care . Healthcare providers in the Trans- Pecos areas around Presidio and Marathon are limited ; patients are often required to travel two to three hours to reach Fort Stockton or Odessa for higherlevel care when needed . In these cases , neighbors will try to coordinate their appointments in the bigger cities to reduce the burden of driving far distances , reflecting part of a unique social fabric that promotes collective health and support for and from one another . Laboratory services are also an area of critical need . Currently , a courier travels from El Paso to each of these smaller rural towns to pick up blood work and samples that are then returned to the El Paso airport and flown to a centralized lab in Dallas . And this is to say nothing of robust networks of referral options and the availability of muchneeded ancillary care services like physical and occupational therapy often found in larger cities .

To meet the many and diverse needs of their patient populations , the rural clinicians I spoke to truly embodied the role of skilled , holistic generalists and domestic medical missionaries . They described moments when they needed to address concerns , perform certain procedures , or prescribe medications they may not necessarily be comfortable with but are essential since they frequently serve as the first line and only physician their patients will see for long stretches

of time . Faced with such resource limitations , rural clinicians consistently demonstrate what Dr . Jill Konkin and colleagues define as “ clinical courage ” – the conscientious and thoughtful practice of medicine beyond one ’ s comfort zone when required to best treat patients .

Despite these hardships , the patients and clinicians I met were hardy and resilient . They maintained a profound sense of independence and appreciation for their health and the resources they do have . They welcomed our group and generously shared their experiences – a testament to the community-oriented culture I came to witness in these towns . To better serve their patients , rural clinics in the area focus on primary prevention through patient education , low-cost point-of-care screenings , and home health services that require a creative approach amid their limited resources . For one patient with a history of poorly controlled hypertension , the provider asked the local emergency medical services team to visit their home two or three times a week to conduct routine blood pressure checks , which would help with longitudinal monitoring . All the physicians , nurses , and other healthcare support staff I had the privilege to meet were passionate about rural healthcare delivery and patient advocacy ; they continuously walk alongside and accompany their patients as partners and are intimately connected with the struggles , strengths , and hopes of the communities they serve .

Volunteering in this capacity as a medical student with FdS provided a special opportunity to listen to the stories of rural communities , collaborate with interprofessional disciplines , and witness frontier medicine in action . This experience has inspired me and many of my peers to critically examine the health and social disparities that exist in such settings and understand how important it is to serve with intention and to promote equitable access to care .

With that , I would like to take a moment to thank the leadership of Frontera de Salud at UTMB , Dr . Norma Pérez Raifaisen , Dr . Adrian Billings and his family , and the clinic staff at Preventative Health Care Services and the Marathon Health Foundation for their support to help make such an experience in Presidio County possible . Dr . Billings was especially valuable for feedback and edits to this article . Thank you to all the patients and community members we crossed paths with for their kindness , warmth , and openness to sharing their stories .

For more information on UTMB ’ s Frontera de Salud , please visit https :// www . utmb . edu / hcoe / fronterade-salud . �