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Life of a Rural OT

Two overflowing bags that look like something Santa Claus might carry, sit just inside the door of her home. They hold inflatable splints, bolsters, balloons and bubbles. Toys to her clients, these are the carefully chosen tools of her trade. As a rural pediatric therapist, Susan is a modern day circuit rider.

During Joyce's fieldwork, she and Susan would pick up the bags and head out the door at 7:30 a.m. First they drove to a rural school where Susan gave six children therapy.

Two hours later, they drove to a home 90 miles away to treat a 6 month-old infant with spina bifida. The floor is littered with bits of peanuts, pretzels and crackers. Susan spreads a blanket on the floor and hands Joyce a toy to use in checking the infant's visual tracking skills. Susan picks up tiny Theresa and begins to gently roll and relax her over a ball. Meanwhile three brothers, all under the age of seven, enjoy going through Susan's toy bag. She massages the baby's feet to increase circulation while keeping an easy dialog going with the baby's mother.

Mom expresses her frustration with the two-hour drives to the doctor appointments in St. Louis. Susan offers to leave the therapy ball and printed instructions so that mom can work with her baby between visits. The father declines stating that the ball might be ruined. Susan leaves the family a bag of clean baby clothes she had purchased at a garage sale and sets the next appointment for a month from now. Lack of transportation and low or unstable incomes are a reality for some of Susan's rural clients.

Back on the road, Susan questions Joyce about the case, not to test her for right answers, but to generate ideas. She stresses that problem solving is an important strength for therapists. Rarely will a child mirror the situations found in textbooks.

Back at the farm that evening, Susan explains how she does her billing. She is reimbursed by the Department of Mental Health, a not-for-profit Home Health Care Agency, local school districts, the Bureau of Special Health Care Needs, and Medicaid. Each has their own policies and paperwork.

Susan uses a photocopier, a computer with fax and CD-ROM in her home to keep up. The computer allows her to take advantage of a Managed Care Course offered on line from her professional organization. Joyce sees first hand how a rural therapist stays up-to-date through journals, conferences, and technology with the wider professional community.