Ticks and Lyme Disease: Why should we care?

After a summer hiatus, school is back in session and so is the Introduction to Rural Health Course. As we are discussing agricultural health issues, I thought it would be pertinent to talk about Ticks and Lyme Disease.

According to the Brattleboro Reformer, tick populations have steadily been on the rise in the state of Vermont in the last 100 years because of the changing landscape from fields to forests. In 2012, Windham county tied Windsor and Rutland counties for the highest number of cases of Lyme disease. Lyme disease can be a debilitating disease if not treated, and it can be difficult to diagnose. People are infected with Lyme disease after being bitten by ticks infected with a specific bacteria, Borrelia burgdorferi. The possibility of transmission can be cut down by wearing long pants and sleeves while working, and by checking for ticks when you come inside. It is therefore important for all residents in Windham county to understand the importance of checking for ticks, as well as what we as healthcare providers can do to spread the word. Anyone who spends a great deal of time outside is at risk, and this includes agricultural workers, hikers, and people enjoying a stroll with their pets. As a future health professional looking to work in Vermont, it is important for me to know the risk factors, as well as be prepared to talk to my patients about their daily activities and to assess who to minimize their daily risk for what can be a devastating disease.

Here is the link to the article in the Brattleboro Reformer: http://www.reformer.com/ci_23127906/ticks-move

Reflections on Health Care in Windham County, Vermont

Over the last two years, I have learned a lot about the different health services, and health care in general in Windham County. It amazes me that I lived there for over 15 years, and still was able to learn more about the area. The people of Windham County are both resilient and resourceful. After Tropical Storm Irene hit, much of the state was a mess, including many places in my study county. My heart ached for the home I had grown up in, but it also gave me fantastic insight into the profession that I have been working towards for so long. The RMSP elective also allowed me to delve deep into health care, and learn the basics of what is there in the county.

I think I was most impressed to see all of the services that the two hospital's, Brattleboro Memorial and Grace Cottage provide. Grace Cottage is a critical access hospital, but it has the bare minimum in terms of services and only recently added an MRI machine for imaging. This means that Grace Cottage has to work closely with Brattleboro to provide the extent of care that many of their patients need. The working relationship with Dartmouth-Hitchcock Medical Center also impressed me. The way trauma patients are quickly airlifted to Dartmouth, and the way emergency services responds quickly is incredible, considering much of Windham County can be considered isolated.

I was also very pleased to work with Dr. Elizabeth Linder at Otis Family Healthcare for my final project. I had been a patient at this facility attached to Grace Cottage since I was little, and it was refreshing to be able to see if from another view point. I learned about the incredible health disparities in such a small area that I knew existed, but had not realized how poignant they were in every day life. It was both a tough and rewarding experience to have.

Overall, I look forward to moving back to the beautiful area, and I know where I can send my patients when the time comes. There are many tobacco cessation, weight loss, drug and alcohol rehabilitation programs. Brattleboro can provide basic surgical needs, Grace Cottage has access to physical and occupation therapy, and if one of these hospitals cannot provide the necessary care, Dartmouth is 1.5 hours away, and Boston is only 3 hours away. The remoteness of the are is definitely a challenge, but one that I look forward to overcoming in leaps and bounds. There is so much potential in every patient encounter, and I believe that someday I will be able to help and care for these people as the many wonderful practitioners of Grace Cottage Hospital and Brattleboro Memorial Hospital, as well as the many other doctor's offices do for the area on a day-to-day basis.

Whooping cough cases increase in Vermont: What does this mean?

Whooping cough is clinically known as Pertussis, and is caused by a bacteria called Bordetella Pertussis. Last summer, there was an increased number of cases in the state of Vermont compared to other years. It is an illness that is most dangerous in young children and infants; however, it can also affect unvaccinated school age children and teens. When I was in high school, I was at a private school that allowed unvaccinated students, and there were two different outbreaks of whooping cough while I was in school. It is important to raise awareness of this illness because treatment must come before the characteristic cough to be effective. This condition is preventable by a vaccine, but it is also important for adults to get booster shots to make help increase their children's protection.

Link to Article

Grace Cottage Named One of Top Hospitals in World

Being from such a small area like Southern Vermont, I become very proud when I see headlines that say the smallest hospital in the state is also only the second hospital to reach "Stage 6" of electronic medical record adoption. HIMSS analytics devised 8 stages (0-7) of EMR adoption. Stage 6 means that Grace Cottage has  physician documentation, a full clinical decision support system, and radiology picture archive and communication system. I interviewed the CEO of Grace Cottage last June for my MSI final project in RMSP, and they were implementing the EMR system that week. It is impressive that such a small hospital was able to reach Stage 6 by October 2012, and is continuing the process. EMRs allow for much better communication and ease of access between offices, and in a rural area, this is critical. The EMR is an important element of the medical home concept, which may by the future of medicine in rural Vermont. As a future practitioner, I am lucky in that my training will consist fully of EMRs, and therefore, I will be prepared to practice anywhere, especially in Southeastern Vermont.

Link to the Original Article
Explanation of the 8 Stages

Diabetes Program at Brattleboro Memorial Hospital: A Healthcare Team

The Diabetes Program located at Brattleboro Memorial Hospital is an excellent example of a rural functioning healthcare team. Diabetes is a complex disease that affects the patient both physically and mentally, but it also affects all of the friends and family of the patient as well. The healthcare team of the Diabetes Program includes a Certified Diabetic Educator, Registered Dietitians, a Physician and an Endocrinologist. All of these people coordinate to help the patient come up with a plan to keep them healthy and able to happily live their life. This includes educational sessions in small groups or individually, and the team encourages patients to bring family with them to these sessions. This is so important with a disease like diabetes because it is a lifelong health problem that can lead to many complications. It is also not an easy disease to live with so having a competent medical team to manage care is essential. It is very nice to see that there is such a program in a rural area, like Brattleboro, Vermont, and I think it is especially encouraging for me since I am interested in Pediatric Endocrinology. I believe I could fit easily into a healthcare team like this one. I think it is the best way to treat patients, and to make sure they have all of their needs taken care of.

Link to the Diabetes Program Website

How does Windham County's Health Indicators Compare with the Nation?

Looking around Windham County, you will see many different types of people in different shapes and sizes. At first glance, the county does not appear unhealthy per se compared to other counties, but it is also at the opposite end of the state from the wealth and health of the city of Burlington and this shows. So how does the county compare to the rest of Vermont and the rest of the nation when looking at indicators of health? Let's just say, it's not the worst, but it's not the best either.

Overall, the county ranks 6 out of 14 counties in Vermont after looking at health outcomes and health factors. It beat the average, but in some outcomes and behaviors, the ranking took a skydive.

Health Outcomes: In terms of mortality, which is measured as premature death, Windham County ranked 11 in 2012. This means that more residents of Windham County will die prematurely compared to the rest of the state. The numbers show that this is also worse than the rest of the nation. But why? Are we really that unhealthy? Morbidity measures show that we actually do pretty well overall by being ranked as 3 out of 14. People have the same percentage of poor health as the state overall, and low birthweight is only 5% compared to Vermont at 6.6% and the Nation at 6%. This is phenomenal as premature and low birthweight can cause significant health complications down the line.

Health Factors: There are four categories to health factors: health behaviors (4), clinical care (6), social and economic factors (10), and physical environment (4). The rankings of 2012 are in parentheses after the category. As you can see, overall, Windham County does very well when looking at health factors, except for social and economic factors. While 88% of students are expected to graduate high school, as compared to 80% as the state average, several other factors are higher than the state and national average. These include children in poverty, inadequate social support, children in single parent households, and violent crime rate, which as 175 compared to 134 in Vermont and 73 in the rest of the nation. I think the last statistic demonstrates why the county is ranked so low compared to the rest of the state, and this is unfortunate. However, it is nice to see that the county does very well when looking at health behaviors. Both adult smoking and adult obesity is lower than the rest of the state and country. This is not by much, but both smoking and obesity create such high health risks hopefully, the county can see this and push more to prevent these numbers from increasing further. In clinical care the county also does very well; however, there is a need for primary care physicians (PCP) with a 2012 ratio of 822 residents to 1 PCP compared to Vermont 720:1 and the national benchmark of 632:1. I think increasing this ratio will be a challenge for the county as many live in poverty and when people think of Vermont, they think of Burlington. If the county is marketed in a positive light such as the beauty and the closeness to Boston, this could be overcome.

In general, Windham County compares well with the rest of Vermont and the Nation. Obviously, there are areas for improvement, but there are also ways to make that happen. Fortunately, it is a beautiful area with a lot to offer even if you have to look a little closer to find it. Good Job Windham County!

Link to Windham County Health Ranking: http://www.countyhealthrankings.org/app/vermont/2012/windham/county/1/overall

Brattleboro, VT Intervention Campaign Against Underage Drinking

In late 2007, the Brattleboro Area Prevention Coalition received funding from a grant aimed at reducing underage drinking. Over 5 years, the grant allowed the coalition to build organizations and to create prevention plans and action strategies. The exciting part is that it seems like the programs are working to decrease the rate of binge drinking. The Coalition also took aim at marijuana usage because surveys showed that 47% of high school students had smoked marijuana. The media campaign "the blunt truth about marijuana" was launched, and so far both approaches appear to be working. In 2011, the rates of underage binge drinking and marijuana usage decreased more in communities that had funding from the grant than those who did not. As a future physician, this is important to understand and realize that funding for specific grants are an integral part of intervention programs. I think that it is important to support these programs as much as possible in order to benefit the entire community, and most of all, our young students.