Challenges, concerns and champions for expectant mothers in rural America
"I never want the quality of my work or the level of care that I can provide to be compromised in any way by my zip code."
In the past four years, four labor and delivery units in northern Minnesota have closed, leaving Sanford Bemidji Medical Center and its four OB-GYNs to serve about 100,000 patients as one of the only remaining facilities providing true comprehensive high-risk OB care in the region.
With some patients driving more than two and a half hours to get to Sanford Bemidji Medical Center, offering video prenatal visits "just seemed like the logical thing to do," according to Johnna Nynas, MD, OB-GYN at Sanford Bemidji.
Dedication to her patients, rural health care and providing world-class care led to Dr. Nynas being selected as one of this year's CNN Champions for Change honorees. This recognition highlights 14 individuals who are making a difference in their communities and across the world. Dr. Nynas joined leaders of industries from health care and education to fashion and art.
Dr. Johnna Nynas grew up in rural Minnesota, "seeing how factors that you normally wouldn't think about as contributing to your overall health really make an impact." When it came time to serve her community, she stuck close to home, providing care to a community that's geographically isolated in one of the poorest areas in the state.
"I had an experience where a patient came in who had delivered at home a couple weeks prior. She was very, very sick with pre-eclampsia. When I asked what her barrier was for not coming in to get care, she said, 'my cell phone ran out of minutes, the people at my home were unsafe to drive, and I couldn't call 911.'"
When asked about the geographically isolated region and the patients she sees regularly, Nynas said, "I feel that the women here are so inspirational and diverse, and I think if there's anything worth fighting for, it's them."
According to CNN, Champions for Change programming "spotlights the extraordinary stories of pioneers who are driving us toward a brighter future and changing the world."
Dy. Nynas spent years of her personal time to help Sanford Health attain a $3.67 million grant from the U.S. Department of Health and Human Services (HHS) ' Rural Maternity and Obstetric Management Strategies (RMOMS) program.
The grant was used to create the Families First: Rural Maternity Health Collaborative , a regional effort focused on improving access to prenatal, obstetric and postpartum care while reducing inequitable outcomes for women in rural, underserved and tribal communities.
Native American women living in rural areas are twice as likely to receive late or no prenatal care and have double the rate of perinatal mortality as white women. While Native Americans make up only 2% of the United States population, 23% of the population is Native American in the area around Bemidji.
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"Access to maternity care shouldn't be limited by who you are or where you live," said U.S. Senator Tina Smith (D-MN) during a recent roundtable with frontline health care providers and leaders at Sanford Bemidji. "It's great to see programs like Families First here in Bemidji using innovative ways to provide care to rural mothers. This is a program that is hopefully the first of many creative, collaborative efforts to bring essential health care to rural women throughout rural Minnesota."
As part of the RMOMS program, Sanford Health assembled a team to help set up doctor appointments, provide patient transportation and facilitate nurse home visits to assess what patients may need outside of medical care. The program also allowed Sanford Health to outfit a number of doctors' offices with Wi-Fi and telemedicine equipment, even those that don't have OB-GYN services, "so that patients just need to go down the street to their clinic."
Developments coming from the RMOMS program also include:
The recent feature story that aired on CNN followed Ashley Jacobson, an at-risk patient from Bigfork, Minnesota, a rural town with a population of around 400:
With a high-risk pregnancy and living nearly two hours from Dr. Nynas and Sanford Bemidji, Ashley was able to attend about half of her appointments virtually, from home.
While the first pregnancy appointment, and any that require on-site procedures such as labs or ultrasounds, need to be in-person, patients are then given home-monitoring kits that include a fetal doppler to monitor the baby's heartbeat and a blood-pressure cuff. The video visits are conducted over the My Sanford Chart secure online connection, giving patients 24-hour access to their medical records, scheduling, prescription renewals and test results.
"We're seeing better compliance with the recommended care and that contributes to better outcomes. It's been very exciting to see it grow. My patients have been very open to doing this," said Dr. Nynas. "A significant majority of my patients end up doing some kind of remote care at some point during their pregnancy."
"One of my greatest joys is being stopped at the grocery store or Target and someone saying, 'Hey, it's great to see you! Do you remember this? Can you believe they're so big?' And I never get tired of that feeling," Dr. Nynas said during her Sanford Health Blue Chair Story . "It's always so exciting to see them and hear how they're doing. That's so rewarding – it's honestly the best part of this job."
Academic Obstetrician with extensive clinical experience
4 个月What an inspiring article. Thank you for caring for the patients who otherwise would have no one.
Basic Health Access
4 个月Look no further than CMS for the termination of hundreds of hospitals, countless practices, and countless delivery team members not only in rural areas with 37 million most left behind but also in 2621 counties rural and urban with 130 million people combined rural and urban. The problem is much bigger than rural and 25% of rural people are doing quite well from the usual reasons - most lines of revenue, highest payments, and best paying private health insurance. But our nation ignores the urban people also with decline by design suffering the terminations of hospitals, practices, team members, paychecks, and local health care leadership. Rural behind is important, but is stagnant. Urban behind was 40 million in 1970 in these 2621 counties, grew to 90 million behind by 2010 and should reach 150 million by 2070 and there seems to be no indication of any need for addressing their health care and other needs. Indeed decline by design is already planned.