By Jason Soong
Dr. Fereshteh Gerayli can speak with authority about the fact that rural communities around the globe face similar challenges in obtaining access to health care. Her pathway to becoming a professor of family medicine started among the mountains of Iran and brought her to East Tennessee by way of eastern Kentucky.
Gerayli is a physician and professor in the Family Medicine Residency Program at East Tennessee State University’s Quillen College of Medicine in Johnson City. While accepting last year’s Notable Women of ETSU award, she explained that practicing medicine in underserved areas of Appalachia came naturally because her medical career started under similar circumstances in her native Iran.
Gerayli was born in Mashad, a city tucked between two mountain ranges, the Binalood and Hezar Masjed Mountains, in Northeast Iran. “Mashad was known to all Iranians for its holy shrine and the university,” she said in her acceptance speech.
Despite the city’s importance to the religious and academic life of their country, Gerayli’s mother and father never had the chance to study. “Neither of my parents had higher education — and this was not by choice. This was solely due to their family and social circumstances.”
Her success as a medical professional began with supportive parents who championed her pursuit of higher education in a culture that did not always do so for young women. Her mother grew up there during a time of dramatic change. The king of Iran was attempting to westernize the country, seemingly overnight. Gone were the hijabs, head scarves so ubiquitous to the impression of Iran among the present generation. Gerayli’s mother experienced a shift in the culture that saw women out in public without head coverings. Men were required to wear western clothes. Gerayli’s religious grandmother didn’t agree with the changes, a common reaction from the devout Muslims of the time. Rather than let her daughters go without conventional headwear, her grandmother cut their education short. This meant that Gerayli’s mother, although a naturally inquisitive girl with a photographic memory, never received a high school education.
Gerayli cites her mother as an early role model who always encouraged her academic success. “We were lucky to have this kind, loving, caring, enthusiastic and energetic soul always on our side,” Gerayli said. “…She inspired us to be a good human being before becoming a responsible professional. Both our parents were extremely dedicated to the happiness and success of their children. They encouraged and supported us through higher education.”
As valedictorian of her university-affiliated high school, Gerayli was accepted to the medical school at Mashad University. There were only five public universities in Iran at the time, so this was a highly competitive honor. In addition to the usual curriculum, she spent weekends and evenings learning from specialists in women’s health. This dedication to obstetric and gynecological care would make a difference in the lives of countless women across two continents.
She also met her future husband during medical school. “We seemed to love each other from early on,” she said. “However, we never said a word about it and kept this secret in our hearts until years later. This was due to our conservative upbringing.”
It wasn’t until after finishing medical school, when they both happened to end up in the same rural region of Iran, that they became a couple. During this time, Iran changed as dramatically as it had for her mother. Gerayli was in the fifth year of her seven-year medical education when the Iranian Revolution took place. Gone was the king, replaced with the Islamic Republic. “Now, all of a sudden, we were required to have head coverings,” she said, adding that “this is just the opposite of what happened during my mother’s generation.” To continue her medical education, she had to follow the law of the land.
When Gerayli graduated from medical school, all Iranian doctors were required to work in an underserved community for a year. Having been raised in a city, she had no real concept of rural life. She ended up in Bandar Torkaman, a port city on the Caspian Sea, located in northern Iran near the Turkmenistan border. Known for its caviar and hand-woven Turkmen rugs, Bandar Torkaman was home to a group of women who had suffered from a lack of access to quality women’s health care.
This was not without challenges. Geryali notes that the local population did not speak Farsi, but Turkmeni, a language she had to learn. She was also “the first and only female physician” in the area. Though challenging, she said it was “one of the best and most rewarding experiences in my professional life.”
Once a week, she went out to an island to provide care for the fishermen’s wives. In an area where travel was difficult, many of the women came from their outlying villages to receive care at her clinic, which itself was an hour away from the nearest hospital. When she first came to the island, she saw much death and disease that could have been prevented if only they had more access to health care. That situation improved with her arrival.
She worked with the head of the local health department to establish a birth center. As the founding physician and one of the few doctors comfortable with delivering babies, she was on call 24 hours a day. “I was picked up by the ambulance multiple times in the evenings to go for a delivery as I was shopping at the market,” Geryali said. She didn’t have the support of a labor and delivery unit with nurses and staff to assist her. If the labor went through the night, it was just her and the laboring mom, no matter how long it took for the baby to arrive.
Gerayli’s soon-to-be husband also ended up in Bandar Torkaman after medical school. After working together at the health department for a year, they got married and started their own private practice, known to their patients as the “Dr. Gerayli and Dr. Mehrbakhsh Health Department.”
As much of a blessing as she was to her patients, having her husband there proved to be just as much of a blessing to her. After those sleepless nights delivering babies, her husband would help see her patients while she rested. Gerayli spent many more than the one required year in Bandar Torkaman. She loved the work and the people that she took care of. Her daughter was born there. She would have gladly continued to be the community’s de facto women’s health provider, but Iran continued to change around her.
“After a couple years, our precious daughter was born,” she said. “As she was growing up and the social restrictions for women and girls were increasing, we decided it was time for us to pursue our dream of further training in the U.S. This road was certainly not a paved one for us.”
After a pitstop in Germany due to denied visas, Gerayli came to the United States in 1997. Her brother and parents were already settled in Anaheim, California, so she went there first. She saw Iranians assimilated into American culture and doing well for themselves there. But she missed the work of caring for an underserved population. In search of her passion, she visited her cousin in Somerset, Kentucky. This part of Kentucky, half the world away from Bandar Torkaman, felt like home. It was rural. Life was simple. The people there needed doctors.
Gerayli did her family medicine residency in Hazard, Kentucky, part of the University of Kentucky College of Medicine system. There was some initial culture shock. Growing up, all that she knew of America was what she saw on television: mostly Los Angeles and New York City. Glamour and bright city lights. Hazard and the Appalachian Mountains were about as far from her expectations as possible.
First, she had to learn the local language around ailments. She learned what it meant for a patient to feel “smothered” or to be “swimmy headed.” She caught on to the dialect in Hazard quickly enough that when she rotated at the main referral hospital in Lexington, fellow residents would sometimes rely on her to help “translate” when a patient came in from that area of Kentucky. She got to know her patients and learned about life in the mountains and hollows. One patient told her that not having running water meant that showers consisted of standing under the gutter during a rain.
Gerayli stayed busy during her time in Hazard, first as a resident and then as faculty after graduating residency. Fourteen-hour shifts and not getting nearly enough sleep was routine. She saw up to 40 patients in a single day. As busy as she was, she loved her time there because the care she provided meant so much to her patients. “I chose family medicine because I love the bonding and connection you build with your patients,” she said. “The fact that you look at the whole patient, not one organ system. You understand their body and their soul and how intertwined and inseparable they are.”
Her work caring for patients also paved the way for bringing more international physicians to the area. She was the first international medical graduate to go through the Hazard residency program, which then began accepting more doctors who had attended medical school outside of the U.S.
While Gerayli continued her medical education, her husband sacrificed his own medical career to support her. He had more than enough medical expertise to do residency in America, but he had not attended a bilingual high school like his wife, and learning English proved to be a challenge.
Their then-teenage daughter was also moving to a country completely new to her. With Gerayli working such long hours, they felt that it was important that their daughter have a parent who could spend that formative time with her as she grew up. “I was lucky that my husband was there for our daughter, a teenage immigrant to the U.S. They both worked hard to give me the time and the opportunity to serve the community,” she said. “I am sure I could not have done it well without their support.”
As much as Gerayli loved the work that she did in Hazard, the long hours and heavy patient load began to take a toll. Patient demand was constant, and resources in short supply. She was doctor, pharmacist, social worker, and chaplain, all in one person. Her colleagues saw her beginning to struggle and encouraged her to join the faculty at ETSU, where she could continue to care for an underserved population but with a more sustainable patient volume. “It was not an easy decision for me to leave my residency and patients behind,” she said. “However, I am very glad I made the decision to come (to ETSU).”
Gerayli joined the faculty at the ETSU family medicine residency in 2005 and says she has had “enormous joy” working with “a team of bright faculty, residents, and medical students. Along with our nurses and our staff, we have had a happy family medicine family here.”
She has published several articles with colleagues and continues to see patients and teach with a focus on women’s health. She was honored with the Notable Women of ETSU Award for 2023, and during her acceptance speech, told the story of her journey in rural health from Iran to Appalachia.
“I could not be any happier in any other position than family medicine at ETSU Health,” she said. “Family medicine is not the easiest field, but certainly the most rewarding one.”
Dr. Fereshteh Gerayli is a family medicine physician who has cared for patients in the Appalachian Mountains for over two decades.
Jason Soong is a second-year family medicine resident at ETSU who plans to practice medicine in Appalachia after finishing residency.