is their resource base for problem solving.
 
Please consider participating in this new venture. Professional electronic conferencing via listservs is special in that it is allows the user to communicate on issues in response to an askerís question, replies can come literally within minutes of the asking of the question and the conversation can be shared with almost no effort with literally thousands of others. Truly we have an opportunity here to create a method of sharing that combines the best of bi-directional and unidirectional communication.
 
 
References
 
 
Bills, L. (1995). Trauma-Based Psychiatry for Primary Care. In B.H. Stamm. (Ed.), Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers and Educators. Lutherville, MD: Sidran Press.
 
Figley, C.R. (1995). Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder In Those Who Treat The Traumatized. New York: Bruner/Mazel.
 
Harnad, S. (1991). Post-Guttenberg Galaxy: The Forth Revolution in the Means of Production of Knowledge. Public Access Computer Systems Review 2(1), 39-53.
 
Stamm, B.H. & Pearce, F.W. (1995). Creating virtual community: Telemedicine applications for self-care. In B.H. Stamm. (Ed.), Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers and Educators. Lutherville, MD: Sidran Press.
 
 
Editor's Note:

Beth Hudnall Stamm, Ph.D is presently a Research Associate Director and Assistant Director at the Institute of Rural Health Studies at Ihado State University.  Dr. Stamm is the contact author - bhstamm@isu.edu   http://www.isu.edu/~bhstamm
 
Joseph M. Rudolph, M.A. is presently at the Department of Psychology, North Carolina State University.