J ill Stewart and Mark Wiles are third-year medical students who have a clear picture of the kind of medicine they want to practice after residency. They both want to be rural family practice doctors. What sets these two apart from others in the University of Kansas School of Medicine is that they were chosen to be involved in a Salina- based pilot project that puts them in a clear, longitudinal rural track. In January, after six months of classes in Kansas City and Wichita, respectively, Stewart and Wiles moved to Salina to begin rotations in family practice, ambulatory medicine/geriatrics, obstetrics/gynecology and pediatrics. After completing one rotation and starting a second, Stewart and Wiles are sold on the pro- gram. “The one-on-one teaching aspect is so beneficial. There are increased opportunities for hands-on experiences here,” said Stewart, adding that it’s so different than a big university hospital, where students can get lost in the crowd if they choose to let that happen. Wiles feels the same, and has found the Smoky Hill residents to be a valuable resource for learning. “I’ve had the unique experience of studying in Kansas City and then had three rotations in Wichita. This program is much dif- ferent from Kansas City and even from Wichita,” he said. Their complete satisfaction with the pilot program, even though some of it is still a “work in progress,” has to do in part with the students’ backgrounds. Both Stewart and Wiles grew up in towns with 1A high schools. She is from Brewster, population 240, a town between Colby and Goodland. He hails from Hunter, population 115, a small town on U.S. Highway 81 in Mitchell County. Stewart said she was ready to make the move out of Kansas City and back to rural America. Her desire to make a break from the big city was fueled by her upbringing, but also through her recent marriage to a farmer near Quinter. “I just feel more comfortable in the small town environment,” she said. Wiles, on the other hand, said he decided he wanted to be involved in the pilot project from the first day it was mentioned. “My wife and I are both from small towns and I’m just passion- ate about that population. I have always known that I wanted to do rural primary care.” Salina is a city that Wiles is somewhat famil- iar with. He did his undergraduate study at Bethany College in Lindsborg, and worked part-time as a phlebotomist at Salina Regional Health Center while attending school. He CONTINUED ON PAGE 5 What’s Inside . . . Page 4 AMA Honors Hanover's Linda Warren, M.D. Page 6 Dean Meek, Rural Advocate, Steps Down From Helm Page 8 Field Art Salutes Nurse Anesthetists Page 10 Scott County Studies Cancer Rate Concerns Page 11 Kansas Study Assesses Rural Dementia Patients Right On Track For Rural Medicine Volume 8 Number 4 Spring 2001 RURAL HEALTH EDUCATION AND SERVICES Mark Wiles and Jill Stewart, third-year medical students, are sold on the one-on-one teaching and hands-on experience the “Longitudinal Rural Track” pilot program offers them.
Transcript
Jill Stewart and Mark Wiles are third-yearmedical students who have a clear picture of
the kind of medicine they want to practice afterresidency. They both want to be rural familypractice doctors.
What sets these two apart from others in theUniversity of Kansas School of Medicine is thatthey were chosen to be involved in a Salina-based pilot project that puts them in a clear,longitudinal rural track.
In January, after six months of classes inKansas City and Wichita, respectively, Stewartand Wiles moved to Salina to begin rotations infamily practice, ambulatory medicine/geriatrics,obstetrics/gynecology and pediatrics.
After completing one rotation and starting asecond, Stewart and Wiles are sold on the pro-gram. “The one-on-one teaching aspect is sobeneficial. There are increased opportunities forhands-on experiences here,” said Stewart,adding that it’s so different than a big universityhospital, where students can get lost in thecrowd if they choose to let that happen.
Wiles feels the same, and has found theSmoky Hill residents to be a valuable resourcefor learning. “I’ve had the unique experience ofstudying in Kansas City and then had threerotations in Wichita. This program is much dif-ferent from Kansas City and even fromWichita,” he said.
Their complete satisfaction with the pilotprogram, even though some of it is still a “workin progress,” has to do in part with the students’backgrounds. Both Stewart and Wiles grew upin towns with 1A high schools. She is fromBrewster, population 240, a town betweenColby and Goodland. He hails from Hunter,
population 115, a small town on U.S. Highway81 in Mitchell County.
Stewart said she was ready to make the moveout of Kansas City and back to rural America.Her desire to make a break from the big citywas fueled by her upbringing, but also throughher recent marriage to a farmer near Quinter.“I just feel more comfortable in the small townenvironment,” she said.
Wiles, on the other hand, said he decided hewanted to be involved in the pilot project fromthe first day it was mentioned. “My wife and Iare both from small towns and I’m just passion-ate about that population. I have always knownthat I wanted to do rural primary care.”
Salina is a city that Wiles is somewhat famil-iar with. He did his undergraduate study atBethany College in Lindsborg, and workedpart-time as a phlebotomist at Salina RegionalHealth Center while attending school. He CONTINUED ON PAGE 5
What’s Inside . . .
Page 4AMA Honors Hanover'sLinda Warren, M.D.
Page 6Dean Meek, Rural Advocate,Steps Down From Helm
Page 8Field Art SalutesNurse Anesthetists
Page 10Scott County StudiesCancer Rate Concerns
Page 11Kansas Study AssessesRural Dementia Patients
Right On Track For Rural Medicine
Volume 8
Number 4
Spring 2001 RURAL HEALTH EDUCATION AND SERVICES
Mark Wiles and Jill Stewart, third-year medical students, aresold on the one-on-one teaching and hands-on experience the“Longitudinal Rural Track” pilot program offers them.
2
R-Rated videoRural Health has a“Rural-Rated” video,
“The Path Less Traveled,” available for checkout.The 16-minute video, produced as a rural recruit-ment tool by the American Academy of FamilyPhysicians, features five physicians from differentstates who have chosen rural family practice.
Students, residents or premedical club advi-sors who are interested in viewing the tape cancheck it out by contacting our Wichita orKansas City offices, 888-503-4221. It is alsoavailable through the Kansas Academy ofFamily Physicians, 800-658-1749.
Senator Roberts recognizedThe National Rural Health Association recently
recognized U.S. Senator Pat Roberts for his yearsof work in protecting and improving rural healthcare by awarding him the 2000 Legislative Award.
Senator Roberts authored the Rural HealthCare in the 21st Century Act of 2000 and has beenan outspoken advocate of the need to correctunintentional consequences to the Medicareprogram as a result of the 1997 Balanced BudgetAct. He has also fought to protect health careproviders from further Medicare cuts and torestore adequate reimbursement.
and the Kansas Association for the MedicallyUnderserved (KAMU) developed a “SurvivalManual for Providers of Health Care for theMedically Underserved.”
The 75-page manual, created by active clini-cians who work in medically underserved areasdaily, is not only a resource tool that providesinformation about KCN, KAMU, other organi-zations and opportunities for networking, it hasa more personal side too.
Ten clinicians, ranging from physicians toRNs to a licensed social worker, share personalwritings that give a realistic view of providingcare to the medically underserved in Kansas.The writings are not intended to “sell” peopleon public health, said Suzanne Giersch, RN,
clinical coordinator, Kansas Association for theMedically Underserved, but to view it throughthe eyes of people with real families, real issues,real challenges and above all, real dedication.
Rural Health recently distributed these sur-vival manuals to all of our new 2001 KansasBridging Plan participants. Others may contactGiersch at 785-233-8483 or [email protected],to obtain a copy of the guide.
Kansas tourRural Kansas will be the focal point of the
fifth annual Wheat State Whirlwind tour forUniversity of Kansas faculty May 18 and May21-25. The weeklong journey across the prairiewill include stops at more than 15 rural townsand cities.
The tour, originated by Chancellor RobertHemenway, takes faculty out of their traditionalacademic setting and places them in the heartof rural Kansas.
Linda Robinson, tour director, said, “We hopethat the participants will grow to know andunderstand the people, places and issues ofKansas, and that this knowledge will assist themin their classroom teaching and in their research.We hope, also, that through the experience theymay discover ways that their particular knowl-edge and research can be of benefit to the peopleof Kansas.”
Publication scheduleIf you would like to contribute a news item
to Kansas Connections or have an idea for anarticle, we welcome your input. Please sendinformation to the KU School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS 67214-3199. Ideas are also welcomed by telephone at316-293-2649; fax, 316-293-2671; or e-mail,[email protected].
Deadline for the next issue is June 14, 2001.If you know of someone who is not receiving
the newsletter but might enjoy reading it, pleaselet us know.
Kansas Connectionsis published four times ayear by the University ofKansas Medical Center,Rural Health Educationand Services, Kansas Cityand Wichita. KUMC is anAA/EO/Title IX Institution.
316-293-2649DIRECTOR
Lorene R. ValentineEDITOR
Jackie Cleary
http://ruralhealth.kumc.edu
From The Director . . .Lorene R. Valentine
K U M E D I C A L C E N T E R RURAL H E A L T H 3
Pharmacy Camp AppealsTo Rural StudentsApply by May 1 for summer pharmacy camp in Hays
Rural pharmacists are making a great impres-sion on their local high school students. At
least that’s the logical conclusion derived fromenrollment in the University of Kansas’ phar-macy camp.
Last year, out of 18 participants at the KUSchool of Pharmacy Summer Camp CareerExploration Program, only one student wasfrom a metropolitan area. The numbers havebeen similar in previous years.
Gene Hotchkiss, assistant to the dean, Schoolof Pharmacy, and organizer of the 2001 camp,said, “The camp has been most appealing torural students, and in general, our pharmacyschool enrollment has a large representationof people from small communities.”
Hotchkiss expects the fifth annual pharmacycamp, June 3-8, to again have a high rural-based enrollment, especially since, for the firsttime, it will be hosted at a rural location – Ft.Hays State University in Hays.
“Many students have a perception of thecorner drugstore, and the camp program willenhance their understanding of the broad scopeof opportunities in the pharmacy profession,”said Hotchkiss. “It will give them a better ideaof what pharmacists actually do.”
The camp for freshmen through senior highschool students, which has an application dead-line of May 1, will include intensive hands-onlab projects, such as learning how to make thesunburn-protecting zinc oxide ointment.
Students will be shown how diverse the phar-macy profession can be when they meet with ahalf dozen KU School of Pharmacy faculty, aswell as community retail and hospital pharma-cists, pharmaceutical sales representatives, andpharmacists from specialty practice areas such ascompounding pharmacy. Tours of the HaysMedical Center pharmacy and other Hays areapharmacies, as well as a few social activities, willalso be on the agenda.
Pharmacycamp tuition is$375, whichcovers dormlodging, mealsand campadministrativefees. Hotchkissnoted that a limitednumber of partial scholar-ships are available, or studentsmay want to contact their localpharmacist for assistance.
“Many of the students are sponsored in fullor in part by local pharmacists and civic organi-zations,” said Hotchkiss.
In Beloit, for example, Max Heidrick, ownerof S & S Drug, sponsors up to four high schoolstudents from his community per year to attendthe camp. “I feel I have a responsibility to helprecruit to the rural areas,” he said. “A lot ofcounties don’t even have a pharmacy.”
Heidrick, a member of the Kansas PharmacyService Corporation and the Kansas State Boardof Pharmacy, knows that the rural shortage ofpharmacists won’t be fixed overnight, but byshowing high school students the good qualityof life a rural pharmacist can have, he believes itcan make a difference.
Applications for the summer camp are avail-able from high school counselors or by callingHotchkiss at the School of Pharmacy, 785-864-3591.
Each applicant must write a brief essay thatprovides a personal introduction and conveyswhy he/she wants to participate in pharmacycamp. Two letters of recommendation are alsorequired.
T he American Medical Association honoredLinda Warren, M.D., the only primary care
physician in the rural Kansas town of Hanover,as one of six honorees to receive the AMA’sPride in the Profession award.
Warren received the award, which recognizesphysicians who have made heroic contributions
to their communitiesas healers and leaders,at the AMA’s NationalLeadership Conferencein Washington D.C.in March.
“I was unbelievably surprised and pleasedthat the Kansas Medical Society nominated mefor the award,” said Warren. “It was a tremen-dous honor. I was totally overwhelmed.”
Warren’s dedication to rural medicine and herleadership and involvement in organized medi-cine earned her the 2001 Pride in the Professionaward. She has been providing medical care inHanover, population 654, since 1971. It is theonly place she has ever practiced. Through theyears, she has enjoyed practicing medicine inpartnership with her husband, Roger Warren,M.D., who is a general surgeon.
“I really believe in rural medicine,” she said.At the conference, Warren said she accepted
the award on behalf of all rural physicians –
those, who, just like she, place themselvesin complex, unique and rewarding patientrelationships that only exist in small, ruralcommunities.
As the audience, which was larger than thepopulation of Hanover, listened, Warren sharedone unforgettable high and one just as unfor-gettable low of her practice life in Hanover. Shemoved them to tears as she talked about the joyof life being confirmed for one friend, and thedeep, deep grief the entire community feltwhen a drunk driver veered off the road andtook the life of a couple as their two young
sons looked on.In accepting the
award, Warren alsoreceived a $1,000 grantthat will benefit theWarren Clinic/HanoverHospital TransportationProgram, a free medical
transportation program that uses uniformeddrivers to assist people who need a ride to theclinic or hospital.
As committed as Warren is to rural prac-tice, she is equally committed to servingpatients and the profession by being involvedin local, state and national organizations.She is a long-time rural preceptor for the KUSchool of Medicine and in 1995, she becamethe first woman president of the KansasMedical Society. She has served the AMAHouse of Delegates as both a delegate andalternate delegate.
Warren, who has four grown children, includ-ing one who is a general surgery resident thatwould like to practice in rural Kansas, feels shehas been blessed to be able to practice and stillbe totally involved with her family.
“My practice in the rural area has allowedme to integrate all facets of my life into one,”she said.
AMA Honors Rural PhysicianLinda Warren of Hanover wins national award
4
Linda Warren, M.D., earned theAmerican Medical Association’s2001 Pride in the Professionaward for her dedication torural medicine and her leader-ship and involvement in orga-nized medicine.
Hanover
“My practice in the rural areahas allowed me to integrateall facets of my life into one.”
K U M E D I C A L C E N T E R RURAL H E A L T H 5
credits his Salina experience for helpinghone some of his doctoring skills. “Youcertainly learn how to develop a bedsidemanner when you’re sticking someone atfour in the morning,” he said.
The pilot program, officially titled“Longitudinal Rural Track,” is based atthe KU School of Medicine NorthCentral Kansas Medical EducationNetwork Site at the Smoky Hill FamilyPractice Residency in Salina. It relies onresidency faculty, residents as teachers,and broad community support fromSalina physicians, Salina Regional MedicalCenter and community agencies.
Thus far, community preceptorsinvolved in the pilot project includeSteve Sebree, M.D., AlisaBridge, M.D., DavidDennis, M.D., LaDonaSchmidt, M.D., and GaryWilliams, M.D.
One training aspectthat Salina offers, thatneither Kansas City norWichita has, is a clinicthat allows students to seea continuum of care. The“Salina Cares” Clinicoffers free care twoevenings per week and isstaffed entirely by volunteer medicalproviders of the community.
Stewart and Wiles each spend oneevening a week at the Salina Cares Clinicand both say it has been a high point ofthis rural track. Not only do they receivethe experience they need, they are able tofollow a single patient from the clinicthrough hospital care, or follow the careof several members of a family. “You lookforward to going there,” said Stewart. “Itgives you a taste of the autonomy thatexists in a real practice.”
At the clinic, they feel they have anincreased level of responsibility, eventhough they are still under the close direc-tion of attending physicians and residents.
“It’s not the same as when there are 15other residents and students who can dothe same thing,” said Stewart.
“You feel like you are an integral partof the patient’s care,” said Wiles. “I havefelt an increase in my self-confidencesince working there.”
The students havealso enjoyed theirhospital experiencesat Salina Regional
Health Center. “The hospital staff seemsto be excited about the program, too,”said Wiles, and Stewart added, “It feelslike that small town atmosphere wherepeople really love to help you.”
The pilot program will take Stewartand Wiles through to the end of theirthird year rotations, and it will also takethem through at least three of theirfourth year rotations for a total of ninemonths of study in Salina. The fourthyear rotations will include Health of thePublic, Rural Preceptorship and oneadditional course of their choice.
At this time, Wiles and Stewart musttravel to the schools of medicine inKansas City and Wichita for testing, but
it is hoped that the National Board ofMedical Examiners will approve SmokyHill as an official testing site.
“We don’t want them totally isolatedfrom their class, but we want to limittravel back and forth to Kansas City orWichita so that they have an immersion
into the community,” said KenKallail, Ph.D., Director ofMedical Education Outreach,and professor, Family andCommunity Medicine, KUSchool of Medicine-Wichita.
Charles Allred, M.D., pro-gram director, Smoky HillFamily Practice ResidencyProgram, said, “I think thatthe students who come outhere have to be motivated, self-
starter types. There’sno one here to followthem around saying,‘Are you at your 9o’clock class?’”
That “morningclass” is also some-what non-existant
for the students. They receive most oftheir didactic training through video-tapes. So far, they like the way that fitsinto the program. “It certainly lets youhave flexibility,” said Wiles, and it’s easyto rewind if they want to go over some-thing twice.
As the pilot moves forward, thingslook good for future students whomight be interested in this rural track ofstudy. Kallail said plans are in progressto pilot at least two more third-year stu-dents in this rural track in 2002, and heis working on a plan for a four-yearrural track program.
“We’re certainly trying to give studentsless of a tertiary care setting and more ofa rural flavor,” said Allred. “Mark andJill have been energetic, enthusiastic andmotivated. They realize the position theyare in as representatives of KU.”
Right On Track CONTINUED FROM PAGE 1
ABOVE: Medical student Jill Stewart takes a look inthe ear of five-year-old Holden Hendricks, a patientwhose family regularly sees pediatrician Alisa Bridge,M.D., in Salina. LEFT: Decked out in surgical scrubs,medical student Mark Wiles checks to see that thecomputer is registering the internal fetal monitor heplaced on a baby’s head just moments before.
Fond Farewell, Dean Meek
6
I n June, when Dean Joseph Meek, M.D.,steps away from his 10-year post at the helm
of the KU School of Medicine-Wichita, ruralKansas will be saying good-bye to a great friendand advocate.
In his 37-year career in medicine, all at theUniversity of Kansas, Meek has been a leaderwho has encouraged, supported and listened tophysicians in rural practice.
“I have always felt it was the right thing to doto try to ensure doctors for rural Kansas,” hesaid. “My rural upbringing led me to a sense ofcommitment to rural Kansas.”
Meek grew up with daily exposure to ruralmedicine. In Hiawatha, his family ran the localdrug store, and one of the community’s physi-cians, the now-deceased Thomas Duckett,M.D., a surgeon and general practitioner, hadan office directly above the drug store.
Meek said Duckett made a huge impressionon him, and when he was in college, Meekshadowed the Hiawatha physician for a time.
One day, as he followed Duckett on rounds,Meek’s emotions ran the gamut from excite-ment to fear when the doctor asked him whathe thought about a particular patient’s case.
“I always admired him tremendously. He wasso dedicated to his patients,” said Meek.
After graduating from KU Medical Schooland completing his internal medicine residencyin 1964, Meek immediately joined KU’s faculty.
One former student, Howell Johnson, M.D., aninternist with a subspeciality in geriatrics whograduated from the School of Medicine in ‘71,remembers Meek as being a great instructor,but also as a “friendly face in a hostile crowd.”
“I have the greatest admiration for Joe Meek,”said Johnson. “He makes me feel like we arevery close friends.”
Perhaps that’s part of what has made Meek sosuccessful. His jovial smile, keen sense ofhumor and genuine interest in people makeshim (and the KU School of Medicine-Wichita)remembered like a good friend.
Howell, who has practiced in Dodge Cityclose to 27 years, said Meek has taken a person-al interest in rural physician shortages andrecruitment efforts in Kansas. “I have alwaysfelt like he was available to help and that Icould call on him at anytime. He’s made severaltrips to Dodge City over the years and he’sgiven us advice on how to recruit doctors outhere,” said Johnson. “I can’t say enough aboutDr. Meek as a person, physician and leader.”
Dean Joseph Meek welcomes everyopportunity to be involved with medicalstudents, preceptors and the community.
ABOVE: At the South CentralKansas Medical EducationNetwork Site’s dedication in1999, Meek shares a smilewith site co-directors RichardWatson, M.D., Marla Ullom-Minnich, M.D., and GregThomas, M.D. ABOVE RIGHT:
Meek congratulates a medicalstudent, Megan Jack, at theAugust 2000 White CoatCeremony.
K U M E D I C A L C E N T E R RURAL H E A L T H 7
Through the years, as Meek was making hismark on the School of Medicine, his small townupbringing often offered subtle reminders ofthe importance of rural physicians. His friendsback in Hiawatha, for example, didn’t miss anopportunity to say, ‘When are you going tocome back to Hiawatha and be a real doctor?’
Though the words were just chides, Meeksays he believes there is some truth to that state-ment. The fact that rural physicians face somany unknowns again and again, he said,makes his career choice seem comfortably safein comparison.
His career, however, shows he didn’t opt for a“safe” course. In fact, his passion and admira-tion of rural physicians is what helped him getwhere he is today.
Thirty years ago, for instance, as a somewhatlowly faculty member, Joe Meek stormed intoKU Medical Center’s executive vice chancellor’soffice, and a bit to even his surprise, he yelled atthe EVC. “I remember saying, ‘KU has got to dosomething to get physicians into rural Kansas!’”
His disdain, which was fueled by themediocre success of KU’s “Murphy Plan,” aprogram that encouraged physicians to establishrural Kansas practices, was, luckily for Kansas,met head on. The executive vice chancelloranswered, “Meek, if you feel this passionateabout it, you come up with a plan.”
It was a moment he never forgot, as it taughthim something about being an administrator, andit led to the creation of his next position, directorof Health Care Outreach. He held the positionfrom 1978 to 1985, and within that time, KUbegan to focus more on rural physicians’ needsand it developed the KU Area Health EducationCenters – which Meek praises as “nerve centers”for community health education.
Meek’s medical school classmate, Earl Merkel,M.D., who practices family medicine inRussell, is another who doesn’t like to miss anopportunity to hassle his urban friend. WhenMerkel heard that Meek had been chosen as theSchool of Medicine-Wichita dean, he calledhim up and said, “Do you know anythingabout medicine outside Kansas City?”
Meek’s reply to Merkel: “Not really, butthere are people like you that will call andkeep me informed.”
And so it has been. Merkel said, “I enjoyedhaving him in his administrative positionbecause it gave us (rural physicians) access todecision makers. I do kind of regret his retire-ment. He’s been good for the university andgood for Kansas.”
During Meek’s tenure as dean, he said he isproud of the development of KU’s KansasBridging Plan and the Kansas Locum TenensProgram. He is most proud, however, that theKU School of Medicine-Wichita has become lessknown as a satellite of its Kansas City counter-part and more known on its own merit.
“We’re now regard-ed as a communityresource. Now, we areconsidered an eco-nomic driver. Theuniversity sharesresponsibilities withthe hospitals for 250residents – that’s nottoo far behind KansasCity,” said Meek.
“We are cementedin as a KU programthat is stronglyentrenched in theWichita community.That’s what I want tobe remembered for –when that transfor-mation took place.That doesn’t countermy pride in whatWichita can do for rural communities,” he said.“All the small towns are Wichita’s constituency.”
Meek may be hanging up his administrativehat in June, but he has more than vacations andgrandchildren on his mind. He’s signed on tosee patients as a part-time endocrinologist inthe KU School of Medicine-Wichita’s InternalMedicine clinic.
Perhaps now, in his retirement, Meek willfinally get a taste of rural medicine. He’s alreadyhad one phone call asking if he’s ready, willingand able to take a few rural consultations.
“What goes around, comes around,” helaughed.
Last June, when the KU Schoolof Medicine-Wichita celebratedits 25th anniversary with aneighborhood block party,Meek took in all the fun, includ-ing having a Jayhawk paintedon his cheek.
“I have the greatest admiration forJoe Meek. He makes me feel likewe are very close friends.”Howell Johnson, M.D., former student
I n a Kansas field near Topeka there isa football field sized portrait of a
nurse anesthetist and a young patient.This field art depicts a certified regis-tered nurse anesthetist (CRNA) in asurgical hat and mask clasping the handof a young girl before surgery.
The image represents a scene thattakes place 17 million times a year aspatients put their lives in the hands of anurse anesthetist. The art form’s one-ness with the rural land is especiallyfitting since more than two-thirds ofall rural hospitals in the UnitedStates rely on certified registerednurse anesthetists to provide anes-thesia care.
Kim Zweygardt, a CRNA whopractices at three small westernKansas area hospitals and coordi-nated the project, said the field artwas commissioned to showcase aprofession that is often called the“best kept secret in health care.”
“Nurse anesthetists havesomewhat of a hidden profes-sion, at least to the patient,” saidZweygardt. “People tend not toremember us since they see usright before surgery and becausethe drugs we give affect thememory.”
Zweygardt hopes the larger-than-life portrait will make peoplethink back to the moments just beforethey had surgery. Many, especially thosewho had surgery at a rural location, arelikely to say, “I bet it was a CRNA whogave me my anesthetic.”
That’s what happened to native Kansasenvironmental artist Stan Herd who cre-ated the field art. As he and Zweygardt,who are both originally from Protection,Kan., began to discuss the project, heremembered having surgery at age 14when he had a football injury. As he
recalled that time, the sympathetic peo-ple and calm voices, he asked Zweygardt,‘Do you think that was a CRNA?,’ andshe replied, “I know it was because ittook place in a rural hospital.”
The recollection sparked Zweygardt’sinterest enough that she looked upHerd’s case. To her delight, she discov-ered that CRNA Andy Bartel, who nowpractices at Meade District Hospital,
remembered that the incident happenedduring his first year of practice at ClarkCounty Hospital in Ashland, Kan.
Herd created “Sacred Trust” in partthrough his memory of Bartel, whomhe recalled as being so nice at a timewhen he was scared, and because nurseanesthetists take their role as a patientadvocate so seriously.
“We feel it is a sacred trust to care forour patients when they cannot care forthemselves,” said Zweygardt. “During
the anesthetic, CRNAs literally holdtheir patients’ lives in their hands.Often, we have only minutes to soothetheir fears and let them know we willtake care of and be there every momentof their surgery.”
CRNAs administer anesthesia for alltypes of surgical cases, from the sim-plest to the most complex. They aretaught to use all available anesthesia
drugs, to manage fluid and bloodreplacement therapy and to inter-pret data from monitoring devices.Other clinical responsibilitiesinclude the insertion of invasivecatheters, the recognition and cor-rection of anesthetic complica-tions, airway support duringresuscitation and pain manage-ment, such as epidural’s for labor-ing mothers.
A CRNA, said Zweygardt, iscomparable to a doctor of anes-thesiology; with the major differ-ence being the place each groupbegins their education. A nurseattends nursing school and mustthen work two to three years incritical care before training to bea nurse anesthetist. Physicians,
on the other hand, attend med-ical school and then specialize inanesthesiology during residency.“We study out of the same books
and, in many programs, study in thesame classrooms,” said Zweygardt.
She believes part of what makes anurse anesthetist special is the impor-tance all nurses place on being a patientadvocate. “From the first day of nurs-ing school, you are told that you arethe patient advocate,” she said. “Seeingthe patient as a person and yourself asthe advocate brings a little more TLCto the process.”CONTINUED ON PAGE 9
8
Outstanding In Their FieldCertified registered nurse anesthetists let Kansas field art showcase their caring qualities
Certified registered nurse anesthetists commissioned this field portrait“Sacred Trust.” Mowed grasses, rocks, wood chips and plowed ground
take the shape of a CRNA holding a child’s hand before surgery.
K U M E D I C A L C E N T E R RURAL H E A L T H 9
CONTINUED FROM PAGE 8
The nurse advocate role, noted Zweygardt,is at the highest level for a nurse anesthetistbecause the patient is asleep. “A CRNA willspeak for you when you can’t speak for yourself,”she said.
Like most rural providers, nurse anesthetistswho work in smaller hospitals have multipleresponsibilities that don’t fit into an eight-to-five job. “In rural areas, we’re on call for theemergency rooms. We are the airway experts ina small town,” she said.
Zweygardt, for example, who has practicedin much larger facilities in Houston andIllinois, is on call for the rural emergency roomsat Cheyenne County Hospital, St. Francis;Rawlins County Health Center, Atwood; andDundy County Hospital, Benkelman, Neb.The only ventilator available for emergenciesis the one on her anesthesia machine.
“It’s a different kind of practice, but I loveit,” she said. “When I came here, it was justlike putting on a comfortable pair of shoes.
I fit the town and it fit me.”Though Zweygardt coordinated the field art
project from rural Kansas, it has been a projectthat CRNAs from across the United States havesupported in both spirit and cashdonations. They feel Herd’s portraitsignifies both the art and science ofthe CRNA profession.
When the earthwork was officiallyunveiled in January, nurse anes-thetists from New York City, Texas,Florida, Montana and several otherstates flew to Kansas for a ceremonyand the chance to view it from ahelicopter. It will be visible for aboutone year, though not as groomed as at theunveiling, and is located near Topeka at 45thSt. and S.E. Paulen Road.
For more information about the projectand plans to place the field art image on T-shirtsand other items, contact Zweygardt [email protected].
Congressman Moran Visits KU-Wichita
I n a one-day tour to listen and learn moreabout health care, U.S. Congressman Jerry
Moran paid a visit to the KU School ofMedicine-Wichita in February.
Moran, who represents the 66-county “BigFirst” District of western and central Kansas,and serves in numerous congressional leader-ship roles, toured the medical school, met withKU School of Medicine-Wichita Dean JosephMeek; Rick Kellerman, M.D., professor andchair, Family and Community Medicine; andLorene Valentine, director, Rural HealthEducation and Services.
Highlights of his tour included an introduc-tion to the school’s state-of-the-art clinicalskills lab in which students are exposed tohigh-tech simulators, a visit to the NationalBoard of Medical Examiners on-site testingfacility, a view of the Standardized PatientProgram and discussion of rural health careissues as they relate to KU programs such asthe Kansas Bridging Plan and Kansas LocumTenens Program.
In Washington, D.C., and in Kansas, Moranis known as a leader in the fight to preserve andensure rural healthcare. His efforts havegarnered him a four-year term as the chair-man of the RuralHealth Care Coalition,a bipartisan group of174 members of con-gress who are commit-ted to advancing ruralpriorities in healthcare policy.
“My job inCongress is to pre-serve our way of lifein rural America andto raise awareness ofrural issues that will affect our lives as we enterthe 21st Century,” said Moran. “Rural Americais the backbone of this country and we mustmaintain its strength.”
“When I came here,it was just like puttingon a comfortable pairof shoes. I fit the townand it fit me.”Kim Zweygardt, CRNA
Nancy Davis, director, Postgraduate Education, showsCongressman Jerry Moran, far right, a patient simulator thatreplicates numerous disease processes and trauma. RickKellerman, chair, Family and Community Medicine, and LoreneValentine, director, Rural Health, look on.
Scott County Citizens Seek AnswersDoes area suffer from higher than normal cancer rates?
10
I n western Kansas’ Scott County, anagging question has been on the
minds of citizens for several years. Theywant to know if they suffer from ahigher than normal rate of cancer andneurological illness.
Now, a definitive answer is near.Experts from KU Medical Center andKansas State University have beenresearching the areas health concernsfor more than a year through their jointAgromedicine program. TheAgromedicine program, established in1997, facilitates communication andcollaboration between agriculture, vet-erinary medicine and human medicine.
The cooperation of these disciplinesin rural areas is of major importance.Frederick Oehme, DVM, Ph.D., toxi-cology professor, K-State, said, “Fortypercent of human health projects have arelationship to veterinary medicine.”
For example, if a rancher says, ‘Mywater is making my cattle sick. What is itgoing to do to me?,’ the expertise of bothphysicians and veterinarians is needed.Cooperation is also considered necessarybecause when a family member visits thelocal physician’s office for health prob-lems, most physicians don’t have muchhands-on experience with farming andranching products to correlate whatcould have made the person sick.
“It’s a brief environmental jumpfrom a cow to a human,” concludesOehme.
With farming and ranching so preva-lent in Scott County, population 6,000,the products which farmers use on theircrops, such as herbicides and pesticides,have been central to the research con-ducted by KU and K-State experts.
Oehme said that K-State has exam-ined the use of herbicides and pesticidesin Scott County and the surroundingareas. Leonard Bloomquist, Ph.D., asso-
ciate professor, Sociology, and directorof the Survey Research Laboratory, K-State, oversaw the surveying of about800 families in Scott County and adja-cent areas to determine risk factors ofthe population. Bloomquist noted thatabout 80 percent of the people contact-ed participated in the 25-minute phonesurvey and that each family representedanywhere from four to eight individuals.
While K-State focused on its researchinto exposures and neurological illness-es, KU experts were simultaneouslystudying the rate of cancer in ScottCounty.
John Neuberger, DrPH, associateprofessor, Preventive Medicine,University of Kansas Medical Center,said, “This is a fairly complex project,”“Much of our work has centered onfact finding.”
For example, in trying to determine ifthere is a greater incidence of cancer,Neuberger has had to gather cancer datafrom surrounding counties and states toidentify a “normal” rate of disease.Neuberger has looked closely at theprevalence of skin, pancreatic and kid-ney cancer, among others, as well as theincidence and mortality from cancer.
“We’re still evaluating and examiningthe data so we can make valid conclu-sions. Statistically correct interpreta-tions are both tricky and time consum-ing,” said Oehme.
Both Neuberger and Oehme hope theanalysis of the data will be concludedby late summer or early fall 2001. “We
don’t know if there is a problem inScott County, but we do know the peo-ple have concerns,” said Oehme. “If ouranswer is no, there are not higher ratesof illness, our project is done. If theanswer is yes, we will try to get morefunding to do further study.”
The Kansas Masonic Foundation, theGlenda Mulch Foundation, an organi-zation established in honor of a Scott
County resident who died of cancer,and the Scott County Hospital havefunded the study.
Greg Unruh, administrator, ScottCounty Hospital, said, “We wanted tobe a good community partner in help-ing find answers to peoples’ concerns.We, as a community, need to validatewhat is true or not true.”
At the request of the funding part-ners, KU and K-State incorporated pre-vention education into their work. “Weare trying to make sure people knowabout healthy habits,” said Oehme.
For example, education and informa-tion about smoking and pesticide safetyhave been offered to groups, andNeuberger said, “Radio and newspaperads have helped provide information onskin cancer prevention.”
“We wanted to be a good community partner inhelping find answers to peoples’ concerns. We, as acommunity, need to validate what is true or not true.”
Greg Unruh, administrator, Scott County Hospital
K U M E D I C A L C E N T E R RURAL H E A L T H 11
Teamwork Benefits Rural Dementia Patients
W ith the assistance of rural doc-tors, patients and a two-person
assessment team, experts at the KUSchool of Nursing have drawn a three-phase study of dementia in rural areasto a close. Now, there is hope that thefinal phase, a pilot study known as theKansas Memory Assessment Program,will someday benefit patients through-out the entire state.
The first part, which began in 1999,assessed the challenges rural patientsand their caregivers faced in getting adiagnosis and treatment of dementia.The second phase looked at dementiadiagnosis and treatment from the per-spective of rural healthcare providers.
professor, School of Nursing, traveledto rural communities throughout thestate to talk with 16 family caregivers,17 physicians and two midlevelproviders. “Our goal was to use theinformation from the interviews todevelop strategies to overcome the chal-lenges each group faced,” said Teel.
The Kansas Memory AssessmentProgram (Kansas MAP), conducted lastfall and this winter in northwestKansas, strove to meet the concerns ofcaregivers and doctors by facilitatingearlier diagnosis and treatment ofdementia while enhancing the assess-ment and management expertise ofrural health care providers.
Modeled after a rural geriatricdementia project in Maine, the KansasMAP developed a two-person in-homeassessment team that evaluated thepatient, the home environment and thefamily caregivers. This information wasthen forwarded to Teel and two othermemory disorder specialists to developa care plan that was implemented incoordination with the patient’s localphysician.
“One of the important program mod-ifications that we made was instead ofjust having the assessment team sendwritten data, we had them videotapethe interviews as well,” said Teel.
The videos of the 10 patients andcaregivers who participated in the pilotstudy have proven invaluable to the spe-cialists at KU. “The tapes have providedus with much more detailed informa-tion. We can see the home environmentand witness the interactions with theprimary care person,” said Teel.
Home assessmentThe home assessment team, consist-
ing of a registered nurse and a socialworker from the Northwest AreaAgency on Aging in Hays, assessed suchthings as the patient’s nutrition, med-ications and any presence of depression.The interaction between the patientand caregiver and the overall homeenvironment were also looked at.
Families, according to Phyllis Brittain,R.N., Northwest Area Agency on Aging,were thankful the Kansas MAP wasavailable, especially since it came tothem and no traveling was involved.
“Some of the families actually saidthat the person having the memoryproblems would not have agreed to gosee a physician, but allowed the assess-ment because it was done in their ownhome,” said Brittain.
Teel and her associates, Grisel Lopez,M.D., assistant professor of Neurology,School of Medicine-Kansas City; andCharles DeCarli, M.D., a former KUprofessor who has continued with theproject since moving to California, saidit has been important to work directlywith the local physicians.
“We’ve involved the local physicianat every step of the way,” said Teel, not-ing that rural physicians have respond-ed to the program enthusiastically.
Physicians have received written docu-mentation and one-on-one phone callsfrom the neurologists to discuss eachpatient’s case. Teel said a few physicianswere so pleased by the program, theymade repeat referrals for in-homeassessments.
Brittain said, “I think the physiciansare very comfortable having us do thetesting. They don’t really have the timeto do this thorough of an evaluation inthe office.”
The cooperation between KU faculty,local physicians and the assessmentteam has allowed families to deal withtheir loved one’s health care in theirlocal environment, but still get a timelydiagnosis. Teel noted that in her care-giver interviews, many families relatedstories of difficulty in getting a demen-tia diagnosis.
“It’s very important for the patientand the family to get a diagnosis in atimely fashion,” said Teel. For example,an early diagnosis of Alzheimer’s willgive the patient and the caregiver timeto learn and plan for the future togeth-er. Also, said Teel, more is known aboutAlzheimer’s today, so there are somethings, such as new drug therapies,that can be initiated.
Some forms reversibleThough Alzheimer’s is the most
common case of dementia, there areother forms that are reversible, unlikeAlzheimer’s disease. For example,depression and drug interactions cancause treatable memory problems.
In her interviews with ruralproviders, Teel found that only oneout of 19 had an organized strategyand basic information to give patientsabout dementia. This lack of strategy,as well as common threads among bestand worst case scenarios described toCONTINUED ON PAGE 12
CONTINUED FROM PAGE 11
Teel, showed that providers needed moreinformation and easy access to it.
The type of information that would be help-ful to any provider who deals with dementia
can be accessed through KU Medical Center’sKansas Geriatric Education Center. This on-line resource, http://coa.kumc.edu/gec, includesinterdisciplinary educational modules on chal-
lenging clinical cases, a calendar of geriatriceducational opportunities and curriculumresources and teaching aids for educators.The on-line educational modules will soonoffer continuing education credit.
Now that the pilot project, which wasfunded by the 2000 Kansas legislature, hasconcluded, Teel is focusing her efforts on theanalysis of Kansas MAP’s success with regardto diagnosis and treatment. At the same time,Teel said the project has been enough of asuccess that she is applying for a federal grantto expand the project.
For more information about any part of thisdementia study, contact Teel at 913-588-1697or [email protected].
The University of KansasSchool of Medicine - Wichita1010 N. KansasWichita, KS 67214-3199
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Kansas Dementia Study CONTINUED FROM PAGE 11
“Some of the families actually said that theperson having the memory problems would nothave agreed to go see a physician, but allowedthe assessment because it was done in theirown home.” Phyllis Brittain, R.N.
K U M E D I C A L C E N T E R RURAL H E A L T H
NORTHWESTCITY: ColbyPOSITION(S): Family Physician w/OBCONTACT: Mark Bieberle, 316-291-4378
