Welcome to Season Four of This Rural Mission. We're excited to connect with you again and talk more about the wonderful things that rural communities have to offer and the impact our leadership and rural medicine students and graduates are making for these communities. I'm your host, Julia Terhune and let's get started. Last season, we highlighted how COVID-19 affected residency, and I thought it might be time to talk about residency and what we as a college have been doing to impact the rural workforce. Now residency, well medical education as a whole, was a totally foreign concept to me before I started with this job. In fact, that foreign understanding is actually something we're going to talk about again this season. Why am I spending so much time talking about this? Well, I think that if we all understood the complexity of training that our doctors undergo, we might better understand the necessity and the resource that they are, especially for our rural communities. So here it goes, here is my brief recap of how doctors are trained. Four years of undergraduate work, specifically in the sciences, test number one, the Medical College Admission Test, four years of medical school, two board tests, residency with board exams throughout their entire training, three years to seven years of residency, depending on what field they go into, plus possibly fellowships. No, they don't make a whole lot of money during this residency. No, they aren't done with their training. No, they haven't learned everything. Yes. They still are under the jurisdiction of other doctors. Yep. They're still learning. And yeah, it's a lot of work. And all of this getting into undergrad, getting into medical school, and getting into residency is earned. It's not a given. You have to have the grades, the volunteering, the research, the personality, the drive, and then be accepted by the programs that you are applying to. It's a big deal. Now it's also a big deal to have a residency in a rural hospital. That's because residencies are sponsored by universities and housed in hospitals that can provide the number of faculty, aka other doctors, and clinical patients to help students finish their training, which means they need to have a lot of both of those things. In Michigan, we have some rural residencies in family medicine. They are located in Marquette and Traverse City primarily. Midland also has a residency program, which at its start was rural, but the county's population has increased to turn Midland county urban. But that limitation of rural residency is changing, both in geography and in specialty. This is all thanks to the fantastic work of our legislators, medical schools, and hospital partners throughout the state. Thanks to a program called MIDOCs, M-I-D-O-C-S, more primary care doctors are being trained in rural and underserved urban areas than ever before. So let's hear about how this program came to be from Jerry Kooiman, our Dean of External Relations at MSU College of Human Medicine. Yeah, so it goes back probably eight years ago, a number of medical school, government affairs folks got together and started talking about graduate medical education and the need for residency's really to be in parts of the state that we weren't training residents now, at that time. And in areas of residency focus that are lacking in the state of Michigan, in particular primary care. And so we began meeting, we met with legislators and began saying what if, and so the legislature gave us some planning money in one of the budget years. And we began to put together, out of research, our research in terms of what are the needs out there, just to make sure that we were data-driven, where are the parts of the state rural, urban, across the state and what are those disciplines that really are shortage areas for health professions. In the UP, psychiatry was their number one issue. In Traverse City in Northern Michigan psychiatry was their number one issue. And then with Alpena it was a matter of, they had been wanting to start family medicine in Alpena for some time from Mid-Michigan health and so that became their focus area. So it's evolved the four medical schools are Central Michigan University, Western Michigan University, Wayne State University, and Michigan State University College of Human Medicine. And so, we presented that back to the legislature and to the budget office at the state and asked for $5 million from the state. $5 million would be contributed by the medical schools. And then we would apply for a two to one match from the Centers for Medicaid and Medicare and from the federal government. And so the idea is we would have $20 million, and that would be enough to fund residents from each of the colleges and medical schools for their entire cohort. So if someone's going into psychiatry, that $20 million would cover psychiatry for all four years for that cohort. Because we didn't want to leave it up to the legislature each year with the possibility that they didn't provide the funding we'd need, be liable for the full cost of that training. Well, the CMS came in with a one to one match, and so we had to downsize the program. And so we're at five residents per medical school per year. We're actually asking the legislature for $6.4 million in this current budget process to get us up to six residents per institution. So total of 24 residents two of our residents are going into psychiatry in the UP. Two of our residents are going into psychiatry in Northern Michigan, and then one resident that's paid for by MIDOCs is going to Alpena through Mid-Michigan Health and Family Medicine. If the legislature gets us to $6.4 million in this coming budget year, we will be paying for two residents in Alpena. So that's the goal. We want to be to a point where it's sort of level funding and not ups and downs, which we've been at for the last four years. If we can recruit medical school students from these areas of the state where there's a shortage, get them to go to our medical school and have them train in, say Midland or Marquette or Alpena, and then our own residency program, which is going to train them as residents in those areas. You're just adding up all of the reasons for a resident to eventually practice in that area. We're just trying to add reasons for them to stay in. And I think this is, it's building our own. It's much cheaper to invest in this at the front end than to have to pay huge signing bonuses, to get them to go to Alpena or to Marquette or to Traverse City, even. So that's why we're in it. I'm really excited that Michigan State, a number of our own students have chosen this program as a way to do their residency program, because that's really the intent. So you heard it, this program is really in line with what our college is doing as a whole and what our college is all about. Not to mention it's meeting the mission of our leadership and rural medicine programs. And our leadership in rural medicine programs have influenced some of the direction of this program. We are all working together to make the MIDOCs program a success. In fact, our first psychiatric rural MIDOC students in Marquette started an LRM graduate. And this year we have a student piloting the family medicine MIDOCs program at Mid-Michigan Health Alpena through the Midland Family Medicine residency. Not only that, but that student piloting the program is a Leadership in Rural Medicine graduate and tipped into the Midland program, a program I'll explain, just a little bit. David Westfall is his name, Dr. David Westfall. And he is a pretty remarkable person. So let's get a bit of his mission and why he's doing what he's doing. But you stayed true to your goals and your mission throughout medical school, now in residency, you are a tenacious human David, good job. That may be even more so than you realize. I have wanted to go to med school since I was in middle school. So the idea that I didn't necessarily get accepted into medical school my first time around wasn't something that was going to deter me. A lot of my family, friends are all sort of in awe that I have gotten to this point where I'm graduating from med school now, because I never gave up on any of that. I applied for medical school five times and during med school, I struggled with my prep for step one, a little bit. So I ended up taking an extra year there as well, but none of that has... It's been a struggle, but it's nothing that I've seen as insurmountable. And I've just taken the challenge and found the best way to address it. What's kept you motivated? So my original aspirations for going to med school, were when I was growing up, I lived in a rural area where there weren't enough physicians. And when your parents are filling out documents for school, they usually ask who your primary care provider is and most of my friends just put closest in that spot because they didn't have an actual primary care provider. A couple of them did, but the number of physicians was nowhere near enough to meet the needs of the community, so that was really something that I always wanted to address. And it was a big part of why I chose primary care to go into as well as my background in public health. But seeing that need was something that I always wanted to help with. And I thought that when I didn't get into med school, okay, I'm going to continue to do that. But maybe this public health thing might be another avenue that I can help address those things. And I found that when I graduated from my Master's in Public Health. It's a lot harder to get into the realm where you would be helpful in those sorts of situations. Getting into administrative positions, you need so much experience that you can't get without experience. So it just makes it a lot more challenging. And I started doing the sanitarian thing as a way of gaining some of that experience, but it wasn't as fulfilling as I wanted it to be. And it wasn't a bad job, but it wasn't what I wanted to do with my life. So that additionally just spurred me to continue reapplying for med school and get the goal that I had set out for initially. And what drew you to the MIDOCs program in Alpena? That was actually you, Julia. You told me about it at some point, and I didn't know anything about it at that point. So I started looking into it and it was like, well, this is what I want to do anyways. Always been interested in working in rural northern Michigan. And when I found out about the program is everything just sort of fell into place. So after I met with Dr. Hill, it just sort of felt like the right fit. Since then, I've gotten to know the residents a lot, and it's a very cooperative feel to it, working on their inpatient service over my fourth year, which is one of the requirements of TIP. I got to interact with a lot of the residents, the current residents, and they all worked very well together. There was a very sort of relaxed, open environment between them and things just went very smoothly. So that just sort of solidified my decision that this is where I wanted to be. So, I mean, there's incentives for the program that were enticing, but like I said, they all are just kind of the cherry on top. It's what I wanted to do anyway, working in a rural area, moving further north has always been my goal. The fact that there's a loan reimbursement associated with it is just sort of a bonus. For more than six years. I have had the pleasure of getting to know and work with the Midland Residency Program and the staff. They have been a tremendous partner in our clinical medical education goals at the Midland Regional Campus. And in the past six years have matched seven of our Midland Rural Community Health graduates into their program. Six of those students have entered the residency through the TIP program. The TIP program stands for The integrated Program. It's something that students apply for in their third year of medical school. It's a partnership between our rural residencies and our medical schools. Students apply knowing that they want to be a family medicine doctor and that they want to work with that specific residency. If accepted to the program, students get a chance to work with faculty at the residency and do rotations there throughout their last year of medical school. They then agree to rank that residency first during match match. Match is how you get a residency, going back to that discussion about applying and being accepted. Plus there is a financial incentive, which is always nice. Now the MIDOCs program is great, but like David said, it's not just these incentives that bring students to the residency. It's the people. People like Dr. Hill, Dr. Hill is the director of the Midland Residency Program and her colleague, Denise Sheldon is the coordinator. They work really hard to make the residency the place it is today, Dr. Hill is also a graduate of this residency. And like many students, she wasn't necessarily going to stay in this small town, but I think we won her over. Yeah. I say this to applicants, I feel and I recognize that I am biased about this place. I think that Family Medicine is such an incredible opportunity and having gone to medical school on the east coast and come out here, the training in general in the Midwest is so good. And there are so many good opportunities, but I really do think it's, a lot of times it's where do you fit in? Where do you feel like these continue my people? And so we just would like the opportunity for people to take a look and say, wow, what we do during interviewing is no different than what we do any other time of year. We all look the same. I think we all act the same. And so I think when people feel just that genuineness within the group. People ask me sometimes what's the story? How did you get here? Why are you still here? I saw in the pamphlet or the booklet that you've been here a long time. And it's so funny, I still remember Bob Lashant, he was a Program Director at the time, kind of making me eat crow after that for so many years and say, tell the applicants how you weren't going to stay and then you stayed. And all he meant by that, he wanted, it was a positive thing, but I came here and was at my last interview and was like, yeah, okay. My husband had a job opportunity. I'll just tell him I don't like it. And Bob, again, the world is such a small place, but Bill Wadland, who'd been the Department Chair for a long time, was my advisor at the University of Vermont when I was in medical school and I had gone to him and I said, "So, hey my husband has a job offer in this town. What do you know about this place?" And he goes, "You need to go look at that place." Okay. And I came in here and I remember thinking, this is where I'm supposed to be. These people are learning a ton. They are smart. They've got a ton of good opportunities. They treat each other well. And that's what it was like for me that whole time. I mean, did we work hard? We did. We worked really hard, but to be able to get that training and do it with people that cared for you and you cared for them, it matters because this is kind of your second family. And it frankly is your first family, because you work a lot. So you get to see your other family some, but to have that kind of support, I think is critical. That is really cool. And Dr. Wadland now has an endowment that he put in the name of our program and- Isn't that crazy. Come full circle. That's so cool. I know, it's so fun when that... You're like, "Hey, I know you, how did this happen that I ended up here." So yeah. I think he got a big kick out of that when I showed up at one of the first MSU meetings. Like, "Oh, there's a student that I had when I was at Vermont." It's like us seeing our residents places or them coming back and finding their picture on the wall with all the photos of the graduates. And that part is so much fun. And to have them come in and smile about the experience that they had here. That's been a newer idea of mine in the last few years when I've interviewed, I've said to people, "I think sometimes we look at residency, you're kind of towards the end of your training, you've been in school for a really long time. And you're like, okay, I need to, I need to survive this three years, but you really don't. You need to thrive in those years." You get to do this one time and it needs to be one of these life experiences that is challenging, but so good. And when you have people around you and it's a happy place, even though it's a challenging place and you work hard, it makes all the difference in your ability to thrive and not just survive. I think I've had residents say to me over the years, "I had no idea. I thought I was going to come here and see kind of regular stuff. I'd see some pneumonias and some heart failure and broken legs. I can't believe all the variety, all the pathology and strange things." And so I said, "Really wherever there's patients, there are all those things." There are a lot of patients who come a long way to see us. And I think when they get out of town or have a day off and drive, realize how far it is to go to Gladwin or how far it is... And some people have been patients here and then moved and then still come back to see us. But it's challenging to say, "Hey, I want you to come back," Well I don't have a car or I live 30 miles away and we don't have a working car or can't they take dial-a-ride, not there, because it's not within the city limits or you can't take County Connection because it's not in the county. So there's a lot of eye opening experiences for residents about that, for sure. I think some of them have had different experiences, poverty at a different level, in an inner city that we don't see necessarily those things, but we see different things. I know that residents don't realize how invested we are in them and this job. For those of us who do it, I mean, you care about the residents, you care about their learning, you care about their experience here. So what's the goal of all of this. Well, Jerry has put it pretty simply- You know, it's not one dimensional. It provides I think, significant value. And then of course the value to the community, you're building a physician base that would not have developed otherwise. Training residents in the UP, and [inaudible 00:24:19], in Traverse City for training family medicine residents, in Alpena where they've never trained before. And so now you're also building a faculty in those communities who can be utilized for undergraduate medical education. And it's a win, win, win. I think from the standpoint of the medical school, the standpoint of the resident, they benefit in terms of their training, being a rural site, or a underserved site, which is what they were interested in, they get a stipend or a loan forgiveness. And in quite frankly, if they do well in their residency, they've got a job coming out of the residency. Thank you, Dr. Westfall, Dr. Hill, Jerry Kooiman, and Denise Sheldon for speaking with all of us today. I'm so grateful that you provided all of your stories, but more importantly, I'm grateful for all of the hard work that you've put in over these last few years. Thank you so much for making the rural workforce a priority and not just talking the talk, but working every day to make a difference. Thank you to Dr. [inaudible 00:25:40] for devoting all of her time and energy and talents to this and for empowering students to go into rural primary care. We are so grateful to you. Thank you for listening to this episode. We can't wait to send more your way and help you learn how you can make rural your mission.

This Rural Mission

Rural Residency

Women Rural II

What the Virus Spread

 Unfortunately your browser, (Chrome 79), is not supported by the Rev Transcription Editor. In order to edit your transcriptions, please update your browser. Update   20 Years of Rural Medical Education_WAV_Final_01 arrow_backMy Files   All changes saved on Rev 2 minutes ago. more_horiz DownloadShare               00:00 00:00 22:50 Play replay_5 Back 5s 1x Speed   volume_up Volume   NOTES   Julia Terhune   This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine, the Herbert H. and Grace A. Dow Foundation, and the Michigan State University College of Human Medicine Family Medicine Department. We are so excited to bring you Season Three. I'm your host, Julia Terhune, and I hope you enjoy this episode.   Julia Terhune   When I first started this job, I was overcome with the needs of rural communities and the wonderful things that doctors get to do in their professions. I was, I guess you could say, fangirling a little about rural doctors. And I told my spouse that this was really what I wanted to do, that I think I wanted to be a doctor. So I had it all figured out. I was going to go to Michigan State University College of Human Medicine. I was going to do the TIP program at the Midland Family Medicine Residency, and then when it was all said and done, I was going to set up a practice with Scheurer Hospital in the Thumb.   Julia Terhune   Now, I have to tell you two very important things that came out of this conversation with my spouse. One, he instantly reminded me that I can barely handle a paper cut, let alone a surgery rotation, and he also reminded me that I would hysterically cry before every anatomy, biology, physiology and chemistry test that I took in college. He also reminded me that my GRE examination for grad school almost killed me with stress, so medical school is not in my future and I will stick to making rural doctors out of the likes of all of you.   Julia Terhune   But one subtle thing that also came out of this conversation was how much I love the Thumb community. Prior to starting with the College of Human Medicine I had never even been to the Thumb, but after six years of working with the Scheurer Hospital and the health departments and other agencies in these communities, I am smitten. I love the people from the Thumb. I love the history, I love the coastline, I love these communities. A story, not unlike many of our medical students, including Shelby Walker.   Shelby Walker   Yeah, so when I found out I would be going to Pigeon, I had never been there before. I don't think I had ever been to the actual Thumb before, maybe close to it but I don't think it was within what they count as the Thumb. And so I had my boyfriend at the time drive me out there just so I could see where I'd be going. So I thought it would make me feel a little bit more comfortable, and we got there and everything was so small. It was such a small town that I almost didn't believe that there was a hospital and a health system there that could especially accommodate students, so it was kind of an odd like, "What am I going to do for two years with a lot of time out in Pigeon?" It was a very odd feeling.   Shelby Walker   And so when we started, my first rotation of third year actually started in the Scheurer Health system with Dr. Scaddan in Sebewaing, and everyone was so welcoming and nice, and who let me do things, which as a third year medical student I was like, "Wait, am I qualified to do actual things?" And I think I had so many unique experiences out there because of where I was at. With Dr. Scaddan I got to be introduced to the ER, maybe a little bit earlier, and their definition of an ER was not what I had seen in the past but they still had some pretty intense situations and things that really were true emergencies that maybe you wouldn't expect in the middle of nowhere in, I think, a five-bed ER situation.   Shelby Walker   We went to the prison to do some healthcare with the inmates. That was an interesting experience that I wasn't really expecting when I had first pulled up into Pigeon. And from there I got to meet so many other amazing physicians and EPPs and just everyone there has been so nice [inaudible 00:05:05] Oh gosh, the administrative staff knows who you are when you show up to their meetings in the morning, because the physicians invite you to go with them to all of these meetings that you feel like you have no business really knowing what's going on, but they bring you to these meetings and the administration staff, they know who you are. They ask how you're doing, they asked how you're liking it. It was such an odd thing to, I guess, stumble into kind of on accident. I'm really grateful that I got that chance.   Julia Terhune   And if that's not enough anecdotal evidence to prove that Pigeon will win you over, well listen to this.   Shelby Walker   So I was talking to Chad about this, and then with Dr. Wendling actually, how odd this all turned out that I didn't want to go to Pigeon and I wanted to go to [Alma 00:05:57] and then I was like, "Okay, I'll do the nice thing." And Chad and I got engaged in Caseville. We went to Caseville on the beach.   Julia Terhune   Our rural medical affiliation with the Scheurer Hospital network didn't start just six years ago. We have a much longer history with the hospital and have been training students in Pigeon for more than 20 years. I sat down with the former CEO, Dwight Gascho, and the current CEO, Terry Lerash, who served and serve the Scheurer Health Network and learned just how it all got started.   Terry Lerash   Well, interesting story. I was working in Saginaw. I had a good position, felt satisfied, but my wife and I were on a Saturday afternoon or morning, we were standing in a field on an Amish farm in Gaylord or near Gaylord attending a wedding of a daughter of my CFO at the time, a guy that worked with me over many, many years. We were good friends so we got invited to the wedding and we're standing in this field and across the field walks Dwight and Theresa. And we had known each other for some time, Dwight and I had, probably over the last 20 years, involvement in hospital council, and health care executives, it's a pretty small circle in the State of Michigan. Most of us know each other.   Terry Lerash   Anyways, I said hello to Dwight. He says hello to me, and I said to Dwayne, "Well, I hear you are interested in retiring," and Dwight said, "Yes, I am. Would you like my job?" And I was a little bit stunned. Said, "Well, geez, I don't know." My wife was looking at me weird and I said, "Well, are you serious?" And he says, "Absolutely am serious." And he said, "Why don't you do me a favor? Why don't you come to Pigeon and just visit with me for a day? That's all I'm asking. No commitment, no strings attached, just come up and visit with me for a day."   Terry Lerash   And out of our friendship, I said, "Okay, I can do that. I can spare a day and run up to Pigeon. This is my old stomping ground anyways. I was born and raised in Bad Axe." So I had been away for probably 40 plus years from my hometown of Bad Ax and it was a chance for me to just get reacquainted with Huron County. So I drove up and I think within the first hour I was so enchanted with Scheurer Hospital because of its culture, friendliness, cleanliness, organization, and clearly Dwight's leadership was a big plus.   Terry Lerash   And as I talked with Dwight through the course of that day and learned more about Scheurer, I understood that the core values of the organization really matched me, kind of fit my dress code, if you will. And so I was intrigued and left and then made a subsequent visit and met with the board and long story short, here I am and I couldn't be happier. This was really a great opportunity for me [inaudible 00:09:29]   Dwight Gascho   And as I reflect on that side of the story, my story would match it almost exactly. I was born and raised in the Pigeon area. I was on a farm, left for a few years for school and the service, et cetera. Came back in 1972 and in 1987, I was invited to serve on the Scheurer Hospital Board of Trustees. And we were having some issues at the time, and in 1990, the board asked if I would take the leadership position in the hospital as the CEO. And I agreed to do that on an interim basis saying, "I'll give it a shot, but if it doesn't work maybe I could help find the next leader." Well, after just a matter of a few months, the board took the interim assignment away and gave me the full-time assignment and so I worked here from 1990 until July of 2016, 26 years plus.   Dwight Gascho   Obviously the hospital was struggling early on. The hospital became more profitable as years went by. We became more successful at recruiting young physicians. And there had been a gentlemen that had served on the board by the name of Loren Gettel. Loren Gettel was a farmer in this area and had a very strong interest in seeing students find opportunities to train in some rural community, and he put that bug in my ear. As a matter of fact, Julie, when I was being asked to serve, Loren asked the board chair if he could spend a day with me. And I'm fully aware of what it was. It was part of a program to see once if I passed the exam, so I think I was being vetted by Loren Gettel.   Dwight Gascho   So we jumped in the car. We drove to MSU and we walked the campus of MSU. He's a very, very strong MSU campaign leader. I mean, he loves that organization. He was grinning away. And he showed me places that were memorable to him and he showed me plaques on walls where he had made contributions to the organization and he said, "Dwight, some how, some way we have got to find ways to introduce medical students to rural communities because I've lived in a rural community all my life." This is Loren speaking, "And candidly, it's a great place to live. It's a great place to raise kids and we've got great schools, great churches. There's all sorts of things that you can do around here and we've got to find ways to do this."   Dwight Gascho   And that was something he just kept putting into my head. Unfortunately, he passed away from cancer just few years after I became CEO here in 1990 but his daughter, Peggy McCormick, continues to serve on the board of directors and she has a very similar burning desire to see some sort of a relationship with rural communities.   Julia Terhune   The Loren Gettel scholarship is a scholarship that our rural medical education students are still receiving today. And in fact, since 2010, 11 students have received this scholarship including Dan Drake who you heard just a few seasons ago and is going to be returning to the Thumb for practice in just a few short months.   Dwight Gascho   Terry was not a hospital CEO, but he was running an organization at the time that was an important part of the whole council and that's was Synergy Medical Educational Alliance.   Terry Lerash   So I was, quite frankly, offering to the hospital council opportunities for them to perhaps have students in their communities and in their hospitals, if they were able to provide the right types of resources. Well, after that hospital council meeting, I had two calls. One of them was from Dwight, in fact he was the first one that called me. And I think he probably was reflecting on Loren's message to him, and saw this was a great opportunity and so he called me and he asked if we could talk more about becoming a MSU student site. And so we worked through all the details. I can't remember all the details involved, but I remember driving two students up here and one of them was by the name of Kimiko Sugimoto. And she is now a general surgeon who actually completed the MSU rotation, her general surgery rotation in Saginaw, and is practicing in Saginaw as a general surgeon as we speak.   Terry Lerash   But she was one of the first students to come to Pigeon, and Dwight was so gracious in entertaining them and took them to board meetings and got them involved and connected with all sorts of things here at the hospital and they had a wonderful experience. And I can't even remember what the length of the rotation was but I know your physicians got involved in-   Dwight Gascho   It was actually a little longer than what it was supposed to be. It just stretched out. That was a first for them and a first for us, and so we were thrilled and enthralled to have these young students. Of course, they're brilliant kids and they're so much fun, they're very respectful. I included them in my leadership meetings and learn from what we were doing. I wanted them to get as much of an experience in a rural setting as they possibly could get. So medical staff meetings, board meetings, leadership meetings, interact with the patients, interact with the staff, it was all part of it.   Terry Lerash   And I think that we got raving reviews after that about their experience in Pigeon 20 years ago. And so I look at Scheurer Hospital as really a teaching hospital, and so we've built that culture. We, meaning Dwight, for many, many years, and me most recently, built a culture of a teaching organization and I think that started 20 years ago with Dr. Sugimoto, actually, as that first student.   Julia Terhune   That involvement with the leadership at our rural hospitals is one of the pillars of our rural medical education certificate, one that really lands with students and makes an impact. Pigeon makes a place for aspiring rural medical doctors, a place where people can come back and grow. People like Elizabeth and our recent graduate, Evan. Elizabeth is a native of Cass City who, when I interviewed her, was planning to go back to the Thumb for her medical education and now is halfway through her third year of medical schooling. Evan recently graduated medical school and is completing an internal medicine residency in Detroit.   Elizabeth   Yeah, I am super excited to go back. I recently had the opportunity to shadow at Scheurer and had some downtime and was able to go back down to the floor and see a lot of the nurses and the nurses aides that I worked with, and it just made me even more excited to go back there and be back with that group of people and in that environment and continue my education there. And I think it's really important if you eventually want to serve in a rural area to see how rural medicine is different. I can tell you, I had my adult wards rotation for second year at Sparrow this morning and it's way different. It's a different environment, there's different types of cases, so I'm excited about that.   Elizabeth   I'm excited to develop those relationships that you get to develop in rural areas that you don't get so much in bigger hospitals, relationships with patients and relationships with colleagues, other physicians, other employees in the hospital. I'm really excited to be a part of that and just be a part of that group and that kind of close knit community again.   Evan   I think the thing that's going to stick with me is that the sort of idealized version of a physician or what a doctor could be, sort of that dream, is still alive in a lot of places. I think a lot of times we get down on what medicine is becoming or has become or how it's changing and how the role of the physician is changing, and maybe it's not what we had thought. You know, a country doctor making house visits, knowing all their patients, delivering babies and doing minor surgeries and really being that do-it-all type of doctor who's also involved in their community, who's also a community leader. We don't see that as much anymore, I think, especially in bigger cities.   Evan   But having that experience in a rural community shows me that it's still possible. I've met plenty of physicians who were that do-it-all type of person. They were in covering shifts in the ED in the night and then in the morning they were in their clinic and after that they were on the board of the hospital and they still made it to their kids' sports games where they were the sports medicine physician there, and they were on the Rotary Club board as well. I mean, they were just in every facet of their community, being that leader and being that physician and everybody knew them.   Evan   And so I think it gives me inspiration that I can be the type of physician some day that I think I always wanted to be, or I was always really intrigued by. And I think that's a really great image and vision to sort of hold onto as you go through your training and ultimately look at how you want to set up your practice in life and where you want to end up.   Julia Terhune   I am proud and MSU is proud of our partnership with the Scheurer Hospital system and all of the hospitals, clinics and health departments that we get to work with in the Thumb region. All of these places have significantly contributed to our students' rural medical education, places like Hills & Dales Hospital in Cass City, McKenzie Health System in Sandusky, the Harbor Beach Community Hospital, and the Huron County, Tuscola County and Sanilac County Health Departments have all been taking our students for many years. The leaders of all of these facilities have become our friends and have taken on so much for our students. I can't even begin to thank them. They have provided not only a place for medical education during regular times and pandemic times, but they've been mentors and leaders that have provided students with perspectives they wouldn't have gotten anywhere else.   Julia Terhune   On top of that, they have constantly supported our program, our Pipeline program, and even things like this podcast. They have gone above and beyond to be so much more than just medical education partners and I think that that's one of the most important things about rural medical education is that you can't walk into a rural educational environment and not leave with family, friends and a brand new community. So we love Scheurer, we love the Thumb, but what do those who receive care from Scheurer think? I spoke to Lynn and Abby who not only receive medical care from Scheurer Health professionals, but are also employees.   Speaker 7   The more we grow, it gives the community another option and they're like, "Oh, well, oh, they can do that there. Okay, well, I'm going to go there then or request services there."   Speaker 8   It goes back to not being a number. Really, everywhere that you go here, they know you. They know your family, they know something about you, and they built a Meijer in Bad Axe that opened in July [crosstalk 00:21:40] We've got a clinic in there and things that can't get handled there, they can do at the Bad Axe site, and if they can't do it at the Bad Axe site they can send them to Pigeon. So it's all within... What is it? We have something within 12 miles of each other always.   Speaker 7   [crosstalk 00:21:57]   Julia Terhune   Thank you for listening to this podcast. I want to thank Dwight and Terry for taking time to speak with me, along with Shelby, Liz, Evan, Lynn, and Abby for their contributions to this episode. As always, thank you to Dr. Wendling for making this podcast a priority. I love getting the opportunity to hear and tell these stories. Also, Dr. Wendling, herself, is from the Thumb just adding more proof to the theory that some of the best doctors come from the pollex, the scientific term for Thumb. See, I learned something in anatomy. The Thumb is a wonderful place, a place where you can really make rural your mission. How did we do on your transcript?     Rev’s Quality Team reviews all transcripts rated 3 stars or less.    

20 Years of Rural Medical Education

*PLEASE BE ADVISED: This episode discusses very sensitive and triggering content including suicide and self harm. Please continue reading/listening at your own discretion. This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine, The Herbert H. and Grace A. Dow Foundation, and the Michigan State University College of Human Medicine Family Medicine Department. We are so excited to bring you season three. I'm your host, Julia Terhune, and I hope you enjoy this episode. On January 24th, 2020, the CDC published the following, "In 2017, nearly 38,000 persons of working age, that is, 16 to 64 years, in the United States died by suicide," which represents a 40% rate increase in less than two decades. 79% of those 38,000 people were male. And the breakdown of those men in different occupations was as follows, fishing and hunting workers, machinists, welders, soldering, and brazing workers, chefs and head cooks, construction managers, farmers, ranchers, and other agricultural managers, and retail sales persons. In addition to this devastating data, the CDC has shown that suicides are around 30% higher in rural communities in general when compared to urban communities. What do these two things have in common? Farmers. That's the population that I want to pay attention to on this list, though I want to acknowledge the depravity and the sadness that this list holds. The thing about farmers is that they are a really important population. They take care of our plates, of plates around the world. And in 1900, 40% of the workforce was in agriculture, but by 2002, that number was down to a staggering 1.9% of the workforce. The United States Bureau of Labor Statistics predicts that there will actually be an even greater reduction, a 6% reduction in farming jobs over the next 10 years. And since the 1990s, the rate of suicides by farmers when compared to the general public is 3.5 times higher. So here we are. In the last six years, more than 450 farmers have killed themselves. The numbers of farms totally has decreased, but the productivity and output of the farms that are left has increased more than 50%, partly because it's had two. And the total amount of debt that farmers owe has increased 5%, which may not sound like a lot, but that number equals $16.4 billion, billion with a B, that farmers owe since 2017, in addition to what the debt already was. There's a fantastic article that USA Today has published, and we will link to that on our website. This article goes over many of the reasons why this phenomenon of farmer suicide is happening, but I wanted to provide all of you a perspective from the people who are working with this population, live with this population, love this population, and are trying to do something about this problem. I conducted interviews for this podcast in late 2019 and early 2020, but the stressors and complexities for farmers that my interviewees talk about are not outdated. If anything, they've become more acute than they were before. The first thing I want to show is that the stressors that the CDC, NIH, USA Today, and so many others have identified as problems were also identified by my interviewees. And I think that these are issues we're all worried about. We all care about the environment, and obviously we all want to have financial stability, but these are all real stressors for farmers because it affects their livelihood, and their livelihood affects our livelihood. Literally. It's actual food. They make our food. Without farmers, we don't eat. And of course, there's a lot to say about small farms versus big farms and how that business phenomenon and how that transition is affecting our food, but the idea of farm stress and the idea of farmer suicide doesn't hit one sized farm over the other. It's something that is taking a toll on everyone, and something that my first guest, Sarah Zastrow, knows firsthand and professionally. So I grew up on a farm out kind of in Freeland, south of Midland a little ways, and my dad and his brother farmed sugar beets, corn, soybeans, and wheat. And I swore that I would never shovel manure again after I left for college. And my dad said, "Don't marry a farmer," and so of course I did. So we just farm a little bit, both with his grandparents, and so that's kind of fun. It's interesting to see the dynamic of several different farms. We've got a lot of farming families, and so it's kind of cool to see that dynamic and the different ways that every farm operates. So that's kind of cool. And then what I do is I have my own wellness business where I teach people how to manage stress, which has turned into teaching farmers how to manage stress. And so that's been really, really interesting this year and really has just taken off this year with this terrible farming season and all the pressure with these tariffs and different things like that. So you came across the issue of farm stress organically? Yes. Can you tell me that story? How did this come to into your purview? Yeah. So I think that farm stress has always been really evident in our family, both my mom's brother's farm and my dad and his brother's farm, and everybody sort of has a touch of anxiety and you just notice things that are affected by that stress. And so I think that I have always known that sort of growing up and that people just handle stress very differently, however, it's always been really apparent to me that farmers in particular are stressed out. And especially when the weather doesn't cooperate and when there's so many factors outside of your control, that contributes to a level of stress because everything feels so crazy and so out of control. And so I think that that was kind of the first introduction I had to farm stress. We had a farmer neighbor who committed suicide a little while ago earlier this fall. And it was just devastating. And I'm going to be honest, I didn't know him at all, however, we heard the gunshot and then heard through the grapevine later that day that he had committed suicide. And I thought, "This is terrible." And then we went out for breakfast a couple of days later, and the girls in the restaurant at the breakfast joint realized that there was something different about him, but what do you do? What do you say? And when you notice something is off like that, at what point do you say something? At what point do you mind your own business? At what point does another person need to reach in and help? And so that was another kind of determining factor for me that this and what I'm doing, this talking about stress management, giving people the tools to communicate with their spouse, with a counselor, with different people, whoever you feel comfortable with is really, really important and really, really needed on every single farm. This issue of farm stress and farmer suicide is so big that people from the community and people outside of the community, people at the state and federal level have taken note. Eric Karbowski is a community behavioral health extension educator for Michigan State University Extension, and Eric's job was created by Extension to tackle the immense social issue that is plaguing Michigan farms. Eric's job is to help find large-scale solutions and also develop grassroots and educational efforts to help this targeted population. Well, my name's Eric Karbowski. I'm behavioral health educator working with Michigan State University Extension. My path to becoming here, I really had no intentions of working for Extension. I grew up in a rural area. My grandparents were farmers. I had the opportunity to participate as part of the CMU football team, which is really part of the reason I actually went to college. My parents never attended a university or anything like that. My dad worked for GM and my mom worked in the post office. And so athletics really was my opportunity to go to the university. And then, so after that, I started my career. I worked in inner city Saginaw in Detroit, working with individuals with mental illness and helping them find jobs, competitive employment. Eric's job was created by Extension, and Sarah was developing her business at the same time that the CDC and other health entities were shocked at the suicide rates among farmers, a discovery that was being published and made known at the same time that huge tariffs and trade wars with China were being conjured up by the Trump administration, an administration that was largely supported by a rural farming base. It was a great opportunity for me to give back, because I married into a farming community, and give back and stay connected with really where my roots are, working with the farmers and talking about farm stress, talking about a lot of the hard discussions, suicide, mental health, mental illness, that really aren't comfortable conversations for people to have. And so it's been a really unique and good opportunity for me to connect with the farmers and really try to make a profound difference in their lives. So with an America first mindset playing out internationally, huge hurdles for selling commodity farm goods were being positioned for farmers in the United States, something that has led to new cultural and social issues that are developing for many farming families, families like Carolyn's. Carolyn is one of our leadership and rural medicine students and she grew up on a small farm in the center of our state, one that is still running today, and one that has been managed by her parents, partly because they ran it as a second full-time job, having other means of income outside of the farm. Yeah. So I just spoke with my father about the tariffs and what his perspective of it was. And he thinks that they lost, because of the tariffs, about $40 to $50 an acre money-wise for... I guess we had soybeans for the tariffs [inaudible 00:12:19] how prices went down. And then a big conversation that's been at I guess Thanksgiving dinner was whether or not they went and got aid packages, whether they got their Trump checks, and my brother did receive aid. So he went and applied to get this emergency aid for his smaller farm, and I think he got around $1,000, $1,500 for the money that he potentially lost because of the tariffs. My father did not collect any aid. And he said, "Why would I want other Americans to pay for my misfortune?" What are these Trump checks? So with the tariffs that happened, there was emergency aid that was given out to farmers in the past couple of years. And so they originally, from my understanding, they originally put a cap on how much that you can collect, but larger farms were using multiple names to go collect more. And then so far, smaller farms weren't able to collect as much. But I think overall, the emergency aid that was given out was just seen as a band-aid. There's no way to really collect that money that was truly lost. You can't get all of that power back, that money back? So here we are. If I can be so bold, I would say we're in a culture war. We have political, environmental and social issues that are trickling, no, rushing down to our food systems and the people who are taking care of our plates and the plates around the world. This is a totally rural issue and there's too much at stake to turn away from this problem, but I do have a hopeful message for all of you today, and it is from people like Eric and Sarah, people who are caring about this population and trying to do something unique and person first to solve this problem of farm stress, not only for the people who are in this work, but for the future of this work and the future of all of our communities, specifically rural communities. So I think some of the changes in the industry that we've really been observing and trying to create some unique opportunities for are that farmers don't communicate as much as they used to. A lot of it is done via social media now. And so you don't see a lot of the farmers connecting at the local coffee shops or gathering where they may have in the past. And I think that it was a pretty interesting feedback to hear from especially a couple of the farmers themselves, but then even locally, we tried to do just an observation where we worked with the local elevator just to create an opportunity for the farmers to get together. We made chili and bean soup, and it was awesome to see even though amidst of all of the difficult times and the financial struggles and the delayed planting and the tough growing season that we had this year, that there was a sense of comradery and there was a lot of smiles and laughter and talking. And it was really cool to see and experience that. I think there is kind of, there's generational differences for sure. I mean, a lot of the things, especially the more I've transitioned into this role and learning that, I think the average average age of a lot of the Michigan farmers are in their early to mid-60s. And then, if they do have a son or a daughter that are going to start working on the farm, Facebook, internet, cell phones, those didn't exist when they were growing up. And so now those are all kind of parts of where they're at or where we're at today, and I think that creates some communication challenges for sure. And part of your job is now almost trying to get people back to that grassroots community piece. Is that what I understood? Well, I think that's kind of one of the things that we're looking into is, if we create some of these social outlets for the farmers that they kind of naturally had in the past, will that help? Because you always feel good when you talk to your peers or your coworkers, or somebody that you know has something in common with you, right? It's like you're speaking the same language, and farmers are no different. It's an opportunity for them to vent, to talk about stuff, maybe good, bad, or indifference, or even just a chance to catch up. And it's amazing just to see really the atmosphere and the environment, how it changed, even just over the course of those two hours. And there was no formal programming or no formal lesson that was being taught at that. It was just, it was farmers talking to farmers. So what I would hang my hat on are community involvement and stronger relationships in your family, with your spouse, with your community in general, and really just working on and focusing on the things that you have control over. Because at the end of the day, we don't have a lot of control over many things. We don't have it over the weather. We don't have it over the grain market or any commodities market. We don't over the tariffs and things like that. Focus on what you can control. And I always tell people, you need to figure out a way to manage stress now. Create habits for stress, stressing less over the long haul, and then building those relationships. Those are the three things that we can focus on and those are the three things at the end of the day that are going to make the biggest difference in our lives, in our families and in our neighborhoods, and that is what is important. And then at the end of the day, whatever happens to China happens to China because I have a good home life and good community and things are going to be okay. Sarah's efforts with her business are helping people and giving people creative solution, and Eric's time with the farming community is starting conversations that need to happen. We can also have hope that the work that farmers are doing is not just feeding us. They are shaping and molding people who are coming out of these communities and working to return and make a difference. Maybe they're not going to be behind the wheel of a combine, but their work will directly affect those drivers. I guess being on a farm where I have to help my father do things that I've never done before or I've only seen done, it's given me a little bit more confidence in the medical setting that, "Hey, I've done things in the past and I can do them in the future." So in that aspect, it's been helpful. I don't know if farming has influenced me to go into medicine, but I know it's influenced in where I want to practice in the future. I know I want to be in a small community where I can rely on neighbors and friends and they can rely on me. Thank you to Eric, Carolyn and Sarah, for speaking with me today. There's so much more to say on the issue of farm stress, and we will be revisiting this issue in season four. So if you have ideas for people, you think would be a great interview for that episode, please email us at thisruralmissionpodcast@gmail.com, or message us on Facebook or Instagram. Our Facebook and Instagram handle is @MSURuralHealth. Our last thank you as always goes out to another farm descendant, Dr. Andrea Wendling. We are so grateful that your time growing up on a centennial farm brought you back to rural Michigan, where you have helped serve so many. We hope you enjoyed this podcast, and I hope that it inspired you to make rural your mission.

A Drop in Yields

Transcript  Julia Terhune: This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine, the Herbert H. And Grace A. Dow Foundation, and the Michigan State University College of Human Medicine, Family Medicine Department. Julia Terhune: We are so excited to bring you season three. I'm your host, Julia Terhune, and I hope you enjoy this episode. Julia Terhune: A common pastime for rural residents and tourists alike is the local farmer's market. I love them, and it seems to be a hallmark for many rural communities. Not only do farmers attend these events, but often you'll find local craftsmen, artists and even local musicians. Julia Terhune: So maybe that's what you were thinking when I said art in rural communities or arts rural for this podcast episode. And you'd be right. After all, there are many artists who are at these events, but my perspective takes a little different turn. Julia Terhune: When I say arts rural, I was actually thinking about some of the doctors and future doctors that I know. So that might sound kind of confusing, but it's not when you think about it this way. I describe it like a Venn diagram. There's one circle with art. There's one circle with medicine and in my world, where they seem to overlap is in rural communities. Julia Terhune: You see, growing up in a small town, I experienced a place where people used their crafts to survive, but also where many arts and skilled crafts have survived. If you've ever been to one of those markets that I mentioned, you know what I mean. People make their living off of the things they make, but they also make things to serve them on their farm, in their home. Some families I know, and maybe you know too, have simplified their lives, to make more room for art and music. And there doesn't seem to be a community gathering without those things in many small places. Julia Terhune: So what does that mean for the doctors that want to serve in these bucolic communities? Julia Terhune: We've talked at length on this podcast about the social and economic complexities that make doctoring in rural communities a little harder. Harder problems sometimes cause more creative solutions, which is definitely something our partners today will speak about. But I think that the people who serve in these rural communities as physicians are themselves a little more complex. They seem to not only come at physical issues with a multi-faceted approach, but have several sides to them as people. Julia Terhune: We've said on this show that doing rural medicine is a brave thing to do. Now, I would like to propose that serving rural communities is a creative thing to do. Julia Terhune: Let's start with some student stories. Right now in the leadership and rural medicine programs, we have two pretty creative women learning to become rural doctors. Kayla, who you'll hear from first, is originally from Minnesota, but is now completing her clinical medical education in Traverse City and preparing to become either an OBGYN or a surgeon. She's not a hundred percent sure quite yet. Julia Terhune: Ellie is originally from Illinois, but came to the upper peninsula during her undergrad and has stayed in Michigan ever since. She will also be going to Traverse City this summer. Both students got a fine art degree along with their pre-medical requirements in undergrad, and yet nothing deterred them from medicine. Kayla: So I went to undergrad. I had actually already completed 60 college credits before I even got there. So I only had two years left to do. Kayla: But I had this four year scholarship that covered a good amount of my tuition. And I was like, "I don't know if I'll be ready to graduate in two years." So I went to undergrad. I knew I was going to do something science, but my whole family is kind of artistic and no one's really been able to go and entertain that or build on their artistic skill. The [inaudible 00:05:00] high school art classes and then my oldest sister just stopped and my mom kind of stopped and I was like, "I would love to do art." Kayla: So I went to undergrad and I did a double major. I did biology and then studio art and then a chemistry [inaudible 00:05:14] but no one cares about that. Julia Terhune: And Ellie reiterated that point. Here she is. Ellie: I kind of have always wanted to go into medicine. From when I was younger, it was like the first thing that I said when I was five. And I feel like it's very cheesy, but then I never really came up with anything else that I liked. Ellie: I just kept finding more reasons as I got older to like medicine. Until I got into high school, I didn't really have any other ideas. And I took my first real art class. I took a ceramics class in high school and I was lucky to be in an area where we had lots of different art classes. So I was able to take a couple years of ceramics back then. Ellie: And I just really fell in love with it and I love working with my hands. I've taken so many science classes to try to do well and prepare myself for the future, being a doctor, that I wanted. Just being in art was really nice and relaxing. It kind of gave me a creative outlet that I didn't know that I needed and I just really enjoyed it. Ellie: After I took those classes and I was a senior in high school, I said, "You know what? I'm just going to be an art major." And I can still take all of my, my science classes. And I had actually met with my future advisor, pre-medical advisor in college. His name's Dr. Lucas. He's at Northern Michigan University. And he told me to just go for it. He was like, "There's so many people that apply as science majors. And a lot of medical schools now are really interested in people that are doing something different. So have other passions. " Ellie: So I just decided to go full force with it. And I really have no regrets. It was one of the best decisions that I made. Kayla: And it worked out really well. It's been kind of a stress relief. I'd go to these really intensive biochemistry and then biochem lab. And then I would go and I'd worked 15 hours on a sculpture and it would be like the perfect little ratio for me. Kayla: It took me a long time to figure out what I was going to do with my senior art show, a big project you put together at the end of your four years of undergrad. And it's a big group show. I was applying to medical school at the time, going through all my interviews. And I started sculpting all of these heads. And I tried to like convey what does it feel to be anxious or to be so stressed out? Kayla: And I kind of just went for it. I just started sculpting this giant head. And then of course it fell apart because art just always falls apart on you. It's really good for problem solving though. So I had to rework it a couple of different ways and it turned out better for it, so that was nice. Kayla: But I ended up doing these five heads on these giant four-foot pedestals. So you'd walk into the gallery and all these heads are staring at you. And each one was kind of a different representation of anxiety or stress or kind of depression, but more anxiety and stress. And I had interviewed some of my friends and siblings and I was like, "Okay, what does stress feel like to you?" I was trying to capture how we all feel stress so differently. Kayla: So the first one I made, it was based off my face and it was screaming. And then half of it was kind of exploded off. Kind of like if you've ever felt so frustrated, your head's going to explode. So I literally made that, but then I did it very realistic on the side and then where it was exploded, it was very artsy and abstract. And I really wanted to highlight clay and what clay can do. Kayla: And then the other four, one was really spiky. It had all these spikes, kind of like how you get really defensive and shove everyone away from you when you get stressed out or at least I do. And then there was another one. My mom was like, "How come none of your sculptures are smiling?" And I was like, "Oh, I got this." The last one I made was smiling, but then it was like empty inside. Kind of how you can put on a smile, but sometimes they're not always... It's just like a face, right?iSo it was empty on the eyes. And the head was crumbling down around it. You put on the face, like I'm still smiling, but on the inside, you're kind of empty. Kayla: And it was just such a cathartic experience. I don't think I even understood the stress and anxiety that I was carrying and just shoving down until I put it into these art and it's so therapeutic. It was amazing. Julia Terhune: I had to ask Kayla at this point, if she ever felt like the two sides of her brain were at war with one another. Kayla: I think in undergrad a little bit. When I was going for it, I had been accepted into medical school and then I had completed this big project and I was so proud of all those sculpted heads. And my art teacher's like, "Are you sure? It would be so like..." She was like, "You would love the art community. You can join us still." And it definitely crossed my mind. I was like, "Oh, if I do medicine, will I have time for art?" But I'm trying to. I'm trying to force myself to incorporate it in, and time management so that I get to embrace both. Julia Terhune: What is always fun and interesting about doing these podcasts is the similarities that come out of your conversations and the commonalities that people have with each other, even if they aren't related. Julia Terhune: This idea of art, not only being a place of relief, but also a way to think about serving patients holistically was something that I found out from Dr. Julie Phillips as well. Julia Terhune: Dr. Phillips is a wonderful partner and friend. While she may not be a rural doctor, she serves in one of the state's largest hospitals as a family medicine doctor who also does OBGYN. So she sees many rural patients. Julia Terhune: She not only has worked on numerous rural related research projects with our program, but has a vested interest in helping students achieve their residency goals and finding ways to help them return to rural communities. You'll hear her again this season, when we talk about the complexities of getting into residency in the midst of a pandemic. Julia Terhune: She is also a talented writer, artist, and textile artist. Her story about her medical work and creativity mirrors that of Kayla and Ellie's, but in a way that shows how necessary art is in general, especially when caring for people. Dr. Julie Phillips: I actually think I was artistic before I learned about science and fell in love with science because when I was a very small child, I liked to write stories and poems. And I like to make things even then, even when I was little, like four or five, elementary school. When I was in elementary school, I used to write, of course. Everybody wrote stories in elementary school. It was a thing that you would do because teachers would tell you to, but I always wrote the stories that the teacher would pull out of the pile and read to the class. I was very proud of my writing, my creative writing, when I was small. Dr. Julie Phillips: I kept doing that through school and through college. I actually took English classes a lot, as well as my science classes, because I really enjoyed and loved them and liked using that creative side. Dr. Julie Phillips: It's something that I've kept with me. I didn't do it as much when I was in medical school because I think I was just working so hard. I kind of let that piece of my brain be dormant, I guess, is the word. But then after that, I started to pick it up again. Dr. Julie Phillips: I love narrative writing as a form of expression for medical doctors. I just think it's really valuable for us to have that and to be able to celebrate it and cultivate it and spend time on it. I think it's a pretty unique way to care for ourselves, to be able to write about our experiences and write about the meaning of being a physician and express ourselves that way. Dr. Julie Phillips: I really love to write poetry now. That's kind of my favorite form of writing. But I also write a lot of research papers, right? I have these two far apart on the spectrum pieces that I do. I do research writing that's more technical and very descriptive and very exact. And then I have poetry, which has many fewer rules, but it's kind of challenging in a different way. And I really like both of them. I get a lot out of doing both. Dr. Julie Phillips: In terms of making things, yeah, I've always made things like since I was a kid. I love to make things. My grandmother taught me to knit and then I didn't knit for a long time. And then I relearned when I was an adult and I just love that. And I like to sew. I don't know. It's just my favorite way to kind of relax and do something fun is to make stuff. Dr. Julie Phillips: I think there's something to be said for thinking outside the box in medicine. And I think I'm pretty good at that actually. That's an indirect link, but yeah, I do think that it does help you look at problems in a different way when you are used to sort of breaking the rules. You can break the rules creatively a lot. Sometimes it's fun to have a patient and just do something that is not the usual because sometimes the patient doesn't need the usual thing. Sometimes they need something special just for them. Julia Terhune: So what does art mean for rural communities? Why is it important for people, not just patients? Let's start with someone known very well on this podcast, Brian Eggers. You'll recognize his name because so much of his work has been on this podcast. Julia Terhune: The cool part about his story is that he's from Northern Lower Michigan. He's been a musician for many years and grew up near Boyne City. Now he's in Nashville, Tennessee, working on his music career and also song writing and producing. His perspective on the contrast of the rural music scene compared to the bustle of Nashville shows just how unifying art and music can be. Brian Eggers: To me, I'd say just as a microcosm, Boyne City has completely changed from 15, 20 years ago 'til now. And they do on Friday nights throughout the summer, they do Stroll the Streets where there's literally live music on every corner of the downtown area. As they've done this, the city has flourished and blossomed and businesses came. The tourism has increased immensely. Just as a whole, it really just pumped up the feeling. When you go there, you're like, "Man, this place is different." Brian Eggers: It's rich. It's diverse. It's not just a one faceted, "Oh, this is the town that's on the lake," because there's thousands of those. There's all kinds of these tourist towns who don't have much to offer aside from the scenery. And when you do something like Stroll the Streets on a Friday night in Boyne City, yeah, it's a little town with on the water and it's cute and it's pretty, but the people that you meet and the music you're hearing as you walk through the town or the waiter in the restaurant or whatever it might be, those connections are really what translate to people and it gives you more of a sense of what culturally is available here. Julia Terhune: And that sense of community is important because it connects and it gives people an identity, something that we're all searching for. Here's Kayla and Ellie again, giving their take on how art can affect rural communities and rural medicine. Ellie: I've had to think about this a lot when people ask me how art is going to help me at all. But I think art is really about communication. And that is something that I think, in medicine traditionally has been a little less of a priority. And I think now people are learning that it's important to talk to your patients and try to educate them and treat them as if they do know and they want to know and be involved in their care more. Kayla: And so I think my art degree really helped me take all this scientific knowledge I have and try to break it down into more simple terms. I think that's a really good skill to have, especially in a rural area. There are a lot of people that might not be... They might've graduated high school and then they went to work with the family business or things like that. Ellie: And I think that's kind of the biggest area and it would help in any other area as well. Kayla: I think, Cold Springs, that's the town I'm from. They had recently got this cute coffee shop, adorable. And they painted this giant mural of the town inside on one of the walls. [inaudible 00:19:41] they painted like this road. So highway 23 is what it takes you to Cold Springs. So it's like the big road that'll get you there. They painted it on the big mural and then they write on it with chalk questions like, "What are you most excited about?" Or "What's your new year's resolution?" And you see the whole community comes in and they're writing on the wall and little kids are drawing pictures on the chalk. And it's just a great way to bring the community together. And everyone gets to see like, "Oh, what did they write?" And so it's just art in small ways that kind of brings the community together. Kayla: I think art is so important to a small town. We think about art being in these big urban centers, but art is really important rural communities too. It totally shapes how we view our environment and it represents the community values and it creates conversation. So I don't think it could ever be undervalued. And if there's ever a chance to bring art into a rural community, it should definitely be explored because I think it's so beneficial. Julia Terhune: I think the more creative minds we get working together on rural issues, the sooner these issues will become a thing of the past. I think if more creative minds can start to consider the opportunities that rural areas provide, instead of just looking at what's common or what's expected, the sooner we can start to make a real difference in the lives of those most underserved. Julia Terhune: It might be one of the most creative things to go back to a rural community and find new ways of tackling medical leadership and economic issues. It's why we make this podcast, to help people think about the differences in rural areas, but how those differences are something that can actually be celebrated, and maybe we could get to that celebration sooner if we understood them better, kind of like an art gallery. You walk in and there's all these styles and approaches and ideas coming together to make one place beautiful and interesting. And yeah, sure. Not everything is your taste, but you can really leave with a sense of appreciation and respect. Julia Terhune: Perhaps if we considered the aspects of rural communities, the same way we consider the different aspects of different artistic approaches, perhaps then we can start looking for those commonalities and finding creative solutions. Julia Terhune: Thank you, Brian Eggers for not only being interviewed, but for letting us use your music for all of these episodes. Thank you to Dr. Phillips for your time and your contribution to this project and so many other projects we've looped you into over the past years. You have been such an asset to our team. Julia Terhune: Thank you to Kayla and Ellie. We are so excited that you are a part of our program and can't wait to see all of the creative things you do with your career. Thank you as always to Dr. Andrea Wendling for letting me exercise my creativity through projects like this. And thank you to all of you for listening. We couldn't do this without our listeners, and we are so grateful for your time. We have more coming for you this season, and we hope that this podcast will inspire you to make rural your mission.  

Arts Rural

To tell you that we are experts in Rural Medical Education is a bit of an understatement! We have been training and retaining rural doctors in our state for more than 40 years! So, let's take it back to where it all began, the U.P., and learn how it all happened from the man that was there!  This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine. The podcast is produced with funds from the The Herbert H. and Grace A. Dow Foundation and The Michigan State University College of Human Medicine Family Medicine Department. Welcome to season two. I'm your host, Julia Terhune, and I hope you enjoy this episode. I don't think there's been a week that has gone by since I started working for the college of human medicine that I haven't talked about how we have been recruiting, training and retaining rural doctors for over 40 years. For those that I work with, I'm pretty sure they were able to dub those words with almost my exact inflection. I talk about it all the time and not just because it's my job, but because I'm really proud of the outcomes of our program. I'm really proud of the work that everyone for decades has put into the success of our medical students and the success of the rural medical systems that take our medical students. Now in 2019, I get to change my script just a little bit because this year we are celebrating 45 years of rural medical education. In these 45 years, we have been able to show the outstanding and significant outcomes related to developing the rural medical workforce, and we have expanded our rural medical education certificate programs to include two additional rural campuses where students can receive that certificate. Those campuses are now Traverse City and Midland. With that expansion in 2012, we have been able to cover the map of Michigan with rural medical education opportunities. Those opportunities provide students with an understanding of the unique needs found in many of our rural regions across the state. For those medical students who want to get rural medical training, they can pick from two different programs, the rural physician program based out of Marquette or the rural community health program that's based in either Midland or Traverse City. Both programs are under one big umbrella called the Leadership in Rural Medicine program. But this umbrella wouldn't exist at all if it wasn't for the men and women who worked so hard to establish rural medical education opportunities in the upper peninsula starting back in 1974. To honor this legacy, we wanted to showcase the man who was there when it started and let him tell you the story about how it all began. Dr. Daniel Mazzuchi was an internal medicine doctor who came to the upper peninsula of Michigan in the late 1960s. He was an integral part of establishing the program first in Escanaba and then in Marquette in later years. His influence on the college was so tremendous that much of what he's established during his medical education career is still in place today. Dr. Mazzuchi sat down with Dr. Andrea Wendling, the current director of our program, and told us the story of how it all began. To talk about medicine in Marquette, you have to kind of... Medical education in Marquette, you have to kind of break it up because nothing happens in a vacuum. The political factors that went into allowing the UP experiment, which is what it was called, to be started, the people or cast of characters involved in it, and then how it eventually evolved as medicine evolved in the UP. We owe a great deal of credit to the development of our Marquette campus and our rural medical education heritage to the late Donald Weston who served as Dean of the college of human medicine from 1970 to 1989. He's the reason why we're here. I mean, that's a simple declarative sentence. He was a fly fisherman and he and his buddies were up fly fishing somewhere in the mountains. They were dreaming. They were iconoclasts. People really have no idea how iconoclastic they were. They thought that they could develop more of an apprenticeship model of medical education. They thought about it for places like they were fishing in, Montana and Idaho and all. Eventually that became the whammy program. They were also very politically aware and connected and hung out with politicians from the state government. They were drinking and talking and talking about this stuff. One of the guys said, "The hell you thinking about Montana for? I mean, we have a problem in the UP. Why don't we do something in UP?" People up here in 1973 had an idea and that was to have this apprenticeship model on an experimental basis built around a practice. He got a lot of communities interested in it. Eventually Escanaba was the site they chose, not Marquette. They hired a guy named Paul Warner and another guy named John Hickner and they developed a family practice down there and he put students in there for all four years. Unheard of. This was an experiment. 10 students every other year. After about three or four years, the LCME called Weston and said, "If you don't stop this, we're going to discredit the school." Why did they say that? There was no way... Unless the students decided to take national boards on their own, the LCME could judge the progress of people. The curriculum was let's call it innovative to sprain the meaning of the word. In terms of available data, the students were doing fine, but the available data wasn't sufficient in the minds of the people who were in charge of the LCME at that time. The long and short of it is a compromise was reached to relocate the first two years back to campus and to make this a clinical campus, but with a different mission. That's lasted to this day. Yeah. What was that mission at the beginning? The beginning was to try to resolve the problem of rural areas in getting people to come here to practice or even more importantly, to encourage people who lived here, who would ordinarily want to stay here, to get into medical school, to open the doors a little wider for them. We, by the way, had a separate admissions committee. The thing was it was a day when the decision was placed in the hands of a small group of people who had their own ideas about who should be going to medical school and who shouldn't. Although I would say they were very, very well intended people, I was a part of them. It was a very serious matter for them. But they took to what would be viewed today as an extreme, their desire to be sure that people came back here as much as possible. The bias, if you will, was very heavily towards people from the upper peninsula as was the intention of the founder of this program. That's what he wanted, but also towards women, also towards older people in general. I would say those things have by and large continued as far as I can see in a much different way and under it. But I think this campus has almost always had at least 50 and more percent women students and has always had a handful... Always had people in their late twenties, early thirties coming in, which I think is outstanding. I think it's the way it should be, but no, it was just that they kind of went a little overboard. Can you talk about how you figured their curriculum out and how you could coordinate that with the main college? I did not figure out the curriculum. Okay? Okay. I worked with department chairs. Department chairs were responsible for the curriculum here from day one just like they were everywhere else. It wasn't a detached program. It was an integrated program. It had people in the department who believed strongly. It was not in a vacuum. It was all integrated and carried out under their distant supervision. Every department had their persons here. They were likely to be local and they made regular trips up here. The students took always the same exams that happened on campus. All that other stuff [inaudible 00:10:25] But anyway, yeah, that part I would describe it as real but imperfect. It wasn't perfect because it wasn't next door. It was far away. I went down there as associate dean in '84, five, six, and I was responsible for all the campuses. I came back here in '87. I think it was when I came back and took stock of things and I thought to myself, you know what, this place looks like every other campus there is. That's not good. It might've been while still I was... I don't remember exactly, but somewhere in there in the '80s started thinking out loud, we need to do something to make this a special program again. Yes, we were no longer called the UP experiment. They were called the UP campus. Yeah, we had had some graduates and they were practicing all over, but a lot of them are in the UP. I thought, hmm, why not a two month long family practice experience in the little towns of the UP with the people who graduated from this program as their kind of overseers and so forth? Ultimately they gave permission for us to do a two month long... In addition to the one month, a two month long family practice experience in these little tiny towns. That extended time in rural family medicine lives on for our rural physician program students in Marquette. I know students are thankful that Dr. Mazzuchi started that model, and I know this because I was able to talk to one of the graduates of the program. Dr. Nicole Zimmer is now a family medicine resident at the MidMichigan Family Medicine Residency in Midland, Michigan. Her longitudinal family medicine experience set her on that path that Dr. Mazzuchi had envisioned. What was a highlight of your time up at the Marquette campus? If you could pick a day that you could relive right now, what would it be? I really enjoyed... We do 12 weeks of family medicine up there. Four weeks was in Marquette and eight weeks we spend kind of in a rural area. Mine happened to be Ironwood. I loved everything about being up there. It was in the spring, so it was absolutely beautiful. I mean, you could go on the trails. Everything was opening up. I worked with this physician, Dr. Hubbard. He was absolutely an amazing teacher and wonderful and hilarious. I mean, sometimes you get nervous about eight weeks one-on-one with a physician, but it flew by. He was a great teacher. He was amazing. While working with him, I had my very first delivery. It's still just like rocks me to this day. I remember going through the motions with him. We're kind of talking about, okay, during this stage of labor, this is what you need to do, and this is where your hands need to be, and this is what you're checking for. It was really funny because they didn't find out what they were having, a boy or a girl. I was so excited to deliver this baby because I wanted to tell them this couple if they were having a boy or a girl. When the baby was born, you're supposed to suction and dry off the baby a little bit and then pass it up to mom. Well, I was so excited I kind of forgot about that. I held the baby up like Simba and I was like, "It's a boy." Everyone starts crying and they're all excited. Dr. Hubbard just gently nudge me. He was like, "All right, Nicole, bring him back down." Then of course, we do the suction and the stimulating and the baby was perfectly fine and crying and everyone was happy, but he always joked with me after that in all of our deliveries. He goes, "Don't do the Simba move this time." It's just kind of stuck, but it was my first delivery. My love of OB as a primary care provider just blossomed on to that and I hope to do that in my future practice. It's one of the reasons I chose this campus too based on the rural medicine and the OB experience you get here. I knew at that moment it had to be part of my life. I had to be delivering babies. It was just such a thrill. The first team we sent to Haute, two girls, two women. I remember on the front pages of the newspaper, there are pictures there. I remember the little teeny hairs on my head standing up. I go, "Wow. This is exactly what I'm looking for." I mean, they treated them... They had never seen students before. None of these people had ever seen students before. They treated them in a truly heroic fashion, and they had the greatest hands on experience since we went to medical school. You don't want to know about our hands on it. I grew up in the city hospital. I mean, honestly God. But anyway, it was an overnight success and what better people to have as teachers than people who are your own graduate. I think part of the benefit of a program that's been so well-established is the connections that are made. When we had to set up rotations there, it was office staff who had worked with that physician for the past 20 years. They'd been taking students that whole time. The atmosphere of education and learning and opportunities was already set up. We didn't have to forge the way for that. The previous students and administration, they have been done. We're working with physicians in the community who loved what they were doing, love the UP. They were great teachers. Having that 40 years experience allowed them to realize, "Oh, hey, I know that you guys have this during this rotation. Let me help you out, or I know in the past students have really struggled with this part of the exam. I think you should read these materials." They were really helpful with resources or kind of identifying weaknesses before you even got there because they had seen students before you who are weak in that area or realizing there was a very human aspect of it too as far as realizing, okay, I know that you have an exam this week. I know that there are surgeries planned for late, but you had seen dozens of appendectomies, why don't you study and we can catch up after this case when the next one comes in? There was definitely opportunities to foster both the educational experience in the classroom still with bookwork and hands on experience. They were really great about realizing kind of what we needed as students before we really knew ourselves what we needed most of the time. Last year we did a study where we looked at the impact of the undergraduate medical education program and the workforce in the UP and really its impact in rural areas throughout Michigan. We took all of the graduates from the UP campus over a 30 year period, from 1978 up until 2008, and looked at where they were practicing in 2011. What we found was that 27% of all of the graduates of that program were actively practicing in a UP County in 2011. It's amazing. Yeah. The impact that that has on the workforce for the UP sustained over time is amazing. We used to wonder out loud with each other, you know, how much longer we'd be working here. Yeah, yeah. Now it's 40 years and it's made such a difference over time. The other thing we found in that study is that the mission of the program based on outcomes has actually strengthened over time. We looked at the first decade of graduates, the second decade, the third decade. In the more recent graduates, it's actually a higher percentage of them are from the UP and a higher percentage of them stay in the UP than even early on. That's wonderful. It is. Because we worried a little bit would we we saturate what the U P could need even over time, but it doesn't appear to be. It just strengthens over time, which Bill Short at the time we published the article, his theory was that having the graduates of the program become faculty has actually strengthened the program over time both from a mission fit and from a stability fit for the community. It makes perfect sense to me. It's easy to look at it once it's already happened. Right. It was one of our goals for sure. Yeah. One of our hopes. I do think that this campus, and perhaps a couple of others, provide students with more clinical hands on experience than most campuses in most medical schools across the country. We used to assess that or try to assess it by asking them after they finished their first year of residency, how they compare to people in their class, and they are always... Many of them had way more physical experience delivering babies hands on in the OR, that kind of thing. They really had a lot of real doctor type experience. We just did another survey of the last 10 years and that message came through very clearly that they felt like compared to their peers, they had more one-on-one experiences. They had more OR time, more face-to-face patient time, early triage, and then procedures, delivering babies and first assisting in surgery, which many of their peers didn't get. Our rural medical education programs are a place for rural students to have a home or to return to home. We are also a place for students who want hands on experience in surgery or emergency medicine or even general practice. They can come and learn in a small one-on-one environment. Finally, we're a place for students who want to learn more about health disparity and the needs of those who are most vulnerable and find a way to fix and solve those problems. Some of our students want all three of these things and we provide that too. We leave you today with a short testimony of what this legacy has provided one student, who at the time of this interview was only a medical school hopeful and is now part of our incoming class of 2023. John Berglund is from Bergland, Michigan. This is what John says about the rural physician program in Marquette and what it means to him to have this opportunity. Well, to be able to start my training in medicine in the region that I hope to end up one day would be huge for me. I can imagine it being a little tough training in a large city for four years or onwards and then making that huge jump to the rural area like the UP, I think it'll be pretty tough. But it's great to be able to learn and train with the people and the patients that I hope to one day care for before I even progressed. Plus, I would not have to leave my favorite place in the world, the UP. I don't think it could get much better than that. If I can give anything back to my hometown, I hope it's that that I can come and serve the people in my hometown and pretty much my whole county. I guess training there would be would be huge because I would get... I know the people from Bergland and to be able to train in that area and to train there and to get people to know even more and to build that trust and connection before I even start to be a doctor there I think is huge. Thank you as always to Dr. Andrea Wendling. Her devotion to rural medicine has paved the way for so many students to make an impact in their communities and has been a mentor and example to so many students. It's an honor and a privilege that I get to work with her. Thanks also to Dr. Mazzuchi, Dr. Nicole Zimmer, and the future Dr. John Berglund. I speak for all of us at the Leadership in Rural Medicine Programs when I say we are happy that our relationship has continued for all of these years. I would like to also thank the community assistant deans who help make our rural certificate programs run in Marquette, Midland, and Traverse City. Those individuals are Dr. Stuart Johnson in Marquette, Dr. Paula Close in Midland, and Dr. Daniel Webster in Traverse City. Thank you for all of the hard work that you do and all that you pour into the staff and students at your campuses. I hope you've enjoyed this podcast, but more importantly, I hope it has encouraged you to make rural your mission.

40 Years of Rural Medical Education

Beyond a One Room School House

The Real Victim

In our effort to cover the issue of opioid use in rural Michigan, we took to the hospitals, providers, and persons who are trying to have an impact on opioid use and overuse in our state.  This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine. The podcast is produced with funds from the Herbert H and Grace A Dow Foundation and the Michigan State University College of Human Medicine Family Medicine Department. Welcome to season two. I'm your host, Julia Terhune, and I hope you enjoy this episode. I'm sure none of you listening are surprised that we did an episode this season on the opioid crisis. The issue of opioid use, overdose and related deaths has been in the news media for several years now and at this point it seems to be synonymous with rural. But that is because this is a tremendous issue concerning rural populations. It affects every facet of life for many rural communities, from the healthcare system to schools to industries. Rural healthcare facilities are dealing with people addicted to opioids and the legislative policies tied to combating drug-seeking behavior every day. School systems are seeing younger and younger students either becoming addicted to opioids, dying from overdose, or living in homes where families have been impacted by drug addiction. US census data shows that unemployment rates are highest in rural areas and the opioid crisis has done nothing to help. Poverty is a contributor to drug use, and yet if you can't stay clean, you can't get a job. But this episode is not about these distressing realities. Instead, we're talking about the people who are doing something to combat this crisis. I'm going to spoil the theme of this podcast and let you know in a word what we are hoping you get out of this. People. We hope you understand that people need people, meaning if we are to make an impact in these communities concerning opioid use and overuse, we have to put people first. Today our stories are going to have a tiered effect. We're going to start at the top and talk about community impact, then we're going to take it down to the practice level, talking about what individual doctor's offices are doing. We're then going to get personal. So starting off our conversations, we're going to talk about system policies that have made an impact on getting access to opioids. I spoke to Steve Barnett, the CEO of the McKenzie Health System in Sandusky, Michigan, a rural hospital in the thumb. In 2012, his hospital started an Oxy-free ED policy that stopped providing opioids for non-acute medical concerns. You have people that are accessing the emergency department for real, acute reasons, and yet there's also people accessing the ED because they've run out of whatever substance they prefer and this is an easy way to come in and probably get a couple days worth or maybe even a month's worth of prescription to get them in and out of there. Rather than wasting resources in the ED and being part of the problem, we decided we wanted to try and at least provide some solution. It's just one door of multiple doors, you know, but it's at least taking a position that we're not going to be that place that pushes drugs. Were you concerned about any unintended consequences of making this change in your ER? Sure, we were. Our primary concern was that once they figured out, those patients that are seeking drugs through the emergency department, that we're not going to support that, then they'll simply move to other emergency departments locally and then we won't be viewed very kindly by those other hospitals who have an uptick in volume, but it's really drug-seeking volume. So we presumed, we assumed that that would happen and we talked to everybody, let them know that we were implementing this Oxy-free ED and they may see an uptick and we'd like to hear about it if that in fact occurs. The other things that we were concerned about is how the patients would react that are seeking drugs when they come in, realize you have a policy and a process that doesn't provide them with what they're looking for, because they could become combative or unruly. So we want to make sure that we have support locally from police and community mental health. Being a County seat, all those services are right nearby anyway, so it was a good way to inform the community and try to get them on board and be supportive of this process that we're going to start implementing, policy implementation, and the way in which we're going to proceed. And all of those concerns did not actually come to fruition. In fact, the policy positively impacted drug-seeking behavior and did reduce the number of people gaining access to opioids through the emergency room. In the five years this policy has been in place, the McKenzie Health System has seen a 90% reduction in the number of prescription opioids provided to patients. But more importantly, staff and physicians found their jobs less stressful, that patients were easier to discharge, and that their interactions with patients were of higher quality than in previous years. And can I just say that this was a dynamic way to build community. What gave you this idea? I mean, obviously, you're the leader of this hospital. It was not my idea. It wasn't your idea? No. It was the medical director for our emergency department, Dr Hamed. He was reading an article about policies in the state of Washington where they were moving EDs into an Oxy-free environment in order to reduce traffic. He had an interest in doing that locally, so he came in and talked to me about those unintended consequences and would we support it as a hospital? And I said, yeah. And so it just began to roll out from that point in that way. Part of the program that we implemented, which is fairly common today, was if there was a legitimate acute pain problem and the physician had accessed the MAPS software and could tell that this particular patient wasn't moving around and hadn't acquired multiple prescriptions, then they have the option of administering some narcotics for that patient, for that problem. But it would be a limited supply, maybe two or three days. And the more important part is that they had to follow up with a primary care provider and so there was a contract established that required that to happen, and if it didn't happen and they showed up again, then they weren't going to see the same kind of prescription being administered. They either have to move on or they have to get help or something has to happen that's different than what they were doing before. Now let's narrow down our discussion. Reducing access to opioids is one way to combat the crisis, but even without access through the emergency room, there are still people living with chronic pain and addiction. Dr Klee is a physician in Northern Michigan and the residency director at the Munson Family Practice Residency Program. He and his team have developed a better way of managing patients who have chronic pain or who use opioids. But when you hear what it is, I'm sure you'll agree it's the common sense approach that has not been very common. You know, this is a big problem nationwide and Michigan for sure is one of the areas that is involved significantly. You know, in 2016 we had 11 million prescriptions for opioids in Michigan, which is more than the amount of people we have in Michigan. Here at our residency we decided we wanted to try to address, how are we managing our patients with prescriptions? So what we did is we developed an algorithm to help all our providers and to figure out how we were going to manage our opioids. That starts with seeing our patients in the office and talking about non-opioid pain relievers. So we started with that, asked people to make sure that we maximize these non-opioids and then if we are considering going on to opioids to use a validated risk assessment such as the Opioid Risk Score that looks at people's personal family history of addiction issues to see if they're someone that's more likely to become addicted and if opioids are really a good idea for them. And we combine that with a functional assessment saying, all right, what can you not do right now because of your pain that we want to try to improve with opioids? Because a lot of times it may be we gave opioids for this issue, their pain's still not controlled and we haven't improved their function and so really we haven't added benefit with opioids. We just added potential complications. And then if we are considering we want to progress to using opioids, then we're running a MAPS report, which is the Michigan Automated Prescription System report that's now mandated by Michigan law and also getting urine drug screens. Have you noticed that it's an increase in workload to do this with patients? Yeah, it is, but it takes a little bit more time with this to be able to do a good job with it. But I think we're doing a better service to our patients when we have these discussions and we do a little more regimented assessment of their risk and benefits. One of the things that we do when we decide that we're going to be using opioids is we have a contract that we sign with the patient and we renew that every year and it is kind of the rules of engagement on using the narcotics. That includes doing annual, at least annual, urine drug screens on patients coming in to see us every three months, you know, not selling their medications and things. With that agreement, when we do our urine drug screens or we have these visits, if we're seeing that the patient has broken the contract or they're positive on a urine drug screen for other issues, then it's a form where we can then say, all right, we can't continue to prescribe you opioids, but it does appear that you have an opioid disorder, use disorder. And so what can we do to help you with that? How can we help you combat that addiction? You know, we care for people and these people have addictions and so if they fall out on the contract that they're not able to use the medication because they didn't comply appropriately by not using other medicines, we don't fire the patient. We just say, okay, we can't use these controlled substances, they're too risky for you, but we'll still be your physician. We'll still take care of you and we need to help manage all your medical problems including helping you have access to addiction services. What comes to fruition as you're graduating from medical school is that now you're actually taking care of patients. You're not taking care of the heroin in room three. You're taking care of Johnny in room three that overdosed with heroin. I think that's an important part, is that we realize that these are people and learning about how to manage their blood pressure's important, but also learning about how to manage people's pain and how to address addictions and not to bring the biases that a lot of times that we do with that and not to internalize those biases. But it can be a challenging group of people to work with, but it can be very rewarding too in being able to help some of these people and be the providers that are there that aren't turning their back. Our final story takes us all the way down to the individual level. In preparation for this podcast, I spoke to a number of persons who are in recovery from drug addiction, but there was one story that struck me. To protect the identity of our next interviewee, I'm going to call him Ray. Ray is now more than four years clean and owes much of his recovery to a recovery program called drug court, an alternative program that instead of putting people with substance abuse issues in jail, they are provided with opportunities to get clean, stay clean, and avoid charges that could keep them in a loop of drug abuse and poverty for the rest of their lives. Here's Ray's story. I grew up in a loving home. Issues just like anybody. Just normal, you know? My dad wasn't real affectionate but he also wasn't abusive. But I grew up not understanding the feelings that I felt inside. I grew up not understanding why I felt so different, despite all the love and all the good qualities of my family. Excuse me. But then I just, I just couldn't be okay, so I started out acting out at school. Finally, my parents are trying to figure out what to do with me because they don't understand, because I don't understand. Really, nobody understands why I'm acting the way I am. And just as they were like, really trying to help, I was sexually abused by an uncle, you know, and it changed my world. I felt like everybody could see me, see it. So I was like, okay, how can I be a man if I was sexually abused by a man? I remember having these thoughts. And it was just, it happened once. How old were you? 10. I was 10. And I couldn't remember the pain, the physical pain, but like, it was instant humiliation, you know? And then, man, my dad was sick all the time, so I begged my parents to let me go hunting with some other uncles. And they introduced me. You know, I remember drinking one night and I just, I can remember it like it was yesterday. Alcohol never became my drug of choice, except for if I didn't have any other drugs. But the feeling of being outside of myself and not having to care about what anybody thought, was the first time I ever drank. Nobody knew I was sexually abused. Nobody knew I was scared. So I was Superman. After the years of drug abuse, failed relationships, minor offenses, and a spiral of depression and hopelessness, Ray was charged with running a meth lab and larger drug possession. But strangely enough, this is where the story takes a better turn. 21 year old kid walks up to me, he says, hey, you look like you want to die. And I said, you have no idea. Because that's what I was doing. I was literally trying to figure out a way to kill myself in jail. So I'm in jail, I'm cleaning up, and everything that I had done during those drug induced hazes became a reality. Real hard. He says, hey, let's go to this meeting with me tonight. I'm like, what's your name? Like, why are you ... He says, my name's Tucker. He's a good kid. He said, you look like you're in a lot of pain. He takes me to this meeting and it ends up being an NA meeting. This guy across the table's telling me he's been, he was a drug addict and he hasn't done drugs in 20 years, and he's smiling. And I said, you lying son of a bitch. Nobody smiles about drugs. Maybe you weren't a drug addict like I was a drug addict. And then this guy started telling my story. He started talking and I'm like, how could you know that? What is this? What is this? What is recovery? And I was sitting in jail and every Tuesday I was holding this NA book and every Tuesday I'd be there, just waiting for this guy to come in. How did I not know about this? You know, I've been on felony probation for seven years and I'm not trying to say that in a [inaudible 00:19:58] way, you know? I know it was my choice to pick up the first time. I also know that after the first time I picked up, I didn't have a whole lot of choice. But I'm looking at three to five in prison with a 40 year tail. [inaudible 00:20:18]. They sent some guy in there and he's supposed to interview me and I lock up because all those old feelings come back. He talks to me and he says, tell me why I should let you on my program? How do I deserve that program, you know? I've been sexually abused, abusive father, like I got all these thoughts rolling through my head. Like, I don't deserve that. At that time, nobody in my life had known I was sexually abused. I probably told the counselor like, three days after that because I finally broke and told someone. It was like, it was like the whole world helped open up to me. Drug court accepted me. The guy came back and interviewed me again. Drug court let me on. I didn't know the world of recovery existed. I didn't know people cared whether or not we lived or died, as addicts. In our world and I know it's a sad thing, but in our world where we live, in here in our heads or in the streets, nobody cares. We're the enemy. We're dirty. We're all these things. When I hit drug court, that was the first time I really thought there was help out there and that the world wasn't against me. It was also the first time I didn't, the first time I remember feeling like God didn't hate me, if there was a God. I was convinced that He hated me, you know? Then I got a taste of recovery. They sent me to a treatment center. I didn't know for a second. It's a treatment center. I didn't even know they existed. And then you get to love life. It was like, almost overnight. It was like a whole new world I didn't know. How do I feel about myself? I feel I'm helping change lives. I don't feel like that would be an option if it wasn't for programs like that. Let's go backwards now. Ray is a person. A person with real trauma that led him down a spiraling path of drug abuse. It wasn't until someone saw him for who he really is that he was able to start getting help for the hurt that drug abuse and addiction was masking. Dr Klee and his residents are intervening in the lives of their patients to not just manage their pain but their needs. Treating the person and not the symptom. The McKenzie Health System is taking a look at the issue of opioid use at the community level and trying to help people when they need it most, but also helping the larger system by keeping more drugs out of circulation. The point of all of this is that people are helping people. This is how we're going to combat this crisis, by taking it one system at a time, one practice at a time, and one person at a time. You know, we're all Michiganders here and we have to understand that we have our differences, but we also have a lot of similarities. One patient may have, a person may have an opioid addiction, but other people may have their own crosses to bear and so we have to work with each other and take care of each other. Thank you all for listening today. As always, I want to thank Dr Andrea Wendling for making this podcast a key priority of our program and for allowing me the flexibility to interview all of these different individuals. There were many others that I interviewed for this particular podcast that you didn't hear today and I want to thank all of them. I want to thank Steve Barnett and Sandusky for taking time away from being a CEO to talk to me. It's always a pleasure to meet with him and this was no exception. I want to thank Dr Klee for also taking his lunch hour to give me a call and talk to me about his program. I also want to thank Ray. Ray and I spoke for hours and hours and it was one of the most powerful conversations I've had to date. It was such a privilege to hear his story and for him to share his story with all of you and be so vulnerable. Ray, we thank you for all that you've done and are continuing to do in your sobriety and all the people that you've impacted with your story, your life, and your care. Thank you to all of you. The opioid crisis doesn't seem to have an end in sight and every year the results and the statistics seem to be staggering as to the level of need and the level of care that is needed to combat this issue. With that, if you are considering a career in healthcare or you're considering a career in criminal justice, then I have one simple thing to say to you. Please consider making rural your mission. Music today was provided by Bryan Eggers. Find Bryan's music on Spotify, Facebook, and Youtube. 

People are People No Matter...

We spoke with experts on bringing fiber internet to rural Michigan. Bringing fiber internet to rural Michigan can reduce major barriers to educational, healthcare, and economic opportunities and benefit whole communities and families. We also speak to Dr. Edward Smith on why advocating for remote areas as a physician is so important when decisions are being made based off of what can be done in urban areas.    Transcript:  This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine. The podcast is produced with funds from the Herbert H and Grace A. Dow Foundation and the Michigan State University College of Human Medicine Family Medicine Department. Welcome to Season Two. I'm your host Julia Terhune and I hope you enjoy this episode. So I was sitting with my spouse talking about jobs, and life, and he got off on a tangent, considering our connection to the internet and the current state of our rural communities in light of our current internet connection. And it struck a chord with me, and it became the impetus for this whole episode. So, I had to start recording him. The reoccurring theme that he brought up and the one that will be reinforced throughout this podcast is that access to the internet in rural America, including rural Michigan, is bad, plain and simple. It's bad. Many rural residents are currently living with limited or no access to the internet and being left behind. Sometimes when I bring up this point, I get push back, and I have people who argue that technology is a choice or a privilege. But where did you get your last bit of news from? How did you access this podcast? How did you apply for your last job? This last point was significant to my spouse because of what he does. He helps connect and mentor low income and transitioning persons to careers and jobs. And this limited access to the internet has been keeping him in business. What happens to them? They get all this information about applying for jobs, and access to jobs and they have these fantastic resumes, and they're motivated, and they have accountability through your program, but then they go home. What are they going to do? How do they, what is their experience when they go home? That everything stops, they get motivated, they get excited, they get interested, and they actually are looking for ways to apply for jobs, looking for ways to get jobs, but you can't go online and study for your driver's test. You can't go online and study for your- GRE. GRE- Well, no, GRE's graduate, but GED? GED. Yeah, and that's where a lot of people are. Yeah, you were talking about occupations, but I would take that even to just being a functional member of society. You can't engage with other thought processes. You can't engage with other opinions. You can't engage with current events without being connected to something digital in this point in human history. I don't want us to make it sound like everybody in rural communities are in the dark ages. That's not true. Because they're not, but I believe that they will be soon. That's not good enough. After the repeal of the Obama era net neutrality regulations in June of 2018, the chairman of the United States federal communications commission, or the FCC, was quoted by the Washington Post as stating, "And in the medium to long term, I think we're going to see more investment in high-speed networks, particularly in rural areas that are difficult to serve." This is our hope too. Rural America accounts for 97% of our country's total landmass. That's 2.23 billion acres of land, and 20% of our population according to the United States Department of Agriculture. But those stats actually are quite worrisome. We're talking 20% of our population spread out over 2 billion acres of land, which makes connecting them to the internet expensive, difficult, cumbersome, sometimes impossible. So because of that, it's not always a key priority for many for-profit or private internet providers. Historically, much of this expansion has been funded by the government and carried out by nonprofit agencies, meaning that historically and currently rural internet access is a federal and state concern. Since 2011, the federal government has funded the Connect America Fund, and it has worked to expand and increase internet and broadband access to millions of Americans. The FCC stated on their website the following quote, and I'm reading it, "The Connect America Fund aims to connect 7 million unserved rural Americans to broadband in 6 years and puts the nation on a path to connect all 19 million unserved rural residents by 2020." The FCC launched this unprecedented broadband expansion in 2011 when it reformed and modernized the Universal Service Fund, which connected rural America to the telephone network in the 20th century. The commission created the Connect America Fund to unleash the benefit of broadband for all Americans in the 21st century. In the first phase, about 115 million of public funding will be coupled with tens of millions more in private investment to quickly expand broadband infrastructure to rural communities in every region of the nation. Joe McCue is the manager for Fiber Assets for Great Lakes Energy. The energy co-op that supplies most of northern lower Michigan, Kalamazoo all the way to the Mackinac bridge. Great Lakes Energy has taken charge of installing, managing, and maintaining fiber connections for all nine of their service areas. They are starting with their Petosky service area and as Joe puts it, writing the book on how to connect their rural communities to fiber internet. So, how we fit into this is, we're an electric cooperative. Cooperatives were started back during the depression. The farmers didn't have electricity. It wasn't cost-effective to run electricity out to the farms. So President Roosevelt came up with the Rural Electrification Act, I think it was of 1935, and all it did is it guaranteed loans for the farmers to start cooperatives to build electric facilities, the poles, the wires, everything out to them and start electrifying the farms. And so that took hold. And that's why you have all of the electric cooperatives in America. Still to this day. Still to this day, yeah. So how does that feed into what you're doing now? We kind of look at it as like the second evolution of our purpose, I think, is what it comes to. It's like, your generation, kind of at the start of my generation, is like, if you heard nobody didn't have electricity, you'd be like, what? Everybody's got electricity. How has that even possible? We want electricity everywhere. But, we're going to be the ones that remember people not having internet. And in 20 years from now, everybody's going to have high-speed internet. So that's where we see this as we own a lot of the infrastructure needed to do it already. We have all the poles, we have the right of ways. And so, it's another wire up on the pole, shall you say. And I always tell everybody, you're never going to find a better organization than Electric Cooperative to build and maintain wire and pole infrastructure. And so prior to this, what has the infrastructure of Northern Michigan or rural Michigan looked like? Pretty much you were down to cellular communication, and then also they call it fixed wireless that you can put in, very limited due to the hills and the trees. You can't get the signals through the trees with wireless. And then you had the phone companies, you had telephone service on copper line that was out, but you could not use that for this high data traffic output that you need. You'd have to have fiber for that, and the volume, the amount you want. And then in the cities, in the towns, you had cable companies come in, and they would start putting that cable in, co-ax cable, and they're able to use that, and then give high-speed internet to their subscribers. It's very expensive for them to go build out into the country. And while what Joe is describing might seem like "enough" for rural communities, it's a very different story when it comes to actually working and functioning within the current infrastructure. The problem is, is a lot of times what everybody gauges is good and acceptable. And I always equate it to, if you had a bicycle and you had to ride to work every day, you'd say, this is great. I don't have to walk. But if I come in and then bring a car in, and give you a car to drive to work, you're going to think, well yeah, this bicycle was terrible. Why did I ever have that? But it was better than walking. So that's what I think everybody out in rural Michigan is going to find out when we bring this high-speed internet to them. A lot of people know it already, that come up here, we have a lot of transient them come up here, and part-time residents who have it down in the cities and they come up here and realize, Oh my gosh, it's not even available. You can't even get it. So with all these grants and these funds being allocated by the government for this specific task, it must be an important aspect of society to have internet. Oh yeah. Yeah. When we started looking at this, and like I said, I've even lived in, so... Boyne City schools, which is rural school here in Northern Michigan and many others, I just know this, my kids go to school. Elementary school to get an iPad, middle school, they get a Chromebook. High school, they get an Apple actual computer and all of their books you'd think, Oh, they're loaded up in the computer. They're not. They're out in the cloud. Everything's going out in the cloud. So they need to have a link to look at their textbook. It's not actually loaded up on the device itself. But, what did kids do? Who are way out in the country? You have to go either get the cellular connection, which is expensive, very expensive. Or you go to the library, schedule time at school, go to grandma's house. My kids go to grandma's house because she lives in town, and they can get a high-speed internet connection there. So, I've actually had to sit at the library with my kids linked up so they could do their homework. So, that's really interesting because there might be some people who don't have those. No, but there are people that don't have that. And then to try to come in, it's hard. Mom and dad are working shift work, or they only have one car. You can see where you start to get the massive disadvantage. And that's just education. So my parents, they're both in their seventies and have to go to doctors and everything, and they're down in Ohio. They go to the Cleveland clinic. I remember my mom called me. It wasn't more than, not a year ago. She could no longer call somebody to schedule her doctor's appointments. It all has to be done online. Now they have internet access, and that's not a big problem for them. But that situation is here. So your interaction with your doctor is going to require a high-speed internet connection. And I mean interaction with the government, anything you do with the government right now is, you need internet connection. Taxes, social security- Your Bridge Card- Your Bridge Card, any forms that you need done that is all done through internet. So without this, essentially we could perpetuate that cycle of poverty. What I heard at one of the symposiums I went to was that, if we did not do this, rural America could slide back 20 years. There are bigger issues with that 20 year slide because it doesn't just change how we connect to our social media accounts or apply for jobs. It's a systematic issue that could impact all of our rural counties in Michigan who are run by the same state and federal government. And some of these policies are very inequitable, but that's why Great Lakes Energy is doing what they're doing. But, the standard for education, what we're deciding to do at the state level with education, for rural education, is being based off of what's going on, what we're capable of doing in Grand Rapids. Correct. Or what we're capable of doing in Lansing. Yep. Even in the suburbs, and in Boyne City itself, if you lived in Boyne City, there is the cable company, there's Charter, and then there's the phone company. This effort I think is going to be just a huge changer especially for the rural society, for rural America out there. So I think this is going to just again, not let rural America slide into 20 years ago. And then business-wise, small business-wise, I mean we've seen that already from people who A, can work from home now. The small home businesses now have access to global market. You can sell your stuff on an eBay or Amazon, or whatever you want to do. But, you have to have a really good communication system set up with high-speed. Education-wise, when I was a kid an encyclopedia was awesome. I can only imagine having high-speed internet, and if you didn't offer that to a kid that had to go to an encyclopedia, and another kid that had access to everything on the world wide web, it's night and day difference. They're just going to get left in the dust. Dr. Edward Smith is a rural hematologist oncologist in St. Ignes, Michigan. That's the city just passed the Mackinac bridge. He serves cancer patients from all over the Upper Peninsula, patients who are not only very underserved but also with very limited access to healthcare and resources like modern technology. A few years ago, Dr. Smith worked with a team from Blue Cross that was trying to develop treatment and quality assessments for patients across Michigan, and Dr. Smith spoke up about what he was facing in the Upper Peninsula. What came next, was two oncologists from the University of Michigan who took the time to come up and understand what barriers the patients they were living with. A lot of what they were trying to do such as contacting patients by phone for follow up, or having them call in, or go through internet portals and stuff, sounds real good except we have patients that live in places in the Upper Peninsula that they don't have internet, or they don't have telephones. And even some of them, some patients, even to make a cell phone call, they have to drive a couple miles to the top of a hill to get cell coverage. And, there's places in West Makinac and in Lewis County where there aren't power lines, and there aren't internet. That's just how it is. Some people live in very remote, isolated areas. And so my contribution, so to speak, to that whole thing is on as well as the Michigan Oncology Quality Consortium, which I'm part of is to say, look, not everybody has these things. And to people that practice in major metropolitan areas, they just don't picture the fact that not everybody has a computer, and people don't have internet. So I mean, you have to realize that not everybody has the resources to do all this kind of stuff. And so when insurance companies or the government want to start making rules and involve this, they really need to take into consideration not everybody has these resources. At one of the meetings, I was telling them about the challenges that I face doing oncology in rural areas. And to their credit, they came to St. Ignes, and they spent a day and a half with me, seeing the facilities, understanding what was here. I took them to Newbury and to St. Marie, and took them to the places where people live so they had a better picture of how far people have to travel for stuff. The fact that not everybody has phones, and internet, and many people drive the total of four hours a day if they need radiation therapy, and it just isn't that easy for the people that live in these remote areas. And even when they do get to a hospital, that's very, very limited. And to their credit, they came up and went with me so they could see it. And on top of it, they actually interviewed the patients that had to do this stuff. So they probably interviewed six people that had to get some of their treatment, not just locally, but people that I had to coordinate it with through the University of Michigan. And when I asked Dr. Smith about the outcome of his advocacy, I found that he really did make an impact. Yeah. They were very appreciative of the challenges we face. And then when we have been at these Michigan Oncology Quality Consortium meetings, looking at standards and stuff, we'll refer to things as what we learned when we spend time with Ed was... And they're finding out that some places in the Upper Peninsula, one of the other providers, they have no hospice in their county. One of the big things is when we refer patients to hospice that doesn't exist, or the hospice people might take a week to get out there. So they're, they're finding out that the distance that people travel, and the resources made available are very different. And so you have to think about that when you start coming up with quality measures in deciding when you're going to pay for value-based reimbursement. Now, not everyone can take a two day trip to the UP, and interview patients in order to understand the importance of equitable policies and the need for adequate infrastructure for rural communities, which unfortunately leaves many people who live in these remote places in the dark. Sometimes literally. Dr. Smith was an advocate for his rural communities, and it brought about awareness to the needs of his patients. Great Lakes Energy is making decisions every day that is going to bring about significant changes to Northern Lower Michigan. But as I say in almost every episode, there is still so much work to be done. The work right now, in regards to what we've been talking about, is bringing rural Michigan and rural America on an equal resource plane as urban America. It starts with leaders like Dr. Smith advocating for their rural constituents, but it also includes policy makers. And policy makers that are considering the most underserved and resource-poor communities when making changes in manifestos. Right now is a crucial moment for rural communities, and if it's going to work, we are going to have to work together. Thank you for listening to this Rural Mission. I would like to thank Dr. Ed Smith and Joe McCue for agreeing to be interviewed for this podcast, and I'd also like to thank my husband, Daniel, for letting me take over our Sunday afternoon conversation. As always. I want to thank Dr. Andrea Wendling, the director of the Leadership and Rural Medicine Programs at Michigan State University for making this podcast happen. This is our first episode of Season Two. We are so very excited to bring you more episodes this year. We hope you'll tune in every week this fall. I'm your host, Julia Trehune, and I hope that this podcast inspires you to make rural your mission. Wherever you send me, I will go. Wherever you send me, wherever you send me, wherever you send me I will go. Alexandria to Baltimore, Statton Island to New Jersey shore, to Ohoma or to Pigeon Forge, Lord, I will go. Montebella down to Oceanside. Pasadena or to Paradise. Sacramento up to Anaheim. Lord, I will go. Wherever you send me, wherever you send me, wherever you send me I will go. Wherever you send me, wherever you send me, wherever you send me, I will go. Albuquerque down to Sante Fe. San Antonio to Monterey. New York City down to Tampa Bay. Lord, I will go. Anaconda down to Evergreen. Broken Arrow to Abilene. Independence or to [inaudible 00:23:00] Lord, I will go. Wherever you send me, wherever you send me, wherever you send me, I will go. Wherever you send me, wherever you send me, wherever you send me, I will go. Wherever you send me, I will go. Music today was brought to you by Bryan Eggers. We are always grateful to Bryan for his tunes that make our podcast better. Check him out on Facebook! 

A Rural Connection

This Rural Mission: Bravery

This week we are staying in Clare, Michigan to discuss how people living in rural communities access food. Food insecurity is 5% higher in rural communities across the country and rural Michigan is no exception. We speak to experts who are trying to make a difference and alleviate this disparity. Kara Lynch is a Registered Dietitian who teachings vulnerable and low-income families about healthy eating and food safety through Michigan State University Extension. Justin Rumenapp provides an overview of the hard work that the Greater Lansing Food Bank puts forth to feed thousands of food insecure and hungry people across the state. Finally, we get a unique look at how the Amish in Clare County feed and cook for their families and impact that has on health and wellbeing.      - [Julia] This Rural Mission is brought to you by Michigan State University, College of Human Medicine, Leadership in Rural Medicine programs. The podcast is funded in part by a generous grant provided by the Herbert H. and Grace A. Dow Foundation. To learn more about the Leadership in Rural Medicine programs, please visit www.msururalhealth.chm.msu.edu. I'm your host, Julia Terhune, and stay tuned for more from this Rural Mission.  (spirited violin music)  (overlapping group chatter) -[Julia] The sounds you are hearing are coming from a mobile food pantry hosted in Harrison, Michigan. These food distributions are organized almost every month in Clare County by the Community Nutrition Network, a group coordinated by Veronica Romanov and community volunteers. - [Veronica] Good morning, everybody. - [Man] Good afternoon. - [Veronica] I hear we have watermelons coming today, so everybody's gonna get some watermelon. - [Julia] Veronica and her team spend weeks making sure that the distribution is supplied with as much fresh produce as they can get, low-fat dairy options, lean protein, and lots of healthy non-perishables like whole wheat pasta, bread, and low sodium canned food. The task of making sure that people living in Clare County, one of the most underserved counties in the state, is a community effort. It takes weeks of Veronica and her team's planning to get the mobile food pantry up and running and then it takes the labor of 10s of volunteers to just get the food to the people. Even Dr. Bremer, who we have highlighted before on this podcast, comes out to help load up baskets of bread. It really is a community effort and it has to be to make these distributions a reality. - [Justin] It's really a community coming together to solve a problem that does affect the whole community. We are so happy for people that want to volunteer, that want to get involved, that want to help out, that if people come up and say, "We wanna work," we're gonna put 'em to work because we're happy to do that. - [Julia] That was Justin Rumenapp, the communications manager for the Greater Lansing Food Bank the food bank that provides food to the mobile food pantries in seven counties, four of which are designated as rural counties by the state of Michigan. We will hear more from Justin in a bit, but I want to make something very clear about the coordination and implementation of these mobile food pantries, they are hard work. Food needs to be shipped from the greater Lansing area, distributed at a local site, distributed in a food-safe manner and sent home with hundreds, yes I said hundreds of people. - [Woman] Does everyone have a number? - [Woman] Yes. - [Woman] Number, number, number? - [Woman] I got mine. - [Woman] All right, perfect. Number, number? - [Julia] Getting food from mobile food pantries and food pantries alike is a reality for so many people living in a state of food insecurity. - [Justin] Even if you've never been food insecure, which means that you've either had to eat less food or lower quality food as a result of financial issues, people understand hunger as a state of mind. Other community issues, while equally important, sometimes are harder to grasp your mind around. And when we say we feed people, we mean exactly that, we ship food. If you volunteer here and you move a hundred pounds of produce, that translates directly into a number of meals that you help serve the community. - [Julia] Food insecurity is something that perils so many people living in poverty. The ALICE population, which stands for Asset Limited Income Constrained Employed, or what used to be called the working poor, and it even plagues certain demographics at higher rates than others, specifically older adults and children. In rural communities, especially across the country, we see food insecure households in greater number than in any other geography. While there are many reasons for this discrepancy, there was one reason that resounded with all my interviewees. - [Justin] Transportation, transportation, transportation. Getting the food out there, getting families to the distribution site, trying to make it centrally located. With a sparse population, it becomes much more difficult to try to get food out there in a cost effective manner. - [Kara] I think Missaukee County is a great example. There's no big box supermarket or anything there, so there's a couple of grocery stores and communities, but people might still have to drive 20 or 30 minutes there and then they're paying more for fruits and vegetables and food in general. - [Julia] Kara Lynch is a registered dietician and an educator with Michigan State University Extension. Kara oversees nutrition education and food safety in Isabella, Clare, Gladwin, Mecosta, Osceola, Wexford, and Missaukee counties, all of which are rural, and she had this to say about nutrition and food insecurity in rural communities. - [Kara] There are more and more food distributions and food pantries popping up in communities. A lot of 'em are faith-based, so the food banks that provide food to these distributions and food pantries are trying to get more healthy foods, more produce, more fresh foods, but there's also some education that has to take place with the pantries themselves. The people that are ordering the foods because maybe they can order in bulk some Little Debbies or some candy or cookies or things like that, and maybe it's even free through the food bank, so they bulk up their order with that kind of stuff and then they don't get some of the nutritious food that they could. Part of what we're doing as well is our effort is trying to teach them how to plan their meals so that they can make lists and maybe get a week or two weeks of groceries at a time, so when they do travel 30, 40 plus minutes to the grocery store, they can get the food that they need.  (gentle instrumental music) The government is actually taking some steps to try to get more food to these areas where they might be considered like a food desert, where they don't have the fruits and vegetables accessible to them. In the past, in order to accept or to be a SNAP retailer, meaning that in order to accept what we used to call food stamps, they had to essentially only offer like 12 items. But now it's moving to where the retailers have to have at least like 84 items. I mean there's a little bit more, there's more to it than just that, so it's making it so that basically stores that accept benefits have to also provide a variety, like fruits, and a variety of vegetables, and a variety of grains. Hopefully that will b helpful and not hurtful. - [Julia] Equitable food policies do make a difference in where and what people can buy on food subsidies, but understanding how to cook can really help bridge financial and social gaps. It can also help to empower persons of all backgrounds to choose healthy options. - [Kara] And just recently with this new organization that's trying to happen within our community, anyways there was a food pantry involved with it and they received from the food bank and a food distribution a bunch of, I think it was eggplant that they said and people didn't know what it was. And then they're like, okay, if I take this, what am I going to do with it? And there's some really, really good recipes that are easy and healthy to make eggplant with, but people don't know. It's helpful to have things that people can taste as well, so that they can say wow, this is really good. So that's nice when we're able to do that. Like yesterday I was actually at an event and we had some celery with hummus. This one child came along and he didn't wanna try it at first. And finally we did encourage him enough that he did try it and he came back, he was so excited. He said, "I really like it." So if he hadn't tried that he would never probably, 'cause his parents were there and said, "Go ahead, try it," and they were encouraging him to do it, they said, "We don't like it, but you might." And sometimes we hear feedback from parents, not sometimes, but quite often, our instructors will get stopped in the grocery store by a parent, or maybe they'll be in the school and see the parent and they'll say, wow, I had to start buying cilantro, or jicama, or something like that that my child tried in the classroom. I never really tasted it before, so I didn't really know how to prepare it and they came home with a recipe and said that they liked it and they're really wanting to eat more fruits and vegetables and so we get responses like that from the people, so that's encouraging to know that it does happen.  (lively music) - [Julia] With the efforts that MSU Extension makes to educate people in almost county of Michigan, organizations like the Greater Lansing Food Bank help to make that job easier by providing healthy options that not only feed, but nourish the people who receive these items. - [Justin] This is the main side of our warehouse where we store a lot of the stuff. You can see there's stacks and stacks and stacks. These are all donated to us. Other things are donated to us directly from the stores because they get too much that they're not gonna be able to sell everything, so instead of letting that go to waste, give it to us, we get it out to folks, and occasionally we do have to buy some product with monetary donations that people give us. We get a great cost, it's below even wholesale 'cause we don't pay for any brand names, and so if there's something we don't have a lot in, like cereal, again, is a big one, we'll buy a pallet of that to make sure that cupboards are full across Michigan. - [Julia] Because that's a big one that people buy? - [Justin] Cereal's a big one. And another thing that people have told us that is really important is fresh produce. So over the last year, we've really tried to make an effort to work with some of our retail partners, some of our agriculture partners, to make sure we have fresh produce in stock to be able to get out to folks.  (lively guitar music) - [Julia] Katie Lindauer, whom you've also heard on our podcasts before, was part of the Rural Community Health Program and spent two years of her clinical medical education in Clare County. She has seen firsthand what people in underserved rural communities have to do to feed their families, but she also had personal experience with the Amish population in Clare County. Through those experiences, she saw how an understanding of food, cooking, food preservation, and nutrition, had an overall positive effect on this population's health. Just a little background, students who complete the Rural Community Health Program in Clare, have a unique opportunity to go into the homes of the Amish and provide immunizations and other public health outreach. - [Katie] So Clare's really interesting. So actually my answer now is different after having hung out with some Amish folks last week. Than it would have been before last Friday, before doing the Amish immunization rounds with the public health folks. I know that a lot of my patients  who have kids get their food from WIC in Clare. I've seen that in the family practice clinic, and so actually that's something I learned this week. We were talking to a couple moms about food and what they're feeding their kids, and they're like, well, I just feed 'em whatever WIC gives me. So Women, Infants, and Children, right, it's a food supplementation program. So I didn't know very much about Amish people at all. It's interesting 'cause I expected like really simple lives and really simple people, but like people are people, and when you have a bunch of kids, so you have 10 people living in a house, like there is really nothing simple about that (laughs) like you may not have a telephone in your house or you may not have electricity, but there's nothing simple about raising eight kids  (laughs) especially when you're cooking for eight kids with no electricity. So it was canning week when I was there, like three or four of the houses we had visited had harvested tomatoes. So like one woman had actually 20 pint jars of tomato sauce on her counter. And she did all that without a blender. She chopped all this by hand. There's no food processor. But also Amish people do go to the grocery store and buy groceries, which I didn't realize. I thought it was all like the fruits of the earth, but no, we saw it. The kids eat cereal for breakfast. And I don't know where they get their milk from, but like one family their child had a lot of food allergies, so like their family only drank almond milk. And the kids, we, the nurses give out cookies after they vaccinate the kids, so they like are known more for the cookies than the vaccinations actually, as they go around. And they're store-bought cookies and the kids can have those too, so it's not, I mean there's like definitely a preference for the simple, but it's not only what they've grown on their farms that their family is consuming, so that's cool. But they're definitely healthier. Like the Amish kids compared to the non-Amish kids, like already in seven year olds I can see a difference. Like they chart different on a growth curve. They listen better. Like all the non-Amish kids I've seen so far, have been on some sort of ADHD medication. And all of the Amish kids sit and focus and have no problems focusing, and it's not a question, they just do it. And so I don't know how much of that is nutritional, like the Amish kids aren't having as many processed foods and sugars and things that we're starting to think now may lead to those sorts of attention issues, and how much of that is that like Amish family community value really preference well-behaved kids, whereas some of the non-Amish families, their lives are so busy and complicated because of their jobs and whatever social issues they have going on that sometimes they maybe spend, I don't want to say spend less time with their kids, but have different  priorities with their kids, or their lives have forced them to sort of spend their time with their kids differently than maybe an Amish family would. So that's been really interesting to see too. - [Julia] Nutrition and food insecurity is a complex animal. Coming from a dietetics and nutrition education background myself, I know that trying to change habits and outlooks on the food we eat can be a deeply emotional and personal experience. But I also know this: food is not optional an hunger does not discriminate.  (somber music) Yet there's a real disparity in rural America. 15.4% of rural households are food insecure compared to 12.2% of all metropolitan homes. Rural communities see 5.1% more people receiving WIC benefits and 3.9% more people on supplemental nutrition assistance than in urban areas. Looking to Michigan, we see that 50% of all children, both urban and rural, are receiving free and reduced lunch. But what that 50% looks like in rural Michigan is a little different. When we say 50% are receiving free and reduced lunch, that means in Beaverton School District, 603 students out of 1,101. And in Clare School District, 664 out of 1,542 students are receiving free and reduced lunch every school day. And yes, I said district, which means there are whole classrooms in Clare and Beaverton where a majority of the students are living in a level of varied poverty. And while I don't have time to get into that now, we're talking about free and reduced lunch during the school year, we haven't even spoken about what that looks like for those children during the summer and on holidays. We don't have an answer to this issue, but we do have efforts. Organizations like the Clare County Community Nutrition Network, the Greater Lansing Food Bank, and MSU Extension, are doing what they can to reach people where they are. While there will always be more room for access and education, we can continue to support these programs and organizations, providing avenues for exposure in nutrition education in medical school can also make future medical leaders into advocates and volunteers for nutrition security. If the theory of equity is to take care of the least, so even the greatest is provided for, then if we can make sure that the most remote and isolated person in rural Michigan has adequate food, then everyone will have food.  (vibrant instrumental music)   Thank you for listening to this Rural Mission. This podcast is produced by me, Julia Terhune. Thank you Justin Rumenapp, from the Greater Lansing Food Bank, for agreeing to be interviewed and for touring me around your amazing establishment. The work that the Greater Lansing Food Bank does in our state is outstanding and makes a difference in so many lives. Thank you also to Veronica Romanov for letting me be part of the Clare County Mobile Food Pantry. And Kara Lynch and Katie Lindauer for agreeing to be interviewed for this podcast. As always, a huge thank-you goes out to Dr. Andrea Wendling for making this podcast a part of the Leadership in Rural Medicine programs. I want to encourage you to make rural your mission and until next time, I'm Julia. ♫ Well, I guess I've got to see that silver lining ♫ I don't mind a little rain ♫ Truth be told, I can't complain ♫ 'Cause life is full of give and take ♫ And there ain't no rainbows without rain ♫ I heard the wind start picking up ♫ Just when I thought I'd had enough ♫ But it was rough and it was coarse ♫ And took the trees with all its force ♫ It blew a left, then blew a right ♫ It rushed the land with all its might ♫ But when the wind had finally ceased ♫ Well we'll cleaned up all the leaves ♫ So I guess I've got to see that silver lining ♫ I don't mind a little rain ♫ Truth be told, I can't complain ♫ 'Cause life is full of give and take ♫ And there ain't no rainbows without rain ♫ I don't mind a little rain ♫ Truth be told, I can't complain ♫ 'Cause life is full of give and take ♫ And there ain't no rainbows without rain - [Julia] To learn more about the Rural Community Health Program, please visit our website at www.msururalhealth.chm.msu.edu. By joining our website, you can connect to us on Facebook, Instagram, and Twitter. You can also find out more about our musician. Music today was provided by Horton Creek and Bryan Eggers, a local musician and Michigan native. We hope you tune in next time to hear more from this Rural Mission.

This Rural Mission: Feeding Rural Michigan

This week we travel to Clare, Michigan to learn about the trials and successes of public transportation in Rural Michigan. **Please excuse the audio quality, it was the first episode ever produced for this podcast!** We get a chance to speak with Leadership in the Clare community to learn what really matters in Clare County isn't how we get to where we're going, but who we ride with.    Announcer: This Rural Mission is brought to you by Michigan State University College of Human Medicine, Leadership in Rural Medicine Programs. The podcast is funded in part by a generous grant provided by the Herbert H and Grace A Dow Foundation. To learn more about the Leadership in Rural Medicine Programs please visit  www.msururalhealth.chm.msu. I’m your host, Julia Terhune and please stay tuned to hear more from This Rural Mission.   Music   Producer, Julia: So the rationale behind making this podcast was pretty simple for me. I started biking, back and forth from work when I have to be in the office all day. I don’t do it every day, and I definitely don’t do it when I have to be in a lot of the different communities that I serve, and I started to look around at the transportation system in my county and I started to really think about, how this system works. Not just the Dial-a-Ride and the County Connect, that’s available in my county, but also things like the bike paths. And even if I didn’t have those bike routes, I have sidewalks, I have clean, well-maintained sidewalks. And I live in this community that is urban. I think with that urban distinction a lot of those things are easier to get simply because you have more tax revenue in these urban areas.   When we talk about poverty, most of us tend to think: urban centers. (Busy City Noises) I deal with rural communities. Rural communities are some of the most underserved rural communities in the nation when we’re talking about the economy, when we’re talking about resources, when we’re talking about medical professional. Medical professionals areas are rural areas. Pretty much across the board. There are urban areas that have shortages as well, but it’s predominantly a rural issue. (Music)   When we think about resources, we first have to think about: how do people get those resources? Because many resources don’t come to people’s doorsteps. Even things like mobile food pantries, people have to go to those places to get the food that’s being offered. They have to get to the health department to get the free health services. They have to get to the dental clinic and that  requires transportation. Now, in a rural community your geography is just so vast. You know, your city centers are smaller your suburban centers are smaller, places where people are living is vastly spread out and so to get to those resources is an even greater track. Combine that with economic issues like not having adequate jobs or having unreliable transportation because of limited finances, you’ve got a huge issue. (Music) One of the counties I’ve served is Clare County, Michigan. The average income, in Clare County, is about $33,000 per year and according to the Robert Wood Johnson County Health Ranking System, they are seventy eighth out of eighty three. I’m not going to bore you with what that means, but as far as health outcomes go, that’s not good.   You know, I look to this community and there’s a lot of poverty, there’s a lot of things that maybe aren’t going so well, but there’s a lot of things that are going right. And I got to talk to some really interesting people about the public transportation system in Clare County. (Music)   Tom Pirnstill: Tom Pirnstill, I’m the Executive Director at Clare County Transit. Well, it started in 1981, we have contributed a little over three million rides in that timeframe. We cover an area of five hundred and seventy square miles, population’s about thirty thousand. They’ve developed this dial-a-ride, or demand response, where people call us up and we start building a route based on call ins. So, it’s all fairly fluid and it’s about scheduling the busses and getting people to where they need to go and then going to the next ride as they call in. We have a thousand miles of road in Clare County and only two hundred and fifty are paved.   (Music)   Julia: Out of a thousand miles, in Clare County, only two hundred and fifty miles are paved. That’s only one quarter of the roads in Clare County. That also means that a majority of people who drive everyday are not driving on paved roads. Which can take a toil on their cars. Even if it’s a new car. Dirt, gravel, sand that can be a costly repair for even someone who’s middle class and has those resources.   Julia to Tom: So, that seven hundred and fifty miles of unpaved road, that’s probably really hard on your busses.   Tom: Oh, you bet!  You bet, yeah. And they’re hundred and ten thousand dollar busses. We can replace them seven years or two hundred thousand miles , depending on the capitol that’s available from the state. I have some busses that have over three hundred thousand miles on them. You’ve got to keep them because there’s nothing coming down that we can replace the busses and then that results in higher repair bills because like you said, the roads, they’re rough.   Julia: But there’s something really interesting about the public transportation system in Clare.   Julia to Tom: What kind of relationship do your drivers have with these people? I mean you talk about having…   Tom: They love them. They love them. Most of the time, the elderly, they cook for their drivers sometimes. They bring them cookies or cakes or whatever. They know them on a first name basis. If they come to their house and they’re not out there, normally the driver will go up to the door and find out what’s going on. They’ve developed that kind of a relationship, because we care about them.   (Music)   Julia: In my experience with public transportation, I’ve separated this idea of bus and bus driver, train and train driver. I think of public transportation as those pieces of metal that take me from point a to point b.   One of the students who is involved in the Rural Community Health Program and just so you know, the Rural Community Health Program is a rural training certificate program through Michigan State University College of Human Medicine. Katie Lindauer, Just spent a year in Chicago.   Katie: I spent the last year doing research and living in Chicago before returning to my clinical years.   Julia: She used public transportation to take her everywhere that she needed to go. And she can tell you that she did not have the Clare experience when it came to public transit.   Katie: As a single woman in a big city I was instructed by pretty much every adult that I interacted with, ever ever take public transit after, like, ten PM at night. I don’t know if that is necessarily a hard and fast rule depending on where you live, you know whether you’re alone on public transit or, you know, whether people are just being really protective.  But then there are other things too, like Chicago’s public transit system is pretty expensive compared to some of the other places I’ve been. But it’s also pretty nice and it’s usually pretty safe and you learn certain train lines are safer than others.   Julia: I also got to talk to Sarah Kile. And Sarah Kile is the Executive Director of 211 Northeast Michigan. And in a nutshell, they connect people who are in need to the resources that they need. Sarah Kile is the Executive Director, like I said, and she and her team serve twenty three counties and a majority of those counties are rural counties; one of them being Clare.   Sarah: The transportation infrastructure here in Michigan needs a massive overhaul. Because we pay insurance in middle class because that’s the bill that comes and we have to pay it. But when somebody’s in poverty and they get pulled over or they get into an accident we just dig another hole for someone. It’s really just an unfortunate situation and I think, looking at communities like Galdwin, Clare we have people who can’t drive. And that public transit, as limited as it is, you know, it’s only from seven to four or seven to five during the weekdays and you have to call a day in advance, sometimes you have to call three days in advance to schedule a ride. That is a lifeline for some folks. Where they couldn’t go anywhere without it. We have people who have to schedule their infusions around the bus schedule. That just blows my mind, like, I’m just flabbergasted that something like an infusion, they have to go three times a week, or well I can’t go on the weekends because I simply don’t have transportation. That’s shocking to me.      (Music)   Julia: And with 211, the Clare County Transit Corporation and the Community Foundations in the area have started to solve problems.   Tom: Non emergency medical transportation has always been an issue following the country. I mean you have ambulances and rescue squads, they do the emergency. The non emergency things has always been an issue of people being able to afford transportation to get there.   Julia: This non emergency medical transport system was created to meet that very need that Sarah talked about.   Tom: At our transit, we did a study about five or six years ago on that very issue. Of how can we get people in Clare County to the doctors when they need to go without fear of not being able to pay for it.   (Music)   Julia: Michigan State University has been training medical doctors in rural communities for over forty years. I know that this University is doing their part to help alleviate that medical professional shortage. But even if we have enough doctors, we will still need to make sure that everybody living in these communities can get to those doctor's appointments and this non emergency medical transport is helping to break down one more of those barriers.   You know, people need to get to doctor’s appointments, people need to get to grocery stores people need to get to play practice. But people also need to be part of a community. And that’s one thing that Clare County has got down. They are a community.   Dr. Bremer has been a physician in rural communities for over thirty years.   Julia to Dr. Bremer: Now, do you ever run across individuals who have a hard time getting transportation?   Dr. Bremer: Sometimes but not always. Most of them have a relative, a friend, neighbor. And so people help each other out in the community if, you know, Mary who lives by herself and doesn’t have any kids or family around, they usually have a neighbor who will take them, kind of thing. So a lot of that kind of stuff goes on. Neighbors, friends, somebody from church will bring you or that type of thing if they can’t find transportation on their own.   Julia: He hit this idea of community right on the head.   Julia to Dr. Bremer: In the rural communities that you’ve served, what is their greatest strength?   Dr. Bremer: The greatest strength is the people in each community. That’s what the strength is. People helping each other. That’s what you’re supposed to do. Whether it’s a big community or small community. You’re supposed to look out for your neighbors, help one another, share, help each other, think about each other, don’t think about yourself all of the time, kind of thing, we’re supposed to be a community. Whether it’s a big community or small community. So, that’s what a community’s supposed to do. A community can be anywhere. It doesn’t have to be a little Clare. It can be a big Midland or a Big Lansing, whatever. Yes.   Julia: Poverty and inadequate transportation will most likely be with us, forever. But there’s something else that will always be with us, and that’s each other. And I really think that what you get out of a community is what you put into it. And places like Clare County are putting a whole lot into their communities. And I think that shows, not only in the public transportation system, but in so many other organizations and collaboratives.   (Music)   Julia: I want to thank everyone for listening to this podcast. This Rural Mission is produced by me, Julia Terhune. I’m the Assistant Director for Rural Community Health at Michigan State University College of Human Medicine, and I just want to say that I love Clare County. I also want to thank Dr. Andrea Wendling and John Whiting for your help and support with this podcast. I also want to thank Tom Pirnstill, Katie Lindauer, Sarah Kile, and Dr. Bremer for agreeing to be interviewed for this podcast. Before I go, I just want to encourage you, I want to encourage you to consider making rural your mission. And until next time, I’m Julia.   To learn more about 211, the Clare County Transit Corporation, or the Rural Community Health Program, please visit our website at www.msururalhealth.chm.msu.edu. By joining our website, you can connect with us on Facebook, Instagram and Twitter. You can also find out more about our musician. Music today was brought to you by Horton Creek and Byran Edgers, a local musician and Michigan native. I hope you tun in next time for more from This Rural Mission.  

This Rural Mission: Transportation

While many rural communities are home to predomenantly male leaders, there are pleanty of professional women making an impact in rural healthcare systems, industries, and organizations. Today we speak to a few of these women who are chaning the face of rural leadership and promoting equity within their communites.    - [Julia] This Rural Mission is brought to you by Michigan State University College of Human Medicine Leadership in Rural Medicine Programs. The podcast is funded in part by a generous grant provided by the Herbert H. And Grace A. Dow Foundation. To learn more about the Leadership in Rural Medicine Programs, please visit www.msururalhealth.chm.msu.edu. I'm your host, Julia Terhune, and stay tuned for more from this Rural Mission.  (lively banjo music) -[Julia] What do you want to be when you grow up? - [Dina] I don't know yet (giggling in background) but I'm thinking about maybe being a doctor. - [Julia] A doctor? What kind of doctor? - [Dina] Probably a doctor that gives checkups. - [Julia] What do you want to be when you grow up? - [Selah] Superhero. - [Julia] I think that you're gonna be a really great superhero, but I also think that you're gonna be a really good doctor, Dina. - [Salah] I'm not gonna be a superhero; I'm gonna be another doctor. - [Julia] You're gonna be a doctor, too? - [Selah] A family doctor.  (quiet giggling) - [Julia] That's perfect. You guys can both be doctors and work in the same office. - [Selah] I can be the person who gives shots. Sometimes we have to give the baby shots and they cry a lot. - [Julia] Yeah, but then you give them stickers and they feel better. I'm excited for you guys to become doctors. - [Selah] And when I become a doctor, instead of giving them a sticker, I'll give them a barbie.  (lively banjo music) - [Julia] Those little voices that you just heard are two of my favorite little people, Dina and Sala. You know, it just warms my heart because Dina and Selah live in a world that I lived in where girls could do anything. Dina wants to be a doctor; Sala wants to be a superhero. There's no reason why she can't be a superhero and why she would think that being a girl would hinder that at all, and I lived in that world, too. I lived in a world where I thought and believed that I could do anything, and for the most part, there have been very few barriers for me reaching my goals and my dreams. That's not to say that I haven't felt adversity or I haven't dealt with other roadblocks, but when it comes to my gender, I haven't felt that as much, but I know my mom did. I know my mom did, and I know that the women before us have fought so tirelessly to make a difference and to stand up for women's rights because women's rights are human rights, and I think that that has been a big thing that we need to realize and I think that there's been a lot of effort made in that area. But it's not to say that there's not more that can't be done.  (slow twangy music) There's a stereotype in rural communities that rural communities are very patriarchal, and to some degree, that actually is the case. And I will qualify that stereotype by stating that when you look at the job structure or the job market in rural communities, what you tend to see is that there is a limit in the number of industries that you find in those different counties. So while this isn't the case for every single rural county in the United States, at least what we see among the demographics in the rural counties in Michigan, the leadership of those more white collar-jobs and the leadership in more of those blue collar-jobs are men. I'm going to be interviewing a number of women who have made and are making some really amazing differences and a pretty big splash in their rural community, and no matter how you slice it or what way you look at it, the women that we're going to talk to today are leaders in their county. One area that we've seen tremendous growth in gender equality is in medical education and the medical workforce. Dr. Young lived at a time and went to medical school at a time when that fight for female representation in medical school was still alive and well. Dr. Young practices rural family medicine and her daughter is enrolled in the Rural Community Health Program at Michigan State University. Katie is a fantastic student and quite an amazing young woman, and I'm excited for you to hear this next segment because I think it really shows if we keep working towards equalizing, and making a difference,  and changing the face, and changing the standard of something, if everybody works for that same effort and if everybody continues to make it a priority,  I really think that some magical things happen and this next segment with Dr. Young and Katie Young really gets to the heart of that idea. - [Dr. Young] So when I was  young and in high school, my counselor said to me, at that time thought I wanted to go to law school, that I should not do that, that I should get a job that helped maybe be a second income when I got married and had children. And my parents always believed that I could do whatever I wanted. I just always grew up hearing that, and so when I went home and told my parents, they were, "What?" And so I always had the motivation from my parents, "You can do whatever you want." (soft melancholy chord) - [Katie] I mean I grew up in a family where my mom was the sole bread winner of the family and my dad actually stayed home with me and my younger brother and then was really involved in community otherwise, and so my sense of gender roles from a very early age was that women can be just as empowered as men easily and I was also extremely lucky to have a lot of other strong women in my life. - [Dr. Young] I had no female role models as a physician as a little girl. I do not remember ever meeting a female physician as a little girl. I was the first woman physician on staff at Charlevoix in many, many years when I started in the fall of '92, so for me it was wonderful. My practice filled up right from the get-go. I've been busy since I got here. - [Julia] Wow. - [Dr. Young] It was so cool because women wanted to see women. - [Katie] I know my mom was one of very few women in her medical school graduating class and now I'm in a medical school graduating class that's slightly over 50% women. - [Dr. Young] I honestly can't remember the exact statistics. I want to say our class was 28 to 30% women. We were less than the majority, that was for sure. - [Katie] And so I think that says a lot about how many areas have gotten broken down by people, and my mom's generation, and then my grandparent's generation. For me, I'm really interested in going in the surgical field, and you know, I got warned by my mentors who were two awesome older gentlemen surgeons when I was in high school, and my mom has pointed out to me, as well as professionals from the Lansing area that if I want to go into surgery, that that's one of the last factions of, I guess, male-dominated area in medicine. - [Julia] Do you think you can handle it? - [Katie] I'm not too worried about handling it. I feel pretty confident in my own abilities, I guess, and I feel like if I allow myself to feel intimidated or to feel embarrassed, then I feel like that just further feeds into that stereotypical role that women should be filling, which would be a subservient one, and so I think it really depends a lot on having the self-confidence and having the class to maintain a real professional demeanor, even when those around you, be they male or female colleagues, can't seem to. - [Dr. Young] I see that, in my professional career, try to set the best example every day that I can. I don't see that necessarily just as a woman, but as a human being and I hope that as we progress with time that we will see that individuals should go into careers or job opportunities based on their skills and their ability, and whether or not you're a man or a woman or the color of your skin. So I really, I mean, I know that I'm a role model, but I hope it's not just because I'm a woman. Kind of like the "When they go low, "you go high." - [Man] Three, two, one! ♫ Don't mess, don't mess ♫ Don't mess with the best ♫ 'Cause the best don't mess ♫ Don't fool, don't fool ♫ Don't fool with the cool ♫ 'Cause the cool don't fool ♫ To the East ♫ To the West ♫ (mumbles) is the best ♫ We're gonna B-E-A-T beat 'em, beat 'em ♫ B-U-S-T bust 'em, bust 'em ♫ Beat 'em, Bust 'em ♫ That's our custom ♫ Come on out, let's readjust 'em ♫ Hip hop, we're on top ♫ Go (mumbles) (upbeat guitar music) - [Julia] It's important to have an array of perspectives, an array of cultures, and an array of persons and genders in every institution and organization because those perspectives, ideas, and opinions are going to make decisions that provide equity to all persons and help to break down barriers and help to break down vulnerabilities in all types of populations and settings, and this is even more concerning and even more important when we're talking about rural communities who are already underserved.  (slow guitar music) - [Darcy] My name is Darcy Czarnik-Laurin. I'm the Executive Director for Thumb Rule Health Network. Well it was created, gosh, over a decade ago. We're looking at probably close to 13 years. A lot of the leaders, the CEOs and department heads and stuff from the rural critical access hospitals in the thumb region, and I'm going to just say that that region is Huron, Tuscola, and Sanilac Counties, there are seven critical access hospitals in those three counties and that's small hospital heavy for a rural region, but it's also very important because there aren't the larger health systems. The leaders of those hospitals, they would see one another at regional meetings and they said, "Hey, historically we are competitors. "We will always be competitors, "but we're working toward the same goal, so what can we do to work together to help one another out?" because they know the importance of rural health care. I was the female voice when I started and that's changed, but I was rather intimidated. - [Julia] Stop. Because right there, that statement is exactly what I'm talking about when I talk about having everybody at the table. When we don't have adequate representation of all persons, all creeds, all cultures, all genders, then that feeling of insecurity is a real thing. And it doesn't just stop at personal feelings because we can't control that, but it does become more systemic when people don't feel adequate, when they don't feel like they're contributing to something or that they can't, they won't, and then that voice that's sitting at the table becomes marginalized and that marginalized voice then doesn't help make all the differences that we need to see being made in communities. When we have a vulnerable population and a marginalized population within that vulnerable population, things can get pretty bad. Now, I don't mean to interrupt Darcy here because she's about to make some really interesting points, but I couldn't let an opportunity like that go to waste, so here's Darcy again. - [Darcy] Here I came onboard never holding the position that I hold with Thumb Rule Health Network. I had a lot of knowledge, I had a lot of experience, but to sit at a table with mostly a male audience sitting around the table and men that hold that position of CEO was rather intimidating to me, you know, so I don't want to mess up. (laughs) - [Julia] Do you ever think about being a female leader while you're doing your position? - [Darcy] Yes, I do. I do think about being a female leader and a lot of it I'm still nervous about, I have to be honest. - [Julia] Is that important to you, being a leader? - [Darcy] Yeah, it's definitely important. And there's times where I just sit back and I say, Hey, I came from  this tiny little village town in Arenac County. "I graduated out of a class of about 26 people," and I look back and I think what would my life look like if I hadn't met the people I met, had the upbringing I had, took the roads that I took. Talking about my class kind of just sparked something else. I want to say we had about 26 people, and out of my core group of friends that we still, and somewhat keep in touch, we have me, I'm the executive director of a nonprofit, we have a veterinarian, we have a couple RNs, we have a zookeeper. And these are all the women! Out of that small, little class out of this tiny, little, rural class D school that when people say, "Oh well, you graduated from Arenac Eastern, that's not a very good school," and it goes down to, again, the way people are raised, their community, their mentors, their support, and their choices in life. So, yeah, I think it's important that I am a leader. I may not always view myself as a leader because I still have doubts, but I know I am a leader and I'm hoping that I have some type of impact or I'm possibly a mentor to some people.  ("Ivory Girl" by Bryan Eggers) - [Julia] That is why women rule and why we need more women in leadership positions in rural America and we need more female physicians willing and ready to go into these small towns and serve for as long as it takes, much like what Dr. Young has done and what Katie Young is about to do.  Those women are making a difference. People like Darcy are sitting on these tough and intimidating committees and speaking up for what is most needed and what is most necessary, and those women are just the start of it. There are so many women who are making a difference in rural communities, so I'm just gonna encourage you  that if you have considered working with an underserved population in any capacity, whether that be a nurse, or an accountant,  or a medical doctor, I encourage you to really consider making rural your mission and making a difference in your rural community or in a rural community that you grow to love. ♫ If I searched the whole wide world ♫ My ivory girl - [Julia] I want to thank everybody again for listening to this podcast. As always, I'm going to thank Dr. Wendling for her support and encouragement of this podcast. She has made a tremendous difference in my life and in my career, as well as the life and career of so many other people and I just want to give her a sincere thank you. I also want to give a sincere thank you to Darcy. She has been a fantastic  colleague and friend over the last two years and I've enjoyed working with her and Thumb Rural  Health Network.   As much as we talked about how the group of CEOs in the thumb  are a bit intimidating, the truth of the matter is they're a group of really fantastic professional men that are devoted to the health and security of the thumb. I want to thank Dr. Young for taking time out of her busy schedule to talk to me, but I also want to thank Katie Young for taking time out of her schedule because she's a second-year medical student right now, and, man, for her to give up the time to talk to me out of her busy study schedule was tremendous, so thank you, Katie. Thank you, again, to everybody who listened to this podcast and please tune in next time for more from This Rural Mission. ♫ Couldn't find another ♫ If I searched the whole wide world, yeah ♫ My ivory girl ♫ My ivory girl ♫ My ivory girl ♫ Couldn't find another ♫ If I searched the whole wide world, yeah ♫ My ivory girl ♫ Couldn't find another ♫ If I searched the whole wide world ♫ My ivory girl ♫ My ivory girl - [Julia] Please visit our website at www.msururalhealth.chm.msu.edu. By joining our website you could connect to us on Facebook, Instagram, and Twitter. You can also find out more about our musician. Music today was provided by Horton Creek and Bryan Eggers, a local musician and Michigan native. We hope you tune in next time to hear more from This Rural Mission.  (beep) When I say that we live in a world where girls think they  can be anything they want when they grow up,  Sala definitely proves that  that statement is true. - [Selah] I want to be famous here as a doctor. - [Man] You want to be famous— - [Selah] Or should I be a grown up that goes to gymnastics? - [Man] Should you be a grown up that goes to gymnastics or a doctor?    (laughter) That's a really tough one because both of those people are gonna be really famous. - [Selah] Both!  

This Rural Mission: Women Rural

This Rural Mission is a podcast that discusses pertinent topics related to rural community health and social issues around the state of Michigan. Each episode highlights rural providers, medical students, and community members who are making a difference in the lives of rural residents.

hubhopper

This Rural Mission

hubhopper