This Rural Mission
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...
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*PLEASE BE ADVISED: This episode discusses very sensitive and triggering content including suicide and self harm. Please continue reading/listening at your own discretion.
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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....
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We started off this season talking about how limited broadband access can impact student performance and the overall well-being of a community. Today we are going from worry to a celebration and talking about the people who make a positive impact on students in rural communities through the public health system. 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....
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This week we are taking a part-two look at the opioid crisis and talking about who opioid addiction really hurts: children. The foster care system in this state is flooded with children who have had their lives impacted and uprooted by opioid addiction. In this episode we will hear from CPS workers, foster care parents, family service professionals and addiction councilors. 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...
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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.
info_outlineThis 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.
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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.
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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.
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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.
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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.
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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.
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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.