Maine AHEC Network

On June 24th - 26th Maine AHEC Network at the University of New England partnered with New Mainers Public Health Initiative and Maine Access Immigrant Network to host the 2023 Health Career Exploration Camp. Thirty students attended the camp to learn about a variety health career opportunities. This camp was made possible with funding from Martin's Point.

The rural health immersion is offered as an opportunity for health professions students to get a glimpse of what its like to live and work in rural Maine. All Maine AHEC Scholars complete a rural health immersion in their first year of the Maine AHEC Scholar Honors Distinction Program. During each RHI students meet with community and clinical stakeholders to discuss the healthcare landscape in the region that they are visiting. As students visit hospitals, community health centers, private practices, community services, they converse with directors and CEOs as the community "rolls out the red carpet" for them to give them a real Maine welcome. We can't say enough how thankful we are of all of our community and clinical partners who take the time out of their busy schedules to meet with our students!

During the third day of the western Maine rural health immersion to Franklin County the group of interprofessional AHEC Scholars visited Franklin Memorial Hospital in Farmington, ME. Chelsea Kimball, first year occupational therapy student at UNE's Westbrook College of Health Professions, shares her experience after meeting with members of the hospital staff.

"Coming to rural Maine and exploring what this area has to offer I thought I was going to find all the reasons why I couldn't live up here this far from "reality", but all I found was all the reasons why I could, more surprisingly it was more real than I'd ever expected.

So to begin describing my revelation we visited the local county hospital, Franklin Memorial Hospital to have lunch with a panel of health professionals to discuss healthcare delivery in rural Maine. Normally, hospitals make me uneasy and overwhelmed but here was a completely different experience. From the waiting room to the emergency department and ICU, the hallways were calm (which isn't the case all the time) and filled with welcoming, cheerful staff. The general atmosphere was simply at ease and not filled with the feelings I generally get from a place where people go when they're hurting. After the quick tour since the hospital is uniquely much smaller than any urban hospital I've been to before, we had lunch with the chief nursing officer (CNO), two nurses, and the director of rehab services. Many topics were discussed but a lot stuck out to me. A quote Tania, our AHEC Coordinator, mentioned that resonated with me was that in rural Maine health care systems "we have the same issues and problems that anywhere else faces, we just have less money."

To dig deeper into that we discussed some unique challenges that this region faces. One of the main issues here explained that it is extremely hard to find full time staff that aren't traveling nurses who aren't really their employees; Franklin Memorial has many "travelers". Additionally, the CNO mentioned that human resources in general struggles with finding highly qualified staff that live close enough to work here. This really stood out to me because Maine as a state has trouble retaining health care professionals and it's even harder in rural Maine because of the geographical location. This is something I never thought about when thinking about health care up in Northern Maine. My assumption was that, even though here wouldn't have many staff, they probably would have less patients and less intense cases. But my assumption was way off and a common misconception when people think of rural Maine care. Hospitals here do have many patients, sometimes having to treat them in the hallways when their 10 beds in the emergency department are filled. Another big issue is the lack of transportation in getting patients to their appointments and needed outpatient clinics. In their regional area, they have little to no public transportation, only one known person who drives Uber, and no longer any taxi companies. To complicate matters further, Franklin county has a vast geographic area which makes getting to health care much harder if you don't have a car or can't drive. The ease of transportation is something we take advantage of on a day-to-day basis so we don't think about the importance of it when it comes to taking care of ourselves. All of these things I've never thought of when thinking of the differences I could have found in rural vs urban communities.

In some ways I thought that rural communities would have less resources but in reality they have plenty of amazing resources but they simply don't have the people staying to run and work for those resources. All and all, if more people knew what this area has to offer and that it is not much different than urban life plus has their own unique qualities that can be appealing, then this small difference and barrier wouldn't leave these health communities in need. Through this experience, I want to carry the idea that I can't assume what small regions might not have without experiencing the area and community first. This trip opened my eyes and quieted my biases of what rural Maine would be like in the professional world. I want to be more open minded and adventurous in trying new things and not be afraid to work in places I'm hesitant about. I think searching for your values in the community you want to serve is the biggest takeaway from this trip and everything about this 'small town' matched in many ways with my values of community, work environment, and lifestyle. It's important to serve populations in need and rural Maine needs us to take the leap."

National AHEC Organization Franklin Community Health Network University of New England - Occupational Therapy Westbrook College of Health Professions

The Maine AHEC Scholar program integrates one or more of the six HRSA designated core topic areas into each activity within the 2 year 160 hour AHEC Scholar curriculum. The six core topic areas are interprofessional education, cultural competency, social determinants of health, practice transformation, behavioral health integration, and current and emerging health issues. All Maine AHEC Scholars complete a rural health immersion during their first year in the program and the rural health immersions includes exposure to all six of the HRSA designated core topic areas. Interprofessional education is a key element of the rural health immersion.

The March 2022 western Maine rural health immersion includes physical therapy, occupational therapy, nursing, and dental medicine health profession students. Today was the second day of the rural health immersion and the students are exemplifying interprofessional education by learning with, from, and about one another. Anne Thomas, second year physical therapy student and Maine AHEC Scholar, shares her thoughts on interprofessional education during the rural health immersion.

"The body is not that big, said CMO Ross Isacke over dinner. This may seem like an obvious statement, but this has been the major revelation for me throughout today. On our second day of our RHI, we had a busy day taking us from Franklin Memorial Hospital to Mount Blue High school, to the CNA course at Beal University, and meeting with those just learning about healthcare careers to those who have served FMH for over 20 years. In describing our individual roles in patient care, I learned so much about where our professions overlap. I think in school or even in our practice, we can become very entrenched in our narrow profession and lose sight of how we’re all working towards the same patient health goals.

One example of this idea from today was from fellow AHEC student, Rose Liou’s oral health and dentistry presentation to CNA class. For me, I had never thought about how dentistry could have implications for PT or share any common goals. As it turns out, the mouth is connected to the rest of the body. Rose did a fantastic job of explaining how poor oral health can affect a patient in many ways, from influencing their diet, their mood, their pain level, or their ability to communicate. Poor oral health is linked to many other health complications such as heart disease, cancer, and diabetes. I think it would not be uncommon to see a patient in an outpatient PT clinic for an ortho diagnosis, but who also could benefit from dental care. With an established rapport built with the patient, and my new understanding and appreciation for dental, I could advocate for that patient to seek out that care. Based off reports from health professionals here at FMH, oral health is an especially big concern in rural Maine.

Today also offered a better sense of what the roles of other providers are, such as where there are overlapping skills, gaps in knowledge, and where there are opportunities to collaborate. At Beal University’s CNA course, I learned the techniques and principles that they are taught for transferring and positioning patients. As students in PT, Rebecca Ocana and I could help provide them with some additional coaching on how to make the experience more therapeutic for the patient and safer for the CNA. This might mean the positioning takes a little more time, but increases the patient’s independence and likelihood for going home. Mora Judd in the nursing program was also interested in how these same ideas could be communicated to nursing staff to have a unified approach and a deeper understanding for safe and therapeutic patient transfers and positioning. Going forward, I will consider where patient care overlaps with other professions and recognize opportunities to share our knowledge and expertise.

Overall, I have been so impressed by my fellow students, the healthcare professionals, and the interested healthcare students we met today. It has been inspiring to see how people collaborate to take care of their community."

University of New England Westbrook College of Health Sciences University of New England - Physical Therapy Franklin Community Health Network Franklin County Memorial Hospital National AHEC Organization UNE Center for Excellence in Collaborative Education

Last week another group of Maine AHEC Scholar health professions students participated in their rural health immersion, this time to western Maine, to get a glimpse of what its like to live and work in rural Maine. The group consisted of six health professions students from the University of New England's College of Health Professions and College of Dental Medicine who traveled to Maine AHEC's Western Maine AHEC Center in Franklin County. The group spent 4 days in the greater Farmington area exploring the health care system and community services offered in this region. All of the students participating in the trip applied and were accepted to the Maine AHEC Scholar Honors Distinction Program based on their intentions to work in rural Maine after they graduate; the rural health immersion is one of the activities that all AHEC Scholar complete during their first year. One of the goals of the rural health immersion is for students to learn more about community services that are available to underserved and disadvantaged populations so that once they are practicing they are prepared to connect their patients to the appropriate services.

Rose Liou, second year dental medicine student, shared her experience after the first day of the 2022 March Western Maine Rural Health Immersion.

"As we embarked on our journey in Franklin County, ME, our first stop was the Healthy Coalition Food Bank, where we learned more about the local partners in this tight-knit community. It quickly occurred to me that the role of this food pantry is far beyond ending hunger. This pantry plays a critical role in this area as a point of contact for resource coordination. This is a space where community members can come in to get fresh produce and seek other resources such as insurance enrollment, healthcare referrals, and cooking classes.

During a simple interaction with one of the pantry clients, we learned that this woman has been working as the sole caretaker for her mother and said that she “needs a vacation.” The staff at the pantry was able to quickly connect her to another staffer who could help process her application to become a paid caretaker for her mother. These honest human interactions, where the staff can provide a referral, can give a breath of fresh air for anyone who is struggling. I witnessed how knowledge is power and “knowing who knows what” is equally essential in a resource strained rural community like Franklin County. Community-based organizations often function as individual entities, but the demographic they serve often overlaps. This experience in the pantry shows that one’s basic needs are not simply food security, but financial stability, safe housing, and access to care are equally important.

As a dental student, I asked myself how I could use my role to further help my community. As dental providers, we are too afraid to ask patients these tough, personal questions on their basic needs to avoid opening a can of worms. Yet, for many people, dentists are the only healthcare providers they see regularly. If we are knowledgeable of our local resources and familiar with the available resources, we would also connect our patients to other experts whose job is to tackle these challenges. It is well established that oral health is far beyond our teeth, but their basic needs must be fulfilled for patients to take care of their teeth. This experience at Healthy Coalition further solidified my vision of creating an integrated clinic. I envision a clinic where doctors, social workers, and allied health work together under the same roof as an integral team in the patient center, whole-person care."

University of New England College of Dental Medicine Franklin Community Health Network National AHEC Organization

Another week, another Maine AHEC rural health immersion for health professions students to get a glimpse of what its like to live and work in rural Maine. This week a group of six health professions students from the University of New England's College of Health Professions and College of Dental Medicine traveled to Maine AHEC's Western Maine AHEC Center in Franklin County. The group will spend 4 days in the greater Farmington area exploring the health care system and community services offered in this region. All of the students participating in the trip applied and were accepted to the Maine AHEC Scholar Honors Distinction Program based on their intentions to work in rural Maine after they graduate; the rural health immersion is one of the activities that all AHEC Scholar complete during their first year. One of the goals of the rural health immersion is for students to learn more about community services that are available to underserved and disadvantaged populations so that once they are practicing they are prepared to connect their patients to the appropriate services.

Rebecca Ocana, second year physical therapy student, shared her experience after the first day of the 2022 March Western Maine Rural Health Immersion.

"As soon as we arrived in Wilton, we began to form a cohesive unit of future healthcare providers striving to bring healthcare access, advocacy, and equity to the forefront. The first conversation we had focused on our scopes of practice, our passions within each of our respective professions, and how we can utilize our AHEC education to provide better resources and care to rural Maine populations. By the end of the first day, we formed a powerhouse collaborative team consisting of PTs, OTs, dental medicine, and nursing.

My biggest question of the day as we worked at the Healthy Community Coalition’s food pantry was, how can a multidisciplinary team of healthcare providers work together to provide all the basic needs that underserved communities require? And just as soon as I was asking myself the question, it was answered by the various people we encountered that day. Our first contacts of the day, Ashley and Cheryl, told us that many resources are available for Franklin County residents. This includes help with homecare, food insecurity, substance use, and job training. The food pantry provided access to a group of people who need only to ask to be set up with any one of the services available to them. In fact, we witnessed this exact scenario during our time at HCC. A young woman shopping at the pantry made a comment about needing a vacation from caring for her mother full-time, which quickly prompted Cheryl to provide home health information. While many people would dismiss this woman’s comment as conversation filler or a little joke, I appreciated the quickness of Cheryl’s thinking to provide options to this person to improve not just her circumstances, but also that of her mothers.

The discussion over Franklin County resources continued during dinner with Doreen Wright from Western Maine Behavioral Health. What resonated with me the most is that she may not know of everything available to rural residents, but she knows exactly who to call who would know. To me, this further emphasized the strong teamwork aspect needed of healthcare providers in rural areas. As a physical therapy student, I recognize that I will spend a lot more time with my patients compared to doctors or dentists. This would require me to know who to contact in an event that a patient confides that they are in need. Therefore, the biggest lesson I learned is when starting my career in rural Maine is to seek out those people that know resources in the community to help play my role in improving any and all persons quality of care and life."

National AHEC Organization Franklin Community Health Network Western Maine Behavioral Health University of New England Westbrook College of Health Sciences University of New England

The fourth and final day of the 2022 March Eastern Maine Rural Health Immersion to Penoboscot and Piscataquis counties included volunteering at a local middle school to assist with vision and hearing screenings and observational experiences at an outpatient clinic in Dover-Foxcroft, Sangerville, or Dexter. After spending the previous three days in the community learning about the healthcare services that are offered in these regions, the observational experience allows students to see how community services are integrated into clinical care.

Eleanor Demmons, first year osteopathic medicine student at the University of New England's College of Osteopathic Medicine, shares her story after the last day of her rural health immersion.

"On the last day of our rural health immersion our group of Maine AHEC CUP scholars visited SeDoMoCha school to assist nurse Courtney Arcaro with hearing and vision screenings of second and third graders to help her meet the Department of Education vision and hearing screening state requirements. School nurses across the state of Maine (and I imagine the country) have been overworked and stretched thin as many of their regular tasks were put on hold for much of the pandemic, and then became backlogged as soon as various restrictions were lifted. At times I’m surprised that many of these nurses are still sticking it out despite a lack of help beyond volunteers such as ourselves, who can lend a hand to take some of the yearly tasks off their plates. But I know why they hold on; Its these wonderful kids. The second and third graders at SeDoMoCha school are so full of life and zest, they are resilient, kind, and hard working. I was struck by their outgoing nature and felt that they were happy to have some new faces to interact with.

Later in the day we had the opportunity to shadow a physician or a provider in a family medicine clinic environment where I was able to follow Brianna Martell, FNP while we followed up with patients she has been seeing for a number of years. This experience reinforced my understanding that health care provider consistency in the primary care setting is of the upmost importance and is something that the state of Maine and our country needs to prioritize when providing incentives for health care workers to become established in more rural settings. I had a wonderful time seeing patients with Brianna and look forward to more experiences in rural medicine such as this one."

Thank you to all of the community and clinical partners who made the 2022 March Eastern Maine Rural Health Immersion possible for our Maine AHEC Scholars!

National AHEC Organization University of New England College of Osteopathic Medicine Northern Light Health SeDoMoCha

Maine AHEC is a workforce development program aimed at alleviating health workforce shortages. There are three priority areas that Maine AHEC targets to inspire future and develop skills for current and already practicing healthcare professionals. Maine AHEC's Pipeline Program aims to inspire current highschool students to pursue health professions programs in college; Maine AHEC's AHEC Scholar program for college students already enrolled in a heath profession program aims to develop the skills needed for working in underserved communities after they graduate; and Maine AHEC's Continuing Education program provides workshops and trainings for healthcare providers who are already practicing in Maine.

Sometimes there are opportunities for two of the priority areas to intersect. Such was the case during last weeks 2022 Eastern Maine rural health immersion to Penobscot and Piscataquis counties. On the third day of the trip, while in Dover-Foxcroft, the group of AHEC Scholars had an opportunity to meet with highschool students at Foxcroft Academy to discuss pursuing healthcare programs in college. Foxcroft Academy is located in Piscataquis County, Maine's most rural county, which continually ranks in the bottom quartile for health outcomes and health rankings according to the Robert Wood Johnson County Health Rankings, which may reflect challenges related to accessing healthcare services due to a shortage of healthcare providers. Indeed, Maine AHEC has not had a student in its AHEC Scholar program yet from Piscataquis County (one of only three unrepresented counties in the AHEC Scholar program, in addition to Somerset or Washington Counties). Hopefully one of the highschool students who joined our panel to learn more about healthcare programs will become an AHEC Scholar one day soon.

Farah Rassam, first year osteopathic medicine student at UNE, shared her experience of the third day of the 2022 Eastern Maine rural health immersion. Farah, an international student studying medicine, was able to share her lessons learned with one of the international boarding students attending Foxcroft Academy who is interested in pursuing medicine.

"A few years ago, I remember how lost I was in the medical school application process. What did I need to do to get into medical school? What did the process look like? I was grateful to anyone who could give advice or provide the right information. I didn’t know a lot of people who were on the same path as me. Being new to America, this made my path to medical school much different than the traditional path taken by most medical student.

Today, during the 2022 Penquis region RHI we had the chance to go to Foxcroft Academy and talk to high school students interested in health care. Listening to their many questions while offering any information I could, reminded me of myself just a few short years ago. It was inspiring being able to answer their questions and describe my experiences to these students so they might avoid the mistakes I made and learn from them. It was an amazing feeling to speak with these students and hopefully impact someone’s life, even if only a little bit. This was more than just a Q & A about medical school, it was an opportunity to share our life experiences and help someone else learn from the paths we’ve taken. For example, one student asked a question that I could relate to about some challenges facing international students who are interested in medicine. I believe these questions are hard to answer and not a lot of people know how to navigate these challenges other than people who’ve personally experienced them.

Additionally, we had the chance to meet and talk with members of this amazing community at the Dover-Foxcroft Commons. During this visit we met a retired physician who practiced rural medicine. Listening to their experiences in rural medicine, I was surprised at the difficulties and challenges that come with practicing medicine in a rural community. I couldn’t believe some patients never experienced a continuum of care because of the difficulties in access to care that rural communities face. As future physicians, it’s important we realize the challenges patients residing in rural community’s face and recognize it is our job to care for underserved communities such as these and try to address health disparities in all our communities."

National AHEC Organization Foxcroft Academy Piscataquis County University of New England College of Osteopathic Medicine University of New England Northern Light Mayo Hospital Northern Light Eastern Maine Medical Center Central Hall Commons

Maine AHEC has offered the rural health immersion to health professions students as an opportunity to travel beyond southern Maine to explore what its like to live and work in rural Maine. The rural health immersion is a unique experience offered to health professions students at UNE, Tufts, and USM who are accepted to the Maine AHEC Scholar Honors Distinction Program. Maine AHEC is funded to accept 45 health professions students per year and students are accepted based on their intentions to work with underserved populations in Maine and northern New England after graduation. All of the students in the Maine AHEC Scholar Honors Distinction Program complete a 2 year 160 hour curriculum which includes multiple opportunities to travel to rural Maine. The rural health immersion is one such opportunity that all AHEC Scholars complete early on in the AHEC Scholar program.

Emily Caron, first year osteopathic medicine student at UNE is one of our Maine AHEC Scholars. Last week Emily traveled three hours north to Dover-Foxcroft, ME, in Piscataquis County where she explored the rural health infrastructure of that community. Emily shared her experience from the third day of the trip and reflects upon how a conversation with a retired physician reshaped how she thinks about healthcare delivery.

"Today we had the privilege of speaking with community members at the Central Hall Commons where we met with community leaders, substance use disorder recovery coaches, and rural medicine clinicians. Our discussions with Dover-Foxcroft community members revealed many struggles embedded in rural healthcare, namely the difficulty with finding a long-term primary care physician. One community member shared that she finds it frustrating to constantly have to “start all over” with a new healthcare provider each year. The rapid physician turnover in rural areas, particularly in Dover Foxcroft, leaves patients feeling stranded, as they yearn for a long-term relationship with their primary care physician.

Dr. Lesley Fernow spoke about her role as a community leader and her 40+ year career as a rural health physician. I enjoyed listening to her passionately explain why she incorporated home visits into her practice. She explained that home visits privilege the physician to understand how their patients function day to day and assess for problems that would have gone overlooked in the clinical setting. For example, she described meeting several patients in their homes who complained of fatigue, a complaint that was often missed in the clinic because of the need to focus on other chronic health conditions like hyperlipidemia, hypertension, and diabetes among other diseases. Taking this patient centered approach led to improved patient outcomes and improved the patient-physician relationship. If I do elect to practice rural medicine, I will absolutely incorporate home visits into my practice.

After meeting with local community members, we went to Foxcroft Academy where we met with a group of students interested in pursuing a career in healthcare. Speaking with them made me think about my own path to medicine, and how I can be of service to others following in similar footsteps. In high school I was lucky to receive mentorship from my neighbor who is an anesthesiologist. She helped me get through applying to college and medical school and became a wonderful friend to me along the way. I look forward to taking on a mentorship role and paying forward the kindness, support, and guidance that I received that supported me on my path to medicine."

National AHEC Organization Central Hall Commons Foxcroft Academy Lesley Fernow Northern Light Eastern Maine Medical Center University of New England University of New England College of Osteopathic Medicine

The rural health immersion is an opportunity for health professions students to explore the healthcare services offered in Maine's underserved communities. After 6 years and nearly 50 rural health immersions we have explored most facets of healthcare for Maine's underserved populations including rural medicine, tribal medicine, islands medicine, addiction medicine, and much more. However, there are still a few opportunities to create new partnerships with underserved communities. The second day of the March 2022 Eastern Maine Rural Health Immersion included a trip to Mountainview Correction Facility in Charleston, ME. This was the first time that Maine AHEC had worked to provide AHEC Scholars an opportunity to explore corrections medicine during a rural health immersion.

First year University of New England College of Osteopathic Medicine student Fajar Alam shared her thoughts after spending the day at the Mountainview Correction Facility.

"For all of us, this was our first time learning about and visiting a correctional facility. Upon entering Mountainview Correctional Facility we were introduced to the Maine Department of Corrections staff and the Wellpath medical staff. While taking a tour of the facility I was initially surprised by the number of windows due to preconceived notions from the media that portray prisons as isolated, dark and completely concrete buildings. However, after learning more about the Maine Department of Corrections’ mission to use evidence-based methods to rehabilitate residents, not only did the windows make sense, but also did the emphasis on education, various peer recovery groups and the different recreational services in the facility. Observing Dr. Razi Ali, the Regional Medical Director of Wellpath, in the medical clinic was especially insightful because of his emphasis on integrated care and social justice. I was aware that the incarcerated population is especially vulnerable and has several barriers to health care, however the approach of the Maine Department of Corrections and Wellpath is an emphasis on integrated care, as each resident of the facility has access to behavioral health services, Medication Assisted Treatment (if needed), physical health services and community resources like housing and employment assistance.

For me, the most impactful part of the experience was hearing from the residents themselves. Several residents that spoke to us were in the facility for many years, they had immense wisdom to share regarding how they reflected on their lives, and I am grateful for the vulnerabilities they expressed to us. A goal of The Maine Model of Corrections is humanization, and I believe hearing from the panel of residents achieved this. I was in awe of how proactive the residents of the facility are in terms of advocating for themselves and other incarcerated individuals. One resident recently filed a testimony to expand the Good Samaritan Law in Maine and wants to start a nonprofit that addresses mass incarceration in the United States. All the residents that spoke to us were motivated to make a difference in their lives and of others. For example, several were peer recovery coaches, tutors, or a part of the Helping Hands program where the residents learn personal care assistance and respite care. One resident spoke about how he approaches his work with other residents in the facility and how he stays mindful of “we all have a history, but we all have a future too.” This perception is something I will carry with me as a future physician and encourage others to hold on to as a way of combatting stigma and bias related to this population. All in all, as someone interested in prison reform and caring for underserved and vulnerable populations, my experience at Mountainview Correctional Facility is one that will inform both my outlook as a citizen but also my future medical career."

National AHEC Organization Northern Light Eastern Maine Medical Center Maine Department of Corrections University of New England College of Osteopathic Medicine