This Rural Mission

We spoke with experts on bringing fiber internet to rural Michigan. Bringing fiber internet to rural Michigan can reduce major barriers to educational, healthcare, and economic opportunities and benefit whole communities and families. We also speak to Dr. Edward Smith on why advocating for remote areas as a physician is so important when decisions are being made based off of what can be done in urban areas.

Transcript:

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.

So I was sitting with my spouse talking about jobs, and life, and he got off on a tangent, considering our connection to the internet and the current state of our rural communities in light of our current internet connection. And it struck a chord with me, and it became the impetus for this whole episode. So, I had to start recording him.

The reoccurring theme that he brought up and the one that will be reinforced throughout this podcast is that access to the internet in rural America, including rural Michigan, is bad, plain and simple. It's bad.

Many rural residents are currently living with limited or no access to the internet and being left behind. Sometimes when I bring up this point, I get push back, and I have people who argue that technology is a choice or a privilege. But where did you get your last bit of news from? How did you access this podcast? How did you apply for your last job? This last point was significant to my spouse because of what he does. He helps connect and mentor low income and transitioning persons to careers and jobs. And this limited access to the internet has been keeping him in business.

What happens to them? They get all this information about applying for jobs, and access to jobs and they have these fantastic resumes, and they're motivated, and they have accountability through your program, but then they go home. What are they going to do? How do they, what is their experience when they go home?

That everything stops, they get motivated, they get excited, they get interested, and they actually are looking for ways to apply for jobs, looking for ways to get jobs, but you can't go online and study for your driver's test. You can't go online and study for your-

GRE.

GRE-

Well, no, GRE's graduate, but GED?

GED. Yeah, and that's where a lot of people are.

Yeah, you were talking about occupations, but I would take that even to just being a functional member of society. You can't engage with other thought processes. You can't engage with other opinions. You can't engage with current events without being connected to something digital in this point in human history.

I don't want us to make it sound like everybody in rural communities are in the dark ages.

That's not true.

Because they're not, but I believe that they will be soon. That's not good enough.

After the repeal of the Obama era net neutrality regulations in June of 2018, the chairman of the United States federal communications commission, or the FCC, was quoted by the Washington Post as stating, "And in the medium to long term, I think we're going to see more investment in high-speed networks, particularly in rural areas that are difficult to serve."

This is our hope too. Rural America accounts for 97% of our country's total landmass. That's 2.23 billion acres of land, and 20% of our population according to the United States Department of Agriculture. But those stats actually are quite worrisome. We're talking 20% of our population spread out over 2 billion acres of land, which makes connecting them to the internet expensive, difficult, cumbersome, sometimes impossible. So because of that, it's not always a key priority for many for-profit or private internet providers.

Historically, much of this expansion has been funded by the government and carried out by nonprofit agencies, meaning that historically and currently rural internet access is a federal and state concern.

Since 2011, the federal government has funded the Connect America Fund, and it has worked to expand and increase internet and broadband access to millions of Americans. The FCC stated on their website the following quote, and I'm reading it, "The Connect America Fund aims to connect 7 million unserved rural Americans to broadband in 6 years and puts the nation on a path to connect all 19 million unserved rural residents by 2020."

The FCC launched this unprecedented broadband expansion in 2011 when it reformed and modernized the Universal Service Fund, which connected rural America to the telephone network in the 20th century. The commission created the Connect America Fund to unleash the benefit of broadband for all Americans in the 21st century.

In the first phase, about 115 million of public funding will be coupled with tens of millions more in private investment to quickly expand broadband infrastructure to rural communities in every region of the nation.

Joe McCue is the manager for Fiber Assets for Great Lakes Energy. The energy co-op that supplies most of northern lower Michigan, Kalamazoo all the way to the Mackinac bridge. Great Lakes Energy has taken charge of installing, managing, and maintaining fiber connections for all nine of their service areas. They are starting with their Petosky service area and as Joe puts it, writing the book on how to connect their rural communities to fiber internet.

So, how we fit into this is, we're an electric cooperative. Cooperatives were started back during the depression. The farmers didn't have electricity. It wasn't cost-effective to run electricity out to the farms.

So President Roosevelt came up with the Rural Electrification Act, I think it was of 1935, and all it did is it guaranteed loans for the farmers to start cooperatives to build electric facilities, the poles, the wires, everything out to them and start electrifying the farms. And so that took hold. And that's why you have all of the electric cooperatives in America.

Still to this day.

Still to this day, yeah.

So how does that feed into what you're doing now?

We kind of look at it as like the second evolution of our purpose, I think, is what it comes to. It's like, your generation, kind of at the start of my generation, is like, if you heard nobody didn't have electricity, you'd be like, what? Everybody's got electricity. How has that even possible? We want electricity everywhere.

But, we're going to be the ones that remember people not having internet. And in 20 years from now, everybody's going to have high-speed internet.

So that's where we see this as we own a lot of the infrastructure needed to do it already. We have all the poles, we have the right of ways. And so, it's another wire up on the pole, shall you say.

And I always tell everybody, you're never going to find a better organization than Electric Cooperative to build and maintain wire and pole infrastructure.

And so prior to this, what has the infrastructure of Northern Michigan or rural Michigan looked like?

Pretty much you were down to cellular communication, and then also they call it fixed wireless that you can put in, very limited due to the hills and the trees. You can't get the signals through the trees with wireless. And then you had the phone companies, you had telephone service on copper line that was out, but you could not use that for this high data traffic output that you need. You'd have to have fiber for that, and the volume, the amount you want.

And then in the cities, in the towns, you had cable companies come in, and they would start putting that cable in, co-ax cable, and they're able to use that, and then give high-speed internet to their subscribers. It's very expensive for them to go build out into the country.

And while what Joe is describing might seem like "enough" for rural communities, it's a very different story when it comes to actually working and functioning within the current infrastructure.

The problem is, is a lot of times what everybody gauges is good and acceptable. And I always equate it to, if you had a bicycle and you had to ride to work every day, you'd say, this is great. I don't have to walk. But if I come in and then bring a car in, and give you a car to drive to work, you're going to think, well yeah, this bicycle was terrible. Why did I ever have that? But it was better than walking.

So that's what I think everybody out in rural Michigan is going to find out when we bring this high-speed internet to them. A lot of people know it already, that come up here, we have a lot of transient them come up here, and part-time residents who have it down in the cities and they come up here and realize, Oh my gosh, it's not even available. You can't even get it.

So with all these grants and these funds being allocated by the government for this specific task, it must be an important aspect of society to have internet.

Oh yeah. Yeah. When we started looking at this, and like I said, I've even lived in, so... Boyne City schools, which is rural school here in Northern Michigan and many others, I just know this, my kids go to school. Elementary school to get an iPad, middle school, they get a Chromebook. High school, they get an Apple actual computer and all of their books you'd think, Oh, they're loaded up in the computer. They're not. They're out in the cloud. Everything's going out in the cloud.

So they need to have a link to look at their textbook. It's not actually loaded up on the device itself.

But, what did kids do? Who are way out in the country?

You have to go either get the cellular connection, which is expensive, very expensive. Or you go to the library, schedule time at school, go to grandma's house. My kids go to grandma's house because she lives in town, and they can get a high-speed internet connection there. So, I've actually had to sit at the library with my kids linked up so they could do their homework.

So, that's really interesting because there might be some people who don't have those.

No, but there are people that don't have that. And then to try to come in, it's hard. Mom and dad are working shift work, or they only have one car. You can see where you start to get the massive disadvantage. And that's just education.

So my parents, they're both in their seventies and have to go to doctors and everything, and they're down in Ohio. They go to the Cleveland clinic. I remember my mom called me. It wasn't more than, not a year ago. She could no longer call somebody to schedule her doctor's appointments. It all has to be done online. Now they have internet access, and that's not a big problem for them. But that situation is here. So your interaction with your doctor is going to require a high-speed internet connection.

And I mean interaction with the government, anything you do with the government right now is, you need internet connection. Taxes, social security-

Your Bridge Card-

Your Bridge Card, any forms that you need done that is all done through internet.

So without this, essentially we could perpetuate that cycle of poverty.

What I heard at one of the symposiums I went to was that, if we did not do this, rural America could slide back 20 years.

There are bigger issues with that 20 year slide because it doesn't just change how we connect to our social media accounts or apply for jobs. It's a systematic issue that could impact all of our rural counties in Michigan who are run by the same state and federal government. And some of these policies are very inequitable, but that's why Great Lakes Energy is doing what they're doing.

But, the standard for education, what we're deciding to do at the state level with education, for rural education, is being based off of what's going on, what we're capable of doing in Grand Rapids.

Correct.

Or what we're capable of doing in Lansing.

Yep. Even in the suburbs, and in Boyne City itself, if you lived in Boyne City, there is the cable company, there's Charter, and then there's the phone company.

This effort I think is going to be just a huge changer especially for the rural society, for rural America out there. So I think this is going to just again, not let rural America slide into 20 years ago.

And then business-wise, small business-wise, I mean we've seen that already from people who A, can work from home now. The small home businesses now have access to global market. You can sell your stuff on an eBay or Amazon, or whatever you want to do. But, you have to have a really good communication system set up with high-speed.

Education-wise, when I was a kid an encyclopedia was awesome. I can only imagine having high-speed internet, and if you didn't offer that to a kid that had to go to an encyclopedia, and another kid that had access to everything on the world wide web, it's night and day difference. They're just going to get left in the dust.

Dr. Edward Smith is a rural hematologist oncologist in St. Ignes, Michigan. That's the city just passed the Mackinac bridge. He serves cancer patients from all over the Upper Peninsula, patients who are not only very underserved but also with very limited access to healthcare and resources like modern technology.

A few years ago, Dr. Smith worked with a team from Blue Cross that was trying to develop treatment and quality assessments for patients across Michigan, and Dr. Smith spoke up about what he was facing in the Upper Peninsula. What came next, was two oncologists from the University of Michigan who took the time to come up and understand what barriers the patients they were living with.

A lot of what they were trying to do such as contacting patients by phone for follow up, or having them call in, or go through internet portals and stuff, sounds real good except we have patients that live in places in the Upper Peninsula that they don't have internet, or they don't have telephones. And even some of them, some patients, even to make a cell phone call, they have to drive a couple miles to the top of a hill to get cell coverage.

And, there's places in West Makinac and in Lewis County where there aren't power lines, and there aren't internet. That's just how it is. Some people live in very remote, isolated areas.

And so my contribution, so to speak, to that whole thing is on as well as the Michigan Oncology Quality Consortium, which I'm part of is to say, look, not everybody has these things. And to people that practice in major metropolitan areas, they just don't picture the fact that not everybody has a computer, and people don't have internet. So I mean, you have to realize that not everybody has the resources to do all this kind of stuff.

And so when insurance companies or the government want to start making rules and involve this, they really need to take into consideration not everybody has these resources.

At one of the meetings, I was telling them about the challenges that I face doing oncology in rural areas. And to their credit, they came to St. Ignes, and they spent a day and a half with me, seeing the facilities, understanding what was here. I took them to Newbury and to St. Marie, and took them to the places where people live so they had a better picture of how far people have to travel for stuff.

The fact that not everybody has phones, and internet, and many people drive the total of four hours a day if they need radiation therapy, and it just isn't that easy for the people that live in these remote areas. And even when they do get to a hospital, that's very, very limited.

And to their credit, they came up and went with me so they could see it. And on top of it, they actually interviewed the patients that had to do this stuff. So they probably interviewed six people that had to get some of their treatment, not just locally, but people that I had to coordinate it with through the University of Michigan.

And when I asked Dr. Smith about the outcome of his advocacy, I found that he really did make an impact.

Yeah. They were very appreciative of the challenges we face. And then when we have been at these Michigan Oncology Quality Consortium meetings, looking at standards and stuff, we'll refer to things as what we learned when we spend time with Ed was...

And they're finding out that some places in the Upper Peninsula, one of the other providers, they have no hospice in their county. One of the big things is when we refer patients to hospice that doesn't exist, or the hospice people might take a week to get out there.

So they're, they're finding out that the distance that people travel, and the resources made available are very different. And so you have to think about that when you start coming up with quality measures in deciding when you're going to pay for value-based reimbursement.

Now, not everyone can take a two day trip to the UP, and interview patients in order to understand the importance of equitable policies and the need for adequate infrastructure for rural communities, which unfortunately leaves many people who live in these remote places in the dark. Sometimes literally.

Dr. Smith was an advocate for his rural communities, and it brought about awareness to the needs of his patients. Great Lakes Energy is making decisions every day that is going to bring about significant changes to Northern Lower Michigan.

But as I say in almost every episode, there is still so much work to be done. The work right now, in regards to what we've been talking about, is bringing rural Michigan and rural America on an equal resource plane as urban America.

It starts with leaders like Dr. Smith advocating for their rural constituents, but it also includes policy makers. And policy makers that are considering the most underserved and resource-poor communities when making changes in manifestos. Right now is a crucial moment for rural communities, and if it's going to work, we are going to have to work together.

Thank you for listening to this Rural Mission. I would like to thank Dr. Ed Smith and Joe McCue for agreeing to be interviewed for this podcast, and I'd also like to thank my husband, Daniel, for letting me take over our Sunday afternoon conversation. As always. I want to thank Dr. Andrea Wendling, the director of the Leadership and Rural Medicine Programs at Michigan State University for making this podcast happen.

This is our first episode of Season Two. We are so very excited to bring you more episodes this year. We hope you'll tune in every week this fall. I'm your host, Julia Trehune, and I hope that this podcast inspires you to make rural your mission.

Wherever you send me, I will go. Wherever you send me, wherever you send me, wherever you send me I will go. Alexandria to Baltimore, Statton Island to New Jersey shore, to Ohoma or to Pigeon Forge, Lord, I will go. Montebella down to Oceanside. Pasadena or to Paradise. Sacramento up to Anaheim. Lord, I will go. Wherever you send me, wherever you send me, wherever you send me I will go. Wherever you send me, wherever you send me, wherever you send me, I will go.

Albuquerque down to Sante Fe. San Antonio to Monterey. New York City down to Tampa Bay. Lord, I will go. Anaconda down to Evergreen. Broken Arrow to Abilene. Independence or to [inaudible 00:23:00] Lord, I will go. Wherever you send me, wherever you send me, wherever you send me, I will go. Wherever you send me, wherever you send me, wherever you send me, I will go. Wherever you send me, I will go.

Music today was brought to you by Bryan Eggers. We are always grateful to Bryan for his tunes that make our podcast better. Check him out on Facebook!

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 www.msururalhealth.chm.msu.edu. 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 www.msururalhealth.chm.msu.edu. 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 at www.msururalhealth.chm.msu.edu. 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.

to live up to our potential and make a positive impact on our world. Moving back to that small town that you swore you would never return to can also be a very brave thing to do. Think about it... Make a name for yourself in a completely new city? Or try to convince your high school English teacher that you are capable of managing their healthcare? For the students and doctors we are talking to on this episode, that is exactly what they've done! We also highlight a program that has been helping rural undergraduate premedical students matriculate into medical school and live out these brave, brave career choices.

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 www.msururalhealth.chm.msu.edu. 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 www.msururalhealth.chm.msu.edu. 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.

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 www.msururalhealth.chm.msu. 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 www.msururalhealth.chm.msu.edu. By joining our website, you can connect with us on Facebook, Instagram and Twitter. You can also find out more about our musician. Music today was brought to you by Horton Creek and Byran Edgers, a local musician and Michigan native. I hope you tun in next time for more from This Rural Mission.

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 www.msururalhealth.chm.msu.edu. 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 www.msururalhealth.chm.msu.edu. 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!

The outcome of the 2016 U.S. Presidential Election was influenced by the rural vote. Host/Producer Julia Terhune talks to Michigan State University and Michigan State University College of Human Medicine students and faculty to see how perceptions of rural America have changed since the outcome of the election.

Transcript:

-[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 and Rural Medicine programs please visit www.msururalhealth.chm.msu.edu. I'm your host Julia Terhune and stay tuned for more from This Rural Mission.

(folk music)

Just after the 2016 presidential election I did what every good wannabe podcaster does. I took my little voice recorder and I went and spoke to a bunch of undergraduate students. Well, maybe a few of them were graduate. I don't know.

(lively guitar music)

Every student that I asked, I asked the same question. What is your perception of rural America after the onset of the election? Most people I spoke to didn't even know what I was talking about when I said the words "rural America".

- [Man] Rural America?

- [Woman] What do you mean be rural America exactly?

- [Woman] What does this mean? Like which part of America are we referring to? Like just farmland America?

- [Woman] I don't know honestly. Just like... I mean...Yeah, it's like farmland and stuff, but I don't know.

- [Julia] The other group didn't have much to say.

- [Woman] Um, it hasn't changed.

- [Man] I think it's a hardworking community. They do a lot for our country. I mean, again, my opinion hasn't changed of them since the election.

- [Man] I think that they're a very hardworking down to Earth people.

- [Woman] Honestly they kind of stayed the same.That there were hardworking people.

- [Julia] But of course I couldn't ask about the election and rural America without talking about racism.

- [Woman] Are you asking if I think that there are a whole bunch more racist people in the world or something? Um, I don't know. It kind of depends. Like, I'm from small-town Texas, so what could be considered rural America, and I know for a fact that my folks voted for Trump. And I was super against it but they didn't vote for Trump because they're racist. They vote for Trump because they're both in the military and, you know, what he was saying was gonna benefit the military more and Hillary, you know, did some horrible crap that military folks could just never forgive.

- [Man] I just feel that people from rural America get like a lot of... Like a little bit of malice from the people from the city and people really aren't that bad from rural America, so.

- [Julia] Well what do you mean by "not that bad"?

- [Man] I don't know, there's kind of just like a sentiment that we're all like racist or we're all like, I don't

know, anti-immigration. But really a lot of us are from different ends of the spectrum, and we're also... Admittedly we're not very...We're not quite as exposed to other, I don't know, other people, it is mostly white out there, but we don't feel like we're racist. We don't judge people, so, I don't know. But I feel like we still get a lot of malice for that.

- [Man] My mom grew up in like up north areas of Michigan and they seem to be a little, I don't know, a little far right. I'm not saying that it's a bad thing or a good thing. I just think that it's just sort of... They seem like they're a little bit disconnected from the rest of the, I guess millennial generation. I don't really know much about it 'cause I'm not from there but I think that they're just sort of closed... I'm not gonna say closed-minded because that's sort of, I don't know, sort of a stereotype. But I think that, I don't know, that somehow they need to get more involved but I don't know how they can do that because they're so far away from everything, you know what I mean? So, I mean, that's kind of it really.

- [Julia] And then there were instances like this.

- [Man] Undereducated. Believe what they want to instead of look at facts.

- [Woman] They're probably not exposed to the more urban, more current understanding of other people because they're stuck in their old ways in their little farmhouses. So they're not really exposed to a lot of different kinds of people.

- [Julia] It wasn't enough for me just to canvas Michigan State University. I also wanted to hear from the people who are from rural America. The people who are serving rural America and the people who are vowing to serve rural America. The voices you're about to hear on this podcast consist of a number of individuals. We are going to start with Doctor Andrea Wendling, the director of Rural Community Health for Michigan State University and a family medicine physician in northern Michigan. She spoke at a round table we held with Leadership and Rural Medicine medical students after the outcome of the 2016 presidential election. All of the students sitting at that round table have devoted their clinical medical education to rural communities. This was Doctor Wendling's first comment to the group.

- [Doctor Wendling] Okay so our question for tonight is how did this election impact your vision of rural America or your feelings about rural America. My feeling is that, you know, my whole life is trying to figure out rural disparities, right? And trying to help rural populations. I think a lot about rural, I dream about rural, and so there was a lot that went on during this election around the time of the election where there were a lot of root words that were floating around like "racist" and "homophobic" and , you know, a lot of negative words. And you know, they were kind of being um...You know, they were kind of being assigned to people who supported Trump, okay, or people with conservative ideologies, right? And then it was really hard for me internalizing so much about rural America. Watching that night, like, county after county after county turn red and having people feel like okay every rural county is gonna be red and every urban county is gonna be blue when I knew that there were all these words attached to this feeling, right? You know I think at the beginning I was, you know, I was upset because all these words were attached to it, but then as you think about it there were a lot of reasons why... You know there was a lot of conversation that happened as part of the election, you know, I think that all of a sudden these issues that face rural America that are really significant, meaningful issues like the economic disparity and the educational disparity or lack of educational opportunities and lack of feeling hope, you know, that your future will be different. You know, that kind of came to light and so there's part of me that feels like it might be an opportunity because this is stuff that was not a surprise to me, right? But seemed like it was this huge surprise to everybody. They're like what happened? Why is everybody so unhappy in rural America? It's like, have you looked at it? (laughs) You know have you seen why people are so unhappy?

(light piano music)

- [Julia] Doctor Joel Maurer is the Dean of Admissions at Michigan State University College of Human Medicine. As a rural native himself and a physician for many years he also had a profound insight to the needs of rural America.

- [Doctor Maurer] Understanding that, you know, I was disappointed with the result, I kind of admire rural America for kind of figuring out a way at the grass roots level to say you can't ignore me anymore. I kind of admired a marginalized group of individuals figuring out a way to have a major impact in the leadership of this country. At least for the next four years. You know, I use Nebraska as sort of my example. And the thing that I think people tend to overlook about the state of Nebraska is that at least if you look at the Democratic side of that state, in the primaries that state went Bernie. So did Oklahoma. So did Wisconsin.

- [Julia] So did Michigan.

- [Doctor Maurer] Michigan, right. I think that in and of itself should be an indicator to the, at least the leadership of the Democratic party, that there's a certain amount of unease and unrest that's going on in some of these states. They just need some attention from someone.

(light guitar music)

- [Julia] But what is more significant is what the students themselves had to say about serving a rural community after the outcome of the election.

- [Woman] Oh yeah, I'll be really honest about how I felt, like the next day one of the first things I said was that I don't want to go to Traverse City anymore. Like it was really a shock and it was hard. And I think that one of the things that someone said to me, my brother said this to me right away, is that these are people that you're gonna be helping, like what you're describing and you have to understand where they were coming from.

-[Woman] I was a medical assistant in Marquette for a while before med school and would hear things from people that were kind of like a racist undertone or... It's these weird things. So I think I always in my head have kind of known if you're working with people, and not necessarily from like Marquette but people who are from these tiny little one stoplight towns outside who are driving two hours to come to Marquette because that's the big city where they're gonna get care, like, it just doesn't necessarily surprise me to hear certain, I don't know, I've heard certain viewpoints before that I disagree with and was still their medical assistant and was able to in my head be like wow I don't agree with what you just said but I can still treat you like a person. Their medical care is what... It's what matters. So I guess, yes it was made more public, but my whole viewpoint of I don't agree with these people I said I'm still gonna treat these patients didn't necessarily change for me.

- [Woman] One of the things that really bothered me was like the generalization of rural America. Because I know so many people that are very well-educated, very well established that both do and do not support Trump. And yet, both alike get thrown into this general stereotype that oh, because you're from this area you're uneducated, you're racist, you're this and that. If you're from these towns, regardless of your standpoints then this is what you are.

- [Man] Another thing too though, that I also noticed with my conversations were we're all healthcare people and so we are super focused on healthcare. And I don't think I ever had a single conversation with people that did support Trump that started or ended with healthcare.

- [Woman] See, I have a different experience. I had multiple conversations that started with Obamacare. Very anti-Obamacare because of all the inflation and health costs and what they didn't realize was that the inflation of health cost comes from other things that we just had a lecture on. There was three pages of a document of just listed things that made healthcare more expensive. And when push comes to shove some of the general population just doesn't understand it because they're not from a healthcare perspective.

- [Woman] Also I'm confused.

- [Woman] I don't understand it.

- [Woman] Yeah it's really confusing too. And so when they bring up Obamacare and they say... They throw this one fact, this one fact that you're unfamiliar with, but you show them all this other facts but you're not able to address that one thing that you're just unsure of. It's like you cannot connect. Even though you know from a different perspective what may or may not be better or what's true.

- [Woman] Similar to that, I forgot where we sat, but someone was talking about how there is racism and sexism in this country. Like those are just things that exist. But they're really subtle and it's these tiny little things to have these nuanced discussions about ways sexism exists in everyday life, ways racism exists in everyday life, that you really have to dissect and think a lot about to understand, whereas if you don't like Hillary Clinton people can just be like oh she's crooked. But to explain why the subtleties of sexism and why sexism lead to why you think Hillary's so crooked. You know what I mean? Like, that's a very long, deep conversation versus just being like yeah, she's crooked so I would never vote for her. And that's the end of the conversation. Or like, explaining how racism exists in society versus being from an all white town where you've never dealt with minorities and being like racism is over, what are you talking about? We have a black president. And that's just the end of the conversation. You know, like it takes a certain level of education just to be able to dissect these issues enough to know that they're even there.

- [Julia] How do you think the perception of rural America in the media right now is going to affect future leaders, future medical leaders. Students right now who might want to go on and serve those communities. Do you think it's going to be a deterrent?

- [Doctor Maurer] I think for those who want... Who know in their heart they want to serve in that capacity it's not going to be a deterrent. I think what we struggle with is you have the rural kid who is able to pursue higher education, depending on where he or she chooses to go, that kid chooses to go to an institution that does have a history of a lot of progressive thought, exposures to people who are different from themselves. What I worry about is is that kid four years later still gonna wanna go back to rural America to serve? For that matter, the kid who is from rural Michigan who really chooses to go outside their comfort zone and I'm gonna go to the University of Southern California for four years. Are we gonna be able to get that kid to come back to serve his or her rural constituents? I think the answer is "I don't know". I mean it I think it depends on what their experiences were. But I think that it's possible that that four to five-year college education, depending on where they choose to go, probably is gonna have a huge, huge influence on whether or not someone wants or chooses to return to the rural community. And that... And so I think that probably plays a bigger role. I think part of our success in being able to get students to return to medically rural underserved communities, we're gonna have to... There's gonna have to be, I think a significant outreach effort that occurs before they even hit the medical school's door. We gotta figure out a way to keep them tied to their rural roots in a positive manner and how can they use these very interesting educational hidden curriculum experiences in a residential college and university. How can they use what they've learned about life and themselves in applying that to the care that they would be able to offer in rural America. I think that's where we need to focus right now.

- [Julia] For four years Doctor Andrea Wendling has been working with pre-med undergraduate students from rural areas of Michigan. Through the Rural Pre-medical Internship Program, Doctor Wendling and Doctor Todd Shepard have worked to mentor pre-medical students who want to become doctors and want to return to rural America. Through this program Doctor Wendling and Doctor Shepard have been teaching students what it takes to get into medical school and what it takes to become a rural doctor. After four years of this program there is significant fruit coming from all of Doctor Wendling's efforts. With the onset of the election, the media coverage, and the perceptions and ideas that have come from and out of rural America, Doctor Wendling wants all rural and rurally-minded medical students, healthcare professionals, and young people to know this.

- [Doctor Wendling] I came in and I said, you know, there's a lot of conversation about rural Americans happening right now. And this election has brought to light a lot of, you know, a lot of things that are happening to rural people in a lot of disparity. And you know, regardless of your political ideology that's a real thing. Like, this disparity is a real thing and it affects people and it affects people in a really meaningful way. And you know, it affects all of you in this room. And you need to understand that MSU...You know, you are part of our mission. We want rural students and we want rural students who want to care for underserved populations and we know that your path to medical school may have been harder than the paths of many of your peers because of these disparities and that's okay. You know, we want you.

(mellow country music)

♫ Gathered near the lake

♫ Celebrate the union

♫ All of my old friends and me

♫ There was singing and dancing

♫ Till the morning had come

♫ And we sang and we danced some more

♫ So long my comrades

♫ Till we meet again

♫ Years pass more quickly

♫ And the reasons for gathering

♫ Are fading away

♫ But you know who I was

♫ And I know what you went through

♫ And nobody knows me like you

- [Julia] Thank you again for listening to This Rural Mission. This podcast is produced by me, Julia Terhune. I want to extend a great deal of thanks to Doctor Joel Maurer for taking time out of his schedule to speak to me. Doctor Maurer will be highlighted on several other podcasts. What he had to say was so tremendous and so interesting. I also want to thank all of the Leadership and Rural Medicine students who took time out of their Wednesday night to meet with us at a round table. And all of them gave their profound insight and perspective onto what happened in the election. I also want to thank all of the people that I terrorized while I was canvasing around Michigan State University. It was cold, it was wet, it was rainy and there were so many people who gave me the time of day and answered my silly little questions. As always, thank you Doctor Wendling for making this project a key priority of the Leadership and Rural Medicine programs. Until next time, I'm your host Julia Terhune and I encourage you to make rural your mission.

(mellow country music)

♫ So long my comrades

♫ Till we meet again

♫ Years pass more quickly

♫ And the reasons for gathering

♫ Are fading away

♫ But you know who I was

♫ And I know what you went through

♫ And nobody knows me like you

♫ My comrades and friends

♫ You don't who I am right now

♫ Years and the miles had their way

♫ But you know who I was

♫ Before I became who I am

♫ I can see where I've been in your eyes

♫ So long my comrades

♫ Till we meet again

♫ Years pass more quickly

♫ And the reasons for gathering

♫ Are fading away

♫ But you know who I was

♫ And I know what you went through

♫ And nobody knows me like you

- [Julia] To learn more about the Rural Community Health Program please visit our website at www.msururalhealth.chm.msu.edu. 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 Brian Edgars, a local musician and Michigan native. We hope you tune in next time to hear more from This Rural Mission.