This Rural Mission

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.

Rural Residency 07/22/2021

Rural Residency 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. /episode/index/show/thisruralmission/id/19899533

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40 Years of Rural Medical Education 01/21/2020

40 Years of Rural Medical Education 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. /episode/index/show/thisruralmission/id/12825971

Beyond a One Room School House 01/14/2020

Beyond a One Room School House 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. Welcome to season two, I'm your host, Julia Terhune, and I hope you enjoy this episode. Education levels in rural communities is something to talk about. While rural communities lead the nation in number of individuals who have a high school diploma, according to the USDA, the number of people living and working with any additional education drops right off. In 2016, only 19% of all rural adults had anything more than an associate's degree as compared to 33% of all urban adults. When we look at county data, rural America leads the way in number of counties where more than 20% of the working population does not have a high school diploma. The prospects for higher education in rural America is bleak and it's low educational attainment seems to perpetuate the issues of rural poverty and the vitality of these communities, but there are success stories. If we drive North to beautiful Charlevoix County, we will get to a five square mile town called Boyne city. Boyne city is home to around 3,750 people, most of whom are over the age of 40. The average family in this area makes about $31,000 a year, which is more than $20,000 less than the mean income for the state, allowing for the average poverty rate in the county to sit around 12.5%. Like the rest of rural America, the majority of citizens have no more than a few college courses. Meaning that 60% of the population of Boyne City has nothing more than a high school diploma. For all those listening who are interested in medical access in rural Michigan, the health resource and service administration or HERSA has designated Charlevoix County as a health professional shortage area for primary care, dental care, and mental health care. In 2018, Boyne City High School saw some amazing students graduate. In fact, around 115 stellar graduates came out of points city, if we're going to be straight about it. We are going to talk to three of these amazing students, but I want to quickly set the stage. Boyne City High School graduates are coming from a rural school in a county that has some big social factors to overcome. 38% of all the students at Boyne City High School receive free or reduced lunch, and around 18% of the population that lives on less than $35,000 per year are families with children. Furthermore, I took the Liberty of plotting how far a student would have to travel to get to the nearest four year university from Boyne and I posted that map on our Facebook page, but I'll give the bag away. The closest four year institution to Boyne City is Lake Superior State University, which is over 90 miles away and across a five mile bridge. Therefore, options for a close to home education don't really exist for young adults looking to get something more than a high school diploma. But I told you there were success stories for this episode and there are. It's just that the students that have found their way to higher ed had more work to do than you would've expected. So let's introduce our leading ladies, shall we? Katie is going to Northern Michigan University. Katie is the daughter of Joe McCue who you heard earlier this season and is the oldest of a big family. She's staying in the state, but remember NMU is over 150 miles from Boyne. Maddie is going to Brown. Yes, Brown, and is going to tell you a lot about her trail to an Ivy League education and Anna, well, Anna is going to Stanford, you know the number two university in the world. So what is different for them? Anna, Katie, and Maddie graduated from a class of around a hundred to 115 people and when I asked them about how many were going on to university, they had this to tell me. University, university? Maybe 40? 50? Yeah. Probably 40. Yeah, because a lot are going to [crosstalk 00:05:04]. Community college. Yeah. Okay, and is that pretty standard for your area? That's pretty good actually. Yeah, our grade I think had- very ambitious. Ambitious, very academically inclined grade at least compared to others and the three ahead. Or even the three behind. Just looking forward. Most of our students put academics before a lot of other things, which was kind of uncommon. So was there a lot of competition then in your grade academically? Yes. Yeah. Yeah. Everybody was applying for the same scholarships. It's like, "I don't know if I want my friends to read my scholarship letters because they're applying for the same ones." It was hard. If you look at the top 10% of our grade- Of level four. Yeah, it's super impressive the number of people who- The top 10 had above [inaudible 00:00:05:58]. Yeah. Okay. So what is different? Why is your class different than the three ahead and the three below? I have a little bit of theory. Okay. So in fifth and sixth grade the math classes were accelerated or there were some accelerated math classes, which was a newer thing in the middle school and they [crosstalk 00:06:21]. They took a whole chunk of us and just pushed us forward. IT pushed us up and then the chunk right behind us ended up meeting at the same place in eighth grade where we were all in an accelerated class and that was 30 students, and those 30 students continued to be the top 30 in the grade all the way through high school because they've been pushing our grade. There are lots of educators who care and care a lot about encouraging and promoting student success, but the concentrated effort that these Boyne City graduates experienced is a positive benefit of being part of a rural school. A rural school where they had the ability to identify and focus on those 30 high achievers. This concentration didn't just stop with that top 30. It had an impact on all the other students as well. Yeah and [crosstalk 00:07:12]. But it grows everybody else up because now the standards- Yes, now there's more competition. ... Were being good or academically good for lack of a better term is so much higher than everybody else raises. Yeah. There's something else about the accelerated English classes too with that. The same 30 people are in that. Because there was so much of a demand. Then it just kind of ... Everybody had to be working a lot harder to be considered the standard. So are there any other theories that you guys have [inaudible 00:07:41]? we were really close and we just so it was all this really positivity. We were are really positive grade and we all had these great outlooks on the future and every chance that we got that we could improve on those AP classes or advanced classes everybody took it, because we'd all just saw this opportunity to do better. And it almost became a social thing in the sense of if you're in honors English now you get to be with all the fun people in the honors English. So now our honors English class is 30 kids big and it's fun. Or AP World or calculus or physics. You get to be with your friends. Yes. So 98 people, that's easy to do, right? If 30 people can easily have an effect on 98 people. So if you guys were at a bigger school, do you think he would have had that same effect or do you think that that would've been the status quo? I don't think we would've. I think we would have just been that one class full of nerds. Yeah, because [crosstalk 00:08:44]. You have all the opportunities. It's open everybody normally. And so it's just kind of like, "Oh, it's still part of the thing." You don't as involved because it's just your educational process. There's nothing different. You don't have to fight. For those advanced classes. For us, we had two AP courses offered taught by teachers and so if there was an AP course everybody's is like, "Oh my gosh, there's something new. We all need to take this." It's really cool where it's like my cousin goes to a bigger school and it's like, "Oh, we have five to 10 AP courses offered and it's no big deal." You take it if you want to take it [inaudible 00:09:24] show your college [inaudible 00:09:26] college SAT scores and all of your grades throughout your previous classes and your grade point average. We didn't even have a [inaudible 00:09:35]. You have to get teacher recommendations to get into these advanced courses because everybody wants to do it. There's a benefit to that fight that Katie and Anna spoke about. It can prepare you for what comes next. We talk about the plight and vulnerabilities of rural areas on this podcast often, but we also need to highlight the resilience, the tenacity that living with limited resources can provide. Catherine Ellison was from my small town. She is one of those brave souls we speak about who goes away, gets tons of experience in education and comes right back to the community. She is currently the elected school board president for [inaudible 00:10:16] Public Schools and I asked her about the barriers, both perceived and real that rural public school graduates face. Well, talking about your perceived in reality. I think it's perceived through a disadvantage. It's a smaller school. Maybe they don't have as many offerings as a big school. You have the same teachers for years and you see the same people in the hallways but in a lot of ways, especially with today's these kids where everybody's on their phone, on the computer, you on the tablets, there isn't that social interaction. Small districts can be great. I mean, you're still going to learn how to read and write and do math, all those basic things. But you're also going to learn people skills? You know everybody you're going to school with, you're going to have a conversation with them, not just on the internet. Right? So there is for that focus. I mean, and teachers care about you because they know you. I mean, you might have the same kid two or three years if you're, you know, teach different subjects in high school or something, right? So you get to know those kids. So I think that's the real advantage is, is the customer service, if you will. Teachers know their kids. Administrators know the kids. It's a small district so a lot of times you'll see a kid ... If you were elementary school teacher you had then so I think you care about those kids as a result because they're not just another random face in the crowd. Did you feel you had any advantages? I mean I think some of the advantages were certainly that, and I was a shy person, but I could talk to people. I wasn't afraid to talk to a teacher because one, I had known everybody in my class since kindergarten, it's the same people. So it was no big deal to get up in front of those people and say something or ask a teacher a question because you knew everyone. So in college, I think that even though I clearly didn't know everybody in my class there I was like, "Well, we got to go talk to the teacher. We've got to ask them the question, we've got to ask the professor a question. This wasn't such a big deal." Which can be the advantage because then once I became a professor I knew if a student makes the effort to come talk to you out of a hundred kids you might get two, I'm probably going to look on them a little bit more favorably when it comes to grading time. Just because they tried, right? They made the effort. A lot of kids don't. I think that is really an advantage, right? To kind of learn that, not be afraid of those people in front of the classroom. So what barriers do you guys perceive you had to getting higher education being in a rural school? I didn't know about a lot of things going in freshman year. Just like the courses you can take, all the places that you could apply. It was kind of like a cookie cutter path because it's such a small school they can't offer all of these advanced classes. So when you go to a big school you can just pick between all of these AP courses. For us, even freshman year we knew we were going to take AP world at some point and AP calculus at some point and that just in between you got to pick your electives. I think also, I mean not to hate on our school. Clearly we had a great academic experience at our school, but in a place that small the measure of success for a school is everybody graduating. That's what they want. They want to push kids through. They want everybody to graduate, which is a good goal. You do want kids to graduate. That's important and for everybody to have a high school diploma, but because of that when it's set up it's set up with the goal of everybody graduating. The goal is not, "We want all of these kids to go to crazy academic institutions." Or anything like that and so when you're setting up your school system for that middle of the road section of your class, then sometimes the top portion has never pushed hard enough. Right from day one it was never, "How are we going to get you into college? How are you going to do this? How are we going to do that?" It was just, "Okay, these are the classes you have to take to graduate." And I mean, granted, nothing against our school. We had great counselors, academic advisors, but it was hard where we only have two AP courses. I felt that the staff definitely helped me and it was a personalized learning experience, but sometimes I felt like, "Why can't you help me more?" I feel so bad because our counselor's the nicest lady ever. She's so nice. She was so sweet to us, but I remember standing in a hallway with her and her saying, "I don't think we're going to have room to put you in this college level government class." And me, because it's saved for the people who are trying to do the early college through the community college and me literally looking at her and being like, "I will bring my own chair and sit in the back every day." Now how's that for overcoming barriers? Another perceived barrier that we have to deal with in rural communities comes in the form of diversity. So where it's not diverse culturally, it's very diverse in the sense of living situations or incomes. It's not everybody who lives a life similar to me, it's here. I feel like people live so many different ... If I went to a big school I would find my niche group and I would hang out with probably people who are similar to me and have similar beliefs than me. Here I sit at my lunch table and every person around that table has a different living situation, different to political view and stuff and we just fight it. It's so fun because it's interesting if they can learn from them and stuff. So even though culturally we're all very similar, I think that sometimes you lose that view that's important with income and everything. I'm sitting here and in my community, I'm a pretty average run of the mill normal living situation, normal everything but from their perspective I'm being recruited by the minority and low income and I'm like, "Huh, that just feels kind of odd that if I go outside of my community I'm in such a different place than they are as compared to all the people I know." And that's just kind of a weird identity thing. I never thought that I will be putting low income as something that my identity as they're trying to recruit me and I'm like, "This feels weird. This feels weird. And you're comparing yourself to ... Yeah, and I have to compare myself to a whole different group of people, different groups of students. In Boyne City it's a normal place, but anywhere else where you have to go you're ... The whole environment just makes you reconsider. I've never felt bad about myself in Boyne and I still don't feel bad about myself going up there because it's I love Boyne, I always have this to come back to, but it's just weird. I mean from the rural standpoint, I feel like the same as you. I'm going out and we're competing against students who have been taking prep classes all four years. I went out last summer for a camp at Brown and all the girls in my dorm, I told them that I worked during the school year and they were just amazed. They're like, "How do you have time with that? Don't you take prep stuff after school?" And I'm like, "No. Then how are you here?" And I'm like, "Ooh, okay. I wonder ..." This is a story I always tell and I'm not like a redneck by any means in any way, but I went out there and I had six girls with me, totally different backgrounds. One was from London, Shanghai, Sudan, all of these places. And we were all just hanging out and talking about TV or something. And I went ... We had a 12 pack of water wrapped in plastic and it took out a Swiss army knife, a little tiny Swiss army knife and cut it open, and they all went silent. They were like, "What is that?" And I'm like, "This isn't a Swiss army knife." And they were like, "Why do you have a knife?" And they were horrified. And I'm like, "I'm cutting open water. The blade is like- It's a tool. It's a tool. It has tweezers. What are you talking about? They were wary of me. They're like, "Why do you have a knife?" And I'm like, "Because I do. Because I have to cut things. Why are you ..." It was just so weird. Just like, "I'm going to go out there and be such a redneck." [crosstalk 00:18:42]. You will always be the girl who had a knife. That's right. They were so afraid of me. So what things are you very prepared for from your rural school experience? Actively seeking out help. That is going to be huge because I mean I was taking these classes and I was the only sophomore high school student in the class full of college students and I'm like, "Oh, this is horrifying and scary. I'm so out of my element." I know the second I go off to school I'm going be like, "This is horrifying and scary. I'm out of my element." Well, I've done it before. So it'll kind of give you the little prep, a little boost like, "Oh, well maybe if to do some extra research. Find the professor who knows what they're talking about and talk to them after hours." Because we can text some of our teachers. Yeah, that's definitely helped me. Just being able to know how to build a relationship with my teachers and be able to know how to ask for help and get help and stuff because everybody I've talked to is like, "The first year I was just stubborn. Didn't get help from my professors and that caused me to fail classes and I was just going in expecting my professors are going to know my name. I'm going to have their cell phone number, any problems I have they need to help me." Bake them cookies. Yeah. I was going to be best friends with my professor because that's just how it's been at Boyne. We'd go camping with some of my teachers at the end of the year and ... And also the concept of personalized learning. Like getting to know, I know all of my teachers so well at this point. And then yes. So my senior year, I don't really have many options to take advanced courses, but because of that it's like, "Oh, I know for example, like Mr. Pantone really well, he understands my learning process." So I did an independent study with him where I could dive so much deeper into something outside of the normal curriculum bubble, but still advanced me for college in the future and just being able to, I don't know, have a personalized learning schedule and have teachers and staff that were invested in that. If you said, "I wanted to do this." Yeah, there were definitely some hiccups, but they were willing to help you. It wasn't just ... You knew them so much better. And I remember at graduation I looked at all of my teachers and I started crying because I was so, so grateful for what they had prepared me for and how they'd gotten me to this... /episode/index/show/thisruralmission/id/12732239

The Real Victim 01/07/2020

The Real Victim 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 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. This season I knew I had to address the opioid crisis that is affecting rural communities, but I really didn't want to do it in the traditional way. Truly because there is so much to unpack and in my opinion, I think that when we talk about the issue, we have a tendency to either focus on numbers or start blaming and pointing fingers as to why and who and when and who's not being considered and what the real root cause is. Really what I think is that isn't where any of the conversations should start because it doesn't matter. It doesn't matter how it all started. It's here and it's affecting real people and we have a problem. We're going to talk about the real consequences and why we should care and why we all should care is because we're talking about children. When it all boils down, the people who are really affected the most and the longest in the midst of this crisis are kids. So in the efforts of impact and to contextualize this real issue, we are going to tell the story of the Brown family. The Browns adopted both of their children from foster care and the origin story for why they are together and a family today is because of opioids. Back in 2010, Todd and I decided to go for foster care and in 2012 we were gifted with two wonderful children, their ages were nine months and four years at the time. They had been taken out of a home where they received trauma from abuse and neglect and they were placed in our home in a very short amount of time. From the call to the time they arrived in our driveway was about 45 minutes. They came to us, very malnourished. They were very dirty. We believe they were under the influence of cannabis or second hand of cannabis because they were very dazed and confused. Our foster son at the time was very underdeveloped. We could tell that he had speech issues. He had gross motor skill issues and the little girl, our daughter now, which was nine months at the time, she weighed about 12 pounds and she wasn't able to crawl yet. She was just barely rolling over, so they were very much on the lower end of the scale of development. Our children's mother had an opioid addiction and actually her mother overdosed on opioids in front of her and died when the mother was about 19 years old. With the opioids, we have all of our children's medical reports and our daughter, especially when she was born she was born at 31 and a half weeks, so she was very premature. She was less than three pounds. She was addicted to meth and cannabis and there was many things in her toxicology when they pulled it. So they had to put her on Suboxone and a bunch of different other medications to help her come off of that addiction along with trying to build her way up because she was so small and she was a premature. Because of that, now she is a fully developed child. If you saw her, she's very small but she is fully developed mentally and physically and all that, but she does suffer from deteriorated vision in her left eye because of the opioids. So unfortunately she has a patch that's over her right eye right now trying to strengthen her left eye. That's one thing. People will always say to me, "Those kids are so blessed to have you," and to me it's not that. We are blessed to have these kids. These are awesome kids and once you get to know them and once you see how many great things they can do in their life, it's such a treat. It's just such an awesome, awesome experience. According to the Center for Disease Control adverse childhood experiences, or ACEs, are referred to as potentially traumatic events that occur in childhood zero to 17 years such as experiencing violence, abuse, or neglect, witnessing violence in the home and having a family member attempt or die by suicide. Also included are aspects of the child's environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with substance misuse, mental health problems or instability due to parental separation or incarceration of a parent, sibling, or other member of the household. Adverse childhood experiences have been linked to risky health behaviors, chronic health conditions, low life potential, and early death. So if we put some data behind all of this, according to the Institute on Drug abuse, babies being born addicted to opioids has gone from less than one baby per a thousand in 2014 to more than seven babies per thousand being born addicted in Michigan alone. That is an eight fold increase. That means that more than 125,000 children each year are being born either addicted to opioids or living in a situation where they are either removed from their families because of that circumstance or living in a family where there are real consequences of opioid use streaming in almost everything they do in Michigan alone. So it's time to consider this and start talking about solutions. I spoke to five experts on the topic of children and opioids. We're going to start with Marnie Taylor from the Isabella County Child Advocacy Center. She is going to introduce us to ACEs and then we are going to jump right into talking about foster care with my friend Afton and my friend Doug Lewis. Afton is now a child protective service worker and Doug Lewis is, well, he's everything. He's a biological foster and adoptive parent and he has been for more than 30 years. He was a child and teen advocate, a foster care worker, an addictions counselor, a community volunteer, a business person, a pride teacher. That's the class you have to take before you become a foster parent and now he takes care of the homeless in rural Michigan. He's also a light in a dark world. [inaudible 00:08:02] has a high use of opioids and other drugs, but because that is an ACE that is going to increase the number of adverse childhood experiences that a child is going to have if they're exposed to a loved one, an adult who is their main caregiver if they are addicted to heroin or opioid prescription pills. But furthermore, an incarcerated parent causes an adverse childhood experience as well. So if that is happening within families, they have not only a parent who has a substance use disorder, they also more than likely will have a parent who becomes incarcerated at some point in time. So ACEs are comorbid typically because when one adverse childhood experience happens, then it's highly likely that other adverse childhood experiences are going to happen because of the chaos that comes around that experience. Though, if a family is going through divorce for example, that in and of itself is an adverse childhood experience, but then when you start to look at the number of maybe domestic situations might be going out because of the divorce. So that child's being exposed to some kind of maybe abuse or neglect, even if it's emotional abuse or neglect, those kinds of circumstances increase substance use probably increases in terms of coping mechanisms and people dealing with a difficult time in their life. So it's very easy when one adverse childhood experience happens that others are happening along with that. You can talk about it being the choices that their parents make in order to have the drugs or the choices they're making while on drugs. So in terms of neglect, children aren't removed from their families because of poverty. However, there is a lot of poverty associated with drug use because money isn't being spent on food, it's not being spent to pay bills and those create very unsafe situations for children. So you get some of those cases being the reasons that children are removed and then the next broad area is of use and abuse of course gets broken down into the types of abuse. But anytime that you are dealing with someone who is trying to I'll say feed a habit, there may be unsavory characters around and then of course there are people who are caring for children while they are high. We know that part of being on drugs, part of being high is that it changes a person's personality, changes their ability to cope with things. So you have a small child in their terrible twos and you have a person who's high and can't handle that and now we have a situation where child abuse is opportune. Prenatal trauma is that trauma that children will experience in utero while their mother's carrying them. What they're theorizing right now is that we have this genetic makeup, but that our environment can trigger certain genetic things to happen in us. So not only does our genetics determine who we are, but our environment can affect our genetics and in the process change who we are. So if we look at cortisol levels in the brain, those can be genetically triggered by a mother being exposed to domestic violence or having a lot of emotional experiences during her pregnancy that not only is that affect the genetics of the child, but if a woman is carrying a female child in her, it can affect her development of eggs in utero. So not only will it affect her genetically, it could affect her children genetically too, down to the second generation. So it's much more complicated than what we thought. Now, as an adoptive parent, I think we need to understand a little bit what families. I think we need to understand a little bit what family systems may look like in a dysfunctional family. I go back to some training I had when I was young concerning a thing called Karpman's Triangle, where we talk about different roles that people play in an in a codependent family. One person plays the victim and another plays a rescuer, and then they both alternate between those two roles and the role of being an accuser or persecuted or because like how dare you do this? Why didn't you bail me out? Or why do I have to bail you out again?, People began to feel like victims who are rescuers and victims not the relationships to be a rescuer, or so it is just an unhealthy pattern that develop in these families, and you can take them out of that family and put them under other relationships and they tend to duplicate those types of relationships and other systems that you put them in. I think it's important for us to begin to understand how family systems often look like in addictive behaviors. We know that there are some roles that people play. There's the role of the addict. There's often somebody in the family who will be an enabler. They will continue to cover for that addict and try to soften the blow on them. There's often the role of the hero in a family. This is the child who is trying to make everything perfect, organizing the chairs on the Titanic. They're constantly trying to make everything perfect in their lives. They become very stressed out people. Oftentimes as adults, they suffer from stress-related illnesses. We have the scapegoat or what we used to call the whipping boy in the family, is the child who gets blamed for everything that goes on because we're not going to blame the addict and we're not going to blame anyone else. Oftentimes one person in that family will be that scapegoat for the family, and that relationship is really a difficult one because they grow up feeling the sense of guilt and shame for everything that somebody else has done. Oftentimes you will have the mascot in the family. They're the kinds of the clown of the family. They try to make everything smoothed over by being, everything's a joke kind of a thing and they will often self-medicate with alcohol or drugs themselves and does thus perpetrate the whole cycle of addiction. I think one of the sadness when is the lost child in the family, a child who just doesn't know who they are, and they just completely shut down. They'll have problems forming intimate relationships. They'll tend to isolate themselves as adults. A number of my children have come who were born addicted to heroin. Back at the time I was adopting, they were not doing tests routinely in the hospital. I would, for instance, one of my children came to us was I'm two days old. We noticed right away she was almost impossible to soothe. It was because she was going through withdrawal. No one knew. It wasn't until July, we were doing a garage sale at our house and her grandmother came to the house and asked how she was doing. We said, "Well, she," we're both, my wife and are both dazed because we haven't slept in months. We said, "She's a lot to handle." She said, "Well as soon as she gets done going through withdrawal she'll do better." We both looked at it kind of with our heads tilted and said, "What withdrawal are you talking about?" She said, "Well, my daughter was using heroin through her whole pregnancy, and so she was born addicted to heroin." That was an eye-opener. There are certain patterns that often exist in homes where addiction is the centerpiece of the family. We talk about codependent relationships that develop in those type of families, which often, those type of codependent relationships create a whole level of ACEs for kids that are raised in those homes. You take all the genetic things that have happened to these kids and then you take the prenatal things that have happened to him and now you include in that whole process, some really adverse childhood experiences, and you've got what we might consider a perfect storm for these kids growing up. Interestingly enough, I was talking to somebody just today. We were talking about a person who I'm working with who is in their twenties, has never had a birth certificate, never had a social security card, didn't know what their social security number was until a couple of weeks ago. It's been almost an impossible task just to get that identifying information for foster care, adoption that went rough. The worker tells me at age 23, the reason he doesn't have these things is because he's done some things wrong along the way. It was one of those moments when I just, I had to quietly lose it because yeah, he's done some things that he probably shouldn't have done, but there is [inaudible 00:16:34] . He's part of that perfect storm. He's just part of a perfect storm. As adults, we have to take responsibility for our lives, but we also need to be given opportunities to take responsibility. But when you tell somebody you can't get a job where you earn a wage because you don't have even a social security number, so you're going to have to work under the table or do illegal activities, take responsibility? Let's give them the ability to have responsibility. Dr. Julia Riddle is a family medicine doctor in Northern lower Michigan. She treats vulnerable women who are addicted to opioids and other drugs while pregnant. This is an important and controversial topic when it comes to rural health care because what we know is that medical-assisted therapy for drug addicts does help with cravings, withdrawal and the effects on developing fetuses. But the opinions on best practice regarding MAT or medical assisted therapy are endless. Dr. Riddle is making a difference in women's lives and taking care of rural women, rural babies, and helping to cut the impact of drugs before they stem and spread and continue this cycle of addiction. Opiate dependence is a disease. Some people are already in treatment and managing their disease. They're already, maybe on Buprenorphine products and they become pregnant. Other people have been using Norcos or Percocets or shooting heroin and then they find out they're pregnant, and they realize that they have to quit and they can't. Then there's some people who aren't necessarily ready to quit. And despite the fact of being pregnant, not ready to move forward with treatment. Very few of those. Once women find out they're pregnant, they really want to get help and they want to do good. They want to be better. They want to not use during the pregnancy. I would say a vast majority of women are like that. So, if they've been using on the street and they find out they're pregnant and it's not a true dependency, a lot of women would quit. Maybe they only take a few pills occasionally at a party once a month. They quit. They just don't pick it up anymore. I think the vast majority of women though, if they are using opiates, they have a real dependence on them, and they are unable to just stop taking the opiates because they get sick and they go through withdrawals. We don't recommend that women go through those withdrawals during pregnancy. There's all kinds of rehab centers or detox centers where people just go, and they go cold turkey, and they have sweats and vomiting and shakes and chills and they're real sick just to get off of the opiates. We don't recommend doing that during pregnancy because that's harmful to the fetus. I put them on Buprenorphine. That takes away their cravings and it controls their withdrawals. They don't withdraw so that helps them with their physical symptoms. The next step is helping figure out their basic needs, trying to find them a place to live, potentially work if they need it, and then getting them into counseling to help deal with the reason they're using, whether it be anxiety, a history of trauma, which is really common. Relationships, getting out of bad relationships. All those things are really important to healing them and healing their brain, getting them off the street, hanging out with people that would get them into the situation of using again. This is a disease and it is a very powerful disease, and it affects the brain in such a way that it can be really, really, really hard to not use drugs. That's why this medication, Buprenorphine is so important because it gets rid of those cravings, it gets rid of those urges to use and it doesn't make anyone high. If Buprenorphine doesn't work because I sometimes I think it isn't strong enough, that's where Methadone comes in. We don't have access to Methadone in Traverse City. This gets down to the whole rural health concern. We don't have access to send people to that higher level of care. That's sad because I have seen people trying. They're coming into extra appointments. They're taking their medication. They're going to counseling, but the urges are still there, and they need a higher level of care that we just don't have here. We see them and support their pregnancy as much as possible. Sometimes they deliver early because of the stress that puts on the infant, depending on what's going on. It's tough, and it's sad because if we had more options for medications, we could potentially help them do better during their pregnancy. That's one of the reasons I started working in Gaylord, is so that even though it's an hour from Traverse City and two hours from Manistee, we still have that somewhat availability. Well, the greatest rise right now is the opioid epidemic, and a lot of the children are coming in because of the opioids. Not that they're addicted to them, but their parents are so addicted to them, they're being neglected and they're not being cared for in the manner that every child deserves. So we're, yes, physical abuse, sexual abuse, mental abuse, all that is still current as it was for many years. But the drug abuse has completely skyrocketed in our system to the point where we are having trouble as a society here in Northern Michigan to find... /episode/index/show/thisruralmission/id/12648653

People are People No Matter... 12/17/2019

A Rural Connection 12/10/2019

This Rural Mission: Bravery 01/10/2018

This Rural Mission: Bravery Young professionals today are super brave. We move across cities, states, and even oceans - [Julia] This rural mission is brought to you by Michigan State University College of Human Medicine Leadership and 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 . I'm your host, Julia Terhune, and stay tuned for more from this Rural Mission. (bluegrass music) -[Julia] Hello, and welcome back to another episode of this Rural Mission, brought to you by Michigan State University College of Human Medicine. Today we're going to take a little bit of a different route. Today we're going to talk about what it means to be brave. That might seem like a really different topic. Typically we talk about rural health disparities or we talk about social issues in rural America and now we're going to talk about bravery? Well, hear me out for a second We do a lot of brave things in our lives. Some of us move overseas, some of us go out of state to a brand new place to get an education or change jobs and all of those things, every single one of them is extremely brave and courageous, but there's something else that's just as brave and that's going back. Going back to that small town that you grew up in, going back to the place you said you would never return to. (electric guitar music) We're going to talk to a number of people today. Some of the people that we talk to are planning to return to their small town after they graduate. Some are already returning to their small town to get an education, and some swore they would never, ever return but have made a career out of their small town. I encourage you to stay tuned and hear more from this Rural Mission. We've got an interesting road ahead and I'm excited for you to see how brave you really have to be to go back. Daniel Drake, soon to be Dr. Daniel Drake, is a Rural Community Health Program student at the Midland Regional campus. - [Daniel] I mean, I grew up in Caro and Caro is a relatively small town. And so I went up to the UP and I was at Michigan Tech. No one in my family is a physician, no one had gone to a four-year university at all. So I was kind of figuring it all out on my own and when I was at Tech, I heard about an early assurance program that Michigan state did and you took your MCAT early and applied early and so I think I found out it was 2012 when I found out that I was going to go to Michigan State for my medical school. - [Paula] So I'm Paula Klose and I am a family physician, I'm a graduate of Michigan State College of Human Medicine and I trained in the Upper Peninsula campus for my clinical years. - [Daniel] I have always kind of known that I wanted to do rural health, that was always my big thing. Being from a small town, going to undergrad in a small town where I knew I wanted to practice rurally. - [Paula] I wanted to work in a rural community, I wanted to live in a log cabin that I built by hand (laughs). And so when I was applying to medical schools, I chose Michigan State College of Medicine because of the Upper Peninsula medical education program. - [Daniel] With R-CHP, the rural community health program, Midland has a site for that in Pigeon. - [Paula] For the past, let's see, six years, I have been involved with Michigan State again and was asked to be the community assistant dean for the Midland Regional campus. - [Daniel] In Pigeon, it is near the tip of the thumb and Huron County, not far from my hometown at all and it was a place that I was familiar with. I was like, it would be really exiting to go back and just be able to actually practice clinical medicine up there. - [Julia] You grew up here too, didn't you? - [Paula] Yes, yeah. I wasn't born here, but my dad worked for Dow Chemical and never thought I would end up back here again. Pictured myself living in the UP, practicing. And so I was going to use the Midland family medicine residency as a practice interview. So I came down, interviewed with the program, actually learned more about the program than I had known and loved it and so ended up ranking them first and matched (laughs). And so, the rest of the story. - [Daniel] For me, if you would have asked me three years ago or four years ago before I started, I would have told you I will never go back to the farm. I would have said I don't want to go back. - [Paula] So I was not going to live in Midland, Michigan. I was going to live in that little community (laughs), but loved my partners, and my practice, and my patients and it's really an excellent hospital system to work in, so I ended up staying here raising my kids. - [Daniel] As I've gone through this, the training, as I've had kids, it's really dawned on me the importance of community and family. But here in a city, there can still be some anonymity with how you're treating patients, right? Like, you blend into the crowd of a couple other. Couple other. A huge group of doctors. A rural area, if you go back, you might be the only doctor in that town. - [Paula] As I started residency and I had a panel of patients, all the sudden my panel was full of nurses I worked with, friends, friends' parents, colleagues of my father (laughs). So you get into this role that has all these multifaceted dimensions, right? I was also the first female primary care physician in Midland and I had overwhelming interest in being part of my practice. - [Daniel] so your reputation is really on the line and I think that to go into a situation like that, I think that takes bravery. - [Paula] As a woman in medicine in a smaller community, you're already a leader of sorts, so some of that came with the position and the same thing with my position as community assistant dean, you know, that's what I am and I represent the health system as well as the college, so that's challenges. I wouldn't say that it was bravery, but it was a challenge. - [Daniel] I honestly look forward to it though. I think that's also one of the strongest things about practicing rural medicine and one of the biggest benefits about it is the fact that you can really carry a community and help them out and I don't know, I just love that idea. (acoustic guitar music) - [Julia] The voices that you're hearing in this segment are of Ali Hoppy, Elana Rosmussen, and Kala Yob. All three are premed undergraduate students from Michigan. All three of them have something else in common. They all participated in Michigan State University's Rural Premedical Internship Program in the summer of 2016. I'll be telling you more about the Rural Premedical Internship Program or the RPIP program I just a bit, but before I do, let's talk a little bit about what it means to be brave. Ali, Elana, and Kala talk a little bit about that. All three of them have spent time overseas. - [Ali] I went to Ghana the summer of 2015, so after my freshman year of college. - [Julia] So you were 19? - [Ali] Yes, 19. - [Elana] I went to Australia for six weeks. - [Kala] I studied abroad in Segovia, Spain. - [Julia] And how long were you there? - [Kala] For two months. (acoustic guitar music) - [Ali] Ghana more picked me. I grew up in a very small town in the thumb. Rural Michigan. My senior year in high school, unfortunately got a phone call one morning that my oldest brother Josh has been killed in a car accident. My brother, he was a high school teacher. He left a legacy through a lot of people in the way he lived his life. I heard of this trip to Ghana and I just wanted to go. I didn't have any real reason behind it. I just wanted to go and touch as many lives. I saw how short how lives can be but how much you can do in that short time. I just hopped on the plane and went to Ghana. - [Julia] Yet when I ask them what they would rather do, get on a plane and go back to those foreign lands or apply to medical school, I wasn't surprised with the answers that I received. When you think about hopping on a plane and going back to Spain or applying to medical school, which scares you more? - [Kala] Applying to medical school (laughs). - [Ali] Ghana, jumping on a plane, going to Ghana, was hands down less terrifying than filling out a medical school application. - [Elana] I know that I can do it, but I have a hard time with that, getting from there to expressing that to somebody else, I have a hard time with. So I have a really big concern for that part as far as applying for medical school, but I know that once I get in, I'm really excited for that next step, but I'm excited to actually be there and be with the people that have that same feeling that I have a hard time explaining (laughs). - [Kala] I just noticed through this whole process how much of a well-rounded person you need to be and I guess in a small town it's like, that's not the focus. It's just kind of survive, get through, and do your best and then in a small town, it's easy to stand out (laughs) because there's less people and then once you get to the medical school process, you need to know how to stand out, you need to know how to be different. (acoustic guitar music) - [Julia] Dr. Mower is the assistant dean of admissions at Michigan State University College of Human Medicine. Michigan State University College of Human Medicine has had a significant devotion to underserved populations since its foundation in 1964. We were the very first community-based medical education program and we're pretty proud of that. Dr. Mower is responsible for making sure that we are not only admitting the best potential doctors, but that we are also admitting students who are diverse and have altruistic reasons for going into medicine. We want students to return to underserved communities, specifically rural communities, and Dr. Mower has some real concerns about how students get their medical education and where they go when they're done practicing because that's also very important. (piano music) - [Dr. Mower] I think we're a medical school that takes its mission seriously. I think we bring a lot of people in who have a lot of ideals and hopes, and ideas of how they want to serve in the medical field. And so, I mean, I just think that there has to be more, I mean if we're going to be serious about this, I think we have to figure out a way to capture these kids before they show up on our doorstep and we have to figure out a way to continue to monitor and mentor them once they walk away, particularly if it's a student who has identified him or herself as having a strong interest in serving an underserved area, whether that be rural, whether that be intercity, urban, whether that be migrant healthcare, LGBT health care, international developing country health care. I mean, we need to figure out a way to continue to follow and mentor these graduates, even though they are under the direct tutelage of perhaps somebody else right now. - [Julia] Dr. Mower's concern for having a place for rural students before medical school, during medical school, and after medical school is a significant concern and something that should be taken very seriously and we have. Dr. Andrea Wendling has been running the rural premedical Internship Program for several years now. It's a place, a place for rural students to learn more about getting into medical school and to help them feel more confident and prepared. And Dr. Wendling is reaching her goals for this program. Let's just return for one moment back to Elana, Ali, and Kala. Hear what they have to say about returning to their rural community, even though they have gone on to do amazing things both in the state of Michigan and abroad. - [Julia] Why, why rural? I know you said that there's a need, but I mean, you're living in East Lansing, you lived in all these big cities, I mean, why go back? - [Elana] It's the whole package that is really appealing to me. I like the idea of going home. I belong there, I don't belong here in East Lansing. It's just a feeling, I know it. - [Ali] I love my rural community, but for people that have grown up rural, you know when you're there that you're ready to go see something new because you don't know the uniqueness and the specialness of the place you live until you leave it. Going to Grand Valley was amazing for me because it really taught me how much I had back home and how unique and special those small communities are. - [Kala] So yeah, I'm really excited to come here and to practice one day and to be that extra resource for people. And not only to help them, but to have known where they come from. - [Ali] And I was so excited to learn that that's something that you can actually specifically pursue and there's people out there that can help you make that happen and know how to make that happen because when I came into this and I've known that I wanted to go to medical school for a long time, but when I came into it, I thought that I was going to have to establish myself in an urban area to gain the training and stuff. I didn't realize that there was an option to directly go to the rural setting and just learn there, start there, and continue on there. (piano music) - [Julia] I get it, we all want to make an impact, we all want to do really brave and courageous things that last a lifetime and even longer. That's the reason why we go to school, that's the reason why we move places, that's the reason why we work. We want to do great things in the time that we have and I'm not saying that going overseas and going to a new land, or starting over in a brand new place isn't brave or courageous or impactful. I think that there are lots of people that have done amazing things by stepping way out of their comfort zone. What I'm actually saying is that going back is just as courageous. Go back and work at your local hospital making sure that hiring processes are up to federal standards for diversity and inclusion. Go become a teacher back at your hometown, go serve the geriatric community as a doctor, a nurse, or a physical therapist. Go back, do great things with the time that you have in a community that you know and love. In my opinion, that's just as brave. Normally, I end with some music, but today I'm going to end with a poem. In Defense of Small Towns by Oliver De La Paz. When I look at it, it's simple, really. I hated life there. September, once filled with animal deaths and toughened hay. And the smells of fall were boiled-down beets and potatoes or the farmhands' breeches smeared with oil and diesel as they rode into town, dusty and pissed. The radio station split time between metal and Tejano, and the only action happened on Friday nights where the high school football team gave everyone a chance at forgiveness. The town left no room for novelty or change. The sheriff knew everyone's son and despite that, we'd cruise up and down the avenues, switching between brake and gearshift. We'd fight and spit chew into Big Gulp cups and have our hearts broken nightly. In that town I learned to fire a shotgun at nine and wring a chicken's neck with one hand by twirling the bird and whipping it straight like a towel. But I loved the place once. Everything was blonde and cracked and the irrigation ditches stretched to the end of the earth. You could ride on a bicycle and see clearly the outline of every leaf or catch on the streets each word of a neighbor's argument. Nothing could happen there and if I willed it, the place would have me slipping over its rocks into the river with the sugar plant's steam or signing papers at a storefront army desk, buttoned up with medallions and a crew cut, eyeing the next recruits. If I've learned anything, it's that I could be anywhere, staring at a hunk of asphalt or listening to the clap of billiard balls against each other in a bar and hear my name. Indifference now? Some. I shook loose, but that isn't the whole story. The fact is I'm still in love. And when I wake up, I watch my son yawn, and my mind turns his upswept hair into cornstalks at the edge of a field. Stillness is an acre, and his body idles, deep like heavy machinery. I want to take him back there, to the small town of my youth and hold the book of wildflowers open for him, and look. I want him to know the colors of horses, to run with a cattail in his hand and watch as its seeds fly weightless as though nothing mattered, as though the little things we tell ourselves about our pasts stay there, rising slightly and just out of reach. Oliver De La Paz is an associate professor of English at College of the Holy Cross in Worcester, Massachusetts. I want to thank him sincerely for letting us read his poem on this Rural Mission. You can find more of his poems at www.oliverdelapaz.com. (acoustic guitar music) ♫ When I turn to little town Thank you again for listening to this Rural Mission. It's an honor and a privilege to get to produce this podcast. Each topic is more interesting and I get to interview some of the most intelligent and intriguing people. I want to thank some of those people. I want to thank Dr. Mower and Dr. Klose for taking time out of their schedules to speak with me. I also want to thank Dan Drake. Dan Drake is a fourth-year medical student and will be graduating in May. I'm really proud of the things that he's accomplished and he's been an outstanding student and a fantastic person to get to know. I want to thank three student-to-be doctors if everything. I want to thank the three R-PIPe students that I spoke to today, Ali Hoppy, Elana Rosmussen, and Kala Yob. It was great to get to work with them this summer and it was even more fun to get to know them a little bit more through this interview. As always, a sincere thanks to Dr. Andrea Wendling, the Director of Rural Community Health at Michigan State University College of Human Medicine. This podcast would not be possible without her and she is a physician who also moved away and went back. She didn't go back to her hometown, but she went back to her husband's hometown and has worked as a rural family medicine doctor for a number of years. Her contribution to rural medicine, again, is also clinical and academic, much like Dr. Klose's and she does fantastic things to make sure that rural medical students are represented in medical education, specifically at MSU. Thank you to everyone and I hope you join us again next time for more from this Rural Mission. ♫ Picking up the pieces ♫ Of where I should have been ♫ And if you see Michigan State University has been devoted to recruiting, training, and retaining doctors in rural communities for over 40 years. We started in 1974 with the Rural Physicians Program up in Marquette, Michigan and we've expanded with the Rural Community Health Program down into the Lower Peninsula through the Midland Regional Campus and the Traverse City Regional campus. For several years now, Dr. Andrea Wending has been running the Rural Premedical Internship Program or the RPIP program. This program works with undergraduate students who are interested in pursuing medicine as their career. The program preference is premed undergraduate students who are from a rural community or have a significant devotion to a rural community. We run the program every summer and students are accepted through an application process. If you are interested in the Rural Premedical Internship Program, please visit our website at . There you can find out more about the program, its requirements, and even apply. ♫ When I close my eyes and pray ♫ The song's rapt hold and wouldn't let go ♫ Until we went our separate ways ♫ Oh little town oh town ♫ I'm on your streets again ♫ Picking up the pieces ♫ Of where I should have been ♫ And if you see the side of me ♫ That brings me to your door ♫ Then hold me little town ♫ And if you see the side of me ♫ That brings me to your door ♫ Then hold me little town Please visit our website... /episode/index/show/thisruralmission/id/6134798

This Rural Mission: Feeding Rural Michigan 12/27/2017

This Rural Mission: Feeding Rural Michigan 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 . 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 . 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. /episode/index/show/thisruralmission/id/6092398

This Rural Mission: Transportation 12/13/2017

This Rural Mission: Transportation 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 . 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 . 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. /episode/index/show/thisruralmission/id/6041133

This Rural Mission: Women Rural 11/29/2017

This Rural Mission: Women Rural 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 . 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 . 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! /episode/index/show/thisruralmission/id/5992150

This Rural Mission: This Rural Election 11/15/2017

This Rural Mission

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