RUSP: Learning from and with rural and urban underserved communities

Sharon Casapulla, Ed.D., M.P.H., Director of Education and Research, Office of Rural and Underserved Programs

This year, our Rural and Urban Scholars Pathways program offered a new opportunity for incoming RUSP students, a three-day community-based rural and urban underserved immersion experience. From Aug. 12-15, more than 40 new and returning RUSP students engaged in conversations with RUSP faculty and community members in rural and urban underserved areas in Columbus and in southeast Ohio. 

On Day 1, we visited the Lower Lights Christian Health Center in Franklinton and learned how Federally Qualified Health Centers work in urban underserved communities. We also heard from community health workers from the Physicians Care Connection.

In the afternoon, we learned about accessing community health data and studied health disparities that exist at the county level by looking at adjacent counties with very different health outcomes. With support from the Central Ohio Somali Medical Association, we talked with health care professionals and other representatives from the Somali community in Columbus at the Masjid Abubakar Islamic Center for Health Issues and Priorities in the Somali Community. We learned from Saida Osman, M.D., a primary care physician with OhioHealth Physicians Group who works with patients from underserved communities.

On Day 2 of the RUSP immersion, we visited Glouster, Ohio, and met with community members at the Glouster Depot and Sam’s Gym who are making a difference. The RUSP students got a taste of the Open Book Project, the narrative medicine project at the Heritage College, as an introduction to the day. We toured the the Tomcat Care Clinic, a school-based health clinic, and discussed the ways this clinic serves the community. That evening, we practiced Clinical Jazz, a small-group strategy in medical education designed to develop interpersonal skills and improve doctor-patient and interprofessional relationships .

On Day 3, we focused on systems of care in rural and urban underserved communities. We toured Hopewell Hocking Behavioral Health/Primary Care Clinic , a Federally Qualified Health Center; Stagecoach Family Practice, a solo family practice; and Hocking Valley Community Hospital, a critical access hospital . We learned about food insecurity and packed 700 boxes at the Southeast Ohio Foodbank!

We engaged in “Reflection in Action” throughout the immersion experience. Students journaled responses to the following prompts:

• What stories do you hear?  
• What themes do you notice in the stories?  
• What surprises you? Why?
• What moves you? Why?
• What is YOUR story?

Here are some of their reflections:

Time to reflect, recharge and reconnect

Alanna Meadows, OMS II

As a second-year student, I naturally fell into the role of becoming a peer mentor to the first-year students. These students had yet to step foot in their first class, but they were engaged and open to soaking in the knowledge and creating connections that would stay with them throughout their journey. Engaging in a meaningful dialogue with my peers allowed me to see what they were inspired by and curious about. What I didn’t know is how recharged I would feel after seeing the energy and passion the rising first-year students had for rural and underserved care.

This retreat has taken the mission of RUSP and brought it to a new level. By framing the retreat around the mission of RUSP, students were able to not just learn about – but truly engage in –  reflective practices, witness resilience in action and engage in community collaboration.

I came away from the RUSP retreat with a renewed sense of gratitude and appreciation for the profession I chose and an understanding of how I can leverage my resources to care for the underserved. It is my hope that each participant in the RUSP retreat walked away with one idea that will transform the way they view rural and underserved care.

Kind smile and a firm handshake 

Raisa Amin, OMS I

On our second day of the RUSP immersion experience, we had the chance to talk to a few of the community members of Glouster and Nelsonville, Ohio, about their life experiences –  especially their experiences with health care. We sat around a table as two women from the community shared their stories with us.

One of the two women talked about being abused at a young age and the struggles of bearing those bad childhood memories throughout her life. Even though she was a good student in high school, she got sidetracked and soon became addicted to opioids. She has been clean for over two years now, after she moved back home to Glouster and “got off the streets of Columbus.” She did not have good experiences with local health care professionals. She felt they didn’t value her because she was a former addict. She told us that all she wanted was a physician with “a kind smile and a firm handshake” who would restore her faith in the health care system. She tried to get her life back on track by becoming a certified phlebotomist, but she’s been unemployed and looking for a job for over a year. Her voice started cracking, and she got very emotional, as she started to talk about her recent horrible court battles and the loss of custody of the oldest of her three daughters.

The other woman from the community at our table also had similar experiences. In communities like Glouster, falling into the opioid addiction trap, run-ins with the law, and lack of support and judgment from the community and health care professionals are far too common. I couldn’t help but feel overwhelmed by her story and think about how different it was from mine. The love and compassion that everyone showed to those two brave women who shared their stories with us is why I am proud to be a part of the RUSP community.

It was an incredible learning experience for me personally. I was reminded why I love the career I am embarking upon so much. It is all about the people. Being from Bangladesh, the literal opposite side of the world, everyone’s story here is different from mine in many major ways. But there is something that can easily connect every human being on the planet: stories. As cliché as it sounds, the two community members opened my eyes that I too hold biases that I might not always be consciously aware of. Their struggle with bad childhood memories, drug addictions, legal issues, accidents, unplanned pregnancies and lack of social support is not something I have experienced firsthand. I was never in their shoes, and I may never completely realize what it is like to have those experiences. However, my heart cried out for them, and I wished I could do something to help.

Everyone has their own sets of challenges. I had to overcome a lot of things in my life to get to where I am in life today, but I had opportunities that were closed to those women. After listening to their stories, I feel the weight of responsibilities on my shoulders to do my part, to use my privilege to serve the underserved. I hope I remember this experience for the rest of my life and become the doctor with “a kind smile and a firm handshake” that the women talked about.

Sam: Your friendly neighborhood boxing legend

Emil Suriel Peguero, OMS I

Walking into Sam’s Gym felt like touring a museum of all of boxing’s history. There were trophies, belts and very famous fight flyers. Above all, there were tons of pictures of Sam and some of the world’s greatest boxers and kickboxers. After a quick tour of the facility, Sam began to talk about his real passion. Sam trains kids not only physically and mentally, but he makes them goal-oriented. He gives them a place to grow and learn. Sam temporarily lifts the burden from their shoulders in order to let them carve a path for themselves. Kids look forward to traveling to the big city for a night, enjoying a new restaurant and seeing new places. With the limited time we spent with Sam, I could feel how much that meant to him. The 79-year-young man fully embodied the well-known quote of boxing legend Muhammad Ali, “Float like a butterfly, sting like a bee,” as he guided me through a few of the differences between boxing and kickboxing.

The indomitable will of one man to do all he can for the youth of his town shows the beacon of hope that exists in a place that suffers from great socioeconomic and socioecological burden. Listening to such an inspiring story sparked a sense a duty and altruism in me. Reflecting on the experiences, I realized that helping the community doesn’t have to be one big, planned, successful event; smaller acts done more frequently tend to produce the most change over time. The original Hippocratic Oath states: “…when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture.” Even though the oath is related to health care, it is easy to understand that it extends far beyond the bounds of what happens in a hospital or clinic. Health care incorporates all of the personal and social aspects of life. Also, the quote precedes the famous “first do no harm,” which in Sam’s Gym doesn’t always apply!