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

Students talk about health policy with Maine State Senator Paul Davis, who represents communities in Piscataquis county

Over breakfast students talk health policy with Maine State Senator Paul Davis, who represents communities in 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 second day of the trip on Thursday, March 15th, 2018.

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The students meet with Mayo Regional Hopsital CEO, Marie Vienneau to talk about working for a Critical Access Hospital in rural Maine.

Emily Krusec, junior ABSN student

It takes a village. What a cliché – especially when referencing small, rural towns – but in Maine, survival in these types of communities is centered around this overused expression. Being from “away”, as Mainers might say to someone like me who was not born in Maine, I noticed the strong sense of community when moving to the state – this profound characteristic is even more exaggerated in rural Maine. This led me to question why rural areas have such a strong sense of community. During this immersive experience, I learned that it is for survival. Access to healthcare and related resources is not ubiquitous; this is especially a reality in rural areas. To help combat this, many healthcare professionals have adopted the “whatever it takes” mentality in addition to tailoring healthcare programs to the community in order to efficiently utilize the few resources they do have. Rural community healthcare providers must heavily rely on collaboration with others in order to meet the basic quality healthcare needs.

Each interaction, during this immersive experience, touched on community participation in its own way – starting with Piscataquis County Senator Paul Davis who told stories about personal involvement with community members and the impact it had on those individuals. He shared his experience with one woman in his community who lost her driver’s license because of poor vision. For bureaucratic reasons, the DMV was not allowed to give her a license after she had her vision corrected. Senator Davis was able to make a few phone calls and work some magic so this woman was able to get her driver’s license back. In this woman’s case, it solved the most common obstacle of healthcare access in rural Maine: transportation.

The students meet with Gail Bergeron, owner and operator of Foxcroft Pharmacy

The students meet with Gail Bergeron, owner and operator of Foxcroft Pharmacy

Transportation was another common motif that was later emphasized in our meeting with elder town residents who were in the process of establishing a community center in Dover-Foxcroft. Among the seniors was Leslie Fernow, a retired local physician who had a strong passion for her community. In response to the transportation obstacles many of her patients faced, she adopted the “whatever it takes” work ethic by providing home health visits to her patients. Doing so offered many other benefits, including seeing her patient’s in their environment to paint a better picture of their health, along with truly interacting and spending more time with her patients on a personal level. Dr. Fernow also emphasized the importance of community involvement and contributions by healthcare professionals – through fully giving back to patients, neighbors and the community in many ways, this completes the integrated healthcare circle.

This theme continued on in our meeting with the staff at Mayo Regional Hospital. Mayo Hospital is an essential part of the community in Dover; it facilitates community town halls to collect feedback, organizes free classes directed toward health promotion and disease prevention, and they tailor many of their programs to fit the needs of the community – thereby efficiently allocating the limited resources. Mayo providers also discussed the staffing shortage crisis and how rural areas are hit particularly hard. The provider shortage has led to increased collaboration among healthcare professionals and one person having to fill many – sometimes as many as 6 – various roles, just to provide basic quality healthcare. This again reiterates the theme of “whatever it takes”.

Before this trip I believed living in rural areas and having a sense of community were mutually exclusive, but I learned that it was quite the antithesis: the limited resources in a rural community actually brings the community together, making it stronger. So what does it take to provide basic quality healthcare services in rural, underserved areas? It takes health professionals who adopt the “whatever it takes” mentality along with healthcare providers who reach out, collaborate and support one another because that’s all they have. Most importantly, to provide basic quality healthcare in rural communities, it takes the contribution of all members; it takes a village.

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First year osteopathic medicine student, Gigi Green, and junior nursing student, Lauren Yelinek, practice intubating a pediatric patient in Mayo Regional Hospitals Sim Lab with Kathryn Brandt, Director of Primary Care in UNE’s College of Osteopathic Medicine.

 

Evangeline (GiGi) Green, First year Osteopathic Medicine Student

When I woke up this morning I had no idea what to expect from the day. As someone who likes to have control of all aspects of my life this left me feeling extremely apprehensive, but in the end it was a blessing. To give up control and have no expectations allowed me to be fully present with the community and the experiences that we were given during the rural health immersion. I wasn’t taking each experience and comparing it to another one or to some made up benchmark that I had set in my head; to some extent I think this parallels the practice of health in a rural community. The lack of resources that we heard about from the providers that we met with requires creativity and support for one another. At Mayo Regional Hospital in Dover-Foxcroft we were informed of the high turnover rate in rural medical practices due to provider burnout. Part of me couldn’t help but wonder if this burnout stemmed from the expectations that we have as practitioners for a certain level of facility or support that can’tnecessarily be reached in a rural setting.

Nikki Chadwick, VP of Quality and Education at Mayo Regional Hospital, talks to the students about how the staff is striving for superior healthcare quality

Nikki Chadwick, VP of Quality and Education at Mayo Regional Hospital, talks to the students about how the hospital staff is striving for superior healthcare quality

In talking with the providers in Dover-Foxcroft I couldn’t help but be amazed with the level of creativity that they used in their delivery of care as well as their dedication to serving as many roles as they felt the community had a need for them to be in. These people were thriving in their roles, they did not hold on to expectations of the way healthcare needed to be delivered, but rather they ditched those expectations and focused on the needs of their community and how they could best provide the services to meet those needs in an effective manner. This idea of working together with the community is something that continued throughout the rest of the day.

After leaving the hospital we went to the Maine Highlands Senior Center in Dover to meet with elders in the community and to hear their take on health needs. This experience dove back into the concept of community and fostering a stronger community in order to address its needs. The building that we stood in was once the center of the town, it was a place that could be used by all and served many roles and fulfilled many needs. For many years it had been neglected and had not been used for some time, but members of the community came together to restore the building and bring it back to what it once was- a community gathering spot- but with additional services to address the emerging needs of the community. What stuck with me is that community means different things in different places. When in a town that has challenges a strong sense of community becomes even more meaningful. Dr. Leslie Fernow talked to us about the unfortunate societal trend of decentralizing a community and moving away from the traditional community-oriented lifestyle. In her opinion, which I agree with, this is not what we should be striving to achieve. Instead, we should be fostering stronger community and bringing people together, which will be achieved through the Maine Highlands Senior Center. Giving people a place to go and a sense of belonging allows you to pool your resources and work together to achieve greater health.

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Students meet with community elders at the Maine Highlands Senior Center in Dover-Foxcroft. They later broke out into small groups to talk to the elder guests about what its like to live and work in a rural community like Dover.

 

Alicia Bergquist, Junior ABSN Student

“We’re both seventy-five, and neither of us are on any medications.” Over the next thirty minutes Joe and Beth, locals to Piscataquis and Penobscot Counties, became my idols for what it could mean to age healthily in a small rural community. Having moved to Dexter, Maine twenty-five years ago with their daughter to, “escape the rat race” of New Jersey, the couple almost immediately were made integral members of the community. With a population of less than 4,000 the citizens of Dexter were eager to take advantage of Joe’s background in middle and high school education and Beth’s speech pathology practice. Since retiring, Beth has started the first chapter in the Penquis Region for the National Alliance of Mental Illness (NAMI), and is forming one of the first geriatric mental health support groups in the area. Once Joe retired from teaching, he got right to building a small house for the two of them on their eighty-six acre plot of land. “How do you two stay so healthy?” I asked, suspecting I may have a good idea already. “Staying active in our community, and a whole food, plant-based diet!” Beth affirmed. They are lucky enough to have had the same family physician since they came to Dexter – in contrast to another community member who had expressed great anxiety over the announcement that her primary care physician was leaving her practice – and emphasized their appreciation for their provider always taking as much time as necessary with their every appointment. Hearing about how involved they were in the towns of Dexter and Dover-Foxcroft, and seeing the positive results reflected in their springy steps, easy laughter, and kind words for each other, their town, and their experiences reinforced the growing sense I was getting for just how supportive and fulfilling a small rural community can really be.

I had been introduced to Joe and Beth at the soon-to-be gorgeous Town Commons in downtown Dover-Foxcroft. The historic building is nearly finished after extensive renovations, and the lively couple were two out of the seven elder community members we had the privilege to spend some time with in what will soon be established as a senior center for the community. As we received a tour of the building, the beautiful stage and event space, and the senior center, my mind was flooded with possibilities of what could soon be happening there. The thought of residents of all ages coming together to celebrate, learn, and just get to know one another appealed to my romantic notions of old-fashioned small town rural America. As we become more isolated behind our phone and computer screens, we become more and more detached from our neighbors and local opportunities for leadership. As populations concentrate in urban centers, resources begin to disappear from rural communities on the margins, and even the simplest things like access to fresh fruits and vegetables can become insurmountable. We hear complaints about America changing for the worst, and it can feel like our environments are becoming more dangerous, hostile, and prohibitive to success. After spending the first part of the day at Mayo Regional Hospital in Dover-Foxcroft, where we learned how the scope of practice for rural providers can be expansive, often with a much heavier focus on community health, meeting with community members made me realize the pathway to community involvement and collaboration is still accessible.

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The stairwell at Mayo Regional is painted with a wonderful mural in order to encourage people to take the stairs instead of the elevator.

Of course there are many challenges to rural health, which we also discussed throughout the course of the trip. Maine’s aging population is one of the largest obstacles; Piscataquis County has the oldest population in the oldest state in the country. “We used to see kids running all over the grocery store…we almost never see any children any more”, mused Beth and Joe. Poverty and food insecurity are very real problems in these communities, and people really depend on each other to make ends meet. When I asked Beth and Joe if it was easy to maintain an organic vegetarian diet in their town, Beth just laughed, and sang her praises for the online food delivery service they use. While small farms are reemerging as providers of tons of produce, meat, and dairy in these areas, cost is still a preventing factor for many families. Lack of transportation can make access to health care, employment, and other needs nearly impossible making the, “under one roof” model of Mayo Hospital and the Maine Highlands Senior Center invaluable. Burnout for health care providers leads to high turnover and a recruitment deficit, and as large numbers of staff members reach retirement there are fewer candidates to replace them. Most of us may react to challenges like these by skipping town to seek more opportunity; the residents of these small towns, however, are committed to their community. The pride, loyalty, and optimism in the face of the facts demonstrated by all the people we met with today is overwhelming. When I left Mayo Regional Hospital and the Maine Highlands Senior Center, I felt motivated by everyone’s tireless devotion to their towns and stalwart faith in their missions to improve the lives around them. We heard several times: the people here are what makes this community work worthwhile. I left Dover-Foxcroft thinking, I may just find myself getting to know these very people much better.

 

The group of ten UNE healthcare students meet with Mayo Regional Hospital CEO, Marie Vienneau

The view from the Kineo View Lodge in Greenville where the group stayed on Thursday night. Just to the right was a beautiful view of Moosehead Lake.

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