Fifteen UNE health professions students are currently participating in a rural health immersion over their spring break in Franklin County, Maine. The immersion experience is a part of a pipeline program with Maine’s Area Health Education Center (AHEC) program and UNE’s Center for Excellence in Health Innovation (CEHI) to address healthcare provider shortages in rural Maine. This is the second immersion experience that the Maine AHEC and CEHI have provided for UNE students, last May a similar number of different students participated in a weeklong immersion in Aroostook County. The students have been split into five interprofessional teams consisting of a medical and nursing students. The students are experiencing a variety of clinical and community activities in underserved areas in Franklin County. Below are reflections from one team after the second day in Franklin County on March 13th, 2017.
Lorri Brown and Tania Dawson, RN, talk to the students about substance misuse in Franklin County early on Monday morning.
Kristina Carlson (first year medical student)
As the group continued to come together in the efforts to break down our barriers of medical student and nursing student, staff and not-staff, our activities during the day also had us thinking of the problems we face when barriers are present in our interactions with patients. One of the labels that gets used often is that of “addict.” While true, using it can place a divide between healthcare provider and the patient. Think of all your traits; all the items people could describe you by. Friend, sister, brother, loyal, trustworthy. Instead, they choose to label you as an addict. By doing so, you have effectively stripped that person of anything else they are, and have instead decided to see them as this one label, instead of a collection of many labels and titles. For patients that are trying to move forward with their life, or who hate the fact that they do have a substance misuse problem, this can be particularly damaging to your relationship with them as a provider.
This same thread came up once again in our meeting with local author, Bill Roorbach. He explained to us that we all hold labels and titles in front of us as part of a personality that we put on for people. However, he claimed that only when we break through these labels do we get to experience a real connection with other people. As introductions were happening, he first started with simple questions: where are you from and what do you do. The answers were equally easy: southern NH, medical school. Questions that immediately place individuals into boxes and slap labels on their head – answers that throw barriers up between people faster than we can see. But then he quickly branched out to questions that required a much more personal connection: why did you move here?, and what are you thinking right at this moment? The takeaway that I received from talking with him is that it is important to get to know someone. It is important to be open to them instead of just the labels that seem to define them.
I would challenge all of us on this trip, reading this post, and working in healthcare to consider how you refer to your patients and reflect on if there is something more you can do to understand them to provide the best healthcare to them. I know I have a lot of work ahead of me, but I’m willing to put the time and effort in. Are you?
Later in the morning the students spent time at NorthStar learning about emergency medical services in Franklin County and how innovative thinking at NorthStar has allowed them to provide coverage over an unusually large geographical area.
Ilija Bratina (ABSN student)
Monday dawned bright and crisp in Wilton, Maine. Energized by coffee-assisted adjustment to Daylight Savings, the fifteen of us arrived at Franklin Memorial Hospital Bass Meeting Room. Lorri Brown gave an excellent introduction to drug use in the community, with interdisciplinary focus on language choice and corresponding effect on patient healthcare access. Language and communication have been identified as critical factors in bridging the gap between provider and patient, and acknowledging negative connotations of medical phrasing in the common parlance was eye opening. She also spoke to navigating minute differences between med seekers and those with health seeking behavior in the opioid crisis that is heavily affecting rural and urban landscapes alike.
We heard a lot about how staff in the rural setting have to wear many hats, as evidenced by an excellent presentation by Candace Hagerstrom. Candace came in on ten minutes notice and spoke eloquently and passionately about the Drug Affected Babies program at Franklin Memorial. She demonstrated the capability and flexibility critical in the rural setting. Her message of how to ask good questions had personal resonance and showcased the benefits of crafting of a culture of effective communication.
The segue to lunch turned into the linchpin of the day. Bill Roorbach, person, discussed his fascination with single point descriptor and how labels make poor substitution for really learning about a person. A single point descriptor, i.e. nursing student, refers to simple ways people use to describe themselves in casual conversation. I found significant correlation to healthcare practice in which patient labels affect how we approach treatment and communication. Bill spoke to remaining intellectually porous, open to soaking up what others have to say. His demeanor and casual manner of asking penetrating questions served one of the best examples of how to open dialogue with patients outside of a clinical setting, truly highlighting the benefits of the interdisciplinary model.
Bill Roorbach, local and nationally recognized author, meets with the students over lunch at Calzolaios in Wilton.
Stephanie Czajkowski (first year medical student)
Today was one of those days that feels like a week has gone by, in a good way. The following are a few gems:
The morning began with a discussion with Lori Brown and Tania Dawson at Franklin Memorial Hospital on substance use and misuse, including patient barriers, such as those that healthcare providers can create. Instead of feeding into our biases, we can work to see patients as fallible people for whom it is not our place to make decisions, including whether they should be given Narcan during an opioid overdose.
Candace spoke with us about how it’s better to treat drug affected babies after birth instead of in utero where they could have withdrawal seizures. Further, the requirement to contact DHHS regarding a pregnant woman with a substance use issue does not equate with her losing that baby. It depends on the woman’s history and efforts to get help.
Tania also played Michael Sauschuck’s TED talk discussing the public health crisis “substance abuse nexus” and how we need to shift from a war on the addict to a war on the disease, because what we’ve been doing is not working. I hadn’t realized how pervasive substance use was from yearly unnecessary lives lost due to overdose to crime, eg. burglary, with a high likelihood of a connection to substance use.
Mike and Lee from Northstar EMS spoke with us about their time in the field and working within Wilderness medicine while covering large stretches of land in most of Maine. Training includes knowing what do to and how in certain situations, including recognizing what you’re not able to do, eg. hike through the woods to find someone while wearing improper gear (eg. heavy, unbreathable). They advised, “Go slow to go fast, because slow is smooth and smooth is fast.” Notably, their operation is subsidized by the state so they’re able to provide quality care in a timely manner, ideally a response within 8-15 minutes.
For our final event of the day, we had the privilege of attending the National Alliance on Mental Illness Suicide Prevention & Self Injury talk with Michael Hollander and Greg Marley, something I believe Michelle McCormack (a local pediatrician heavily involved in making community-wide change) was pivotal in organizing. We learned about the nine-fold increase in risk for a suicide attempt for teens who have exhibited non suicidal self injury (NSSI) behaviors of which the most common is cutting. This included remaining calm when learning of said behaviors, educating communities about how best to handle these types of situations, validating (not condoning) the teen expressing these behaviors, and working to provide support and the proper care to help these teens thrive.
Lastly, I could not have asked for a better group to go through and share in this experience with. Our immediate bonding and connecting has continued to blossom in just two short days to include inside jokes, lots of laughter, and countless insightful conversations. I can’t wait for what’s next!