UNE Students Share Experiences on their First Day of the 2018 Piscataquis County Rural Health Immersion

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Ten healthcare students from the University of New England recently participated in a rural health immersion to Piscataquis County.

 

Ten UNE health professions students recently participated in a weeklong rural health immersion to Piscataquis County in 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 fifth immersion experience that the Maine AHEC and CEHI have provided for UNE students but the first time that a group has traveled to the Penquis area.  Last Fall a group of 10 students traveled to Oxford County and Carroll County in New Hampshire for a long weekend immersion; in May of 2017 a group of 13 medical, pharmacy, dental, and nursing students traveled to Maine’s midcoast region of Knox and Waldo Counties for a weeklong immersion; in March of 2017 medical and nursing students participated in a weeklong immersion in Franklin County; and in May of 2016 a group of 15 medical, pharmacy, and dental students participated in a weeklong immersion in Aroostook County.  Throughout the immersion the students are purposefully split into interprofessional teams so that they can learn the roles and how to communicate effectively with other disciplines in order to learn the skills necessary to provide high quality team-based care and improve patient outcomes.  The students experienced a variety of clinical, community, and population health activities in rural and underserved communities in central Maine communities, including Newport, Dover-Foxcroft, and Greenville.  The group was also supposed to visit Eastern Maine Medical Center and Penobscot Community Health Care but due to a Nor’easter the first two days of the trip in Penobscot County were canceled.  Below are reflections from one team after the first day of the trip on Wednesday, March 14th, 2018.

 

Colleen Moore, Junior ABSN student

For the typical student of health care, an immersive experience in a rural setting is unimaginable, if attainable to any extent. On a cloudy, slightly snowy day in Newport, Maine, however improbable the circumstance, ten students were granted the opportunity to begin a tour of rural healthcare across the Penobscot and Piscataquis counties of Maine. The trip already having been truncated due to a massive snow storm, the plans for visiting Eastern Maine Medical Center and Penobscot Community Health Care were regretfully cancelled, leaving the fresh osteopathic, pharmacy, and nursing students with little rural exposure after the first day. With some quick thinking by the trip leader, we were graciously received by Robin Winslow, the CEO, of Hometown Health Center, a Federally Qualified Health Center (FQHC) devoted to serving rural Maine in different locations across five counties.

In a well-lit, comfortable, clean clinic, with the walls adorned with stickers from the movies Cars and Frozen, Robin educated our group about the role of Federally Qualified Health Centers in rural settings, and how her clinics operated within those strict parameters. We learned about the lack of providers coming to rural health clinics due to competing incentives from hospitals, and the struggle for the future of quality rural healthcare due to the aging population of Maine’s healthcare professionals and the impact of opioid addiction.

The most striking aspect of rural healthcare for me that Robin presented was the complex role that each health care professional played in her clinic. In a rural setting, a patient faces many challenges in receiving quality, individualized health care. In an urban setting, quality care usually entails referring a patient to a specialist. In a rural setting, certain barriers, such as transportation, lack of providers, lack of funding, limited resources, and distance between health care facilities present challenges. To address these challenges, Robin talked about the benefits of providing integrated medical, dental, and mental health care all in one facility. In order to provide the best care possible for Hometown Health Care, Robin told us about the nurses, the doctors, and the one pharmacist, and how each contributes to the clinic in by playing many roles that go beyond merely examining their 7,300 patients.

Throughout our discussion, the staff members of Hometown Health Center awed me with their level of interdisciplinary cohesion, and how each healthcare professional worked with compassion to deliver excellent health care in a setting with limited resources. I was left with an impression of Robin’s emphatic resilience, and her dedication to providing affordable, quality care for a community she genuinely cared for, by expanding the roles each of the healthcare providers played.

The success of Robin’s clinic seemed not to come from being financially well-supported, well-staffed, or having especially attracted top-ranked professionals, but from the uniquely dedicated and compassion that each professional brings to the clinic. Each member of the clinic was personally invested in meeting whatever role was needed by the patients, and indeed each staff member wore many hats regardless of the role expectations of that professional’s background. Any clinic can grow and learn from the dedicated interdisciplinary efforts of Hometown Health Center.

 

Alivia Spicer, First Year Osteopathic Medical Student

Finally, after having our trip delayed by 1.5 days due to a Nor’easter, myself and nine other pharmacy, nursing, and medical students were on our way north for the March 2018 Rural Health Immersion Program. Our first stop in the journey north was at the Hometown Health Center (HHC) in Newport, ME. HHC is a federally qualified health center (FQHC) and is a non-profit organization, serving roughly 7300 patients in four locations.

We dropped off boxes of medical supplies at HHC that we had picked up in Portland before departing for the rural health immersion and we were able to get a tour of the facility and meet with Robin, the CEO. Within minutes of listening to Robin discuss the history of the four practices she operated located in Pittsfield, Dover-Foxcroft, Dexter, and Newport; it became very apparent to me of the need for more healthcare providers in rural areas. She stated that out of four locations, they had only four nurses and seven providers (one being a medical doctor and the rest being mid-level providers). She stated that as a non-profit organization, they struggle with recruiting and keeping physicians due to the hard to compete with nearby hospitals that offer better pay and better benefits.

Throughout the entire talk, I could see how driven and compassionate Robin was in providing healthcare to patients in rural Maine with limited resources to the best of her ability. Whether that meant rallying staff together to contribute money to pay for a cab ride for a patient to the hospital or if it meant guaranteeing to see that patient the same day they called for an appointment, you could tell that the providers working there do it out of the goodness of their heart with their patient’s health and well-being as their number one priority.

Having grown up in rural Maine myself, I have seen the need for more healthcare providers and the lack of access to healthcare first-hand. However, todays visit at HHC made me realize that we as future nurses, pharmacists, and physicians will be playing a significant role in the direction and future of medicine. It starts now.

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Jen Van Deusen, Director of Curriculum in UNE’s College of Osteopathic Medicine, discusses the goals of the trip after dinner on the first night.

Jenny Lau, Second Year Pharmacy Student

March 14, 2018 marks Day 1 of the 2018 Central Maine Rural Health Immersion. Our first stop was at Hometown Health Center (HHC) in Newport, one of their four offices in Maine. Upon delivering several boxes of medical supplies, the CEO (Robin Winslow) graciously welcomed us and introduced HHC to us. As I reflect back on what she said, what I found most memorable is when she mentioned there is only a total of 7 providers in all 4 locations and they get about 23,000 patient visits annually. The majority of these providers are mid-level providers and there is only one physician. As she expressed her concern of physician shortages and provider shortages in general due to the aging healthcare workforce and inevitable retirements, I can’t help but to question why there aren’t any promising solutions to this crisis. How is it possible to have such disparities in healthcare? As students, what can we do now to help with the reform?

On a brighter note, this brief experience showed me a different side of a conventional workplace environment. I was surprise to see how well the staffs worked together as a team towards the same goal. I didn’t sense there was a chain of command in place; the nurse practitioner spoke freely in the presence of the CEO. I believe these particular healthcare members face additional stress and challenges as they account for their patient’s transportation and the financial burden of medical expenses for their patients. Despite these unique challenges, the staff were seemed very happy at work. Unlike in urban communities with adequate healthcare access, it was apparent here that the staffs here are valued and not easily replaced.

I look forward to the rest of this immersion and continue to learn with an open heart.

 

Lauren Yelinek, Junior ABSN Student

We left for Dover-Foxcroft at 3:00pm on Wednesday March 14th 2018, a day and a half later than we had planned. It is March in Maine, and it is clear that Mother Nature does not care about our Rural Health Immersion itinerary. As I watched the piles of snow on the side of the road climb higher as we rolled north, it occurred to me that we might not be the only ones whose plans may have been changed due to the third Nor’easter in three weeks. As we would come to find out at an impromptu visit to Hometown Health Center in Newport, transportation is one of the most considerable challenges to accessing quality healthcare for communities in central Maine.

Hometown Health Center (HHC) is a Federally Qualified Health Center (FQHC), a non-profit organization funded by and beholden to federal grants. While this means tight regulations and careful documentation by administration, it also means that rural communities in central Maine have access to quality healthcare providers and programs that they might not otherwise have, such as the Prescription Assistance Program that allocated over $1 million worth of prescription drugs to the 7300-person patient pool at HHC. Robin, the CEO, repeatedly referred to the efforts of the HHC as “the mission”, which underscored that the work done here is more than a note on a chart or a tally mark for a grant application. She mentioned that the staff participated in dress-down Fridays to contribute to a petty cash fund for patient needs, and that some of these funds recently went toward a patient’s medical procedure. The sadness in Robin’s voice when she described the difficulty of finding a cab to transport this patient to their procedure made me feel ashamed for being frustrated with our delay hours earlier.

Robin was clearly more than a CEO; she cared deeply about consistently and effectively being able to reach those in the community who needed care the most. This was evident in her explanation of current providers within the HHC system, and her concern for the future. The need for more providers at HHC – particularly, physicians – is met with economic and geographic constraints. As a FQHC, HHC cannot match the provider pay and benefits offered by traditional, for-profit healthcare organizations.

As we exited HHC, we walked past brightly-colored Sliding Scale signage and community resource pamphlets, and I sat down in the UNE van that had delivered me here, with accessibility on my mind. We had still arrived at HHC, despite the storm. But how many patients had missed an appointment? How many community members don’t see providers because they can’t get there in the first place? How many young professionals think that Newport, ME, is just too far, “too rural”? How many can’t afford to work at an FQHC, for a “mission”? Accessibility is not just a patient issue, it is a systemic healthcare issue that impacts those receiving and providing care, particularly in rural communities. I told myself not to forget this as we drove north toward Dover-Foxcroft, passing several homes that had snow piles nearly blocking their front doors.

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