Ups and downs of rural health care
By Nick Hytrek Journal staff writer | Posted: Thursday, May 01, 2008
Patient Barbara J. Mathys has her blood pressure checked by nurse Darnell Dennehey April 14, 2008, at the Midwest Health and Wellness Center clinic at Mapleton, Iowa. (Staff photo by Tim Hynds)
MAPLETON, Iowa -- It's probably fair to say no one really likes having to go to the doctor.
But when you're not feeling your best, it's not a bad thing to go to a clinic where you're treated like family.
"When I walk in here, the receptionist calls me by name and I know everybody in the waiting room," said Gene Vanderbur, who frequents Midwest Health & Wellness Center in Mapleton. "I'm a personal friend of the doctor. He knows my history. The person who draws my blood, I know her.
"It sounds strange to say it, but it's a jovial atmosphere."
For rural residents like Vanderbur, a medical clinic is a luxury not available to residents of other small towns. He doesn't have to travel half an hour or more to see a doctor.
Patients in towns lucky enough to have a clinic tell similar stories: they enjoy the convenience of having a clinic in town and the comfort of knowing the people who work there, people who are friends and neighbors who take a personal interest in how their visitors are feeling.
"I value the rural clinic, its convenience and the relationships you develop with people," said Loren Lee of rural Schleswig, Iowa, who also visits Midwest Health & Wellness Center.
Like patients, the health care professionals who work in rural settings appreciate the familiarity of the rural clinic setting.
"I think I get to know my patients more," said Dr. Curtis Hesse, the lone physician at the Mapleton clinic. "It's a more relaxed atmosphere. We're more like a family to some of these patients."
But does that make working there easier? Not necessarily, Hesse said. A native of nearby Smithland, Hesse grew up with some of his patients and, after having worked in Mapleton for 15 years, he has gotten to know most of the rest pretty well.
"It makes it easier in the fact that they tend to trust you and what you're doing," Hesse said. "The hard part is when you find something bad or terminal and these are people you know your whole life and then you've got to tell them that."
And being on a friendly basis with just about everyone in town means those friendly folks are less apprehensive about asking for medical opinions outside the clinic.
"If you go to the grocery store or Bomgaars or (local eatery) Beef & Brew, you can count on someone coming up and saying 'Hey, can I chew your ear about ...,'" Hesse said. "You've got to be ready for them to come to your door, too."
Growing up in a small town himself, Hesse expected that. He prefers it to big-city medicine. He served a residency and internship in a Detroit suburb. The population of Detroit far outsizes Mapleton's, but Hesse said he's busier now.
"There's just not enough time to see the number people we need to see," he said.
Working in the rural clinic also presents other challenges.
"I have no hospital nearby," Hesse said. "One of the bigger challenges is we're not only a clinic, but an emergency room as well. I've got to be able to do everything here because I don't have the support nearby."
Nelinda Rhode, a nurse practitioner at the Mapleton clinic, spent eight years working in a Sioux City emergency room. She said not having quick access to medical equipment to perform diagnostic tests can be challenging, but she also knows her patients better when she sees them.
"You know what they're capable of, their support groups. You know how to fit their needs in with their lifestyle better," Rhode said.
Mapleton is lucky in that it has two medical clinics. That's rare for small towns, which face difficulties attracting doctors.
"It's hard getting physicians to a rural clinic," said Michelle Weber, clinic manager.
Hesse and Rhode split on-call duties. Each is on call 26 weekends and 26 weeks per year.
"Most doctors coming out (of medical school) right now don't want to work that hard," Hesse said. "With the city clinic, you have more time off, probably a little more money."
But having a clinic in town means a lot of money to rural residents, especially considering the price of gas.
"They don't have to drive 60 miles to the nearest doctor," Weber said.
Hesse said a medical clinic provides an economic boost to small towns. Before he arrived, he said a study commissioned by the city council showed that 66 percent of a town's business can come directly or indirectly through a doctor's office. The study showed that patients will spend time shopping in town before and after a visit to the doctor.
"Without a doctor's office, if you lose 66 percent of the business, your town's going to struggle," Hesse said.
That's why it's so important for small towns to hold on to their clinics. Many are now operated by hospitals in larger cities like Sioux City, organizations that can afford to buy the equipment needed in the clinic. Those affiliations also make it possible to send specialists out into rural areas like Mapleton, which hosts specialty clinics regularly.
"When these specialty clinics are in, the clinic is busy," Weber said.
It all adds up to patients' convenience.
"Elderly people appreciate the convenience of having a doctor locally and not having to go farther," Lee said.
Convenience and community, Vanderbur said.
"I have up-to-date mechanical capabilities available to me and I have the personal touch of a small town," he said.
Nick Hytrek can be reached at 712-293-4226 or nickhytrek@siouxcityjournal.com.
But when you're not feeling your best, it's not a bad thing to go to a clinic where you're treated like family.
"When I walk in here, the receptionist calls me by name and I know everybody in the waiting room," said Gene Vanderbur, who frequents Midwest Health & Wellness Center in Mapleton. "I'm a personal friend of the doctor. He knows my history. The person who draws my blood, I know her.
"It sounds strange to say it, but it's a jovial atmosphere."
For rural residents like Vanderbur, a medical clinic is a luxury not available to residents of other small towns. He doesn't have to travel half an hour or more to see a doctor.
Patients in towns lucky enough to have a clinic tell similar stories: they enjoy the convenience of having a clinic in town and the comfort of knowing the people who work there, people who are friends and neighbors who take a personal interest in how their visitors are feeling.
"I value the rural clinic, its convenience and the relationships you develop with people," said Loren Lee of rural Schleswig, Iowa, who also visits Midwest Health & Wellness Center.
Like patients, the health care professionals who work in rural settings appreciate the familiarity of the rural clinic setting.
"I think I get to know my patients more," said Dr. Curtis Hesse, the lone physician at the Mapleton clinic. "It's a more relaxed atmosphere. We're more like a family to some of these patients."
But does that make working there easier? Not necessarily, Hesse said. A native of nearby Smithland, Hesse grew up with some of his patients and, after having worked in Mapleton for 15 years, he has gotten to know most of the rest pretty well.
"It makes it easier in the fact that they tend to trust you and what you're doing," Hesse said. "The hard part is when you find something bad or terminal and these are people you know your whole life and then you've got to tell them that."
And being on a friendly basis with just about everyone in town means those friendly folks are less apprehensive about asking for medical opinions outside the clinic.
"If you go to the grocery store or Bomgaars or (local eatery) Beef & Brew, you can count on someone coming up and saying 'Hey, can I chew your ear about ...,'" Hesse said. "You've got to be ready for them to come to your door, too."
Growing up in a small town himself, Hesse expected that. He prefers it to big-city medicine. He served a residency and internship in a Detroit suburb. The population of Detroit far outsizes Mapleton's, but Hesse said he's busier now.
"There's just not enough time to see the number people we need to see," he said.
Working in the rural clinic also presents other challenges.
"I have no hospital nearby," Hesse said. "One of the bigger challenges is we're not only a clinic, but an emergency room as well. I've got to be able to do everything here because I don't have the support nearby."
Nelinda Rhode, a nurse practitioner at the Mapleton clinic, spent eight years working in a Sioux City emergency room. She said not having quick access to medical equipment to perform diagnostic tests can be challenging, but she also knows her patients better when she sees them.
"You know what they're capable of, their support groups. You know how to fit their needs in with their lifestyle better," Rhode said.
Mapleton is lucky in that it has two medical clinics. That's rare for small towns, which face difficulties attracting doctors.
"It's hard getting physicians to a rural clinic," said Michelle Weber, clinic manager.
Hesse and Rhode split on-call duties. Each is on call 26 weekends and 26 weeks per year.
"Most doctors coming out (of medical school) right now don't want to work that hard," Hesse said. "With the city clinic, you have more time off, probably a little more money."
But having a clinic in town means a lot of money to rural residents, especially considering the price of gas.
"They don't have to drive 60 miles to the nearest doctor," Weber said.
Hesse said a medical clinic provides an economic boost to small towns. Before he arrived, he said a study commissioned by the city council showed that 66 percent of a town's business can come directly or indirectly through a doctor's office. The study showed that patients will spend time shopping in town before and after a visit to the doctor.
"Without a doctor's office, if you lose 66 percent of the business, your town's going to struggle," Hesse said.
That's why it's so important for small towns to hold on to their clinics. Many are now operated by hospitals in larger cities like Sioux City, organizations that can afford to buy the equipment needed in the clinic. Those affiliations also make it possible to send specialists out into rural areas like Mapleton, which hosts specialty clinics regularly.
"When these specialty clinics are in, the clinic is busy," Weber said.
It all adds up to patients' convenience.
"Elderly people appreciate the convenience of having a doctor locally and not having to go farther," Lee said.
Convenience and community, Vanderbur said.
"I have up-to-date mechanical capabilities available to me and I have the personal touch of a small town," he said.
Nick Hytrek can be reached at 712-293-4226 or nickhytrek@siouxcityjournal.com.
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