Rural Health and the Compass Program

Rural American populations face significant health disparities compared to their urban counterparts. This does not only mean fewer physicians per capita, but also longer distances and lack of transportation to care, lower household income, higher tobacco and alcohol use, lower access to healthy foods and recreational activities, and inferior health literacy. Nearly 20% of American people live in Rural areas, equating to about 60 million people. While the patient to primary care physician ratio is 53.3 per 100,000 in urban areas, it is only 39.8 per 100,000 in rural settings, and an even more shocking discrepancy exists for specialists: 263 per 100,000 urban residents while only 30 per 100,000 in rural communities (ruralhealthweb.

org).

This provider shortage in combination with lack of healthy recreational activities, poor health education, and high rates of drug and alcohol use lead to higher disease incidence in these communities. According to the CDC, the five leading causes of death in the United States including heart disease, cancer, accidents, chronic pulmonary disease, and stroke are higher in these underserved populations.

Thankfully, the Office of Rural Health Policy (part of the Health Resources and Services Administration, of the United States Department of Health and Human Services) has been working to address this crisis. As a consequence of these efforts, aspiring physician medical students now have access to university-sponsored programs aimed at tackling these issues. Such programs include The Kenan Primary Care Medical Scholars Program as part of the UNC School of Medicine, the ROME Rural Scholars Program as part of the Texas College of Osteopathic Medicine, and of course, the Rural Physician Program as part of the Michigan State University College of Human Medicine.

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I grew up in a town of nearly 7,000 people, often struggling to find appropriate, timely medical care. I have witnessed the beautiful way of life in these quiet places, but on the same token, the disadvantages. In this area, and other rural settings, yes, there is a shortage of physicians, but also other medical providers from outdoor emergency technicians (first responders), to EMTs and paramedics, to higher mid-level providers. Health status is worsened by the fact that knowledge about and resources for a healthy way of living including diet and exercise are limited. Because of my firsthand experiences and desire to close this gap in healthcare, I chose to complete my clinical years of medical school in the Upper Peninsula of Michigan. With the aim of someday returning to practice, I chose to partake in MSU CHM’s Outdoor Wilderness Program, to support a healthy way of life, understand medicine outside of the hospital setting, and give back to the community that was training me.

The “Northern Wilderness, Emergency and Sports Medicine” or “Compass” elective is unique to the UP Campus. It gives students the opportunity to learn more about how to care for patients with emergent wilderness and sports-related injuries outside of the hospital system. It is a longitudinal elective occurring during the third year of medical school. The curriculum requires participation in the Outdoor Emergency Care (OEC) course including 3-hour didactic lectures once weekly from August to December (my participation was in 2017); related outdoor activities to learn about lower limb splinting, creation of arm slings, making devices to stabilize impaled objects, steps of chair-lift evacuation; and proper back boarding techniques.

There were several other outdoor events including a bike ride and lecture about hypothermia, a day hike to become familiar with survival tactics, and a walk through an herbal farm to broaden our knowledge of alternative medicinal techniques and mushroom safety. After completion of the OEC course and passing of the written and practical examinations, I became a member of the National Ski Patrol (NSP). Those who were interested in becoming Alpine Patrollers (ski-rescuers on the hill) continued to take ski-technique lessons, however, I volunteered my time in the medical chalet. In addition to serving at the local ski hill, the skills obtained from this elective enabled us to participate in several volunteer events throughout the community.

The first of several events that I volunteered for was called the “Ore-to-Shore” bike race, where I helped in the medical tent. Most people coming to see us had finished the race, covered with cuts and road rash. They were very thankful for somebody to sit in front of them, remove pebbles from their knees, wash them to prevent infection, and bandage them up for their post-race celebration. Reflecting on this event, I am grateful to have been in the place to encourage this and other similar activities in the community.

I was made aware of the fact that it isn’t that people do not want to engage in these activities, as is often accused of people in these small towns, it’s that they don’t happen often and certainly not in many towns smaller than Marquette. In fact, Marquette community members are fortunate to have these events available to them – they just need to be popularized and spread to other flanking towns – perhaps with offered transportation to encourage fun and healthy recreational events. I also volunteered in the medical tents at the Canal Run in the Keweenaw, the Veterans Day 5K, the Lions’ 5K/2K Fun Run for Simple Kindness for Youth, and other sporting activities throughout the last couple years.

I also spent time volunteering in the ski chalet at Marquette Mountain. The NSP was founded in 1938 and has forever followed the mission of “Service and Safety”. Although today the NSP is a large organization with more than 30,000 patrollers, some of whom are paid, it continues to be largely a volunteer service organization striving to provide medical care in support of the safe participation in outdoor recreational activities – not only for skiing, but for other outdoor sports such as water rafting and mountain climbing. I spent the majority of my time in the NSP chalet, helping to care for patients at the bottom of the hill. Being a member of the national ski patrol is a rewarding experience, because it enables the community to safely enjoy healthy outdoor events, especially in places such as Upper Michigan, where much of the year is winter. Having a volunteer ski patrol crew enables the ski hill to remain open while keeping costs low and provides a safe place for people of all ages to spend their free time.

Aside from these volunteer services, being a part of the OEC course put us as medical students in a unique position. Most people in the course were community members wishing to volunteer with the National Ski Patrol. We were privileged to already know much of what was being taught and more than the level of the basic sciences being presented. For this reason, we were able to give presentations to the class regarding whatever particular topic was being covered that week. Although I did not give a formal presentation during this course, all of us were able to contribute significantly to group discussions. I chose to do my community presentation at a “Paddleboard Yoga” event in Houghton, MI, where I addressed the topics of water safety, hypothermia, and basic resuscitation techniques to 13 members of the class and 3 instructors. It is humbling to be able to share medical knowledge for the betterment of our community and to educate the public so that they, too, can help others.

By spending my clinical years in Marquette and through this aforementioned volunteering, I have been made aware of the many assumptions regarding life in rural America and the people that live in it. For example, it has been said that rural Americans, in particular, “Yoopers”, “act tough” and therefore, delay seeking medical care. There is also an assumption that sedentary lifestyles and poor eating habits are fully a choice, both of which I have come to learn are not entirely true.

Though many people in rural communities do present with advanced diseases that may have been preventable with earlier intervention (i.e. the late manifestations of diabetes), it is not because they want to ignore their problems or are “too tough”. In many situations, it is because they lack the funds to pay for travel or healthcare bills, are unable to take time off work, or have no transportation to get to a provider. In addition, many people have vocational careers and were not educated beyond high school. This goes hand in hand with the second assumption I have mentioned – that eating poorly and lack of exercise are completely a conscious decision.

There is a lack of access to fresh foods, poor outdoor infrastructure including public parks, a deficiency of organized recreational activities for exercise and lack of promotion of it (across the U.P. as a whole), and poor community education regarding the importance of the above. To add to this, much of the population works for minimal pay and may struggle to obtain whatever food they have or to find time for physical activity. For these reasons, teaching the community through lectures, volunteering at sporting events, raising money for children’s parks (which I have done since high school), and becoming a member of the ski patrol have been my small efforts to combat these setbacks.

This service learning project did more for me than allowing me the opportunity to participate meaningfully in service of others. It enabled me to realize the importance of teaching others to help each other through the dissemination of medical knowledge. It gave me insight as to what I would like to contribute as a practicing physician. It is my desire to come back and practice in this place that I have forever called home; however, I don’t want to return as “just” a doctor. I want to stand as a stimulus for health in the community and to support safe places for people to spend time together. As current students and future practitioners, especially in these programs tailored for rural medicine, we have been given tools necessary to begin fixing this healthcare disparity.