Mental and physical health are both vitally important to any community, but especially to rural communities, which the U.S. Census Bureau reports to be about 15 percent of the population. National Rural Health Day is celebrated on the third Thursday of every November, Nov. 16, 2023, highlighting some of these unique challenges and how they might be addressed.
The Centers for Disease Control and Prevention (CDC) has found that rural Americans are at greater risk of death from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than those in urban areas.
Humboldt County’s main health source, Humboldt General Hospital (HGH), offers the community medical services for both physical and mental health, but has to work hard and come up with creative approaches to overcome limited access to services, especially in more remote areas, transportation barriers, a shortage of healthcare workers and how to recruit and retain them, various health disparities, and appropriate emergency response, according to HGH Chief Executive Officer Robyn Dunckhorst.
“Humboldt County is truly very blessed to have the robust health care delivery system that we do which includes but is not limited to dentists, optometrists, private clinics, mental health providers, state health offices, and the local public hospital. We celebrate Rural Health Day not just as a hospital but as a system in our incredible county where our rural roots run deep and we pull together to persevere TOGETHER,” said Dunckhorst in an email.
A look at local healthcare:
Limited Access
Dunckhorst and other community stakeholders agree that rural communities have fewer healthcare facilities, specialists and other resources/services, but Humboldt County, local governments, and community agencies like Humboldt Connections Suicide Prevention Task Force have been working diligently to “fill gaps”, especially in regards to mental health.
Humboldt Connections President and local Director of Juvenile Services Pauline Salla said in an email that “Agencies have partnered to strengthen services and identify how to fill the gaps within our system with effective treatment options. There are many organizations that provide education on substance use and mental health wellness, help with housing and basic needs such as food, electricity vouchers etc.”
According to Salla, the Humboldt County Commissioners have created an Opioid Litigation Needs Assessment Committee to complete a comprehensive Needs Assessment, which helps the county in gaining access to millions of dollars that at the state level that can help combat local opioid addiction due to the national opioid epidemic that has “taken lives, increased disenfranchised families and exacerbated the need for more intensive services.”
“The Frontier Action Agency Warrior Youth Team is active within our community’s younger youth population. Humboldt County School District (HCSD) provides a social worker at each school and operates Communities in Schools, which provides support to any age youth enrolled in the school district, the HGH Behavioral Health Unit, Rural Mental Health Services and Family Support Center all offer mental health counseling and evaluation,” explained Salla.
Humboldt County also has a high population of elderly residents, which is an added challenge to the often limited rural healthcare system and resources, but the county is fortunate enough to have cardiology services, urology services, cardiac/pulmonary rehab, a Memory Care and Long-Term Care Facility and various support groups through HGH, to support enhanced geriatric care, according to Dunkhorst.
Transportation Barriers
Because many of the communities in Humboldt County are remote, like Denio, Orovada, Kings River, Paradise Valley, and others, utilizing healthcare, mental or physical, can be a challenge as people have to travel great distances to reach the services without the help of any public transportation.
Dunkhorst explained that these great distances also pose a significant challenge for emergency response services, but HGH has worked with the Orovada community to staff an Emergency Medical Services (EMS) station in Orovada to combat long response times and forged a solid partnership with MedX, providing helicopter transportation “that can also be dispatched to remote and possibly
treacherous areas of our county.”
“Limited public transportation and long distances to healthcare facilities can hinder patients from seeking timely medical attention,” said Dunckhorst, which could be a contributing reason to the health disparities, such as greater risk of death from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke that the CDC reports.
The HCSD is also among the many that are working towards improved healthcare opportunities for rural Nevadans, including young people, that can be accessed conveniently, as students are already traveling to attend school.
“Within the district, we have secured support both physically in our school sites with our school counselors and social workers, as well as teletherapy for more intensive support. Staff are provided opportunities for exposure and training in Youth Mental Health First Aid, as well as Signs of Suicide. Our recent federal grant award will ensure a continuation of both physical and mental health support over the next 5 years,” explained HCSD Superintendent Dr. Dave Jensen.
Healthcare Provider Shortages
National reports have found that provider shortages are affecting both rural and urban areas. A 2022 study by the University of Nevada Reno found that “11 of 14 rural and frontier areas of Nevada are single-county primary care health professional
shortage area,” which is roughly 60 percent of Nevadans.
The Nevada legislature has made the statement previously that “Nevada is experiencing significant shortages of qualified, competent health care workers in virtually every health care profession…The situation in Nevada reflects a national phenomenon and the shortage is of great concern to many because it compromises access to quality patient care.”
Unfortunately, these types of issues affect treatment and many other healthcare aspects for patients, including their perception of care itn their area.
Another community stakeholder, such as Humboldt County Manager Dave Mendiola, explained in an email that he sees the community’s perception of HGH as a challenge, but the negative perceptions seem to be based on past experiences.
“Since Robin Dunckhorst took over I believe much has been improved and she has done great work…[Health] is really the core to our existence. When in pain (mentally or physically) we are impacted in every area of our life from day-to-day activities to our work. Staying on top of one’s health leads to more productive lives and happiness,” said Mendiola.
Despite the challenges, Dunckhorst said that “HGH has one of the rare Family Medicine
residency programs to be offered at a critical access hospital in a rural location. This program allows HGH and our community to help educate and develop residents and has also been a successful recruiting strategy because these residents spend two years here. We also have sign on/relocation bonuses, tuition reimbursement, nurse residency programs and so much more.”
Health Disparities
Because of the compounding nature of the challenges that Humboldt County faces, like other rural communities, there are often higher rates of certain diseases, cancers, obesity, addiction and other health issues.
Addiction and substance abuse, sadly, run rampant in rural communities, with the American Addiction Centers finding that “per capita, the opioid overdose rate in rural communities is 45% higher than in cities,” though it is falsely thought that addiction and substance abuse rates are found to be higher in urban areas.
Locally, there are several groups working diligently to help address this calamity, with the local government taking steps to access funding and gather input from the public about how to use it. Through many different meetings and the dedication of many groups, important education has been shared and the apparent need for an in-patient facility to address mental healthcare and addiction has been ultimately identified, according to Salla.
“Our community needs an in-patient facility. But infrastructure, workforce development, and financial sustainability must be in place before that occurs…The primary goal is to provide services and treatment to every community member who needs or wants it.