Lauren Kuschel
First Week at Miller
Day one in Miller showed me the true definition and challenges of rural healthcare for patients. One patient had to drive almost 60 miles to the clinic to get much needed stitches. It was a successful experience for me, as I managed to watch the suturing process without getting faint! I also learned more about the patient population, as many farmers and ranchers refuse to quit working due to an injury or take it easy following an injury. I am quite familiar with this type of patient because of my family and community, but it was enlightening to see how providers have to improvise to work with these types of patients to provide optimal care.

Another major lesson of the week was how big of a role technology plays in rural healthcare, especially thanks to the Helmsley Charitable Trust. I had the opportunity to sit in on two telemedicine appointments, one for a respiratory therapy follow-up and the other for a Continuous Positive Airway Pressure (CPAP) follow-up. This type of technology makes it easier for patients to see the necessary specialists without driving the miles. There is even a stethoscope and headphone apparatus, allowing the telemedicine provider to hear the heart and lung sounds of the patient. Another example is the program that allows the Holter monitor reports to be sent to and read by specialists without physically sending the Holter monitor in. This prevents delays in getting the next patient in need set up with the monitor. I also heard from one of the providers about how much of a “luxury” e-pharmacy is. It allows providers to have access to a pharmacist for extended hours, as rural communities often do not have the capacity to staff a pharmacist as long as bigger facilities are able to.

Overall, it has been a very rewarding week in Miller! I have seen many aspects of rural healthcare, and there are many more to be explored. I have thoroughly enjoyed the people here, as well as the incredibly comfortable bed in the Sleep Study room in which I am staying. Rebecca and I also had the pleasure of heading to the baseball diamond to watch her nephew play and relax with some delicious brats at their family farm. I am really looking forward to the next three weeks!

Week Two
It is hard to believe this experience is already half over, but week two was another great one! Marissa, a respiratory therapist, showed me a very interesting machine called the Lucas. This machine performs chest compressions for CPR on a patient. She demonstrated the use of the machine on a dummy. Family members are often asked to leave the room when this machine is used on a patient, as it can be quite alarming to watch. I could definitely see why as I watched it on the dummy! Next, we performed the ultimate trust exercise: Marissa strapped the Lucas on to me to demonstrate proper positioning, and I had to trust her not to press the button! Of course, I knew she really would not do that, as it may have resulted in a little bit of pain for me, along with some cracked ribs. After experiencing the Lucas, I went for the ride of my life in a lift machine to experience what a patient goes through when needing to be transferred by this method. I also got a tour of the Emergency Room to learn about the equipment, discover which medications they stock, and see E-emergency in action.

On Tuesday, I was able to attend a quality improvement meeting at the nursing home. It was interesting to hear about the issues of operating a small town nursing home, as I also worked in one and dealt with the struggles. Even more interesting was seeing innovation in action, as they developed plans to overcome the obstacles and problems. For example, they discussed the struggle of finding enough Certified Nursing Assistants (CNAs) while still managing to develop solutions to work around these issues and provide proper care for the residents.

I had the pleasure of visiting the local drugstore, Rexall, on Wednesday. I worked in a small town pharmacy throughout high school, so it was great to be back in that setting. Travis, the pharmacist, knows basically everybody that walks through the door. He will have customers’ prescriptions waiting for them at the counter before they even make it back to the pharmacy. It was fun to watch him interact with the customers and see the relationships he is able to develop working in a small town pharmacy.

The weekend also proved to be great! I started the weekend with a Gid’s Addiction ice cream treat from The Takeout. It had grilled glazed donuts, vanilla ice cream, chocolate, caramel, and sprinkles, and let me tell you, it was sure delicious! Rebecca and I then attended the Johnny Holm Band concert in Huron at Wheel Jam 2016. I also finally had the joy of going to the drive in movie theater to see The Jungle Book. The movie was great and the popcorn was delicious (and much cheaper than any movie theater popcorn I have ever had)! I was also able to experience true small town kindness. My money fell out of my pocket at some point, so I went to the concessions to see if it fell out there. They took my name and number and said they would call if anybody found it, as they have had $50 and even $100 bills turned in before. They also “loaned” me some Mini-Melts, since that is what I went to the concessions for when I discovered my money was gone. Thankfully, I ended up finding it in my vehicle, but it was so wonderful to experience that small town atmosphere I have dearly missed while at college.

Week Three
Week three in Miller provided more great experiences. I was able to spend more time in the physical therapy wing this week. This experience showed me how innovative healthcare professionals are in rural areas. I have been through physical therapy before in a larger facility with much more equipment, but these inventive physical therapists and assistants manage to provide the same great care with less equipment by thinking outside of the box. These people can do anything with a set of bands, and even just the walls and counters around them!

On Thursday, I had the pleasure of observing several cataract surgeries and even a blepharoplasty. The doctor has a teaching scope that attaches to his eye piece, allowing the observer to see the same view as the doctor. This allowed me to observe every step of the procedure up close while he thoroughly explained it. It was incredible to see how precise each movement is. I also had the opportunity to talk to the nurse anesthetist about the medications used during each procedure. I am looking forward to discovering what the final week in Miller will hold.

Week Four
As the final week of REHPS in Miller comes to a close, I wanted to share the major lessons and experiences gained from this experience that I have not yet mentioned. Following my time in the lab and sitting in on a medical staff meeting, I learned to appreciate the strategy for workflow in the lab and determining which reagents, tests, and equipment to carry. In a small town lab, it is not practical to carry every reagent or test. Nicole, the lab manager, looks at the numbers to see if it is feasible to continue carrying each test. If the numbers are low and reagents are expiring before being used, she will have a discussion with the providers about potentially not carrying a test and how to deal with not having certain tests in house.

From my time in the clinic, I learned a lot more about the other side of prescriptions. In a pharmacy, I see the prescription as the prescriber sends it to be checked for appropriateness and accuracy in filling. In the clinic, I was able to observe the process of diagnosing the condition and choosing the appropriate medication for the patient and condition.

On the pharmacy side, I was able to observe pharmacist-physician relationships. Providers would call at least once each day while I was at Rexall to receive input and collaborate with Travis to determine the appropriate course of action for the patient. I also had the opportunity to set up a screening for community members. I screened 20 patients for blood pressure, referred 8 to their provider, screened 11 patients for blood glucose, and referred 1. It was rewarding to be able to do something for the community that has provided me with this great four-week experience. Everybody here has been so welcoming and helpful, and this experience would not have been what it was without them!