“There are some considerable issues in the delivery of health services to rural areas,” says Sherry Fontaine, Ph.D., director and associate professor in Creighton University’s Master of Public Health program. Recruitment and retention of an adequate health care workforce, compounded by the geographic isolation of rural areas, create significant barriers to health care access.
With 25 percent of the country living in rural areas, the National Rural Health Association estimates just 10 percent of the nation’s physicians practice in these areas and nearly 500 hospitals in the nation’s countryside have closed in the last 25 years. In dentistry, there are just 40 dentists per 100,000 rural Americans, compared to 60 dentists per 100,000 people living in urban areas of the nation.
As a result, rural Americans are twice as likely to die from injuries sustained in accidents, have higher incidences and mortality rates of cardiovascular disease, and generally pay more for treatment and prescription drugs than their urban counterparts, with lower rates of access to private insurance.
“But there are some promising initiatives beginning to take shape,” Fontaine says. “Telehealth and mobile clinics are expanding access to health services in rural areas. In programs such as the online Creighton University Master of Public Health (MPH) program, we provide access to an MPH program to students who reside in rural areas who will hopefully become public health practitioners in their communities. There are certainly opportunities for us to continue to improve the delivery of health services and expand outreach to rural populations.”
With schools of medicine, pharmacy and health professions, dentistry and nursing located in the largest city of one of the nation’s most rural states, Creighton University has turned out a number of practitioners who have found true vocation in the Nebraska countryside or farther afield.
Their stories are representative of what’s happening in rural America and how dedicated professionals are finding ways to return home or start anew in areas desperately in need of their service. Here are a few of those stories.
Palmer, Alaska, with a population approaching 8,000 and proximity to the state’s largest city, Anchorage, doesn’t readily fit Sarah Thompson’s definition of rural.
“But if you want to be out in the beauty of Alaska’s wilderness, it’s not a long drive,” says Thompson, a 2011 graduate of the Creighton Alaska Pathway program, a Doctor of Occupational Therapy degree offered jointly by Creighton and the University of Alaska at Anchorage (UAA).
“That’s a major factor in what has kept me here all my life. There’s really no place like it. Being able to practice OT in Alaska, where there is such a shortage of therapists, has been very important to me, too.”
Thompson’s status as a “lifer Alaskan” was in jeopardy for a time when she and her husband, Mike, tinkered with the idea of leaving the state for job opportunities elsewhere.
“We were getting ready to move when Creighton sent out this message about an OT program they were going to do jointly with UAA,” she says. “I thought, ‘Maybe I should check this out.’”
After her graduation with the inaugural cohort of the Pathway program, Thompson began working in highly specialized OT areas, including oncology rehabilitation and lifestyles management. She developed programs previously unavailable to most people in Alaska, and her patients traveled far and wide to receive these services.
Today, she works with developmentally and learning-challenged children in the Matanuska-Susitna Borough School District, spanning 25,000 square miles of Alaskan wilderness and dotted with 45 schools ranging in enrollment from 20 students to more than 1,000. Thompson also continues to maintain a link to Creighton, serving as a teaching assistant in the spirituality curriculum for the OTD Pathway program.
“Creighton has given me such a great opportunity to serve,” Thompson says. “That’s at the core of what Creighton does. I have loved being able to be a part of Creighton and to be able to help people.”
Born and raised in the northeast Nebraska town of O’Neill (population 3,700), with a dentist father and a medical technologist mother, Mary Kersenbrock Losing says she saw very early on what the needs were in terms of health care in a rural community.
As an undergraduate, Kersenbrock Losing knew she wanted to do something in health care. She decided dentistry was the best fit. And as a second-year student at the Creighton University School of Dentistry, she decided practicing back home in O’Neill, with her dad, was the best path for her career.
“I really value what a small town brings in its sense of community and family,” Kersenbrock Losing says. “My experience growing up in O’Neill, the values I learned, it all factored into that decision. And I knew going back home was going to bring with it the opportunities to fill those needs in dentistry.”
Kersenbrock Dental Care, composed of Kersenbrock Losing and her father, MJ Kersenbrock, a 1981 Creighton dental graduate, opened in expanded offices in 2010, shortly after Kersenbrock Losing’s graduation from the dental school.
In serving a patient base drawn mostly from the countryside and smaller towns outside O’Neill, Kersenbrock Losing has immersed herself in being a neighbor to her patients. To that end, she’s traded one Creighton for another. Kersenbrock Losing and her husband, Aaron, make their home in Creighton, Neb., roughly equidistant to O’Neill and Crofton, Neb., where Aaron is a teacher.
The feeling of weaving herself into the fabric of the community is something Kersenbrock Losing says she learned growing up in O’Neill, and also in her days as a dental student at Creighton, where she took part in the five-week Institute for Latin American Concern mission to the Dominican Republic. There, she and other students in the health professions established clinics in small towns dotting the Dominican countryside. While rural Nebraska is still a far cry from the rural Dominican Republic, she says the basic mission is similar.
“There is a huge need in rural Nebraska for dental providers,” Kersenbrock Losing says. “I feel like I followed my heart back home. I’ve never regretted it. I knew there were lots of opportunities in cities, but I wanted to be in O’Neill, to be in practice with my dad and have the ultimate mentor in a place where we can make a major difference.”
Kersenbrock Dental may just have to make room for a third member of the family in the practice, too. Kersenbrock Losing’s younger brother, John Kersenbrock, just completed his second year at Creighton’s dental school.
“It’s really a privilege for me to do what I do here, and to see that Mary has found a calling and a purpose to serve O’Neill and the surrounding areas,” says MJ Kersenbrock, who began his practice in O’Neill in 1982. “We have patients who will drive 70 miles and more to get here and it’s very edifying for me to serve that population and to have my daughter here doing this work in the new generation. It’s been an honor.”
When it comes to distance, rural Nebraska has plenty to cover. Closing the gap with technology is the aim of Rebecca (Erickson) White’s pharmacy clinic at the U.S. Department of Veterans Affairs Community-Based Outpatient Clinic in Lincoln, Neb.
White, a 2008 graduate of the Creighton School of Pharmacy and Health Professions, helped inaugurate the Lincoln VA’s telepharmacy program, which, with webcams, a secure Internet connection and TV screens, helps serve patients at satellite locations in Holdrege, Neb., Norfolk, Neb., and Shenandoah, Iowa, who log in, look in the camera and speak with their pharmacist in Lincoln. Many of White’s patients drive upwards of 60 miles round-trip to get to one of those satellites for medication therapy management care.
“It is a different way of serving rural Nebraska,” White says. “But I enjoy it a lot and I think my patients do, too. It feels very much like a small town when I get in front of the screen and see them there. We talk a lot, not just about their prescriptions and health care, but what’s going on in town, what the weather’s like. It’s like we’re speaking face to face. A lot of the patients I see are very sweet, older men who haven’t had a lot of experience with webcams. They come on and say, ‘Wow, I’m on TV!’”
The fact she’s serving veterans living in rural areas is an added measure of fulfillment, White says. The telepharmacy program at the Lincoln VA is one of a handful of similar initiatives the department has enacted nationwide. White has published on her work in the Journal of Pharmacy Technology, and the Lincoln program has been cited by the Department of Veterans Affairs as a Network Star for its initiation of the telepharmacy program.
“What we’ve seen is that telepharmacy saves time and it cuts down on stress for the veterans,” she says. “It can be a little intimidating driving into some of the bigger cities, so if we can keep them in their comfort zone, it’s a better experience for them. With the number of patients we see, it feels like I’m really filling a hole.”
In 2014, between herself and one other pharmacist at the clinic in Lincoln, there were more than 4,700 telepharmacy visits.
“We’re touching a lot of lives,” White says. “I had no idea this is where my career might take me, but I’m glad it has gone this route.”
After four weeks in Wheatland, Wyo., last summer, Justin McCarthy underwent a minor epiphany, something on a continuum of feelings he had for the balance of his educational career.
McCarthy, who says he has an overarching desire to practice what he sees as “jack-of-all-trades medicine,” had his first sampling of rural life and work on a rural rotation in primary care and general practice. Having grown up in suburban Denver, McCarthy, who earned his bachelor’s degree from Creighton in 2012 and just completed his third year of medical school at Creighton, admitted his connection to rural America was tenuous at best.
“But from the taste I got of rural living there, I found it suited me well,” he says. “I felt drawn to that kind of life. It was rewarding to see medicine practiced across numerous generations, across numerous fields. And you felt a community concern that I think is lost in larger cities.”
Moreover, in an age of progressively granular specialization, an opportunity to broaden the practice and study of medicine was just what McCarthy found on the windblown scarps of southeastern Wyoming.
“I’ve always had the image of the primary care doc in the clinic, working across the broader scale of medicine,” he says. “In my rural rotation, I got to see that firsthand. It was something very striking to me, something seemingly very simple in practice, but profound in the way it can touch people’s lives.”
Working with underserved urban populations in Omaha at Creighton’s Magis Clinic at the Siena-Francis House Homeless Shelter, and also in the Dominican Republic and Guatemala on service trips as an undergraduate, McCarthy knew from an early stage his vocation lay in practice with people who don’t always have ready access to health care and who need the capacious knowledge a general practitioner can bring.
“It has been motivating for me to imagine distributive justice in becoming a physician,” McCarthy says. “Not everyone is dealt an equal hand in this life. I’ve not gotten where I am on my own. In this whole process, I’ve felt God has motivated me to do what good I could for those who were in need and, in that process, I’ve seen some amazing things. I’ve seen people healed. I’ve seen incredible innovations in working with a population that doesn’t have access to many of the things a lot of people take for granted. If I can be mindful of those things and remember that I’m doing what good I can, where I can, then I’ll have a rewarding career.”
She actually broke the leg in November, but Dawn (Stave) Nahrstedt couldn’t quite bring herself to get off it until she was ordered to do so in March.
Because even at Rock County Hospital in Bassett, Neb., a north-central Nebraska hamlet of about 550 people, the emergency room doors never close, and Nahrstedt, a nurse practitioner who is about the closest thing Rock County has to a full-time physician, felt she couldn’t let her injury stand in the way of serving the people she calls friends and neighbors.
“I didn’t want to let my patients down,” says Nahrstedt, who holds bachelor’s and master’s degrees in nursing from Creighton and is one year away from attaining her Doctor of Nursing Practice degree from the College of Nursing. “I couldn’t. I’m a health care provider. And out here, that means a lot, because there aren’t a lot of us.”
Rock County and neighboring Brown County — where a larger hospital at Ainsworth, Neb., is situated — can boast five nurse practitioners, something Nahrstedt says is a luxury compared to other rural areas. While there are some doctors who will rotate through the ER on an occasional weekend, Bassett is visited just once a month by a physician who commutes from South Dakota, meaning Rock County Hospital’s clinic and emergency room are staffed almost entirely by that rotating group of nurse practitioners.
“In a rural setting, you get a little bit of everything: ER, surgery, OB,” says Nahrstedt, who grew up in Bassett and left for 20 years before returning after attaining her first nursing degree. “But I’ve had an excellent education. Creighton prepared me for life practicing in a rural setting, where you can’t just be a specialist in any one thing. You kind of have to be ready for it all. Horse accidents, cow accidents, tractor accidents, yes, but also car accidents, lacerations, amputations and sore throats.”
For slightly more major cases, a larger hospital at Ord, Neb., is 90 miles away. Beyond that, bigger medical centers in Norfolk (125 miles) and Kearney (145 miles) get severe trauma cases, heart attacks and strokes after stabilization at Rock County, but both emergencies and routine procedures largely fall to Nahrstedt and her nursing colleagues. A typical day in Bassett means a full day’s slate at the clinic followed by a long nightshift in the ER, then maybe a few hours’ sleep before clinic duty again.
“Some days, you really have to ask yourself, ‘Is this what I wanted to do?’” Nahrstedt says. “Most days, though, you can’t help but love it. I never thought I’d be in a rural setting as a nurse, but I do love it. I love my job. I love the people I serve. There is a genuine place in my heart for the people I serve.”
