Rural Health Immersion: UNE students share experiences from fourth and final day

May 27th, 2016 by healthinnovation
The UNE students and faculty pose with legislators John Martin and Judy Paradis at the US Rte 1 first mile marker, designating the beginning (or end) of Rte 1

The UNE students and faculty pose with legislators John Martin and Judy Paradis at the US Rte 1 first mile marker, designating the beginning (or end) of Rte 1

Tyler Gagnon, (CDM)

We started this morning off at the beginning (or end depending on who you ask) of US Route 1. We were lucky enough to be joined for breakfast by long time legislators, and rural health advocates, Judy Paradis and John Martin. Listening to them talk about their experiences in regards to public health in their communities was pretty eye opening. They both really cared about what happens in the area that the represent, not only professionally, but personally. That personal tie really shows you what a caring, family-like community Aroostook County really is.

From breakfast we went to check out federally qualified health center (FQHC) facilities in Fort Kent and Eagle Lake. Heather Pelletier, CEO of Fish River Rural Health, graciously gave us tours of medical and dental clinics in Fort Kent. At the dental clinic, it was great for me (a dental student) to get an inside look at an FQHC clinic and how things tend to work. At the clinic in Eagle Lake it was awesome to see a truly interprofessional clinic setting between doctors, dentists, and their supporting teams. The providers are literally right down the hall from each other and are in constant communication. Getting a look into these dental clinics was a great sneak peak into places that could potentially end up as externship sites, and places I could practice.

Today was a day that was enlightening from a legislative, social and clinical standpoint. On the clinical front I was able to speak with Heather one-on-one about FQHCs to get a handle on the way they were run and the benefits of providing care at them. I was really grateful to get insight into John and Judy’s perspectives not only as legislators, but as inhabitants of the county. I feel as though their passion is the same flame that burns brightly in the majority of this county’s proud people.

UNE students discuss health policy with legislators John Martin and Judy Paradis over breakfast

UNE students discuss health policy and Franco-American culture with legislators John Martin and Judy Paradis over breakfast

Jhoana Meza, (Pharmacy)

Today marked our last day in Aroostook County, in the span of a week we have traveled to Presque Isle, Madawaska, Van Buren, and Fort Kent being exposed to different types of rural health care. For example, today we were exposed to a Federally Qualified Health Center (FQHC), which are health centers that qualify for enhanced reimbursements from Medicaid and Medicare due to providing care in underserved areas. The FQHC we were exposed to technically counts as one FQHC, however it was composed of three different medical centers spread out across 20 miles along the Fish River. We visited the Fort Kent Health Center, Fort Kent Dental Center, and the Eagle Lake Health Center. The Dental Center was very surprising as they only have one Dentist but cared for over six thousand patients. Even though he has several dental hygienists along with a couple EFDAs (Expanded Functions Dental Assistants) who all come together to provide care for their patients, it is clear that the ratio of providers to patients is astonishingly low. This experience served as an eye-opening moment about the providers and health care professionals counties like this one are in dire need of.

This adventure in rural medicine allowed me the opportunity to meet fellow students from other medical professions and make new lifelong friends. From sharing our personal backgrounds and stories around a campfire to relentlessly looking for our first sighting of a moose (which we finally saw though not on the moose hike itself but on route 11), these bonds and friendships we made not only benefit ourselves both personally and professionally, but our future patients as well. This pilot program served as an invaluable experience in exposure to rural medicine and just how important an interprofessional medical team really is.

 

UNE students tour Fish River Health Center in Eagle Lake

UNE students tour Fish River Health Center in Eagle Lake

Ellen Clark, (COM)

This morning our interprofessional team concluded our trip to Aroostook County with a morning discussion with two politicians, followed by tours of Federally Qualified Health Centers in the Fort Kent area. As I listened to the politicians explain the progress and changes they have seen in the communities of Maine I felt very impressed to hear about the development and future directions to improve behavioral, psychiatric, and dental health care in the county.

I also enjoyed learning about the integration of care in the Fish River Rural Health center, where the goal is to have medical, dental, and vision care all located in one campus of buildings. By having these services in proximity to one another, this will hopefully have a positive impact on health care efficiency and quality. In this area, we also met a dentist and I was amazed to learn the huge magnitude of his active patient load. He was an inspiration to me as he demonstrated his personal investment in the health and wellbeing of the community.

It has been an honor to be a member of the team participating in the Rural Health Intensive program in Aroostook County. My experiences interacting with the community with my fellow students of osteopathic medicine, dental medicine and pharmacy has reinforced my desire to become a clinician who is actively connected with my community. I am so grateful for the knowledge and experiences I have gained exploring rural health in Aroostook County, Maine.

 

A view of Mt. Katahadin

A view of Mt. Katahadin

Rural Health Immersion: UNE students share third day experiences

May 27th, 2016 by healthinnovation
Students visit the St. John Valley community pharmacy in Fort Kent

Students visit the St. John Valley community pharmacy in Fort Kent

This week fifteen health professions students participated in a rural health immersion in Aroostook County, Maine.  The students were split into five interprofessional teams consisting of a medical, dental, and pharmacy student.   The students experienced a variety of clinical and community activities in underserved areas in Aroostook County.  Below are reflections from one team after the third day in Aroostook County on May 25th, 2016.

 

Casey Hutchinson, (Pharmacy)

Today was very different from the past few days. I woke early this morning with another Pharmacy student, a COM student, and a Dental student to go to the WAGM 8 news studio to be interviewed for the 6 o’clock news with Dr. Mills. We all got to watch a side of our everyday lives that we take for granted and don’t fully know much about: our morning news. There was no camera crew, just a few stationary cameras that are controlled remotely via the director in another room. To watch them reconfigure their news story line up on the fly to include an interview with us as students in this immersion and what we are learning about was really intense. But being on TV in the end was a pretty cool experience only a few of us could and chose to go on. It was well worth the 4:15 am wake up for me.

Upon returning to the farmhouse where we were staying, the DO and pharmacy students went to the senior center in Madawaska to do mini health screenings and blood pressure checks. However, most of us ended up sitting and interacting with the locals that had come in to play cards and get lunch. One kind gentleman taught a few of us how to play a French card game whose name I will not even begin to attempt how to spell but is similar to Hearts. From a health perspective many of the people end up having to travel to Fort Kent for their primary care and even further to any type of specialist. The gentleman I spoke to was ok traveling the 30 plus minutes that it took to get there and traveling around in the area to the variety of specialists that do practice in the area. From a pharmacy standpoint, it was great to learn just how much (or little) training the medical students had in the routine “art” of taking a patient’s blood pressure. I’m also going to geek out here and say how tickled I was to have one gentleman who got his blood pressure taken that had all of his medications written down on a piece of paper that he proudly handed to me (strength and frequency included!) I wish there were more patients that did things like that.

After lunch, we headed out for Fort Kent and on the way were led to a pick-me-up spot of none other than Tim Horton’s by a couple who had been at the senior center with us. Arriving in Fort Kent and having to turn around once or twice to discover our next stop on our trip with more than enough time to kill before our next stop, the two professions piled into two cars and explored a bit of the main drag here in Fort Kent to end up at a little pub named Moose Shack 2. It was a neat little joint that was decorated with moose and deer antlers. It was a great chance to relax and take some time for ourselves to bond as friends and future providers. The free time was something that we really needed and so it was great to have on the fly really. After that it was onward to a visit to the St. John’s Valley Pharmacy where the owner and head pharmacist himself walked us through both their long term care and community (aka retail) settings. It was a very proud moment to watch the medical and dental students see exactly what happens “behind the curtain” of the pharmacy bench.

Dinner at The Swamp Buck just feet from where we are spending the night was spent meeting Cathie Pelletier, a local author that bases her many novels in Aroostook County. And as someone who has always been a creative writer, it was great to ask about her creative process when it comes to putting together a final manuscript. Tomorrow we head back after a few more busy stops. I’ll be sad to leave all the amazing mountain views and the wonderful communities behind. But I have gained so many friends in such a short time interprofessionally and created stronger relationships within my own program.

UNE students join Dora Mills live on 'WAGM' in Presque Isle

UNE students join Dora Mills live on ‘WAGM’ in Presque Isle.  Click to read more.

 

Wesleyan Deibner, (CDM)

This experience has helped me solidify my interest in practicing rural dental medicine. Today we traveled to Van Buren to perform basic dental screenings on children grades Kindergarten through 4th and provide them with fluoride varnish and oral health instructions. This population was very interesting to treat because on one hand, the overall oral health was very good relative to the other experiences I’ve had with this age group; and on the other hand, some of the attitudes were jaw-dropping. I noticed that they had the same procedure done 6 months ago and some of the children had records of decay at that time. When I assessed them, that decay was treated. It simply shows that parents are listening and these screenings do make a difference for the patients. There are, however, things that need to be addressed.

Dr. Mills had mentioned a culture that exists here where dentists have been scarce for so long that the habit of visiting a dentist is almost lost to some. For instance, I screened and varnished a child today who informed me that you only need to brush your teeth once every two weeks. After informing him of the proper number, he told me he is planning to get dentures when he’s older to resolve his eminent tooth loss. It was interesting to experience this first-hand account of the some of the attitudes here and gives me a better understanding of how much preventative dental care and education is needed out here.

I had several goals in mind coming up here, two of which included: getting a good understanding of practicing and sustaining a dental practice in a rural area, and seeing these mystical beasts they call “moose.” Before this adventure I had read books and heard stories from several folks including my parents but after moving to Maine and going on several drives, I had yet to see one. It’s not very well known, but in Scotland, the national animal is none other than the unicorn! I was beginning to believe Moose are the unicorns of Maine… until Wednesday afternoon on the drive to Fort Kent! This whole week I have been going on walks attempting to find signs of these famous beasts and finally, one came to me! We saw it in the ditch minding it’s own business, we pulled over to snap a couple pictures, I almost dropped my phone out of the car window I was so excited! Needless to say… to those who, like me, think that Moose exist much like unicorns do, there is hope!

In all seriousness, today’s activities at Van Buren were amazing! The kids were great and had a good understanding of the benefits of fluoride and general dental care. I loved working with them, telling corny jokes and letting them wear my gloves. They loved it when I acted like a painter working on a canvas (their teeth) with my “paint brush” dipped in topical fluoride. The kids bring great joy into doing what we do as dentists. It’s great to see that we can make a difference in rural Maine and that the community is grateful for it.

"Moose, the unicorns of Maine". Photo credit Tyler Gagnon.

“Moose, the unicorns of Maine”. Photo credit Tyler Gagnon.

Danielle Beard, (COM)

During our rural health IPE pilot, the medical students and the pharmacy students had the opportunity to spend time with the senior population at the senior center in Madawaska, Maine. The pharmacy and medical students did health assessments and took blood pressures for the members of the community, and got the chance to get to know the members of the community.

It was interesting to converse with the pharmacy students and compare our procedure for taking a history and taking blood pressure, and just working with the pharmacy students on this project. It is such a great experience to share our different subjects of knowledge and work together on a project, and put our strengths together. After we finished taking blood pressures and health assessments, we joined the seniors for lunch and had a chance to really get to know them and their hardships that accompany living in such a rural area.

A common theme was that many individuals had to travel more than 30 miles in order to access their primary care provider, and many of the individuals stated that they had trouble affording foods that met their nutritional needs. It was an eye opening experience to meet the members of the community, and to see how important and needed medical care is to these individuals.

Sam Wood, a medical student, takes a blood pressure reading of a senior in Madawaska

Sam Wood, a medical student, takes a blood pressure reading of a senior in Madawaska

Rural Health Immersion: UNE students share second day impressions

May 27th, 2016 by healthinnovation
One of the main forms of transportation on Tuesday, Molly the Trolley!

One of the main forms of transportation on Tuesday, Molly the Trolley!

Fifteen health professions students participated in a rural health immersion in Aroostook County, Maine.  The students were split into five interprofessional teams consisting of a medical, dental, and pharmacy student.   The students experienced a variety of clinical and community activities in underserved areas in Aroostook County.  Below are reflections from one team after the second day in Aroostook County on May 24th, 2016.

 

Sam Wood, (COM)

It all started with a very necessary morning cup of coffee… We then ventured out to a small clinic founded and run by a Nurse Practitioner and her family. After a quick stop at an Amish Bakery (solid cookies and pastries!), we visited 3 more clinics, grabbed lunch at the local grocer, visited a local photo gallery at the library, had a high speed and off-road tour of the mountains on an impressively durable trolley (named Molly), toured TAMC, attended Grand Rounds, and ended with a stop at one of the best ice cream shops known to man. Needless to say, the day was full, and we saw a lot.

It’s hard to fully capture what we are experiencing while we are in the middle of it, but there are already a few consistent trends. First, the healthcare providers we meet are happy. Sure, it’s based on the big things most of us want: flexible and consistent time with patients, less paperwork, minimal fumbling with insurance, and the ability to truly practice our skills and make a difference in a community. However, there is something truly special about the rural component of this place, in that it is a true community. The people here all know each other, their kids know each other, they run into each other at the local ice cream shop, and they leave their keys in the car without fear. Most importantly, the healthcare system acts as an integrated and functional unit… because it HAS to. Every component, and every member of the healthcare team are essential, and this fact is crystal clear in this environment.

These people work very hard, learn fast, and have to be incredibly flexible. In all, it seems as though our eyes are being opened, and we are already incredibly grateful for the experience. This rural town in upstate Maine is filled with a rich culture, and passionate, brilliant people. Now, bring on Day 3!

Students visit a local photo gallery

Students get a taste of local culture during a visit to a photo gallery in Presque Isle

 

 

Christopher Parent, (CDM)

Today my eyes were truly opened to the need for dental providers in the Aroostook County. Although I knew many towns in the county did not have a dentist and needed to travel to larger towns such as Fort Kent and Presque Isle, the volume of patients that the few clinics handle was overwhelming. Although not many dentists may think being a provider in very rural areas such as Wisdom is feasible, it is important to take into consideration that people in the county are willing to travel long distances for care. If the provider decided to set up shop in Presque Isle where there are other providers, they are still helping alleviate the large numbers of traveling patients and improving access to care.

In the county, there is also a large need for specialists. Although, this stood out to me most as a dental student seeing the lack of endodontists and periodontists, the problem is also similar at TAMC where they have the staff they need, but more providers would give needed flexibility in the event of a maternity leave, accident, or any other reason one of their specialists could not be available.

One way to get involved in rural areas that was highlighted today was the Indian Health Service (IHS). The doctor involved with the IHS in Presque Isle pointed out many great benefits for physicians in the program. Lower volume and more time spent with each patient meant the patient was truly getting the attention needed to address any problems. This also created a much less stressful working environment for the physician and staff. Another great benefit of the IHS was that the patients do not need to worry about the cost of treatment so the doctor can give them the best reasonable treatment plan for any problems they may have.

Aside from the serious aspects of public health, we were able to take a tour of Presque Isle on “Molly the Trolley.” It was great seeing the rich historical and cultural heritage the people in the region have. It was evident talking with people in the area that they are very proud of their town and the region that they live. Everyone was very outgoing, trusting, and loved to brag about one aspect of their town or another. It is easy to see why people want to be involved with a community that has so much pride in what they have.

Students visit the local Micmac dental clinic

Students visit the local Micmac clinic in Presque Isle

Ian Greenstein, (Pharmacy)

Today was a whirlwind of explanation of rural medicine and recruitment. First, our interprofessional group was given a tour of a local health clinic designed for county citizens and the Amish community. Next, we were shown a local non-profit pediatric dental clinic. Afterwards, we visited a clinic affiliated with the bureau of Indian Health Services, and then we were given a trolley ride on “Molly the trolley” by members of the city council, and our day concluded with grand rounds at the Aroostook Medical Center.

The positives of this day were abundant. Everyone we talked to seemed to be very enthusiastic about the community here. All of the citizens of Presque Isle and the surrounding towns took a great deal of pride in the closeness of their community. All of these people wanted to provide the best possible service to their fellow community members, and this enthusiasm was really contagious. I really appreciated this desire to help others in close proximity, and I hope to bring this sense of community into whatever practice I go into after I graduate.

I am very grateful to have the opportunity to get a hands-on learning experience in rural medicine, and I love the sense of community and connection that I feel being here. The camaraderie between the medical students, dental students, and myself has been excellent, and I would not trade this experience for anything. Despite some feelings of awkwardness regarding new and different situations, I think I could definitely make the adjustment to the slightly different culture of rural medicine if I needed to, and I think that it would require a very high level of interpersonal skills, which I am very confident in my ability to utilize. I hope to have the opportunity to practice pharmacy in a rural setting after I graduate, and I hope to help make a difference and provide positive outcomes for people in this type of community someday.

pineland farms

Rural Health Immersion: UNE Students share first day impressions

May 25th, 2016 by healthinnovation
An interprofessional team of healthcare students learn a clinical airway skill

An interprofessional team of healthcare students learn a clinical airway skill

 

Fifteen health professions students are currently participating in a rural health immersion in Aroostook County, Maine.  The students have been split into five interprofessional teams consisting of a medical, dental, and pharmacy student.   The students are experiencing a variety of clinical and community activities in underserved areas in Aroostook County.  Below are reflections from one team after the first day in Aroostook County on May 23rd, 2016.

From Tara Formisano (COM)

As I sat in my car on my 7.5-hour journey up to Aroostook County, ME, I didn’t have a clue what to expect. I knew it was going to be “rural” and I knew it wasn’t going to be like the hustle and bustle of the every day life we have grown accustomed to as health professions students. What I didn’t know, however, was that my experience in Aroostook County was going to be where I found my purpose.

As a medical student, I have accumulated a wide variety of different health care experiences in a diverse array of settings, but I have never felt that “perfect fit” that people claim you feel when you finally find that special place you are meant to be. That is, until I walked the hallways of TAMC today. During our rescue airway training, I strolled the halls of this incredible hospital and felt an overwhelming sense of belonging. As cliché as it sounds, I could literally step back and see myself strolling these same halls as a future OBGYN going up to deliver a baby or prepping for a gynecological surgery. From the actual facilities, to the people, to the genuine sense of community, this rural hospital offered everything I want in the place where I practice.

I have always wanted to practice rural medicine, but today undoubtedly confirmed that desire. I could briefly touch on the numerous reasons why, but instead, I want to focus on perhaps the most important reason; being able to truly make a difference in your patient’s lives. The physicians, staff and other health care personnel we interacted with today made it clear that the work they do has a significant purpose. They leave work every day knowing that they were able to impact someone’s life and that they are appreciated. That is what I want out of my career as a physician working in a rural setting. I want to be the best physician I can be so that I can help the people who need me the most. Today, I was surrounded by other physicians and health care professionals who have that same exact goal and, wow, was that an empowering feeling! I want to continue to feel empowered and supported as I continue my medical career and I know, without a doubt, that I will experience that empowerment in a place like Aroostook County.

 

From Alexandra Hensen (CDM)

It marks the end of day one in “The County” and I find it safe to say that we have all had a great time so far. This experience is already something I cannot imagine I’ll ever forget- from moonlit kayaking to cooking fiddleheads, this trip has been one to remember… and it’s only day one!!

I’ve always been very drawn to interprofessional work, partly because I really enjoy working with and learning from other people but also because I find that being able to communicate and work well with other professions is key to providing your patient with the best possible care.

Having three different disciplines on this trip- Osteopathic Medicine, Pharmacy and Dental Medicine, brings a lot of diversity but also the group as a whole is one I couldn’t be happier to get to know!   As a dental student I am really interested in better understanding the care available in a rural area such as Aroostook County. It’s becoming more apparent how important interprofessional work is in rural areas. I am really grateful for everything I have learned already and am looking forward to the remainder of the week!

 

From Marina Izzi (Pharmacy)

When first applying for this program, I was very excited to get a taste of rural medicine, and thought of the inter-professional part as a bonus. I really had no expectations, and just planned on going into the experience with an open, enthusiastic mind. Looking back on the first 24 hours of this program, I couldn’t have approached it with a better mentality. I found that the dental and osteopathic medicine students were just as eager and excitedly nervous to meet the other professions, and we were all able to connect on the basis of rural healthcare. Barriers quickly came down with just one or two social activities, and I feel like I’ve made some great lasting social and professional relationships already. Overall though, I can definitely tell that the thing that connects us all the strongest are our desires to learn with passion. I am extremely thankful for this opportunity, and could not have wished for a more welcoming group of people to spend a week with. To say I’m learning and overjoyed to be a member of this team of fantastic people is an understatement!

RHI Day 2