Eastern AHEC June 2024 Rural Health Immersion - Student Reflection: Halina
Healthy Acadia has served as Maine’s Eastern Area Health Education Center (AHEC) since 2023. Our AHEC service area includes Washington, Hancock, Waldo, and Knox counties.
Maine AHECs provide community-based clinical training experiences to health professions students; encourage Maine youth to pursue careers in the health professions; offer training and continuing education programs to practicing health professionals; and develop public health approaches to address current and emerging community needs.
As part of this program, Healthy Acadia and community partners work together to create rural health immersion opportunities for health professions students to learn more about rural and underserved communities, including Rural Health Immersions (RHI) for Care for the Underserved Pathways (CUP) AHEC Scholars. and community-based experiential learning opportunities for non-CUP scholars.
We will periodically publish guest blog posts from AHEC Scholars who have agreed to share their experience with the program.
Guest post contributed by Halina Shatravka, UNE COM Student. Halina participated in our June 2024 RHI and reflects on the experience.
On Wednesday afternoon on June 5th, our group carpooled together to tour the Downeast Community Hospital in Machias, and sat down with Julie Hixson, Director of Marketing and Communications. One major disruption in healthcare that I’ve been following has been the closure of hospitals – both urban and rural – across the United States, which has a devastating effect on patients. The shuttering of maternal units in Maine has been particularly worrisome, as the closing of these units means patients must travel for hours, often in difficult weather, to receive care. It was fascinating to sit down with someone dealing directly with this issue, as Down East Community Hospital is the single remaining obstetrics unit in all of Washington County.
Julie shared that the hospital’s obstetrics unit had only seen just a single birth during the month prior to our visit, a number which truly shocked our entire group. I reflected on a level of complexity that I hadn’t considered previously: the lack of births highlighted a cyclic problem, in which maternal units didn’t have the volume to sustain, in the view of hospital executives, and in which new families and would-be-mothers may feel hesitant to live in rural Maine altogether, given the shaky atmosphere of closures and limited services in more rural areas.
As a secondary issue, this makes it difficult to attract new medical staff, particularly if they are keen on starting a family. I reflected on the issue of volume-based metrics for hospitals and thought that a new model of healthcare altogether needs to exist in the United States, which isn’t determined solely by profit.
Julie mentioned that, as part of the solution, the hospital would get involved in the housing sector to secure living for healthcare workers as an added attraction and benefit. While I knew that housing costs are exorbitant in places like New York City, where I’m from, I was surprised to hear that the housing crisis also plagued Washington County. We learned that the volume of housing stock was inadequate and that building costs to create new structures from the ground up are immense, with a shortage of workers in that realm, too. Julie shared with us that as a result, medical personnel could not find housing – which plays a role in their ability to live and work in rural Maine. On our later visit to Lubec’s Regional Medical Center, similar sentiments were uttered: housing was prohibitively costly, and daycare centers were shuttering, which made it very difficult for growing families and the medical workforce with children to sustain and thrive.
Despite the difficulties of hospital unit closures and staffing challenges, Julie expressed an attitude of independence and strength as it pertained to Downeast Community Hospital, which was commendable as the many mergers and acquisitions of hospitals across the country often lead to worse outcomes for patients.
Later that day, we visited the Downeast District’s Maine CDC and met with the Public Health District Liaison, Alfred May, Jr., and two public health nurses, all of whom work in proximity. Our group learned that this district actually covers two counties, both Washington and Hancock County. I wondered if, with such a large territory to cover, the group was spread thin – but the team was immensely resourceful. The CDC nurses discussed an important environmental issue and public health initiative currently affecting Mainers, that being well-water testing for bacteria and arsenic.
Having lived in Washington County as a child with my dad, I instantly recalled the day our family had a well drilled in our yard, and how we sat for hours marveling at the workers drilling in this new addition – with not a single thought of the dangers of arsenic on our minds. This highlights how truly important the work of the Maine CDC is in promoting the health and livelihood of Mainers, and how powerful and vital public health infrastructure is in the United States—particularly in rural communities.
We also discussed the findings from the group’s report, the Downeast District’s Health Profile of 2022. Compared to the entire state of Maine, Washington County had many alarming findings: higher than average numbers of opioid-related hospitalizations and higher numbers of drug-affected infants, among others. I reflected on how truly immense the needs of rural communities were, and how, despite the massive challenges ahead of them, local organizations were inventive in approaching and finding solutions to these issues.
Later that afternoon, we visited the Safe Harbor Recovery Home for Women and Children, which is a model of community healthcare unlike any other. I am conditioned to think of “healthcare” as something that happens in shiny, long corridors, but Safe Harbor acts as a bridge between a traditional clinical setting and housing to allow women to stay with their children as they recover from substance use disorder. I was surprised to see a neat, welcoming home with a beautiful sunroom and backyard garden, and a resident cooking a pasta dinner. We learned that residents in the recovery home must commit to doing multiple pro-social activities per week, like attending recovery meetings. We met Lauren and Katie, who work in managing the home and in providing support to its residents. I reflected on what a difficult job it was for two people to manage such a robust operation that requires 24/7 attention, but Lauren and Katie shared with our group that, while difficult, the work was very personal and intrinsically meaningful.
A local told me how to pronounce “lupine” properly, and we were lucky to see them blooming in-season in Machias.
Overall, the day left me with a strong impression on how powerful the local community and organizations were in identifying and addressing issues with unique approaches, even given limited resources or limited staffing. Safe Harbor Recovery Home, for example, took a common-sense approach in its mission to keep women in recovery together with their children. These sorts of person-focused approaches contribute to better outcomes for patients. I reflected that rural communities had their strength in working together in an autonomous way that is not always visible in more urban environments.