Dr Malin Fors is a psychotherapist, author and Associate Professor at the Arctic University in Norway. Her reserach focuses on power dynamics between rural and urban areas.
Episode Summary:
01.00 Dr Fors tells us about her professional background and interest in rural health
03. 25 What does she most enjoy about rural settings and what does she find most challenging?
05.45 How are challenges different for people living in rural areas regarding mental health?
09.30 What is “Potato Ethics”?
12.45 How does potato ethics show itself in rural healthcare practice?
15.52 How do new clinicians adjust to rural areas and potato ethics?
19.00 Do the differences in approaches to rural practice indicate where someone might practice in the future? What is the role of medical education?
22.15 What is “Geographical Narcissism”?
24.28 What are the power dynamics that geographical narcissism describes?
32.05 How does geographical narcissism play out in the experience of rural communities?
37.05 How does the concept of having a voice play out in rural areas?
40.00 What are some key insights that she has from her research?
44.50 What is she working on at the moment?
Key Messages:
Research focused on power dynamics, and became aware that power was not only in the consultation, medical records or encounter, but also in the place. Started to discover that “rural place” was rarely described in text books and missing in the discussion on intersectionality and power. Approaches rural health with a psychology gaze.
She met her own geographical narcissism as she had an image of the rural world as different, or inferior or that urban standards were more normative.
Enjoys that rural contexts mean you always have to stretch yourself and what you do matters, it is challenging and demanding and feels it keeps her mind sharp and developing.
The most challenging is the isolation, feeling alone, feeling like the person that is always teaching and mentoring people that do not stay for long. You can feel like it is useless. It can be frustrating to not have an expert team available.
People seem to be more ill when they decide to ask for help in rural areas. They are sicker because there is less healthcare. If you wait, mental health can get better on its own or it can become very serious.
Colonization of indigenous peoples' lands in Norway, generational trauma following the second world war, the community is underserved when it comes to healthcare and there is a lack of specialists, this can also contribute to how they present to health services.
Potato ethics is the ethics of making yourself useful. In Swedish being a potato means that you are not specialized but that you could be used for anything. It can be used in a condescending way, saying that you are not the expert.
She combined care ethics and the ethics of consequences to counter the narrative that we who work in rural areas are less ethical in the way we provide care, not meeting urban standards, working on things we are not specialized enough to do, or treating people that are too close to us.
Rural healthcare professionals are potatoes, they are versatile, keep track of patients, do all the tasks that are necessary. We often have to do tasks that are not done in urban areas to prevent disasters.
Potato ethics is the core of rural healthcare as this is how it is organized. It is a way to describe the core of rural ethics. It is also applicable to different kinds of healthcare settings. We are assessing consequences, we know that if we don’t treat the person no one else will, so we do what we can. We can not assume that we have sent a referral and now the patient is taken care of. This is not always the case due to distance or availability. We have to make sure we follow up on our patients.
Different professionals approach being in a rural area differently. Some people may start to point out errors and try to say how things are done in the city, pointing out what you should do because they can not see that the system is not working for these populations. While others ask “how can I help” because they get it.
Geographical narcissism is the subtle devaluation of rural people, rural knowledge, rural experience and rurality. It is a form of oppression like others being addressed within the human rights movement. It is assumed that no knowledge could come from rural areas, can not do research, can not be in the front and that we need to conform to urban ways of doing things.
Geographical narcissism is a way to have a term organized around power themes and to put the urban-rural theme under the intersectional lens. It allows us to use the other movements formulations to talk back i,e blaming the victim, aggression and “urbansplaining”.
Rural expertise is not thought of as expertise, we are always not reaching the urban standards, however we are often going beyond in a lot of situation.
Rural places are seen as being “the other” in comparison to urban places. Talked about almost now one living there, therefore we do not count. Often this is used as a way to explain why we are not entitled to the same services. Rural people are not important enough to get the best care.
The idea that anything goes in rural areas, people that can not get a job anywhere else end up in rural areas.
Can be explicit sometimes, like when people say if you choose to live rural then you have chosen to have less opportunities or less services available to you.
In geographical narcissism there are patterns of devaluation, exploitation, sometimes violence, this is very similar to other types of oppression.
When urban experts come to work in rural areas for a few weeks, they can sometimes speak to rural clinicians as if they do not know national guidelines or how to do procedures. Not considering that we may have been involved in developing the national guidance, do research or perform procedures independently. This can be provoking for rural clinicians and they can feel like they are being talked down to and not be seen as equal.
When you have a language to name things it becomes more obvious and it is easier for people to become aware about their assumptions. We need to be able to speak with confidence about what we are doing.
It is important to not only be angry but to also be open to engaging with people who have a capacity to change. We need to use different strategies to bring awareness and change.
Geographical narcissism is also a political question, it is part of discussion about where hospitals should be placed, how many resources communities should be assigned, where schools are positioned and many other things.
Urban standards do not always fit in rural areas, ideas about how healthcare should be organized based on urban contexts will not be effective in rural areas as the context is very different. We get told that the rural context is wrong instead of being asked what might work in our context.
Rural people are told like all subordinate groups that they are “aggressive” or “will not cooperate” or “silent” and that this is why they are not being heard or listened to.
Rural communities represent “counter power” as they have small and subtle ways with which they handle or respond to geographical narcissism.
It has been surprising how many parallels you can see between rural-urban dynamics and other human rights issues.
Website: https://malinfors.no/en/psychologist-specialist-malin-fors/
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