‘I’ve found my passion in rural health care’

The Nicole Wertheim College of Nursing and Health Sciences received a $1.39 million grant from the U.S. Health Resources & Services Administration in 2017 to provide nursing students in the master’s degree program with innovative training in rural settings. The Advanced Nursing Education Workforce (ANEW) program takes place at clinical facilities in Hendry and Glades counties, about 80 and 100 miles northeast, respectively, of Miami-Dade. The goal is to increase nurse practitioner availability in rural and underserved communities while assisting in the understanding of unique challenges often faced by those who live in areas with limited access to health care.

A Pew Research Center study in 2018 found that rural Americans face longer travel times to hospitals—something that might get even worse as more hospitals continue to close—and feel they enjoy a lower quality of health care than urban residents. Demographic trends of rural areas include lower median incomes and a growing proportion of seniors as younger people move away.

A member of the first cohort to participate in the program, in 2018, shares her perspective here.

By Angelina St. Germain MSN ’18

I am from beautiful Redland, Florida, an agricultural community just north of the Keys. My town is lined with plant nurseries, avocado groves, squash and zucchini fields and strawberry farms. I live with my 3-year old son and my husband, a third-generation plant farmer.

In my hometown there is a sizable community of immigrant farmworkers and American citizens living below the poverty line. For several yearsI worked as a bedside nurse in the local hospital intensive care unit where I had the opportunity to serve such people, the majority of whom were uninsured. Caring for this patient population presented unique challenges, among them language barriers, complex cross-cultural communication and varying health beliefs.

I also learned that geographically isolated areas must be creative in meeting the health care needs of the community. For instance, during my time as an ICU nurse, I used the eICU Telehealth system. Unlike at many other hospitals, our unit did not have a round-the-clock physician on site who specializes in the care of critically ill patients. Instead, during gap times, we relied on telemedicine to address urgent issues and immediately connect with an expert.

Those days in the ICU often had me wondering how individual patients ended up in such a medical crisis. Working closely with them reinforced for me that the heartbeat of health care is preventative medicine and patient education. And those two are the job of primary care providers, the ones who give general health exams and most often detect chronic conditions such as diabetes or high blood pressure beforethey become full-blown medical issues.

As a nurse I witnessed the gap in accessibility of primary care services to rural Americans. When the ANEW program was announced, I saw an opportunity to be a part of the solution, to help bridge health inequities and gain life-changing clinical experience. Off I would go to work in primary care in a town even smaller than my own!

Where in the world is Clewiston, Florida?

I was intrigued by Clewiston for its history of sugar cane production. Known as “America’s sweetest town,” it is located on the south bank of Florida’s Lake Okeechobee and a popular attraction for freshwater bass fishing. When I told friends where I was spending my summer, many of them exclaimed, “Oh yeah, I have driven through there before,” but few could share any details about the area.

From my hotel room window I could see the billowing clouds of white smoke rising from the sugar mill. During the three months that I worked there (staying for two or three days each week before returning home to my family in Redland), I often heard patients report allergy or asthma-like symptoms as a result of “living too close to the sugar mill.” I was interested in learning more about the potential community health hazards of sugar cane production.

I completed my clinical rotation at the Dr. James D. Forbes Family Care Center, a walk-in facility where I shadowed Dr. Shaun Nazar and pediatric nurse practitioner Debbie Mccarthy, APRN. What I learned from them has shaped my attitude toward primary care in the rural setting as well as my professional future. 

My time in Clewiston brought home the severe shortage of mental health professionals in rural areas. On various occasions, I witnessed patients suffering from depression, substance abuse, suicidal thoughts or anxiety—and there was no psychologist or psychiatrist for miles around.I was most inspired by Dr. Nazar, who treated each of these patients, no matter how complex the case, with sincere compassion.He went above and beyond to connect them to mental health resources, even when it meant having to get on the phone himself to arrange for a mental health provider to come to town for a day. Many times doctors tell patients to “go see a specialist,” and that’s the end of the conversation. But Dr. Nazar had to do so much more to ensure their care.

Part of my job was to ask patients a series of routine questions, an aspect of primary care that becomes even more important when people have fewer opportunities to visit a doctor. So I would inquire about smoking and the use of smokeless tobacco—statistically, those who live in rural areas have higher rates of both—and to those who expressed an interest in quitting I offered information about a smoking cessation class in the community, and the doctor might follow up with a medication intended to help them stop. I would also ask about their last pap smear or colonoscopy, as appropriate, to encourage such screenings.

A health care topic about which I grew passionate during my ANEW training is vaccination as I saw first-hand the urban-rural inequities in childhood immunization rates. I have been fortunate to have as my mentor Professor Tami Thomas, the ANEW project director and an expert in prevention of HPV-related disease. My hope is to investigate effective strategies to improve understanding of the HPV vaccine as a cancer prevention tool, which could increase vaccine uptake, reduce stigmaand enhance informed decision-making among rural parents. In December I will graduate with my doctoral degree in nursing, and I have chosen to focus my studies on strategies to increase HPV vaccination rates, particularly among rural middle schoolers.

Abraham Lincoln once said, “Don’t criticize them; they are just what we would be under similar circumstances.” In other words, never undervalue a patient's worth because of their socioeconomic status, culture, creed, age, or health risk behaviors. My mentor, Professor Thomas, always emphasized this message to me: to go in with a humble heart and treat each patient encounter as an opportunity to serve, learn and connect with another human being.