Tierna Unruh-Enos is publisher at The Paper.


COVID Pandemic Exposes Cracks in Rural Health Care

In the United States, healthcare is a business. In many of our rural communities around the country, that business is failing miserably right now. Much of New Mexico relies on small hospitals and clinics, and the COVID-19 pandemic has exposed cracks in the system that existed long before any mass shutdowns. The stress of the pandemic has exacerbated the problem of how to care for an influx of patients coupled with a lack of revenue from elective surgeries and outpatient procedures. Budgets are strained and stretched, but it’s just not enough. And our rural communities are struggling to survive while attempting to take care of a population that is verging on ambivalent about the cost of their few existing healthcare workers. 

Renee Despres is a Ph.D. who teaches Public Health at New Mexico State University. She studies rural health care systems and works with local municipalities on pandemic response in communities with public health officials. “Our rural health care systems are under-prepared for a COVID situation because they are under-resourced,” says Despres. “Before the pandemic, these hospitals were already operating on a razor-thin edge.”

Despres says the focus for so many rural hospitals is just attracting qualified candidates to live in the community—and then convincing them to stay. She says administrators aren’t trained on how to operate a hospital within that type of community. People from outside of the community are hired, and often only care about the bottom line. Most of the time, they leave after a few years. On the other hand, when administrators are hired from within the community, they often lack necessary training or education. Couple that with a shortage of doctors and nurses, and it’s a recipe for failure. 

A Bad Situation

Sierra Vista Hospital serves the greater Truth or Consequences area in southern New Mexico and is walking a healthcare tightrope. Celeste Bierner is an R.N. who has lived and worked in the tiny community of 6,000 for over eight years. “We were in a bad situation before this hit us,” says Bierner. “We don’t technically have an ICU, and the few nurses we do have aren’t trained to care for patients who need intensive care. In a normal situation, we would airlift out ICU patients to Albuquerque or Tucson County. And now we’re holding on to patients with a heart attack or other acute needs and we can’t ship them out until the next day wherever there is a bed.” Bierner says the older part of the hospital that was abandoned due to asbestos has now been reopened to accommodate 38 new beds, which Bierner says are really just cots in a hallway. Up until October of this year, nurses were reusing much of their PPE equipment. Hospital administrators fought for new gear, but it was a long time coming.  

The problems at Sierra Vista are a prime example of Despres’ research. A shortage of nurses and doctors, unprepared administrations and a lack of training for staff are placing a crushing weight on the healthcare system. It isn’t just COVID patients that rural hospitals are left to contend with, it’s all of the other critical-need patients that the staff is left to care for. As hospitals are overwhelmed, personnel shortages are amplified. Rural hospitals aren’t adequately staffed to take care of people who have problems outside of COVID. 

A Nursing Shortage

There is a nursing crisis around the world right now, and the healthcare system in New Mexico is no exception. Governor Michelle Lujan Grisham said the state was hiring traveling nurses from Canada to help ease the burden on the system during the pandemic. Presbyterian Health Care is the largest critical health care provider in New Mexico, operating nine hospitals around the state in both urban and rural communities. The nonprofit health care giant said in a statement that it is operating under a contingency plan of hiring traveler nurses to their various hospitals and “redeploying” staff to other areas of the state in a scramble to meet critical health care needs.  

According to a study by the American Association of Colleges of Nursing, the national nursing shortage is largely due to an aging workforce and not enough graduates of nursing programs to keep up with the demand. As recently as October of this year, the state Health & Human Services Committee stated that Doña Ana County had the worst shortage in the state. The committee estimated that the county was short over 700 nurses. The committee also noted that the state needed to hire at least 1,200 registered nurses in order to keep up with the health care needs in New Mexico. 

Project ECHO

Despres says one solution on the horizon for rural health care systems is UNM’s Project ECHO. It’s a telehealth program that was designed at the UNM School of Medicine to help support health care professionals in areas of need. It connects specialists in Albuquerque and around the state with local hospitals to provide much-needed training and support. Its COVID-19 response resources focus on first responders and critical care providers. “Telehealth is opening up huge possibilities for what we can do to serve people in homes and rural communities,” says Despres. “Hospitals are going to be transformed in the near future. We need to start thinking about them differently. We need to provide support with technology if we’re going to survive this and provide sustainable healthcare now and in the future.”

Celeste Bierner knows that whatever the solution is, this current situation isn’t sustainable even in the short term for her or her hospital. She’s a single mother of two, and can’t keep working at her current level of mandatory overtime. “I’ve been doing this for over 20 years. I love what I do, but this has made it really hard. I don’t see my kids anymore, and it’s taking a huge toll on my family. I don’t want to leave my staff or my community; but this is life and death now, and we need help.” [ ]