Caring Through Sharing: One PNWU Student's Plan to Improve Healthcare Across Rural America

UNADJUSTEDNONRAW_thumb_d2e9_preview.jpg(Yakima, WA) According to the National Institute of Health (NIH), pain affects more Americans than diabetes, heart disease and cancer combined, and stands as the most commonly cited reason for people accessing the health care system each year. The NIH also states that one in every four Americans suffers from chronic pain. It is the most common cause of long-term disability, and treatment with opioids is often viewed as one of the major contributing factors to our nation’s ongoing opioid epidemic.

As many of the factors associated with chronic pain, including obesity rates and average age, continue to rise, Americans are faced with a mounting public health issue that is expected to get worse.  

The devastating effects of chronic pain are visible across the United States, and especially apparent in rural communities. In places like Lincoln County, Idaho, the toll that chronic pain is having on the population is painfully obvious and explicitly crushing.  

Despite its size — approximately equivalent to the entire state of Rhode Island — the expansive landscape of Lincoln County is home to only around 5,300 people, most of whom work in the farm industry. The labor-intensive and often dangerous demands of farming are complicated by our nation’s overwhelming need for health professionals in rural communities. Only about 10% of all physicians practice in rural areas despite the fact that about 20% of Americans live in those areas. This trend has played a major role in making Lincoln County -- where there is only one medical clinic -- statistically unhealthier than nearly every other community across the state of Idaho.  

Third-year Pacific Northwest University osteopathic medical student Jacob Thatcher has witnessed the devastation first-hand. Six generations of Thatcher’s family have farmed the fertile lands of Idaho, and he has seen the price they’ve often paid for their hard work and dedication. 

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“My grandpa recounts stories of summers spent working on his cab-less tractor as young as 10 years old,” said Thatcher. “He often said, “The best equipment a man can put on his land is his shadow.”” 

Thatcher’s family tamed the land, where there was no such thing as a “sick day,” and pain and fatigue were part of the sacrifice to put food on the table. While today’s generation has it a bit easier — with cabbed-tractors, air-conditioning and even GPS — proof of the attrition of life on a farm is not hard to find.  

“Over 60 years of hard work have taken a toll on my grandpa,” said Thatcher. “Initially, the opioids controlled my grandpa's pain enough to continue farming, but soon, it was his dependency on them that would prevent him from continuing our family tradition.”  

In his first year at Pacific Northwest University of Health Sciences’ College of Osteopathic Medicine, Thatcher plunged into the pathophysiology of dopamine. As he did, his grandfather slid deeper into opioid dependency and, for the first time in six generations, everything the Thatcher family had worked for was at risk of being lost.  

The family helped his grandfather to countless medical appointments, including Osteopathic Manipulative Therapy (OMT), to combat his pain, but it soon became apparent that his inability to control the pain, coupled with his hesitancy to talk about his opioid abuse, were a problem facing not only the Thatcher’s, but countless farmers throughout the region.

Determined to do something for his family and his community, Thatcher applied for, and was chosen to be a Paul Ambrose Scholar.  

The Paul Ambrose Scholars Program is a cohort of students from health professional programs throughout the country with an interest in public health. Scholars arrange and complete projects which aim to achieve the goals of Healthy People 2020, the federal government's prevention agenda for building a healthier nation. Thatcher set his projects crosshairs on substance abuse. 

In conjunction with the Shoshone Family Medical Center and Hazelden Betty Ford, and thanks to a grant from the Health Resources and Services Administration, the program has provided the tools to begin exploring options to improve the lives of the people in rural communities like Lincoln County. A micro-research RuralPREP grant through the University of Washington and Ohio Heritage University is helping to provide the funds necessary for the program to be successful. 

“Shoshone Family Medical Center is the only clinic in the county," Thatcher explained. "Despite the challenges of running a private clinic in an underserved area, Dr. Davis has provided incredible care for his community for over 30 years. This progressive environment, coupled with provider retention issues, reimbursement cuts and an opioid epidemic, created the perfect arena to test the efficacy of Shared-Medical Appointments (SMAs) in Chronic Pain.” 

Thatcher has started hosting bi-monthly SMAs to evaluate the effectiveness of treating patients with chronic pain. The appointments, which offer an innovative, interactive model to healthcare by bringing patients with common needs together with one or more health care providers, have been largely untapped in regards to treating chronic pain, explained Thatcher.  

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According to a meta-analysis published in the Journal of Osteopathic Medicine, S.M.A.s have been shown to be more effective than the traditional office visit at not only motivating patients, but reducing hospital admissions and emergency department visits, which is particularly crucial in rural health care settings where resources are limited, practitioners are overburdened and more health care professionals are desperately needed.  

“We believe our osteopathic approach and collaboration with Hazelden Betty Ford and the Chronic Pain Association will truly benefit these patients in Shoshone and, perhaps, serve as a pilot program for other rural medical clinics around the country to mirror and adopt,” said Thatcher.  

Today, Thatcher’s grandpa is improving. Though his pain is still debilitating, he has discovered alternative ways to control it.  

This month he will drill wheat for the 70th time.

“I believe his principle method of recovery has been connecting with another farmer with similar issues,” said Thatcher. “If all goes well, my grandpa will be farming the soil of Idaho for many years to come.”