_{My journey in healthcare has been a continual evolution, shaped by experiences that have deepened my understanding of patient care and the challenges faced by rural communities. As a child, I held a naive belief that becoming a doctor would enable me to cure my grandmother's illnesses. However, her chronic conditions taught me the limitations of medicine and the significance of quality of life over a complete cure. These realizations led me to become an EMT, seeking firsthand experience to better serve patients. While my role as an EMT was crucial in stabilizing and transporting acute patients, it was my time as a scribe in an Oregon rural urgent care clinic that opened my eyes to the struggles faced by rural healthcare providers and the communities they serve.}

_{Immersing myself in the world of rural healthcare, I witnessed firsthand the barriers patients encounter when accessing medical services. The limited availability of healthcare facilities, particularly on Native American Reservations, creates significant disparities in healthcare access. Many times, smaller rural clinics lack essential resources and imaging capabilities, most offering only generalized care. The logistical challenges are immense, with some providers even flying in from out of state, distant cities to support these underserved regions. I realized that healthcare extends beyond diagnosis and treatment; it encompasses a holistic approach to patient care.}

_{As I grappled with doubts about my own path in healthcare, knowing the commitment to become a doctor is a significant undertaking, my grandmother's passing helped me prioritize my values. Witnessing her decline in health and the impact it had on her quality of life and observing my parents consumed by work and raising a family, I yearned for a more balanced and fulfilling lifestyle. Delving deeper into my research, I found solace in discovering the role of Physician Assistants (PAs). Their emphasis on work-life balance, reduced stress levels, and the flexibility to explore various specialties resonated with my values. Becoming a PA presented an opportunity to serve rural communities in a meaningful way, addressing healthcare disparities and working towards a better future.}

_{At the start of 2023, I was fortunate to secure a position at Arizona’s Resource Equity & Access Coordination Hub (AZ REACH), a job that has provided me with a deep sense of fulfillment. AZ REACH is an innovative program operated through the University of Arizona Poison Center that coordinates medical transfer from Arizona’s critical access, Indian Health Service (IHS), and tribally operated PL.93-638 hospitals. These were the exact locations I had witnessed the logistics struggles while working as a scribe in Oregon. The stories shared by the providers utilizing the AZ REACH services highlight the urgent need for improvements in rural healthcare.}

_{One case that deeply impacted me involved a patient in dire need of emergent dialysis who also suffered a post-operative bleed in his foot. Shockingly, prior to surgery, the patient had never been advised to discontinue his blood thinners, leading to continuous bleeding for several days. The situation became critical, requiring a blood transfusion, yet the small rural hospital lacked the necessary resources to perform dialysis or provide a transfusion. Fortunately, the doctor monitoring the patient's condition discontinued the anticoagulant and successfully controlled the bleeding while trying to search for a location to transfer the patient for blood should it become necessary. The struggles to find placement at a larger hospital that could accommodate the case were met with rejections with the potential accepting physicians clearly not fully understanding the urgency to this “routine case”. This patient will forever stick with me as it spotlights systemic challenges in healthcare coordination and resource allocation.}

_{Despite the patient's urgent need for dialysis and a blood transfusion, every hospital system in Arizona declined to accept the case, including some hospitals in California. Instead, they focused solely on the post-operative bleed and suggested the patient return to the hospital system where the surgery was performed. Regrettably, that hospital was already operating at full capacity and could not accommodate the patient. After persistent advocacy, we finally managed to secure a placement for the patient at a hospital in Las Vegas. This hospital was, wait for it, the TWENTY SIXTH location that we attempted to transfer the patient. Hours upon hours were spent by the emergency room provider, health unit secretary, and even the hospital’s administrative team as a level of escalation. The whole experience emphasized the challenges faced by patients in accessing the appropriate level of care and the need for systemic improvements in healthcare coordination. Despite all these obstacles, witnessing the dedication of rural healthcare providers to serve their communities was truly inspiring.}

_{Shortly after starting my position as an AZ REACH coordinator, I was provided the opportunity to visit one of the Arizona IHS Hospitals. This was a remarkable experience where I shadowed the emergency room director. I witnessed a provider performing an incision and drainage procedure and then educating the patient on dressing changes and irrigation methods. While that is routine for most, follow-up care was significantly more challenging since the patient lacked access to a refrigerator or even clean water. Additionally, I observed a trauma case and a code situation. At one-point, Navajo EMS called to inform the team that they were five minutes away but subsequently lost radio service. The emergency room care team had just five minutes to prepare for both scenarios. Despite the challenges seen, this experience exemplified what healthcare should be— providers doing their utmost to assist those in need, driven by genuine care for their patients and their outcomes.}

_{I’m beyond proud to say that the next journey I will embark on is joining the Northern Arizona University Physician Assistant Class of 2025, my passion to improve healthcare for rural communities burns brighter than ever. I am driven to continue advocating for better resources, infrastructure, and policies to empower rural healthcare providers to deliver optimal care. The struggles faced by rural patients and providers deserve attention, and I am committed to making a positive impact.}

_{Although I had always been drawn to medicine, I had never found a specific aspect that resonated with me until now. The disparities in health care access for rural patients and the dedication of providers that serve these communities have fueled my determination to incite change. As I step into the next chapter of my journey, I carry with me the stories of those I encountered along my path, reminding me of the profound impact a committed provider can have in transforming lives and communities. Together, let us work towards a future where rural healthcare flourishes, and every patient receives the care they deserve. Let us all be champions for rural healthcare.}

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_{Thienan Le, AZ REACH Coordinator
Northern Arizona University Class of 2025}

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