W Eugene Smith Country Doctor Photo Essays

The life of an American country doctor was heroic, necessary, and utterly exhausting

Rural health care has always been a difficult problem

Finding a doctor in rural America has never been easy. Even as more people were choosing physician and hospital care over traditional, “alternative” healing at the end of the 19th century, hospitals and physicians tended to locate in urban centers with a solid patient pool to keep beds filled. Today, still, the dearth of physicians in remote areas means hospitals are few and far between. And even should you find one, they may not be able to treat what ails you. Being a rural doctor often necessarily precludes specialization, so don’t expect a kidney transplant in Tonopah, Nevada.

Of course this is no new problem. Country folk have been bootstrapping their healthcare for generations through the use of hard to reach clinics, rural hospitals, and the traveling doctor. And even in the 1920s, when half of Americans still lived rural, 80 percent of doctors were in cities. The postwar shift from general practitioners to specialists didn’t help, either. Before WWII most physicians were still GPs. But specialization brought a higher potential income, and by 1960 85-90 percent of med school grads were choosing to specialize their practice. According to the Western Journal of Medicine, “nothing affects the location decision of physicians more than specialty. The more highly specialized the physician, the less likely he or she will settle in a rural area.”

With the rise of private “third party” health insurance beginning in the 1940s, doctors were no longer paid by their patients, and reimbursements for specialists were generally larger. Truth is, efficient healthcare and rustic living had never mixed very well—but the situation has worsened as medical careerism shifted from an emphasis on altruism to profit. Blame your orthopedist.

Some large government initiatives have attempted to alleviate the maldistribution of health care, between both urban and rural areas and across the income spectrum. The Hill–Burton Act of 1946 did much to pump hospital funding into middle class communities, but was plagued by accountability issues and accusations of ignoring stipulations aimed at enhancing care for poor patients. The Affordable Care Act, too, brought much needed funds to rural hospitals with its expansion of Medicaid coverage for some 9 million Americans—many of them the rural poor.

W. Eugene Smith’s genre defining photo essay may be pushing 70 years old, but its relevance is still felt in places where medical services are rare or nonexistent. The 1948 Life magazine story was groundbreaking for its narrative use of still images and intimate look into the day-to-day life of Dr. Ernest Ceriani, the sole physician for around 2,000 people living in and around the town of Kremmling, Colorado (current population: 1,500). Smith’s images portray the 32-year-old Ceriani as a heroic figure, selflessly nurturing his patients with a surgeon’s clinical focus and the bedside manner of a nurse. He alternates between stoic exhaustion and preternatural focus, and in the absence of other options for health care outside a 115-mile drive to Denver, he is, quite literally, a savior.

W. Eugene Smith: The Photo Essay

Excerpt from Time.com:
W. Eugene Smith’s Landmark Portrait: ‘Country Doctor’  by Ben Cosgrove
For his groundbreaking 1948 LIFE magazine photo essay, “Country Doctor” — seen here, in its entirety, followed by several unpublished photographs from the shoot — photographer W. Eugene Smith spent 23 days in Kremmling, Colo., chronicling the day-to-day challenges faced by an indefatigable general practitioner named Dr. Ernest Ceriani.

Six decades later, Smith’s images from those three weeks remain as fresh as they were the moment he took them, and as revelatory as they surely felt to millions of LIFE’s readers as they encountered Dr. Ceriani, his patients and his fellow tough, uncompromising Coloradans.

Born on a sheep ranch in Wyoming, Dr. Ceriani attended Chicago’s Loyola School of Medicine but opted not to pursue a medical career in the big city. In 1946, after a stint in the Navy, he was recruited by the hospital in Kremmling, and he and wife Bernetha, who was born in Colorado, settled into the rural town. Dr. Ceriani was the sole physician for an area of about 400 square miles, inhabited by some 2,000 people.

Eugene Smith’s at-times almost unsettlingly intimate pictures illustrate in poignant detail the challenges faced by a modest, tireless rural physician — and gradually reveal the inner workings and the outer trappings of what is clearly a uniquely rewarding life.

“Country Doctor” was an instant classic when first published, establishing Smith as a master of the uniquely commanding young art form of the photo essay, and solidifying his stature as one of the most passionate and influential photojournalists of the 20th century. 
                                                                                     - Ben Cosgrove, published Feb. 1, 2012
This image of two small children walking into a path of light is more of a biographical statement than any other of Smith’s work.  If we relate to it, it is because it encompasses within it a very familiar human requisite: our search for hope. If it seems soothing, it is because these children have seemingly found their hope, their strength, and the photograph associates itself with philosophical propaganda regarding darkness and light, which we often embrace because of its simplicity and romanticized beauty.  For Smith, however, it served as an image of departure.  A departure from the horrors of war towards his dedication to the coverage of humanitarian activities which occupied his time and directed his photographic work for the rest of his life. 
                                                                                                           - Belenna M. Lauto
Smith's Personal Narrative:
In May of 1945, after completing several documentary assignments from LIFE that took him from Saipan, to Guam, to Iwo Jima, and Okinawa, to cover invasions associated with World War II, Smith was gravely injured by shellfire. During his two years of surgeries and recuperation, dismayed by his first hand experiences of the horrors of war, he ceased from photographing until he found within him the strength to, as he put it, “command my creative spirit out of its exile.”  The result: “The Walk to Paradise Garden”, later to be included in Edward Steichen’s organized exhibition for the Museum of Modern Art in 1955, “The Family of Man”. 

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