When There's No Doctor Nearby, Volunteers Help Rural Patients Manage Chronic Illness

Gary and Celeste Havener live 40 miles outside of Laramie in southeast Wyoming. They spend a lot of their time growing vegetables and riding horses across the prairie.

A few weeks ago, Celeste fell off her horse.

"[I] had a very ungraceful dismount and tweaked my knee pretty good," Celeste says.

Afterwards, she lay on the ground for a while, trying to figure out how hurt she was. But she was also wondering if a visit to the closest doctor in Laramie was worth it.

"After it didn't get better, I did go to town," she says.

This kind of decision-making is something she and her husband do often, since they both have other health issues. Gary deals with pain from injuries working as a carpenter. And Celeste just recently wrapped up radiation treatment for breast cancer.

"I think most rural people choose doctor denial as their first choice," says Celeste. "Doctor Google is their second choice."

In a recent poll by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health, 26 percent of rural Americans said there has been a time in the past few years when they needed health care, but did not get it. A majority of them say it was because financial barriers kept them from seeing a doctor. But almost a quarter of them said it was because health care was too far or difficult to get to.

To address this problem, the Wyoming Center on Aging at the University of Wyoming created a program called Healthy U. Based off a program originally developed at Stanford University, it supports people with a chronic disease and their caregivers by teaching self-management skills and offering a support group.

"In a rural area, if someone can manage their own health better and go to the doctor less often, then that's a win for everybody," says Janet Korpela. She works for Healthy U as program development specialist and has a background in senior care.

She runs workshops with volunteers for the program. The volunteers from those trainings will go back into their communities to teach patients living with chronic conditions like diabetes, high blood pressure, arthritis, pain or depression how to better manage their health.

For example, for people with diabetes, volunteers may teach them how they can prepare a meal for their diet, or add an exercise program that works for their lifestyle.

These peer volunteers, called "leaders" in Healthy U, don't need a medical background. Korpela says they just need to be willing to do the 40 hours of free training.

"This curriculum is really designed to be led by peer leaders, which means that the leaders should be equivalent or equal to the people who will eventually be taking the workshops," she says.

The curriculum is based on an approach called chronic disease self-management, which research shows can be effective at improving quality of life and reducing the number of doctor visits or hospitalization.

Marcia Ory, a professor and public health researcher at Texas A&M University published a paper in 2013 on how chronic disease self-management programs work.

"It's effective because most health happens at home," she says. "Basically you teach people how to set small goals for healthy living. You teach them how to problem-solve. That's different than someone just saying, 'you need to do A, B, and C to live a healthy life.' "

Ory says the program is an especially good fit for rural patients since it can be delivered where people live.

"They [the workshops] are held where it is convenient for people to attend. If that means the local clinic, it's held there. But if the community center is easier for patients to come to, they have it there," she says. "The population is less, but the need is just as great."

Anna D'Hooge is one of 62 volunteer leaders trained in Wyoming. Over the course of six weeks, volunteers like D'Hooge lead Healthy U participants in weekly meetings. Each meeting focuses on a single topic, like how to have difficult conversations with friends and family about their health, or how to make the most out of a visit to the doctor.

There's also time set aside in each week for participants to talk about their small weekly goals, called "action plans" in the program. That way participants can celebrate their successes — like taking their medication at the same time everyday, or simply drinking more water. It's also an opportunity for them to brainstorm solutions with their peers when they struggle.

"I think we tend to think of it [chronic conditions] as a medical issue in the sense of disease management, like you just need to go to the doctor or take your medication," she says.

She's a nutritionist at a hospital in Cheyenne, and the majority of her patients deal with a chronic condition.

"Hopefully people will realize that 'Oh, well, I'm not a health care doctor, I'm not a nurse, but I do have these skills so I can help my friend with a chronic disease by doing this,' " she says.

Healthy U has reached 378 patients across Wyoming so far, and is available in all but four counties in the state. The program is attempting to expand into those four remaining counties.

D'Hooge says she decided to do the training as a way to make her community a healthier place to live.

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