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It’s not PPE, but alliances prove key weapons in rural health care’s fight against COVID-19

Jennifer Bacani McKenney knew by the first weekend of March that the coronavirus would reach the rural county in southeast Kansas where she serves as a family physician, the county health officer and school board president.

She got on the phone on Saturday. By Monday, almost 50 people convened either in person or remotely. They represented Wilson County’s two small hospitals, its schools, local governments and long-term care facilities. 

They examined the Centers for Disease Control’s website and tool kits, making lists of what they had on hand and what they were likely to need once people began showing symptoms. 

“I think because we started early, there’s been less panic and more communication and preparedness,” says McKenney, who runs a family clinic in Fredonia that her physician father, O.C. Bacani, founded more than three decades ago.

Rural health physician meets with patient

Dr. Jennifer Bacani McKenney of Fredonia meets with a patient in a photo taken March 4. She realized early on that the coronavirus would reach her southeast Kansas county. (courtesy photo)

The fragility of health care in rural Kansas is well known. Hospitals have closed. Physicians and other health professionals are in short supply. Years of inadequate funding have left health departments and hospitals worried about running out of essential protective equipment such as masks and gowns.

But professionals like McKenney are used to working with shortages. They are compensating with contingency planning, collaboration and a reservoir of trust they’ve built with their communities. Wilson County had yet to record a confirmed case of COVID-19 as of 11 a.m. April 14, but most of the counties surrounding it have.

Providers first want to make certain all Kansans have a place to turn if they think they might be showing symptoms of COVID-19.  

“In the rural setting, we do get used to taking care of our friends and neighbors,” says Robert P. Moser, a longtime rural physician and dean of the University of Kansas School of Medicine-Salina. “I think both the local health departments and the rural health systems have a pretty good process in place.”

In Wilson County, providers and public officials put the word out that people should call the health department, a doctor’s office or a hospital. “We’re telling people, regardless of their insurance status or whether they’re established with a doctor, call and we will help,” McKenney said.

For seriously ill patients, the planning becomes more complicated.

For weeks, leaders at the Greenwood County Hospital in Eureka have been figuring out how much its facility and staff can handle. Its normal 25-bed capacity could be expanded to 35 beds. But because the hospital lacks an intensive care unit, the sickest patients would need to be transported by ambulance to a larger hospital, probably in Wichita, an hour away.

What keeps hospital CEO Sandra Dickerson up at night is the fear that members of her staff might become ill.  

“If people in the community start getting really sick, it only stands to reason that our staff will also start getting sick because they live in this community,” she says. 

In situations such as tornadoes, the emergency plan is to ask nearby small hospitals to send personnel, Dickerson said. “But that’s not going to happen now, because they’re needing their own people in their hospitals.”

Moser is concerned about the same thing. “Our rural communities don’t have excess staff,” he says. “So the more we can do to prevent the outbreak from taking off like a wildfire, the better, not just for the number of patients that could be exposed, but also for us to be able to manage the day-to-day things, like heart attacks.”

For several weeks, Dickerson and staff members have been hosting Friday Facebook Live sessions to update residents and urge them to follow social isolation orders. They’re relying on trust that Dickerson has worked hard to build.

When she arrived in Eureka almost three years ago, Dickerson, an alumna of Kansas Leadership Center programs, walked into a minefield of adversarial relationships, the most serious being long-simmering mistrust between the hospital and County Commission. She started attending weekly County Commission meetings, answering questions and sharing financial information. The hospital hired a marketing coordinator, who works on educational events with schools and organizes a popular annual health fair.

The work has paid off in the COVID-19 crisis, Dickerson said. One example: When the hospital ran out of hand sanitizer, it was able to obtain the precious liquid from school buildings that are shuttered for the academic year.

Rural hospital CEO Sandra Dickerson, Greenwood County hospital

Greenwood County Hospital CEO Sandra Dickerson’s efforts to build trust the past three years are helping her community deal with COVID-19. (courtesy photo)

Wilson and Greenwood counties sit in the state’s southeast quadrant, but rural hospitals elsewhere in the state have also taken steps to keep communities informed about the virus and their preparations.

The Kearny County Hospital in Lakin created a portal on its new website with detailed information on how residents should respond to COVID-19, including resources in Spanish. 

At the Graham County Hospital in Hill City, a physician assistant invited online questions from junior and senior high school students and answered them in a Facebook Live video. 

In many places, competition has, for the moment, been set aside. Greenwood County Hospital, which operates a clinic, has shared gowns with another health clinic in town. In nearby Wilson County, the hospitals in Fredonia and Neodesha are exchanging protocols, McKenney said. And the state’s county health officers are communicating more than before. 

“I absolutely think this crisis has caused us to combine forces and share ideas,” McKenney says. “There’s no one, really, to tell us how to do this. We are our own, best resource.”

The Journal, the print and digital magazine of the Kansas Leadership Center, is publishing a digital newsletter that explores what is working, what isn’t working and what’s being learned during the response to COVID-19. To receive twice-a-week updates, subscribe here: https://kansasleadershipcenter.org/contact-us/join-our-email-list/

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