Rural health care perspectives from a graduating PA student

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Two photos of Alisha Fong, UNR Med Class of 2021 Physician Assistant Studies Program graduate.

Alisha Fong, B.S. '03, UNR Med Class of 2021 Physician Assistant Studies Program graduate. Left photo by Brin Reynolds/UNR Med. Right photo courtesy of Alisha Fong.

The rural town of Winnemucca, Nevada, is located 165 miles northeast of Reno, nestled next to the Humboldt River. Known as Nevada's "friendliest town," Winnemucca's primary employers include the mines and the school district. You can't go far without noticing the area's Basque influence or the beauty of the cowboy lifestyle.  The main road is full of quaint shops and family-run businesses; it has that quintessential small town charm, where everyone knows everybody else, and they genuinely care about their community and its residents. 

During my time in Winnemucca, I felt like a welcomed member of the community. The relaxed pace of this small town was refreshing, and the people very much reflected the unspoken promise of being the friendliest town in the Silver State.  

As with all health care in Nevada, Winnemuccans are not immune to issues ranging from access to care, the time it takes to see providers, or the struggles of working with insurance companies that require referrals to specialists. But in the rural setting, this is even more noticeable. 

I worked with many exceptional providers in Winnemucca over my four months in the community, including a rotation in Women's Health. The Women's Health Center at Humboldt General Hospital (HGH) is a gem in the community; it serves the outlying communities spanning 100 miles away, including Orovada, Imlay, Battle Mountain, and even Elko.

As rural providers along the I-80 corridor, I learned that it's best to expect the unexpected. We cared for women who were traveling across the country only to stop and be admitted to the hospital in active labor; most had minimal, if any, prenatal care or information regarding their pregnancies.

It was an absolute honor to work with the entire team at the Women's Health Clinic. Their compassion and care are obvious in the time they take with their patients. Under the guidance of Merleen Grover, certified midwife, and Roger Brecheen, M.D., I had the privilege of caring for many women and expectant mothers, and it was one of the most rewarding experiences of my clinical year. The patients themselves offered countless life lessons and experiences every time they entrusted the Center's staff with their care.

One of the most incredible experiences I had in Women's Health was being a part of the delivery team. One night, I was fortunate to witness a mother giving birth. What an incredible privilege to share in that moment of joy for the family. I will never forget that first breath and cry of a newborn. It was a jubilant moment, showcasing the absolute strength of a woman creating a life, and seeing the joy in the family's eyes as they welcomed a new member into the world. Truly it was a miracle. As a student, it was rejuvenating after seeing so much sickness, stress, and sadness brought on by the global pandemic.

That stress, it should be noted, affected everyone. Care providers and patients, including first-time mothers, have been frustrated and scared, but also resilient, throughout the pandemic. Learning to care for these stressed women as I shadowed Dr. Brecheen and Merleen was enlightening and inspiring. We cared for women who not only had roles as mothers, but also educators, colleagues, and, due to pandemic restrictions, something akin to wardens policing over their children. No one could deny that the stress to parents increased significantly because of COVID-19. Women took on much of this challenge; many quit their jobs to help educate their children and lost insurance because of it. Yet these amazing women always found a way to persist.

I remember speaking to a woman who lost a family member to COVID-19. She had a particularly difficult time understanding how others believed the virus was a hoax or refused to wear masks. She expressed how challenging it was to grieve when people still questioned the validity of the disease that killed her loved one. She taught me something exceptionally valuable that day: Our smallest actions affect those around us in ways we never anticipated. I hope I was able to offer some level of comfort by taking time to support her. The pandemic was pervasive in all areas of people's lives: emotionally, politically, and medically.

As health care students during the pandemic, we were asked to be flexible in every aspect of our care and our studies, in our understanding of the COVID-19 virus, in acquiring PPE and masks, and in seeking out access to the vaccine. We were asked to enter communities and provide support, regardless of our own fears for our families and the potential of bringing home a virus that had already killed millions.

During difficult moments, I frequently thought of my patients in Winnemucca and what they'd taught me: how to grow stronger through adversity and to constantly learn and strive to do my best for those around me. Thank you, Winnemucca, for showing me how to be strong, even in the darkest times, and helping me share in miracles of life, including a baby's first cry. I have learned so much from your kind-hearted residents.

I was particularly lucky to have such an amazing rotation. I will never forget my time in the friendliest town in Nevada.

To the Physician Assistant Studies Class of 2021, Congratulations! Here's to taking part in more miracles on our journey!

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The University of Nevada, Reno School of Medicine, Nevada's first public medical school, is a community-based, research-intensive medical school with a statewide vision for a healthy Nevada. Established in 1969, UNR Med is improving the health and well-being of all Nevadans and their communities through excellence in student education, postgraduate training and clinical care, research with local, national and global impact and a culture of diversity and inclusion.

Released: Tuesday July 27, 2021 @ 8:00 AM