Providing health care in rural Pennsylvania isn’t easy. Over the years, primary-care doctors have been leaving rural towns due to a shrinking patient base and greener pastures at growing medical centers in cities like Pittsburgh. This rural health-care drain has also occurred as health problems increase in rural counties, thanks to the growing opioid epidemic.
But somebody has to provide care to the 2.7 million rural Pennsylvanians. One such doctor is Dr. Sima Assefi. She was born in Iran and became a U.S. citizen in the 1990s. For the past four years, she has been working with a temporary-doctor agency, driving hundreds of miles across Pennsylvania to serve rural communities.
Assefi came to the U.S. in 1981 to work and to attend George Mason University, in Virginia. Before Assefi came to the U.S., her family sent her to boarding school in England, to avoid conflicts erupting out of the 1979 Iranian revolution, when the Islamic Republic replaced the Pahlavi dynasty.
When her visa expired in the ’80s, she spent seven years working as a waitress and taxi dispatcher to save up for medical school. With help from her brother in Iran, she attended medical school in the Dominican Republic, eventually returning to the U.S. to earn her medical license and complete her residency.
Assefi’s first permanent position was as a family-medicine doctor, providing care for Latino mushroom farmers in Southeastern Pennsylvania. (She speaks Spanish, Turkish, Persian and English.) Unfortunately, she left that position after being diagnosed with cancer and wasn’t able to practice medicine until treatment was completed.
Now, cancer-free at 54 and based in a Philadelphia suburb, Assefi works as a traveling physician at urgent-care centers across the state, staying in nearby hotels for weeks at a time. She serves towns like Somerset, Greensburg, Hermitage and Johnstown, seeing up to 45 patients a day by herself. Assefi says she treats most conditions that don’t require immediate hospitalization, such as lacerations, non-serious bone fractures and sprains.
“I go to the areas that have a hard time maintaining physicians,” says Assefi. “There are hardly any physicians that live and work in these areas. Many primary-care physicians have closed their practices. This is a huge problem, as patients have lost their care.”
Her dedication is such that her agency, Consilium Staffing, awarded its first-ever Distinguished Service Award to Assefi in February. “[Assefi] has spent more than 4,000 hours treating patients,” wrote Landon Webb, of Consilium, in a press release, “and the facilities at which she worked have consistently sent glowing reviews about her competence, warmth, and attention to care for every patient.” Consilium functions as a temp agency for physicians. It locates clinics or hospitals that need doctors and then fills those positions with its doctors.
Lisa Fiorentino is the director of the Center for Rural Health Practice at the University of Pittsburgh Bradford, in McKean County. She concurs with Assefi that it’s hard to find doctors to serve rural areas, and adds that some rural hospitals are offering to pay off med-school debt just to retain physicians. “What [Assefi] is doing is wonderful,” says Fiorentino. “You have to have people with high energy to do that.”
Assefi is among only a handful of doctors willing to drive long hours and sleep in hotels to serve rural towns. But says it hasn’t always been easy because of confrontations that sometimes transpire because of her accent and native land.
“It has been definitely challenging because it’s Middle America and I am Persian from Iran,” says Assefi. “As soon as I open my mouth and start talking, [patients] realize the accent and their attitudes immediately change as soon as they find out where I am from. I hear a lot of remarks and some aren’t very nice.”
Many of the counties Assefi serves voted for President Donald Trump in record numbers. (For example, voter turnout in Trump-dominated counties like Clarion and Somerset was up more than 8 percent in 2016.) During his campaign, Trump called for a “complete and total shutdown of Muslims entering the United States” until further security measures were in place; Iran was among the seven majority-Muslim counties subjected to his controversial travel ban. Assefi says some patients tell her she should “go home” and some ask her “why do you hate us?”
“At the beginning, it made me upset, I would cry and get angry,” says Assefi. “I wanted to tell my agent I’m not going to come back to these areas. But I have learned to be a better human being. I have learned patience.”
Now, Assefi sees herself not just as a doctor, but as messenger, spreading the word about how many Iranians love America.
“Every city I go to, although very small, they have their own culture and their own people. It’s amazing. I love the people, I love the middle of America,” says Assefi. “I am here because I love serving [rural patients], and I am glad to have the opportunity one by one to make a change.”
Assefi’s patience and kindness are paying off. After patients and clinic staff have interacted with her for a few weeks, Assefi says some have apologized for misjudging her. Assefi believes this is because she might have more in common with native Pennsylvanians than they realize.
While Assefi isn’t religious, she says, she believes in God. She identifies most with Catholicism, because she attended Catholic school during her youth in Iran. “I had to go to chapel every morning and read hymns,” says Assefi. “I am more familiar with Catholicism than Islam. My grandmother drank Johnnie Walker Black and played gin rummy.”
She hopes her work in rural Pennsylvania not only improves the health of the community but also combats xenophobia. “Sima, you are here to educate and broaden their horizon,” Assefi tells herself. “I am very happy with myself and very proud of myself. I am not planning to retire, I am planning to work."