RURAL HEALTH
COVID on the North Shore Establishing trust to meet the challenge KURT FARCHMIN, MD
A
s we in medicine face this pandemic of COVID-19, we face a reality where therapeutic medical approaches and public health measures start to become one and the same. In a disease where treatment is largely supportive even in the most advanced tertiary care hospitals, we have been repeatedly humbled and brought to the realization that what answers we have, lay largely outside clinic and hospital walls. I practice family medicine in the far reaches of the Arrowhead in Grand Marais, MN. Many readers will associate this area as a popular outdoor tourist area and have likely visited themselves. The Sawtooth Mountain Clinic where I work is a Federally Funded Qualified Health Center and the only outpatient clinic in our county of 5000 people. Likewise, the attached county hospital, North Shore Health, is the only hospital in the county where we as family medicine providers also staff the inpatient service. We have 16 beds, no ICU capacity, and no specialty physician presence other than infrequent orthopedic follow up. The nearest ICU is over 100 miles away in Duluth, Minnesota. When the COVID-19 pandemic became a stark reality, our local public health department had a sum total of one
OB & GYN CARE FOR ALL STAGES OF LIFE Low- and high-risk obstetrics,
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M A P L E G R O V E • B L A I N E • P LY M O U T H • C R Y S T A L
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OCTOBER 2020 MINNESOTA PHYSICIAN
staff person covering the entire county. Our remote location and small scale immediately pose significant obstacles when it comes to providing care for an illness that causes rapid deterioration and too often requires highly specialized care, not to mention that our age demographic is heavily weighted to those most at risk of complications. Those same obstacles, however, also have proven to be assets. At the time of this writing, our county has the lowest case count both in absolute numbers and per capita across the state. I readily admit that much of our success can be attributed to factors out of our hands. We have a low population density, only one longterm care facility, no meat packing plants, a nearly nonexistent homeless population, and nearly everyone speaks English as a primary language. I also readily admit that our situation can change in an instant. That being said, we have clear examples of the success of our local efforts and I hope that it can be of help to others. If I could name the most important strategies that have had the biggest effect in keeping our numbers down, it would be the collaboration across public entities and our investment in public health. Early on in the pandemic, it was clear that we could not place our hope in a readily accessible cure for this disease. COVID-19 was humbling advanced hospital systems across the world. Our clinic and hospital recognized that our best chance to avoid becoming overwhelmed was to do our part to promote the public health measures shown to reduce the burden of this disease on healthcare. Already some of our staff was funded in part by public health funds through the County. These team members quickly shifted gears to support public health messaging and outreach to local businesses. We also immediately brought our local public health coordinator into the incident command meetings at the hospital so that she was aware of the capabilities and challenges of our remote healthcare system and vice versa. From those regular communications we coordinated with the popular local radio station that graciously offered regular airtime three times per week where representatives from public health, the clinic, and the hospital could keep the public informed on the latest COVID-19 information. A lot of time was spent making sure that our messaging was consistent and accurate. I don’t think I can emphasize how important that consistent messaging has been in establishing trust with our community. From a foundation of trust with the community, we have been able have some impact on how this virus spreads. One of the most immediate obstacles we faced was the fact that over 80% of our economy is tourist based. This seemed to be a major liability realizing that with tourism would inevitably come the virus. We made statewide headlines highlighting tensions between locals and visitors, most notably when a large tree was cut over the highway in an effort to keep tourists and COVID-19 out. Despite objection from some locals, however, it was readily apparent that tourism was coming whether we wanted it or not, and that the implications of trying to shut down 80% of our economy would have far reaching effects on the overall health of our communities. Our response was to bring together representatives from the local Chamber of Commerce, the clinic, hospital, and not least public health. National
