In studying healthcare in Lewis County, I have come to understand just how much such a small place has to offer its patients.  Lewis County Public Health does a phenomenal job with preventive health measures, home care, end of life care and community involvement.  They also do a great job in maintaining the tight knit community feel in the county’s healthcare system that is already so prevalent in the small county’s social system.  I have also learned that having a municipal public hospital poses special challenges and advantages that are unique to such a hospital.  For example, big decisions regarding the hospital might sometimes be split between party lines.  

As is the case with most rural hospitals, Lewis County General Hospital faces many financial challenges that continually threaten its functional status.  Moreover, it’s still very difficult to attract physicians to areas like Lewis County due to the assumed professional and social isolation, discomfort with geographic remoteness, and more work for less pay.  On the other hand, for those who do see the beauty in rural living, practicing medicine in a rural area provides an incredibly intimate experience with patients, the land and the community as a whole.  Rural medicine involves generations of families, the opportunity to visit patients in the comfort of their own homes,  and the opportunity to understand how the society and culture affect health.  In my opinion, such awareness of the land and the people provides a greater opportunity to practice preventive medicine as well.  

My ultimate goal is to practice family medicine or pediatrics in a rural area much like Lewis County.  I understand the dire need for physicians who not only know medicine, but who are also passionate about the land and the people.  I want to spend my life not only practicing in a rural area, but also sharing my knowledge and passion for medicine with future generations so that we can continue to replenish these communities with physicians.    

http://www.watertowndailytimes.com/article/20110605/ADV01/306059902

Lyme disease is a real threat in Northern New York.  As a medical director for the local school district, I would need to educate the school about how tick bites happen, how to prevent them, what lyme disease is and how it affects the body, and what the consequences are if we don’t treat it.  During school physicals, I would also make a point to check for signs of lyme disease.  School-aged children, particularly in rural areas, are at risk for lyme disease because of the extensive amount of time they spend playing outside in wooded areas and tall grass.  By being meticulous about checking ourselves and each other for ticks after being outside in such areas, we can certainly prevent ourselves from contracting lyme disease.  Because schools are focal points in rural communities, the more we educate the school, the more the community is educated as a whole.  

The Lewis County Hospice “team” is composed of several members with varying roles and qualifications.  Members of the team include LPN’s, RN’s, physicians, chaplains, and social workers.  Each has a unique role in providing and ensuring comfortable end of life care for both the patients and families.  While the nurses and physicians focus on providing physical care by distributing medications, gaging the comfort level of the patient, and monitoring vitals, the social workers and chaplains play an essential role in the emotional, psychological, and spiritual care of both the patients and their families.  Together, these individuals provide incredibly comprehensive care and make the last weeks of a patients life as comfortable as it can be.  In the future, I would love to be part of such a team as a physician because I believe that such comprehensive and compassionate care during such a sensitive time can only be accomplished by working as a team. 

According to County Health Rankings and Roadmaps, Lewis County is ranked 39 out of 62 counties in terms of mortality, where we have about 500 more premature deaths than the state average.  In terms of morbidity, we rank 7 out of 62, where poor or fair health, poor physical health days, poor mental health days and low birthweight are all lower than the state average.  In terms of social and economic factors, we are ranked 43 out of 62, with 85% high school graduation which is 20% higher than the New York average, only 22% of children living in single-parent households compared to the state 34%, and a violent crime rate of only 156 compared to the state’s 399.  However, only 44% of the population has had some college compared to the state’s 64%.  Our unemployment rate is also higher than the state average at 9.2%.  One indicator for Lewis County that sticks out in the “Health Behaviors” section is the motor vehicle crash death rate of 23 versus the state’s rate of 8.  This means that a significantly greater amount of motor vehicle accidents in Lewis County lead to deaths than the rest of the state on average.  It would be interesting to see the data behind what causes the high amount of deadly motor vehicle accidents, but my guess would be the high frequency of bad winter weather.  An area of need in Lewis County, as outlined in the “Clinical Care” indicators is for more primary care physicians.  While the state average is 781 patients to 1 PCP, in Lewis County there is only 1 PCP for every 1,627 patients.  This places an incredibly heavy burden upon the PCPs of Lewis County and creates a lot of room for error or incomplete care.  Perhaps the high preventable hospital stays figure of 80 versus the state’s 69 can be partially attributed to overworked, overwhelmed, and understaffed PCPs.

http://www.watertowndailytimes.com/article/20120826/NEWS04/708269881

The Fit-N-Fun Fair hosted by Lewis County Public Health in Lowville, NY is a great health intervention activity in Lewis County.  It provides a fun way for kids and their families to learn about eating healthy and leading active lives.  By surrounding these topics with the excitement of a fair, kids and their families are more apt to learn about the important aspects of healthy living.  Prevention at this early stage in life is imperative for an overall decrease in sickness and injury.  Knowing how to take care of one's body from the get-go prevents children from being sucked into the obesity endemic with its associated diabetes and cardiovascular issues.  It also helps children stay more protected from trauma, the number one cause of death in this age group.  I think this fair is an excellent idea and should be a part of every community.

http://www.watertowndailytimes.com/article/20120930/OPINION02/709309959

As Lewis County General Hospital struggles like many other rural hospitals to stay afloat, they are looking to cut costs wherever possible.  Obviously cutting costs in a hospital setting is never easy, but in the setting of a municipal hospital,  these decisions have the added advantage/disadvantage of the public's close scrutiny and voting power to effect these decisions.  In an attempt to cut costs, LCGH has recently considered terminating its contract with a local group of ER physicians and bringing in an outside group.  The community has responded with adamant disproval.  This article exemplifies the type of community response regarding the desire to keep the local ER physician group and the resistance to outsiders.   Health care attorney Ann Phillip asks: "Will they live in your community or commute? Will they have a vested interest in the local people and hospital?"  In a small, rural community, these are valid concerns, as so much of medicine is centered around the patient physician relationship.  This relationship is very unique in rural areas, where interaction with the local physicians spans beyond the hospital.  These are our neighbors, our fellow church-goers, our golfing partners, etc.    Ann Phillips argues, "The ER physicians in place are skilled, dedicated and local. They have established relationships with their peers and patients. They have made their livelihood amongst you, for you and serve you well."  It is this relationship with their physicians, and the trust that it engenders, that the community doesn't want to lose. 

http://www.mountainviewprevention.org/programs.htm

Mountain View Prevention Services, Inc. is a phenomenal substance abuse prevention resource in Lewis County, NY.  One of their main focuses is to provide educational initiatives to prevent substance abuse.  They are widely involved in the community and in the schools, educating children, teens, and adults.  Among a long list of programs they provide, is the S.U.P.E.R.Ed. Program, or Schools Using Prevention Education Resources Program.  This program is aimed at K-5 students and provides a comprehensive curriculum on alcohol and substance abuse, safety, decision making, and self esteem.  The intent of this program is to inform students at a young age of the hazards of substance and alcohol abuse, and to advise them how to make good, safe decisions when confronted with drugs and alcohol in the future.