Neal Hayhurst ’21 — This summer, I had the opportunity to work as an EMT for the Crawfordsville Fire Department. First, I would like to thank Jill Rogers for organizing this for me and the Global Health Initiative for covering my housing costs. The time, effort, and money they have dedicated to me embodies the Wabash spirit and reminds me why I chose to attend this special college.

As an EMT, you meet people where they are. Patients don’t shower, dress up, and drive over to the clinic to receive the treatment we give. Patients sometimes need treatment in the middle of the road, in their car in a parking lot, or on the floor of a bathroom. These are all situations that I encountered this summer which required me to meet patients where they were. I guess you could say that our goal was to meet every patient at the starting point–whatever state of need they are in—and get them to our end point- the hospital in a stable or improved condition. The complicating part—the emergency part of emergency medicine–is that the EMT never knows what the starting point may be, which means it may be harder or take longer to get some patients to the end point and easier and more straightforward for others. Whether the patient is a man bleeding and in pain in the road, a man seizing in his car, or a lady who has fallen in her bathroom, we see each and every patient as deserving of our best work and our best effort to get them to the same endpoint. EMTs meet these people at their worst, their most vulnerable, and do what they can to heal.

The interpersonal connection between an EMT or paramedic and their patient is often just as important as a well-developed knowledge of emergency care. One of the paramedics that I worked with this summer told me that if you talk to a patient long enough and are truly interested in their story, they will tell you exactly what is wrong with them. I found that to be especially true in the context of older patients who can quickly become annoyed with poking and prodding and tests. It is so easy to become obsessed with data and the cold hard numbers and to consequently miss the easiest way, both for the patient and the care provider, to uncover the problem. It was fun to put the EMT skills I had learned into practice, but I think interacting with patients and learning how to connect with them and earn their trust was the most beneficial part of the whole experience for me as an aspiring physician.

Samuel Marksberry ’21 – As an intern at the Montgomery County Health Department, my main role has been with the vector program. That includes doing mosquito surveillance around the county by collecting, typing, and sending mosquitoes to the state health department in order to be tested for West Nile virus. I’ve also worked with the education side of public health by writing articles about food safety and nutrition for the local newspaper and designing activities for kids at the local health fair. The other piece of my role at the health department is learning the structure and responsibility of how the department influences positive health in the community. I have also participated in food, pool, house, and septic inspections.

Sam Marksberry ’21, left, and Owen Doster ’20

My most powerful experiences have been when I tagged along on some of the house inspections. I have observed poor air quality, human and animal feces, stuff piled to the ceiling, or dirt everywhere in a home. These conditions are factors that play into deeming a house unfit for human habitation because they all have a negative impact on health. Through my liberal arts education, I am able to piece together the many components that play into an individual’s health. Rather than just assume some people are, for lack of a better word, dirty, health is more than what can be seen on a house inspection. In my Global Health class with Dr. Eric Wetzel, we discussed that many factors such as education, socioeconomic status, family, and experiences are what make up someone’s health. I have learned that to truly help someone, it is important to practice empathy and understand where an individual is coming from. Helping someone can be tricky at times because it can be difficult to figure out what would be most beneficial to them, but listening and caring make improving someone’s situation less difficult. My experience at the health department combined with my education at Wabash has given me another lens to view the world, a lens that is focused on understanding others.

Matthew Hodges ’19 – As a pre-med student with a primary care focus, I tend to frame preventive care at an individual level. When I think of preventive health measures, I generally think of proper diet, adequate physical exercise, reducing high-risk behaviors, and receiving routine checkups, vaccinations, and examinations. While these factors are undoubtedly important and play a key role in public health, there are so many preventive measures beyond the scope of individual lifestyle choices that are absolutely vital to a healthy community. Working at the Montgomery County Health Department this summer, I’ve had the opportunity to see a small fraction of the work that goes on behind the scenes to keep our community healthy.

Matt Hodges ’19 laughs with Sam Marksberry ’21 while picking up mosquitos

Many of the health department’s responsibilities are things that we don’t think about; we simply take them for granted because they have been done so well for such a long time. Food inspection and sanitation specifically come to mind. When we sit down at a local restaurant and order our favorite menu item, we assume the food is clean and won’t make us sick. When we look down at our plate, we generally don’t ask ourselves at what temperature the meat was cooked, whether or not there was cross-contamination in the kitchen, if everyone was wearing a hairnet, or if the freezer was cold enough. Fortunately, Adrianne Northcutt has already asked all of these questions so we don’t have to. Similarly, the whole appeal of indoor plumbing is that we don’t have to think about what happens after we flush. That isn’t magic – it’s a man named Don Orr. Don personally inspects every septic system in the county to make sure they meet standards that prevent a whole host of unpleasant sewage-related problems.

Without people like Adrianne and Don, it would only be a matter of time before diseases and health issues that primarily exist in history books and developing countries come back to bite us. Working at the health department, I’ve learned the importance of a sound, well-regulated infrastructure. Many of the societal comforts we take for granted are in fact substantial victories for public health.

Hunter Jones ’20 – I was hired by the Montgomery County Health Department through a grant specifically to create materials aimed at helping those who had recently experienced an overdose due to opioids. In this capacity, I began by creating an updated list of substance abuse treatment centers and resources in the area. However, in doing this, I was shocked to find how disorganized and incomplete current local and national resources were. This led me down the path of creating a new website for Montgomery County to create a centralized and inclusive resource for substance abuse treatment, prevention, and information in our community. I am currently working with the health department to submit a grant to fund this website and thrilled when thinking about how much potential this resource has.

Owen Doster, Hunter Jones, Sam Marksberry, and Matt Hodges at the local health department.

I attribute a lot of my success in my role at the health department to my time spent in a liberal arts environment because it has taught me to not only identify a problem but also take the steps needed to establish a solution. Wabash has equipped me with the tools to view a problem through a critical lens and walk my way around a problem in order to create a well-rounded response. My liberal arts education has also been critical when observing discussions from different community members and other organizational efforts to combat the opioid epidemic. As with all issues of this magnitude, there will always be differing opinions on what the best answer is. The most important tool Wabash has given me regarding these discussions and plans is the ability to take a step back and see a problem through a bigger lens than my own experiences to help establish a versatile solution.

Owen Doster ’20 – Like many of the employees of the Health Department in Montgomery County, I do multiple things. For the most part, my classmates Matt Hodges ’19 and Hunter Jones ’20 are here for very specific opportunities, but I am getting more of the all-encompassing experience. Primarily, I work as a member of the Surveillance of Water and Airborne Transmitters, or SWAT team, for the health department. We are the vector control experts. That means we trap, determine the species, and send the mosquitos off to the state health department to check for carriers of West Nile virus.

Sam Marksberry ’21, left, and Owen Doster ’20

I have also experienced almost every other facet of the department: home inspections, restaurant inspections, septic inspections, county meetings, nursing procedures, and vital records. It is incredible to see how people whose families have been ravaged by drug abuse, prison time, health issues, or just overall family troubles can bounce back and continue to try and live. These powerful moments really make me stop and think about not only the people but the circumstances revolving around how they got to this point of intervention. This summer has been humbling and a true test of how I think about people and the hardships they face.

To me, the ability to be serious, professional, yet empathetic is essential to being a great physician, a medical professional, or just human. This summer has been a constant test to my empathy. I came from an upper-middle class family where I’ve never had to worry where my next meal was coming from, if I was able to shower or brush my teeth safely, or any other circumstance revolving around safe living. I don’t know what that feels like and don’t profess to. However, this is where my empathy comes in. I have challenged myself to try and understand and think more deeply about those situations involving the people we are helping and working with. I may never see that person ever again, but how will they remember our interaction? And if we do ever cross paths again, how will they remember how I treated them last time? I have two choices. I can be selfish and lack the ability to take the time out of my day to care and understand where they are coming from. Or, my second choice is to act like the human we are created as and show care, empathy, and love. Without that approach we will continue down a path of selfishness without ever making a positive difference in the community or potential the world around us.

Eric Lakomek ’21– This summer I have had the pleasure to participate in an Immersive Learning experience funded by the Wabash Global Health Initiative with alumnus Dr. Sean Sharma ’98 and the staff at the Fountain and Warren County health departments. I was given the opportunity to experience the outreach of public health in the only bi-county health department in the state of Indiana.

Dr. Sharma ’98, left, and Eric Lakomek

The principal task I spent most of my time on this summer was developing an open-ended project that addressed a major health care need in the community that would have a lasting impact on the residents for years to come. After searching through many recent demographics of the area, I decided to develop a project to combat the mental health crisis facing both Fountain and Warren counties.

Nearly one in five people in both counties are affected by depression and anxiety. In Fountain County, 15 methamphetamine labs were seized in 2013, and both counties have an extremely high drug overdose rate. However, the ratio of mental health and addiction care providers in Fountain County was 2,082:1. These statistics helped demonstrate a serious problem that desperately needed to be addressed in this extremely underserved area.

For the little help residents do receive, the rapid ascent of mental health illness and substance abuse diagnoses is not coupled with an accelerated awareness of resources available to the community. In addition, the stigma surrounding mental health must be reduced so that those who need help are more willing to seek it.

I created a series of posts and articles detailing the many different disorders, common symptoms, and where to seek treatment, as well as a list of around 50 immediate and professional resources within 50 miles of the health department. I also called different locations of treatment facilities and attempted to find out the average wait times and what to expect to make things more transparent. This made me realize the difficulties an individual goes through just to get in the door of these treatment facilities.

Often times, individuals can not receive the proper treatment they need because of the lack of access to care and governmental funding. What I observed this summer has allowed me to put my liberal arts education to use and apply it to addressing the behavioral needs of the community. Mental health is not a clear-cut subject. Each person has a different story and viewing it from different perspectives has allowed me to understand a completely diverse side of this growing topic.

I am excited to use what I have learned and look forward to using it to make the mental health process easier to navigate in the future. There is a growing crisis in America today, but as I have learned, there still a reason to keep on fighting the stigma. Many groups today are working on moving mental health to the forefront of healthcare problems that must be addressed. Thank you to all who have made this internship possible!

Chris Wilson ’19—This summer I am interning with the St. Joseph County Department of Health in South Bend Indiana, predominantly with the health education division. I am involved in a wide variety of activities including, but not limited to, co-teaching a lecture about nutrition to students at a local elementary school, participating in the Reducing Obesity Coalition, and helping to organize the Michiana Opioid Task Force Opioid & Addiction Summit. However, my main task is creating a lead poisoning and prevention education program. This program will be five weeks long and provides general information about lead poisoning, proper nutrition and hygiene to reduce the risk of poisoning, and home cleaning and remediation tips to prevent exposure to lead. Approximately 77% of homes in South Bend have lead based paint, which puts a lot of residents (especially children) at risk for lead poisoning. The purpose of the program is to educate families on what they can do to reduce the risk of lead poisoning, make their home lead safe, and prevent lead poisoning in the future.

I have learned a great deal in the short time that I have been here but one topic that really stands out is social determinants of health. While I had heard about them previously, I did not fully understand how social determinants of health effect an individual’s well-being. A person’s community and socioeconomic status are often as important as one’s genetics in determining overall health.

I plan to become a physician after Wabash so understanding how non-medical factors affect a person’s health is critical knowledge. This internship has provided a foundation of knowledge of how a patient’s community and education effects their health. Also, I have gained a deeper appreciation for public health and how medicine fits into public health. The opportunity to intern with the St. Joseph County Department of Health has provided me with experience in and knowledge of public health while also humbling me by allowing me to serve the community of South Bend.

Unity Garden Camp

The photo on the right is from our time at Unity Garden Camp. It’s a free camp that teaches kids about gardening, environmental sustainability, wellness, etc. We provided healthy snacks to this camp and had an activity/lesson. In this picture, the lesson was about eating a variety of fruits and vegetables. The activity was “Eat the Rainbow.” The kids would draw/write their favorite food of a certain color (e.g. drawing a banana in the yellow part of the rainbow, an avocado in the green part) within the corresponding color on a rainbow.

Whitaker is on the far right, in the green.

Joe Whitaker ’19 – “Things are going really well in South Bend. I’ve been working with Latorya Greene on two major projects. For the first project, I compiled a list of all of the bars in St. Joseph County and I collected info regarding their smoking policies, their structural layout, and any thoughts they might have on going smoke-free. For the second project, I’ve been preparing Indiana Tobacco Quit-Line information packets and delivering them to all of the physicians in network. On Friday’s I work as a volunteer at the family medicine clinic in the St. Joseph’s Regional Medical Center. I do simple things like getting patient’s vitals, cleaning rooms, and restocking supplies, but it’s great to meet people and see the variety of patients that come through the door.

In addition to my two projects, I also do community outreach events where I educate St. Joseph County citizens on the dangers of all forms of tobacco and I help get signatures for a petition. The petition advocates for two things: an increase in the purchase age of tobacco products from 18 to 21 and an increase of the cigarette tax by $1.50. I’ve had to do a lot of

Whitaker on the right in green

information seeking to be able to defend these two proposals but in educating myself I’ve really come to believe in the work we’re doing here. The community outreach programs have really influenced the way I view public health and those individuals who can slip through the cracks of the healthcare system. Ultimately, I’ll take the information I’ve learned here and I’ll carry it forward with me as I begin my career as a health professional.”

Joe is interning with the St. Joseph Health System in South Bend, Indiana.

Artie Equihua ’20

Artie Equihua ’20 — When I was around three or four years old, I told my grandfather I wanted to be a scientist. This statement did not evoke the greatest response considering he probably wanted (and still wants) me to pursue a career in professional sports. However, my fascination with science and deep desire to help those who feel hopeless has crafted my current dream of becoming a physician. However, even a kid who has dreamed of working in healthcare for his entire life can become overwhelmed by the negativity associated with it. Most recently, I had a discussion with a primary care physician working out of North Carolina. In our conversation he mentioned he had always wanted to be a doctor because of his love for science and his ability to utilize it in order to help people, but the current system was not allowing him to care for his patients to the extent he wanted to. Shortly after this comment he looked at me and said, “Healthcare is going to hell. What is it you want to do, again? Primary care? Pick something else.”

This encounter with the primary care physician had truly shook me. How could someone with such similar aspirations become so depressed and resentful toward healthcare? I tried to formulate a response that would somehow change the subject, and I ended up blurting out what his statement had made me feel. I started with the story involving my grandpa. I explained how I had identical interests and why I wanted to become a physician, but I did not say I agreed with his current perspective. Instead, I explained that I often, too, feel very cynical about the industry that I hope to someday find a career in; however, there is so much innovation and change already occurring that it keeps me hopeful.

Unfortunately, I could tell that he had not changed his position on the matter. Perhaps, he believes me to be naive, but I can live with that. Fortunately for me, with each new daunting flaw that I hear about in healthcare, I am exposed to the innovative work of twice as many people who are dedicating their lives to solving current healthcare issues on all levels. With so much innovation and optimism radiating from individuals at Volunteers in Medicine, HealthLINC, NCHICA, DHIT, Duke, UNC, and many other organizations, it is hard not to feel hopeful for the future.

This summer Equihua is participating along with Nathan Gray in a Global Health Initiative internship with Wabash alumnus Dr. Todd Rowland (www.bridge2medical.com). This is his second blog post in the series of posts on exploring the world of health care and those trying to revolutionize it. The G. Michael Dill Fund makes this internship possible.

Nathan Gray ’20, Dr.Todd Rowland ’85, Dr.Raj Haddawi, Arthur Equihua ’20. Dr. Haddawi helped found the Monroe County Volunteers in Medicine (VIM) Clinic in Bloomington in 2007, raising nearly $1 million in donations from the local community and engaging 200+ physicians in a volunteer effort. He now lives in Chapel Hill and was happy to meet with the students.

Nathan Gray ’20 — This summer I am fortunate to participate in a Global Health Initiative internship with Wabash alumnus Dr. Todd Rowland (www.bridge2medical.com) with my fellow intern Artie Equihua. This is the first of a series of blog posts where I share my experiences and observations about the healthcare field. I would like to thank the G. Michael Dill Fund for making this valuable opportunity possible.

During my week in Bloomington, I had the pleasure to shadow many of the staff at HealthLINC, a health information exchange, and at the Volunteers In Medicine (VIM) Clinic of Monroe County which provides care for the medically underserved. As I learned, in a healthcare system as fragmented as ours, a patient can quickly rack up a laundry list of medical care providers, and the failure of providers to coordinate their care can be deadly. Medical errors may result in as many as 251,000 deaths in the U.S. each year, making it the third leading cause of death in the country.1 Coordinating care and patient medical records across providers is critical to challenging this unacceptable statistic.

Health information exchanges, like HealthLINC, are playing an essential role in this battle by developing tools that aggregate a patient’s data into more complete and accessible records for all the providers using the tool. Sitting-in on a staff meeting and a conference call with their software developer provided Artie and I a unique peek into how these tools are developed, and my time at the VIM Clinic, which uses HealthLINC’s tools, demonstrated their important use.

The dedication of the VIM staff to their mission and the empathy with which they treated everyone who came into the clinic was an astounding sight. In my time at the clinic, I was inspired by an approach to medical care that was truly focused on improving patient outcomes of wellness—not only through clinical treatment but also by tackling the behavioral and social determinants of health whether that be overcoming language barriers, lifestyle counseling, or accessing social services. In carrying out their work, the VIM staff make effective use of digital health tools to the betterment of their patients.

Finally, a visit to the Critical Access hospital in Paoli, Indiana exposed me to the challenges for rural populations to access medical care. Critical Access is a designation given by the government to hospitals which serve rural populations and meet a number of other requirements. Critical Access hospitals, and especially their 24/7 emergency departments, are often an essential provider of care to these communities. Rural populations have greater difficulty accessing affordable medical care than their urban counterparts due to the limited supply of rural healthcare providers and other obstacles like transportation. It seems many now rely on the emergency departments of these hospitals as their primary care providers. This causes financial strain on the hospitals, is non-ideal for long term patient care, and if proper information systems are not in place, larger hospitals to which patients are transferred, may lack access to their patients’ complete medical records.

My experiences highlighted how various groups are working to reduce disparities in access and quality of care for the medically underserved and the important role that coordinated care plays in improving patient outcomes. In the coming weeks, I look forward to gaining a better understanding of the different actors involved in our healthcare system and how they are responding to changes in the industry of healthcare in innovative and patient-centered ways. A special thanks to Kathy Church from HealthLINC, the VIM Clinic staff especially Ed Hinds, and Sonya Zeller from IU Health Paoli for their time and effort in making this week so valuable.

1.         Anderson, JG; Abrahamson, K. “Your Health Care May Kill You: Medical Errors” Stud Health Technol Inform. 2017