COVID-19 Has Experts Rethinking Rural Health Care in America

VOA News By Kane Farabaugh

WALNUT, ILLINOIS  – In mid-March, Illinois high school math teacher David Lind wasn’t feeling well and knew he needed a medical opinion. An eventual diagnosis began with a few mouse clicks. 

“I was sleeping a lot; my wife could tell that I was really run down,” he told VOA by phone, through intermittent coughing fits weeks after he first exhibited symptoms. “It felt to me like there was this little demon monster gripping my lungs. It was a cough, dizziness in my head, sensitive headache, a lot of skin sensitivity on my head. One or two days in there I had a little bit of nausea.”   

Lind lives in Walnut, a town of 1,500 in a rural Illinois county. He hadn’t traveled recently, and initially didn’t think it likely that he’d contracted the coronavirus. But his symptoms concerned him enough to reach out to a medical professional.  While several physicians have offices in Walnut, the town has no hospital.  “We’re used to not having that in our town,” says Lind. “It’s part of our life.” 

So instead of driving to a hospital in Dixon, Illinois about 40 kilometers away, Lind consulted with medical staff online. “We did a virtual tele-doctor online, it was a questionnaire that was diagnosing things, and at the end I could put my own comments more explaining my story.” 

A health care professional followed up by phone soon after. “It was a person at the hospital in Dixon. Even though I was sick when I was talking to her…we didn’t think it was coronavirus. Nobody in the town or county had coronavirus.” 

With much of the country on lockdown and hospitals overwhelmed with those showing coronavirus symptoms, many rural patients who need care are using remote methods to consult with health care professionals. 

“What we really want is for people to go on our website and do our symptom checker and find out what the right place is for them to be seen,” says Dr. Stephen Hippler, chief clinical officer for OSF HealthCare, owned and operated by the Sisters of the Third Order of St. Francis, headquartered in Peoria, Illinois.  OSF HealthCare serves patients in small cities and rural markets in Illinois and Michigan, although the facility David Lind consulted with was not in the OSF HealthCare system. 

“Our message has been for our patients to not show up unannounced,” Hippler explained to VOA during a recent Skype interview. “So on our website, we have a chatbot called Clare that can help patients really understand their symptoms, and to really stratify them based on risk and send them to the right place.” 

Responding to the COVID-19 pandemic is “going to have us rethink our business,” says Pat Schou, executive director of the Illinois Critical Access Hospital Network, or ICAHN, which connects and supports 57 rural medical facilities, many of them independent, throughout Illinois. “I think you are going to see more outpatient services.” 

Schou says ICAHN is offering to help educate and equip partner hospitals to provide remote and online consultation services. But there are challenges to overcome. Many rural Americans lack broadband internet access, and some are offline entirely.  

“Some older individuals may not have that,” says Schou. “They don’t have internet service, or strong enough internet service, or they haven’t purchased it at all.” 

Making matters worse, many of the places Americans could once go to for internet access are also closed. 

“Sometimes, their main sources are closed for internet services, which includes libraries and schools,” she explained. “Some of them are having to go to the parking lot of McDonalds to get access to an internet connection.” 

OSF’s Dr. Stephen Hippler sees the coronavirus pandemic as a watershed moment in the relationship between patients and providers and believes the use of digital tools is here to stay. 

“In my mind health care and the world might not be the same after this,” he told VOA. “I think this emergency has forced us to look at how we are prepared, and to rely far more on digital tools than we ever have before.” 

After David Lind’s consult by phone, medical staff recommended he go to the hospital in Dixon for further tests.  

“They met me at the door, took my temperature. I had fever of 100.5. At that point they let me go to the ER,” he said. “The doctor came in, and he did some things to check me out, and didn’t feel that I had pneumonia, so then he recommended several things, and one of the options was to be tested for the coronavirus because my son had come home from Europe.” 

Even though his son was asymptomatic, testing for the coronavirus was one of the options in diagnosing Lind’s illness, although he admits there was little that could be done to treat his condition. 

“They didn’t know it was coronavirus, so they gave me some penicillin in case it was bacterial,” he said, adding that the hospital sent him home to recover in isolation. 

“I had to wait eight days to get test results back, and that’s when I learned that I had tested positive for coronavirus.” 

By that time, Lind says he was nearing a full recovery.  

“We went through the hospital and county health office to make sure we followed the isolation protocols,” he says. 

It was all a lesson the teacher learned the hard way. Lind was the first COVID-19 case in his town, and his county of 33,000 residents, and he was thankful he could reach medical staff remotely as a first step.   

“For as new as it was to everybody, it was a pretty good job for handling it,” he told VOA. “I don’t wish it on anybody, but if you have other underlying illnesses or your age, it is a serious thing, but I know that just waiting it out ends up being really the only thing you can do.”