UNE students share reflections on day three of their week-long rural health immersion in western Maine

March 17th, 2017 by healthinnovation

Fifteen UNE health professions students participated 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 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 third day in Franklin County on March 13th, 2017.

Students wake up early to meet for breakfast and talk health policy with Maine state senator Tom Saviello

Students wake up early to meet for breakfast and talk healthcare policy with Maine state senator Tom Saviello

Kane Kunst (first year nursing student)

Today started earlier than most with an 7 AM meeting with legislator Tom Saviello. A thirty-year native to Franklin County, Mr. Saviello informed the students about many of the complications surrounding a rural community. The dynamics of the Maine rural communities are changing with the closing of the mills. The lack of jobs and shrinking forest industry has worried the community as the unemployment rate climbs.

A common theme surrounding the trip is the close-knit-community. Most of us do not come from a small town, let alone from a major industry promoting an individual as a focal point.  In Franklin County, the three main employers are the hospital, school, and ever shrinking mill.  If you work in the health care field it is not uncommon to spend additional time grocery shopping, or at the bank or shopping in general.  As a provider, you service the community and that community sees you as always on duty.  The staff speaks to the work life balance and the overall feeling of community, both in the hospital and out.

As we moved through the day, we were granted a guided tour of the hospital. The aesthetics resemble that of a rural cabin.  This hospital is an all-inclusive approach to patient care.  Considering the rural community, the goal is for people to visit once and receive all the treatments and screening to prevent a return trip just a few days later for more tests. The emergency department, hospital, patient service, general practitioners, behavioral health, MRI, and other screenings are all in connected buildings.  Patients can make an appointment with one facility and additional services can be scheduled/coordinated.

Students get a tour of Franklin Memorial Hospital from nursing staff at the hospital

Students get a tour of Franklin Memorial Hospital from hospital nursing staff

Kristin Frisby (first year medical student)

Today began at our new favorite restaurant, Calzaolaio’s Pasta Co., having breakfast with legislator Tom Saviello. Tom spoke at length about his desire to do right for his community and give back to them the same way they had so generously given to him in his time of need. We learned even more about the unique problems the area has faced with unemployment and some of the possible solutions.

Our final event of the day before the impending snow storm was a tour of Franklin Memorial Hospital followed by a discussion of the preventative health efforts put forth in the community. The stand out message of the tour was the amazing capacity for flexibility and teamwork that everyone displays in order to provide the best possible care for the community. At the end of our discussion, it felt as though we too were being invited into that team as our ideas and suggestions were openly embraced, which served to solidify a goal of this trip, interprofessional collaboration.

It is becoming increasingly more evident that there are overlying themes of communication and teamwork that are interwoven into every aspect of the immersion. We are learning that, even though the problems are monumental and overwhelming, this doesn’t stop people from all different professions from coming together and trying to solve them. This is a true testament to the spirit of the people in rural Maine.

Brad Gilbert, RN, talks to the students about his career path as a nurse and how he ended up in rural medicine

Brad Gilbert, RN, talks to the students about his career path as a nurse and how he ended up in rural medicine

Valerie Bedard (first year nursing student)

Today we had the opportunity to take a tour of the Franklin Memorial Hospital in Farmington. Walking around the hospital with Brad and Tina gave us a firsthand view of what it is like to work in a rural hospital. The sense of community that is instilled into their facility is clear and insightful of the qualities of life people that chose to work here deem important. Hospital faculty are able to snowmobile and cross-country ski to work demonstrating their passion for the environment as well as their personal health. When the children of hospital faculty are sick they are encouraged to bring them to work where they would be cared for on the pediatrics unit while they work.  It is evident that health care providers that chose to work in this area thrive in a setting that is dedicated to the care of its residents.

Whereas for a large portion of the events and collaborations we have attended thus far have been conducted by managerial staff, the tour of the hospital was conducted by working nurses. They held different perspectives on the pros and cons of working in a rural health care system, as well as the nature of the position. Providers in this particular location are held to high standards in that they are often called upon to be knowledgeable in several different fields.  The amount of staff working at one time is smaller then would be found in an urban hospital and so it is imperative for staff to have leadership experience, as well as the necessary medical skill set.  Staff collaboration is not only encouraged but also necessary to facilitate successful patient care in rural healthcare.

Although our day was cut short midday due to the impending blizzard it was an efficacious morning. As a collective group we reiterated all the information we have absorbed over the last few days, building on what we have learned and considering all of the competences of rural healthcare that we have not yet begun to understand. The night was spent in deep conversation with other students about our ability as educated professionals to empower change in communities, which begins to expand in potential when we open our minds to the opinions and viewpoints of other professions. Even though the storm limited the events that were attended that day the extensive conversation that ensued throughout the night ensured that the time was not wasted.

Students hunker down for dinner during a Nor'easter that brought more than 16" of snow overnight

Students hunker down for dinner during a Nor’easter that brought more than 16″ of snow overnight

UNE students share experiences on second day of weeklong rural health immersion in Maine

March 15th, 2017 by healthinnovation

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.

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 and how the innovative thinking has allowed NorthStar to provide coverage over a very large geographical area.

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.

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!

UNE’s weeklong Western Maine Rural Health Immersion Kicks-off

March 13th, 2017 by healthinnovation
Fifteen UNE healthcare students from the UNE College of Osteopathic Medicine and Accelerated Bachelors of Science in Nursing program gather on UNE's Portland campus before driving up to Western Maine for a weeklong rural health immersion

Fifteen UNE healthcare students from the UNE College of Osteopathic Medicine and Accelerated Bachelors of Science in Nursing program gather on UNE’s Portland campus before driving up to Western Maine for a weeklong rural health immersion

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 first day in Franklin County on March 12th, 2017.

Cynthia Mosher (ABSN Student)

Today has already been more than I could have asked for. It was a great ride into Wilton, our van was buzzing with conversation. After arriving at the hotel a few of us took a walk to Wilson lake, taking in the beautiful mountains and scenery.

Following dinner, we had a great conversation with Dr. Michelle McCormick and Tania Dawson, R.N. It was so nice to hear from local providers about what they feel are the struggles are within the community. Michelle was an excellent speaker and her passion for helping the community really comes through when she speaks. I loved hearing about the progress the community as a whole is making and what steps they are making to engage and help more people as well.

Afterwards, the group walked onto the lake to see the full moon rising. Although most of us were freezing it was nice to be part of nature and enjoying its beauty. After we came inside and thawed out for a few minutes we did a few ice breaker activities. It was great to get an opportunity to let loose and enjoy sometime with other students prior to the busy week ahead.

I’m very much looking forward to seeing what the rest of the week has in store for us and continuing to learn as much as possible about rural health in western Maine!

 

Michelle McCormick, MD, and local public health leader talks to the students about her experiences addressing community health and what it's like to be a provider in Western Maine

Michelle McCormick, MD, a local public health leader talks to the students about her experiences addressing community health and what it’s like to be a provider in Western Maine

Sean Bilodeau (First year medical student)

Today began the rural health immersion experience in rural Maine. The theme for today was getting to know each other, icebreakers, and settling in; getting to know the other members of the group has been incredibly fun and interesting. The interplay between nursing and medicine has started to be explored by all of us students with facilitation by our faculty who are joining us on the trip. The focus on getting to know the other nursing students has been great, and even getting to know my med student colleagues better has been an unexpected benefit from this first day.

Michelle McCormick, MD, a local pediatrician, and public health champion in Franklin County also came to dinner to speak about the health care challenges that Franklin County faces as well the challenges of the local residents. Michelle’s talk was eye opening because she was discussing a new program that they are attempting to implement that sounds very interesting, and hopefully we will learn more about it at our next meeting with Michelle at tomorrow’s Suicide Prevention & Self Injury talk with the National Alliance on Mental Illness at Franklin Memorial Hospital.

It has been really fun getting to know the other students as well as the faculty on a more personal level thus far and I assume that will continue in the coming days. Taking a little time off from studying and taking part in the experiential learning of our lives is nice change from the day to day life of a med student. Moving forward, I am excited to learn more about rural health care and more about Franklin Counties health needs.

After dinner, the students and faculty pose on Wilson Lake underneath a full moon.

After dinner, the students and faculty pose on Wilson Lake underneath a full moon.

Sarah Rafferty (ABSN Student)

The day began in a freezing cold parking lot meeting 8 fellow ABSN students, 6 College of Medicine students, our leader and 3 faculty members. We stood in a circle and learned more about the intention for our trip, as well as some expectations. What stood out the most to me was the sentiment that rural living is as much about connecting to nature as it is about connecting to community.

The 2 hour drive to our accommodations flew by with the myriad of conversations with new faces. Upon our arrival, we split up into our rooms and a few of us headed down to wander on the frozen lake. Then, a pizza dinner with an hour-long talk, question and answer session with Pediatrician Dr. Michelle McCormick on community health needs, the rural Mainer spirit, and specific strengths and challenges for members of Franklin County, Maine.

Night capped with a -10 degree stroll on the frozen lake, just in time to catch the full moon rise.  Such a great taste of what lies ahead for this week.