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AHA NOVA Award winners know that healthy farmers are vital to a healthy rural community

July 23, 2012

“Community Connections” spotlights the many ways in which hospitals serve their communities. AHA members can learn more by going to “Advocacy Issues” under www.aha.org, scrolling to “Key Initiatives” and clicking on “Community Connections.”

Healthy farmers are vital to a healthy economy in rural Shawano County, WI. Agriculture accounts for more than 22% of the local economy and dairy farms make up the biggest part of that contribution.

But many dairy farmers find health insurance too costly – nearly 20% lack coverage and 80% lack insurance that covers checkups and preventive care. And given their long workdays, farmers are reluctant to leave the farm to visit the local doctor or clinic for a checkup, even if it were provided at a reasonable cost.

So community leaders decided that, if farmers were not going to leave the farms to get care, the county would bring care to the farmers. Area health care, agriculture and business leaders hired Rhonda Strebel as a rural health coordinator in 2004 to visit farm families and provide free health risk assessments, such as blood pressure, cholesterol and skin cancer screenings, as well as offer health information and referrals to area services.

Called the “Shawano County Rural Health Initiative,” the program is spearheaded by
ThedaCare, a five-hospital community health system based in Appleton, and Shawano Medical Center. For helping to build a healthier farm community, the two health care organizations received a 2012 AHA NOVAAward July 21 at the 2012 Health Forum and AHA Leadership Summit in San Francisco. The award honors hospitals and health systems that go beyond caring for the ill and injured to help people live healthier, more productive lives.

Under the outreach program, now executive director Strebel brings primary and preventive care services directly to the farmers free of charge. She or one of her nurses visit more than 300 farms and make about 1,000 “farm calls” a year. Nearly 40% of those contacts result in referrals to other resources.

With little or no health insurance coverage, Strebel says farmers are not likely to seek medical treatment for minor accidents or chronic conditions such as high blood pressure, diabetes, melanoma, hearing problems and arthritis or seek help for bruises or broken bones. And they are not likely to seek preventive care for themselves or family members. “Farmers can work up to 16 hours a day and they are not leaving the farm to come in for a screening,” she says.

But neither can they afford to be laid up. “Who is going to milk the cows?” Strebel says. “Who is going to get the work done? They know their health is important, but there also is this feeling that they can’t afford to leave the farm.”

That’s the case with dairy farmer Kay Reminger, who can’t remember the last time she or her husband John visited the doctor.

“The Rural Health Initiative has been a godsend for us,” she says.

Strebel or one of the nurses comes to the farm for free every year to give them a regular checkup – an “invaluable” service for busy farm families, Reminger says. “They bring the procedures to our farmhouse kitchen table,” she says. “It’s a blessing.”

The rural outreach program resulted from a 2002 ThedaCareled “plunge” into the county’s dairy region. Health system, community and business leaders took a bus to visit farmers and hear their problems.

ThedaCare organizes one or two of these community plunges a year, visiting different parts of the county to gauge residents’ needs. “It’s a way for us to visit with and speak to people who are living the issues,” says Paula Morgen, ThedaCare’s director of community affairs.

Plunges are a first step toward bringing the community together to address issues like poverty, homelessness, domestic violence, literacy, and, in this case, dairy farmers’ lack of access to health care.

“Many stakeholders of the farming community were at the table from the beginning, discussing the issues farmers face and feeling ownership of their health situation,” says Morgen, who, like Strebel, is a member of the initiative’s 19-member rural
health committee. “Farmers, bankers, veterinarians, UW Extension agents, for-profit businesses, school districts, health care providers and more all came to the table and took ownership of the problem and solution. It’s been an incredible community partnership from the very beginning with everyone ending up a winner.”

ThedaCare CEO and President Dean Gruner, M.D., said the Rural Health Initiative is a powerful example of community collaboration. “From the beginning, we worked with the [dairy farm] community to develop a plan that would work for them,” he says.

ThedaCare provided $60,000 in startup funds to get the program off the ground. The seeds planted in 2002 continue to grow. Last
year, the program expanded its reach and now covers three counties.

“When we started out, I rode with the milk truckers to meet farmers and introduce them to our program,” Strebel recalls. “It’s amazing how much we’ve grown.” Shawano Medical Center CEO Dorothy Erdman says the program’s partnership-funding model, with money from both hospitals and community partner fundraisers and pledges, can be duplicated in other rural areas. “This is an innovative, practical, low-cost way to reach a large population of high-risk residents who normally fly under the radar,” she says.

Dec. 7 is the deadline for applying for a 2013 AHA NOVA Award. Learn more by visiting www.aha.org/nova.