Meeting the need: Mobile medical begins service in rural areas

Kathleen Ellyn

Wallowa County Chieftain

Published on May 16, 2017 2:07PM

Kathleen Ellyn/Chieftain
Cooper Matthews, 4, of Anchor Bar Ranch in Troy pedals toward the medical van outside Troy School.

Kathleen Ellyn/Chieftain Cooper Matthews, 4, of Anchor Bar Ranch in Troy pedals toward the medical van outside Troy School.

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Chieftain ArchivesRedmond Grade into Troy.

Chieftain ArchivesRedmond Grade into Troy.

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Kathleen Ellyn/Chieftain
A big portion of the student body of Troy School District gathers with Kathy Siebe prior to well-child checks in the medical van. Left to right: Josie Jensen, 11, Lucy Matthews, 10, Mom Chelsia Matthews, Medical student Madeline Boyd, Katelyn Matthews, 8, Cooper Matthews, 4 and Pediatric Nurse Practitioner Kathy Siebe.

Kathleen Ellyn/Chieftain A big portion of the student body of Troy School District gathers with Kathy Siebe prior to well-child checks in the medical van. Left to right: Josie Jensen, 11, Lucy Matthews, 10, Mom Chelsia Matthews, Medical student Madeline Boyd, Katelyn Matthews, 8, Cooper Matthews, 4 and Pediatric Nurse Practitioner Kathy Siebe.

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Kathleen Ellyn/Chieftain
Pediatric Nurse Practitioner Kathy Siebe (sitting) and Wallowa Valley Center for Wellness representative Erica Stockdale work to hook into the Troy School Internet as guests so they can send a message to patients in the no-cell-service area.

Kathleen Ellyn/Chieftain Pediatric Nurse Practitioner Kathy Siebe (sitting) and Wallowa Valley Center for Wellness representative Erica Stockdale work to hook into the Troy School Internet as guests so they can send a message to patients in the no-cell-service area.

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Kathleen Ellyn/ChieftainInside the ACT medical van.

Kathleen Ellyn/ChieftainInside the ACT medical van.

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The new rural medical van creeps around and down the hairpin turns through the incised basalt canyons of the Grande Ronde and Wenaha area.

The van is on the way to the remote hamlet of Troy, nestled at the confluence of the Grande Ronde and Wenaha Rivers.

There are three roads into Troy from the valley, but the Wildcat Road route is washed out and the Grande Ronde River Road to Troy passes through the Washington/Oregon border twice.

Redmond Grade, twisting from Hwy. 3 through Flora to Troy is the shortest route today.

It’s April 29 and the “shakeout” trip for the medical van and the team inside. The trip is designed to see how long it takes to get to Troy from Enterprise and see who has shown up for the new rural medical and mental health service.

Organizers Erica Stockdale and Danielle Nash of the local mental health nonprofit Wallowa Valley Center for Wellness have posted informational fliers across the county and spoken to school boards and city councils. Now it’s up to the healthy rural grapevine to get the word out.

In addition to Troy, the van will serve rural families out of Wallowa and equally remote Imnaha. There are 14 clients so far, Stockdale said.

Troy’s permanent population swells with regular summer folk and visiting fishermen, but this spring it is “about eight” souls, according to ranch wife Chelsea Matthews of Anchor Bar Ranch.

The one room school in Troy had two students, Buck and Chelsea Matthews’ oldest children, up until last week, but the child population has more than doubled overnight with the addition of the Jensen family children. Brandon and Angela Jenson, parents of four, just came to work for the Matthews.

Oversized mailboxes lined up in the town of Troy testify to the hidden population of farmers and ranches up in the hills, canyons and high altitude benches of this starkly beautiful country.

For these folks the drive into Enterprise for medical or mental health care would be a full-day excursion. Often, the self-reliant folk in remote locations simply go without medical, mental health, addiction counseling or dental care until their condition is an emergency.

The van is made possible through the Assertive Community Treatment program, which serves the entire county. It multidisciplinary and engages in “wrap around care” that includes medical, substance abuse, mental health and employment support professionals. It’s designed to aid persons with persistent and serious mental health issues.

That would be enough of a goal, given that the Oregon Health Association reports that one in 20 Oregonians have serious mental health issues, and one in 10 Oregon children have serious emotional disorders.

But the center also engages in “reverse integration,” scheduling the time of doctors, acupuncturists, behavioral health coaches and others to visit their community annex offices in Enterprise weekly.

When the rural care van came along, there was a push toward sharing that asset with dental and medical clinics in the county. And local clinics responded.

“This is a partnering service, so the medical and dental part will never stop being a part of it,” Stockdale said.

Expanding ACT mental health services to remote locations has not only been found to be economical, it’s part of a state goal. During the last several years, Oregon has engaged in a significant effort to transform its community mental health services with legislative support.

Although Wallowa County is the fourth least populous county in the state, the center has one of the most diversified county mental health programs in the state.

“Our programs, including ACT, boast some of the highest fidelity scores in the state,” said Chantay Jett, executive director of the center.

Stockdale and Nash wrote for a $310,000 Oregon Health Association grant to purchase the Freightliner Sprinter Van and set up the program.

Stockdale, who has a degree in educational leadership, and Nash, who has a bachelors degree in public health and is a few months from her counseling license, hope to help rural people with persistent mental illness receive regular service. They are also trained to help find insurance coverage through the Oregon Health Plan.

Wallowa County’s medical and mental health van is the only such mobile unit in the state, according to Heidi Herinckx, director of Oregon Center of Excellence.

There were no mental health clients scheduled for the first Troy trip, so van staff is medical professional heavy. In addition to Stockdale, the van carries Dr. Scott Siebe a “mostly retired” doctor of internal medicine and the director of Home Health for the county; Kathy Siebe a pediatric nurse practitioner; and Madeline Boyd, a medical student with a year to go for her medical degree in family medicine.

The Siebes are accustomed to “Spartan and frontier environments” and can “practice medicine without ideal medical support,” Dr. Scott Siebe said. “I’ll tell you this story,” he added and began another story from a seemingly endless catalog of rural doctor’s tales that illustrated his point.

Most of the professionals in the van are long-time residents or, as is common in the county, locals who have gone away for an education and to start their career and then returned to serve the community.

Stockdale is a former local rodeo queen, Nash is part of a local pioneer family, and the Siebes have spent a lifetime doctoring in the county, beginning long before Enterprise built its award-winning critical care hospital.

Conversation in the van ranges broadly. Time passes quickly. The group arrives in Troy an hour early for an appointment to meet the Matthews children at the one-room Troy School. Kathy Siebe is offers well-children checkups to the three Matthews children, Lucy, 10, Katelyn, 8 and Cooper 4. They’ll arrange for immunizations on the next trip.

There’s no cell service in Troy, but “millennials know this stuff” an unconcerned Dr. Siebe said. The visitors sit outside the school and tap into the school’s internet provider as guests, and a message is sent.

Yes, Chelsea Matthews, who is cooking for a branding crew today, can round up the kids and be there early.

“Having the van come out is incredibly helpful,” said Matthews, when she arrived. “Normally this would take a whole day to organize.”

Now it’s Matthews turn to tap into the internet as she lets the new folks, the Jensens, know about the arrival of the van. Soon the entire population of the Troy School District is standing on the road outside school grounds. Angela Jensen brought her children, Taylor, 14; Bronc, 12; Josie, 11; and Paisley, 8.

“This is very handy,” she said. “I’d have to drive over an hour to town otherwise.”

The “shakeout” trip provdes to be a success. Now the Troy grapevine will be doing its work. Today Kathy Siebe saw four children, inoculated one and scheduled a return appointment for the end of the month.

She laughs as she finishes her notations.

“I’ll have seen 100 percent of the school age children in Troy,” she said.

The combined medical and mental health program has grown to 20 clients.

The van will also do house calls.

“If someone is elderly or has a lot of kids, and it’s hard for them to get out, we’re happy to make a stop,” Kathy Siebe said.

The van runs three rural routes per month: Second Friday to Lostine and Wallowa; third Friday to Joseph and Imnaha and fourth Friday to Troy, Flora and Leap Lane.

To schedule a visit, call 541-426-0801.









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