March 8, 2010 — When she first arrived at the University of Virginia School of Nursing as a nurse practitioner student, Jesse Begley was embarrassed.

"I couldn't open my mouth without being asked, 'Where are you from?,'" she said in her distinct Southwest Virginia accent. In fact, she was raised on a tobacco farm.

But the accent that originally drew comments marks her as an important cultural interpreter.

In Charlottesville, she helps her fellow nursing students understand the culture of the rural patients they serve. Taking clinical rotations at the Charlottesville Free Clinic and at the Health Wagon in Clinchco in Dickenson County, they have been learning about disease processes, patient noncompliance, inadequate mental health services and often-undiagnosed diabetes, hypertension and obesity. 

What they learn from Begley is that the patients who live in these rural, often agricultural areas, are proud, self-reliant people with strong family values who have learned to "get up early and work hard in order to eat." They are actually raised to not use the health system, but to rely on home care, largely because they see nothing else available to them and have limited financial resources.

"They are untrusting because they believe the country has turned its back on the region," she said. For men in particular, seeking professional health care is often viewed as a weakness. Most prefer to remain in the dark about life-threatening diagnoses like cancer, since they don't believe they can access appropriate care and see no need to ruin their last weeks or months by worrying.

Strong religious faith is an important value, and these patients also expect to have faith in their health care provider. Begley's been told by many of her patients that they are much more comfortable receiving care from a nurse practitioner than from a physician because the nurses "listen and seem more caring."

It was this reputation that led her into the profession. "My cousin died of leukemia when she was 16 and she always talked about how wonderful her nurses were," she said.

Alan Howard understands. His mother fought cancer for 20 years before she died.

"She had very good doctors, but it was her nurses who always gave her the most comfort," said Howard, a former U.Va. professor who directed the American Studies program who grew up in a rural part of Colorado.

Seeking a way to support the work of nurses in rural Virginia, he and his family's foundation have created a scholarship program, the Marguerite B. Howard Fellowship, for students like Begley who plan to return to their homes in Southside and Southwest Virginia to provide primary health care as nurse practitioners.

Howard hopes to help build a supportive network between graduates who were able to become nurse practitioners through Howard Fellowships.

"I want to develop education in, outside and beyond classrooms," he said. "Improving online capacities will help increase professional development and certifications to achieve better patient outcomes." 

He sees the scholarship program as a way to bring rural nurses to the U.Va. School of Nursing for further education. Supporting students like Begley also serves to introduce other nursing students to rural patients' needs, in Virginia and throughout the country.

What they learn from Begley augments their clinical experiences with the Charlottesville Free Clinic, the U.Va. Health System's Telehealth program and participation in the annual Remote Area Medical Clinic in Wise.

Begley also is a designated fellow of the Healthy Appalachia Institute through U.Va.'s College at Wise, and has been helpful in recruiting other nurses in the region to consider U.Va.'s nurse practitioner program.

For this young nurse, coming to U.Va. was a personal matter, though she had several geographically closer options.

"My dad had surgery here as a teenager to save his kidneys because there was no one available in Southwest Virginia to perform a surgery like that at that time" – a situation that still exists, she said. "In a way, if my dad had not received the care from U.Va., I might not be here today to be a health care provider for the Appalachian region."

She is proud to serve as a cultural interpreter for her classmates. "I want to help people here learn how to do a better job with rural patients and keep my eyes open for ways to help build trust in caregivers," she said.

She is grateful for the scholarship that is supporting her education as a nurse practitioner, but she knows that as a cultural bridge, she's playing a role in something much larger. And she knows she has support and resources to back her up.