What a 2,700-mile bike ride taught a Mass General Brigham researcher about health access in rural America
In case you're skimming: When Mass General Brigham postdoctoral researcher George Usmanov, PhD, completed the grueling 2,700-mile Tour Divide bike race, he achieved more than a lifelong endurance goal. The journey also gave him a a firsthand look at the healthcare barriers facing rural communities, reinforcing how health resources and education must be tailored to people's real-world circumstances.
You may not think that a solo, ultra-endurance bicycle race across one of the most desolate stretches of North America would be a good way to meet people and learn about different ways of life. But you’d be wrong.
The opposite in fact, turned out to be true for George Usmanov, PhD, a postdoctoral research fellow at Mass General Brigham who completed the Tour Divide—a 2,700-mile self-supported mountain biking race from Banff, Alberta, Canada to Antelope Wells, New Mexico—this summer.
George Usmanov, PhD
The race, which is considered one of the toughest endurance events in the world, takes riders on a journey from the glaciers of Canada through the mountains and deserts of the Mountain West through to the hot southern border with Mexico.
For Usmanov, the race proved to be more than just a test of his athletic skills and opportunity to remote parts of the country—it also gave him a chance to connect with the residents of rural areas of the American West, whose healthcare challenges are uniquely shaped by geography, infrastructure and local culture.
The ride also served as a fundraiser for Usmanov's research group, helping support future rural health research.
A physical and emotional roller coaster
The Tour Divide is considered one of the toughest bike races in the world, with an annual drop off rate of about 50%. Participants are tasked with riding long hours each day and must cover vast distances in between resupply areas.
Usmanov completed the trek in 25 ½ days, a pace that averaged out to more than 100 miles a day for more than three straight weeks.
While he is an experienced mountain biker, Usmanov admitted to experiencing some doubts before the race began. “Everyone is freaking out and checking out each other’s bikes and equipment; and it is easy to get intimidated,” he explains.
By a few days into the race, however, those initial nerves started to fade. People settled into their paces, and it became easier for Usmanov to find flow during his daily rides.
About 10 or 12 days into the race it became clear to him that each day on the trail encapsulated a vast range of human emotions. There were times when he’d feel elated to be taking on such a big challenge, as well as times of feeling crabby, frustrated and overwhelmed.
“You’re going to have doubt, you’re going to have gratefulness and you’re going to miss home,” he says. “And you never know when each of these emotions will come.”
Seeing rural health up close
At Mass General Brigham, Usmanov’s research focuses on helping people adopt healthier habits that can support brain health and may reduce the risk of stroke, dementia and depression.
One example is the Brain Care Score, a digital tool that helps people identify lifestyle changes that can be beneficial to the brain, such as increasing physical activity, reducing alcohol consumption or strengthening social connections.
But Usmanov and his colleagues have also been exploring how brain health resources can better reach people outside major metropolitan areas—some of the same areas he was now exploring during this lengthy ride from Banff to the US-Mexico border.
One conversation in particular stood out. At a bar in Atlantic City, Wyoming, he spoke with several ranchers about the pain, numbness and tingling that they often experience in their hands and arms, side effects of performing physically demanding work.
For these ranchers, those symptoms were often considered part of everyday life—not a potential signal of a larger cardiovascular issue such as the onset of a stroke.
This difficulty in identifying stroke symptoms, coupled with the often-long travel times that are required to access stroke care in rural settings, makes it much more difficult for patients to get treatment during the window when therapies are the most effective.
“When you have a stroke, you need treatment ASAP, within hours,” Usmanov says. “If you can't really distinguish these subtle differences, it's not the fault of the person, but it is a reality of the lived experiences different people have.”
For Usmanov, the conversation with those ranchers highlighted the importance of designing brain health awareness and education tools that fit people's real-life circumstances, rather than assuming the same approach will resonate with office workers in urban settings such as Boston and ranchers in the rural Mountain West alike.
When health information will not load
Another surprising lesson that Usmanov learned involved a tool that most of use to find information every day: The internet.
Since cell service was unreliable along the race route, each rider carried a GPS tracker so organizers could verify they completed the course. But even when Usmanov encountered grocery stores, gas stations or convenience stores along the way, internet service was frequently unavailable. Store owners told him that limited internet access was a part of daily life.
The challenge became especially clear when Usmanov tried to connect people with the lab’s Brain Care Score website, which includes educational resources and an online quiz.
While the site is visually engaging on a good internet connection, its graphics and interactive features were slow to load in areas of weak connectivity, which made it difficult to access information on the site.
The experience highlighted how even well-designed digital health tools can miss their audience if they are not built to accommodate the technology people have access to. It also prompted Usmanov to consider creating a simpler, lower-bandwidth version of the site with fewer visual elements.
Lessons from the road
For Usmanov, the trip reinforced a simple lesson: Health recommendations are only effective when they fit people's real-world circumstances. A website must be able to load, resources must be accessible and relatable, care must be reachable, and health messages must align with the culture, relationships and daily demands of a community.
Sometimes, understanding those realities means leaving the research office behind and experiencing the country one mile at a time.
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