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

March 21st, 2018 by healthinnovation
The students and faculty pose for a photo after teaching their lessons to students at Greenville School.

The students and faculty pose for a photo after teaching their lessons to students at Greenville School.

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 last day of the trip on Friday, March 16th, 2018.

Mooshead Lake as seen from the Kineo View Lodge

Mooshead Lake as seen from the Kineo View Lodge

Taxia Arabatzis, First year Osteopathic Medicine Student

Dynamic and innovative are some of the words that come to mind when I think about the health care providers we have come across over the past few days in the UNE Maine Rural Health Immersion trip to Piscatquis county. The providers ranged from school nurses to hospital doctors to administrative staff in the clinics and hospitals, and all were very dynamic and innovative. Being in rural areas these providers are limited in almost every way, yet, through strong dedication they are able to make it work.

In rural communities everyone knows everyone, so the local providers are ingrained in the community and they know the needs of the people. Therefore, rural providers are able to directly meet the needs of the people by doing things like delivering extra educational classes at their hospitals, or starting programs to combat substance abuse, or any number of other initiatives to help their community. One thing in particular that I noticed at every facility that we went to was that the staff always mentioned that Fridays were Jeans days for the employees and the money they raised from this was ALWAYS put right back into the direct needs of their community. At one hospital in particular they said the money went towards a food pantry that they could send their patients to if they screened positive for food insecurity (unfortunately a common occurrence in parts of rural Maine). The providers started the food pantry because they felt terrible asking patients about their access to food before the food bank was started since, at that time, they didn’t have a solution to the problem. This is a simple example, but it shows how the providers in rural Maine are truly dynamic and problem solvers. It was clear that the providers we met with understand the needs of their patients in an intimate way that is often hard to find in an urban setting, and that they do everything they can to address their patients needs.

After visiting at the Greenville School the students spent time at Dean Memorial Hospital.

After visiting at the Greenville School the students spent time at Dean Memorial Hospital talking about rural health with the local providers.

Despite the tremendous needs of the rural communities that we visited, they are ahead of the game and innovative in their approach to determining the needs of their community and directly addressing them.  It can be very daunting to look at the health needs of a patient, including physical, social, emotional, and socio-economical health factors and try to address them all. However, in the rural communities health providers are used to this, and they are used to fighting for their patients, who are their neighbors and community members, and that is a lesson that all of modern medicine can learn from.

The last stop of the trip was in Shirley at Lone Wolf Guiding Services where the students learned about dog sledding.

The last stop of the trip was in Shirley at Lone Wolf Guiding Services where the students learned about dog sledding.

Matthew Senno, First year Osteopathic Medicine Student

Meeting with the kids at the Greenville School this morning was such a great experience. I loved interacting with a group of students that is still learning, and it is a great opportunity to improve all of our teaching abilities. It’s always great to spread awareness about brain injuries, and how the brain works in general, especially to children in the 4th grade, who are riding their bikes and playing outside, so have a lot to learn of the proper safety equipment. I was surprised at how much some of the kids knew about the brain already and I was blown away by some of their questions (many of which I didn’t have an answer to). The school nurse was amazing as well. She seemed so dedicated to her job, and to helping all of the kids in the school.

After we left the school, I really enjoyed meeting with Dr. Galen Durose at Dean Memorial Hospital in Greenville. It was interesting to hear how he alone had to run the ED, and how he could be one of the only physicians in the entire hospital. This was eye opening because previously I didn’t fully understand the extent of the lack of providers in such a rural area, and all of the extra work that these health care providers have to do for great patient care, and how willing they are to do it. That seemed to be the overall theme of this trip- that there is a lack of providers, but all of the practicing providers in these areas are willing and happy to work so hard in order to better the health of their patients. This is an encouraging thought for myself as a future physician, knowing that there are currently providers like this that I can look up to, and contact for any advice in my coming years.

One last group photo before heading back to Portland.

One last group photo before heading back to Portland.

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

March 20th, 2018 by healthinnovation
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.

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

March 19th, 2018 by healthinnovation
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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.