UNE Students share their Experiences on the first day of the 2018 DownEast Rural Health Immersion

 

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Ten graduate healthcare students recently participated in a weeklong rural health immersion to Washington County, Maine. Here, the students pose in from of Calais Regional Hospital before spending the day meeting with a number of the hospital staff.

 

Ten UNE health professions students recently participated in a weeklong rural health immersion to Washington 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 sixth immersion experience that the Maine AHEC and CEHI have provided for UNE students but the first time that a group has traveled to the DownEast area.  In March a group of 10 students traveled to Piscataquis County; 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 Washington County, including Calais, Eastport, Lubec, Campobello, and Machias.   Below are reflections from one team after the first day of the trip on Wednesday, May 23, 2018.

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The students stayed at the Washington County Community College for three nights during the trip. During the first night they got to use the rock wall at the community college.

Kelsey Hickey, second year osteopathic medicine student

A common theme from spending just two days in the quintessential Maine town of Calais is pride. I grew up in rural Maine and I remember laughing about this fact at lunch with all the various faculty and staff at UNE – namely those in the group who are “from away”; thinking it was a fun quirk us Mainers have. However, as we toured Calais and its hospital and mental health facilities, I have begun to recognize this pride in myself and in other Maine people who are living in this rural area. I never really realized before, but whenever someone asks me where I’m from, I get a rush of pride to say that I am from Maine. As I reflect on our experiences so far, I think the thing that stands out to me the most is really the people that we have met in Washington County.

This sense of state pride is well earned; I have had the pleasure of traveling to many different places around the world and nothing compares to a the life of a being true Mainer. Hard-working, proud, stubborn for sure, and certainly compassionate. Living in rural Maine is no easy task – you have to work for everything that you get. The rural areas tend to be poor and less educated (a drastic generalization, but I think it can be applied to Calais). Talking with our hospital tour guides and the Calais hospital staff, you would never be able to pick up on these factors that make Calais an underserved population. What I mean by that is again, I just felt an immense pride in all that the greater Calais community has accomplished. Keeping the hospital running in a harsh economic environment is no easy task; but I really liked that everyone seemed able to recognize each other’s strengths (and weaknesses). My impression is that everyone makes sacrifices in living in rural, poor communities, but this is more than made up for by the fact that you are all family, in a sense. I love that everyone looks out for one another and takes care of each other. While I was working in Boston, for example, this was most definitely not the case.

I think this is my rather clumsily-worded way of saying that despite growing up in rural Maine and having my own personal experiences in rural healthcare, just being surrounded by community members and healthcare workers who take such pride in their work just strengthens my resolve and pride in being a Mainer myself. I consider myself lucky to be part of such a strong community, and as our tour guide at the hospital put it, “no matter how poor you are, you always provide for your community.” These are the values I really want to take with me as a physician, because to be able to give back to your community in meaningful ways is truly a privilege, in my opinion. I think everyone found meaning in Dr. McHugh’s sentiment that it is our responsibility to give back and contribute to other’s lives in a meaningful way. These are words I hope will guide me throughout my training.

 

However, despite these wonderful experiences I look forward to talking to more providers about their careers as rural healthcare providers, to see how they overcame the challenges of practicing rural medicine. It’s very true that you make personal and career sacrifices by dedicating your time and effort to a small hospital that has limited resources. I know that my personal and professional goals are somewhat contradictory – I really want to experience a diverse and enriching training after I graduate, and realistically this is best accomplished in a somewhat urban environment. After all, more people = more money. But I found hope in Dr. Lee’s career path: get the most out of your training and do all that you can to enrich your own experiences. Then you can take this training back with you to the rural areas that need it the most. These past couple days have given me clarity in that I know I want to stay in Maine and practice. After all, that stubborn Maine pride usually wins out over everything else.

 

Aliza Hanif, second year dental student

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Aliza Hanif, second year dental student, participates in a conversation on the importance of interprofessional education and practice at UNE with international thought leader, George Thibault, MD.

During my rural health immersion experience with the University of New England, I found myself fully appreciating the sense of community and collaboration that various areas in rural Maine offer. The experience of this trip reminded me of the time when I mentored girls at The First Tee of Miami program on translating the life skills learned from golf into academic and leadership pursuits. Within this program, we learned how each of the nine core values can be applied to their daily lives as students. While on my trip to the health centers in Calais, I too found myself applying those same core values to the experiences that we gained at each site visit.

We ended our first day of the immersion trip with a bit of rock climbing in which we exercised The First Tee core value “courtesy.” It was amazing to see the respect for one another regardless of what profession we were in. It was apparent that all of us had each other’s best interests at heart. This core value is particularly important in healthcare because there should no longer be competition, but rather collaboration.

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While at Calais Regional Hospital, the students met with Dr. Tom McHugh, MD, to talk about substance use disorder.

Bright and early the next morning, we began our journey to different healthcare centers in Calais. One of our site visits included interacting with Dr. Karen Delaney, a family dentist who also performs endodontics and oral surgery. While most general dentists in the field may not feel comfortable performing extractions and root canals, Dr. Delaney was very much the dentist to go to when it came to those particular procedures. I admired her go-getter attitude and the notion that she is truly a champion of evidence-based dentistry. Seeing the state-of-the-art technology in her office taught me that you can truly be innovative even in a rural area in Maine. The experience reminded me of The First Tee core value “judgement” because though Dr. Delaney had the latest technology, she made sure to tailor her procedures to each patient’s needs.

 

The next day of our rural immersion experience began with engaging high school sophomores and juniors at Calais High School. I think the one core value that all of us stressed to the students was “perseverance.” All of us have our own story to tell and it is what makes each of us unique. As a collective group of students, we are from areas that range from extremely rural areas in upstate New York all the way to metropolitan cities like Los Angeles. Whichever pathway we took to get here, we all persevered through our own struggles to solidify a position within our respective professions. We never let anyone’s opinions of us define who we were.

I think one of the biggest takeaways so far from this experience is one of The First Tee’s core values, which is “respect.” While at the Aroostook Mental Health Center in Calais, I witnessed each of our osteopathic, pharmacy, and social work students actively listen to the services provided by this center. We were all awestruck by how much of a powerful role these women play in the lives of the youth. As we discussed various ways to improve communication in healthcare, the hierarchy of medicine disappeared and we all acted as one unit within that room.

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Later in the day the students visited the Aroostook Mental Health Center in Calais.

The best part of this trip was creating a new network of professionals and making life-long friends that I would not have otherwise had the opportunity to meet during dental school. From meeting social workers who deal with cases such as those suffering from bulimia nervosa, to hearing a triple-board certified pulmonary specialist express the importance of mentorship, and finally to being treated like family at a federally qualified healthcare center reminded me of the core value “responsibility.” It is our responsibility as future healthcare professionals to put our own values aside for the sake of our patient. It is our duty to be informed with the latest research of the type of medicine that we will provide to our patients. It is our responsibility to create that beautiful sense of community that all rural areas offer within our own medical practices. I challenge you as my fellow student colleagues to think about your own core values and how you can translate those into your own profession, whether it be an osteopathic physician, a pharmacist, a social worker, or even a dentist.

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Sara McConnell, Maine SNAP-Ed nutrition educator, welcomed the group of students into her Nutrition Education class at the Methodist Church in Calais.

Anna Dempsey, third  year pharmacy student

If you have never been to a hospital in a rural area, Calais Regional Hospital is the place that carries a motto of strong dedication of healthcare professionals committed to serving the community. Dr. Thomas McHugh and Anne Perry (also a state representative that has initiated passing the legislation for PMP in Maine) were some of the professionals who emphasized that if we eventually decided to move to Calais or its surrounding areas then we would need to have solid professional expertise and we would need to be willing to seek resources and opportunities to provide the best possible patient care with limited staff and funds. What impressed me during the visit to the hospital is the inspirational mindset of the providers- having to practice in community-based healthcare and knowing your patients really well and what they are dealing with. This style of healthcare practice actually allows for better patient care outcomes or even patient adherence to medication or appointments; such provider-client relationships brings the patient closer to proposed clinical goal.

The fact that Anne Perry started nursing school at the age of 50 also inspired me as a healthcare professional and someone who can take on a challenge and be able to be innovative and creative in structuring new ideas, especially since most patients are to be perceived as a whole with their mental, physical and psychosocial concerns. And that’s never easy to do, partly because it means you have to be prepared to answer questions and contemplate over things you’d never think of while working in retail pharmaceuticals.

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Anne Perry, F-NP, State Representative, talked to the students about her experience living and working in a rural community.

Dr. Thomas McHugh, who has been practicing in the Regional Medical Center in Lubec as well as in Calais Regional Hospital over the course of his career, also has extensive experience working with patients with substance use disorder. He mentioned that what drove most patients to become addicted was hopelessness. During his career, he has seen patients struggling with addiction and coming back to their providers claiming they aren’t on the right path to recovery. Yet Dr. McHugh always tried to work with patients to overcome resistance and focus on patient’s willingness to suppress or overcome addiction. Dr. McHugh urged us not to be discouraged by the “placebo effect” of the treatment and, for example, that it’s okay to tell a patient, “I can provide the resources but you have to do the work.”

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The students debrief about their experiences in Washington County after the first day of the weeklong trip.

In order to improve healthcare outcomes, both Dr. McHugh and Anne Perry have been working on a project for substance abuse disorder, to collaborate with police, social workers, etc. to get involved with the community and better observe the results of the patient’s path to recovery. The project, they said, will take about two years and is a promising example of the innovative culture in Washington county and an idea that could possibly serve as a sample project to target neighboring counties if positive outcomes are discovered.

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On the way down to Washington County the group stopped in at Renys for “A Maine Adventure”.

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