Identifying Health Concerns in Rural and Underserved Areas

Each summer, medical students attending the University of Washington-Gonzaga University Health Partnership look for ways to address targeted issues throughout the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) region.

Raising mental health awareness among Latino farm workers in Othello, Washington. Providing information about community resources regarding diet and exercise to diabetic patients in Seattle. Educating teens in Conrad, Montana, about the importance of wearing seat belts.

Three students tackled these topics during their summer Rural Underserved Opportunities Program experience.

The four-week elective immersion in community medicine takes place between the first and second years of medical school. During their rotation, students live in rural or urban underserved communities, working side-by-side with local physicians to identify health concerns in the area. 

Conrad, Montana

The Portland, Oregon, native completed a bachelor’s degree in biochemistry at Gonzaga in 2017. He thought he might pursue research or organic chemistry, but gap years working as a medical scribe changed his mind.

“It helped me realize the human connection is what is so appealing about medicine,” he said. “As a scribe, I had mentors who engaged me in the puzzle-solving aspect of medicine, and I realized I could combine scientific inquiry and connecting with patients.”

“It’s so cool to see the medical community grow in the area,” said Hunt. “I wanted to stay here because Spokane has given so much to me already.”

Four weeks of living and working in Conrad proved eye-opening.

While working at the Conrad Rural Health Clinic, he learned that single-driver accidents are a major cause of auto-related injuries and death in Big Sky Country.

“The majority of fatal accidents in Montana occur on rural roads,” Hunt said.

A contributing factor to motorist injury and fatality is a lack of seatbelt-wearing compliance.

“Seatbelt adherence is pretty low in Montana, and Conrad is so small that they get used to driving without a seatbelt in town at 20 mph, and then they get on the highway where the speed limit is 80.”

Hunt decided to create a safe-driving pamphlet explaining the importance of wearing seatbelts to teens and engaging their parents as primary educators of their kids. The material will be distributed at the high school-based health clinic as well as the Conrad Rural Health Clinic.

Hunt values the time he spent working in the small town.

“It was an incredible experience,” he said. “It was truly a glimpse into rural and underserved medicine.”

Othello, Washington

Blanca Mejia grew up in the rural, largely Latino community of Sunnyside, Washington.

“My parents had only 5th grade educations, but they instilled in me the importance of education and hard work,” she said. “I grew up picking apples, cherries and pears.”

A scar on her hand serves as a reminder of why she pursued a medical career.

With the encouragement of her high school counselor, she enrolled in the University of Washington for her undergraduate degree.

“That’s when I realized I was not a city girl,” Mejia said, laughing. She was thankful to be accepted at UWSOM in Spokane. “Spokane is a city with a small-town vibe.”

Mejia is a TRUST (Targeted Rural Underserved Track) Scholar. The TRUST program creates a continuum for students interested in rural or underserved medicine to do most of their rural/underserved training in one community. Mejia’s TRUST community is Othello and completed her immersive experience working with physicians at Columbia Basin Health Association there.

Understanding the stigma about mental health issues in the Latino community, she created a Spanish language flyer with an embedded QR code and live web link to help increase mental health awareness and decrease stigma among Latino/a farm workers in Othello.

“The Latino community continues to face mental health care discrepancies, and COVID-19 disproportionally affected the mental health of rural Latinos,” she explained.

The website includes a YouTube video featuring a mental health-focused, culturally relevant telenovela (soap opera) episode.

“I grew up watching Mexican soap operas, and I think telenovela is a way to engage the community in a familiar format using personal narratives,” Mejia said. “I hope to distribute the flyers at the Othello Food Bank during high-traffic days.”

Seattle

Far from the farms of Othello, Anthony Mantz spent his immersive experience with the underserved population at Harborview Family Medicine in Seattle.

Mantz had worked as an emergency medical technician (EMT) during his gap years between undergrad studies and medical school and is no stranger to the urban underserved community. 

“I spent time assisting unhoused people at a ‘sleep-off shelter’ for people with alcohol use disorder,” he said. “

During his four weeks at Harborview Family Medicine, he saw a diverse patient population: 25% black, 25% white, 25% East African immigrants, 25% mix of Southeast Asian immigrants, and Hispanic immigrants.

He also saw many diabetic patients.

“The prevalence of diabetes in King County is 7.3%. Anecdotally, the prevalence of diabetes among Harborview Family Medicine patients is much higher,” he said.

Language barriers make it difficult for patients to understand diabetes self-care. Working with Community House Calls (a program within Harborview Medical Center’s Interpreter Services) and its EthnoMed outreach website, Mantz developed a diabetes navigator.

Based on the “Steering Wheel of Self-Management,” by Rose Cano, the brochure simplifies abstract concepts for diabetes patients.

He also included a list of helpful resources. For example, diabetics are urged to exercise and eat healthy meals, but Mantz said those directives can be difficult to follow.

“In Seattle, outdoor exercise isn’t always easy, and getting healthy food is difficult if you don’t have the resources.”

So, he called local food banks to see which ones had diabetic-friendly foods available. He also researched fitness and community centers to find those offering free or reduced-priced indoor classes and activities.

Mantz is delighted to know the brochure will be available at Community House Calls education events.

“I feel fulfilled knowing the people I worked with say it’s a resource they’re going to use,” he said.

About The UW-GU Health Partnership

The University of Washington School of Medicine and Gonzaga University formed a Health Partnership in 2016 with a vision to improve health and prosperity throughout eastern Washington by transforming medical education, research and innovation. The combined strengths of each institution -- deep community roots and world-class health and medical education – and the vast network of students, faculty and health care professionals is creating an impact by preparing the next generation of health care professionals to advance discovery and develop new ways to care for patients.