When neighbors pull together, amazing things happen

Often on this page, we point out a problem and highlight a path to a solution. This week, we are writing about a solution that may serve as a model for the way citizens, committed to a cause, can make a difference.

In May, the Hilltowns were dealt a difficult blow.  A decades-old doctor’s office in Berne was closing.

One of the many people who called The Enterprise when the news was reported was Raymond Schimmer. “I think people will die up here if this goes through,” he told us.

Schimmer is an emergency medical technician who also worked as a vitalist for the doctor who was leaving, Kristin Mack. She had started the innovative vitalist program in which people like Schimmer visited homebound patients to take vital signs and communicate, via computer, with Mack.

We wrote on this page — “Corporate medicine, managed care, and other oxymorons” — that Schimmer spoke the truth. We looked at studies that showed the combination of rural residents being older, poorer, less well-insured, and with less access to preventative services leads to a higher mortality rate.

Over the last 40 years, we wrote, the gap in life expectancy between rural and urban populations in the United States has grown, with rural residents living increasingly shorter lives. “Causes of death contributing most to the increasing rural–urban disparity and higher rural mortality include heart disease, unintentional injuries, COPD [Chronic Obstructive Pulmonary Disease], lung cancer, stroke, suicide, diabetes, nephritis, pneumonia/influenza, cirrhosis, and Alzheimer’s disease,” a 2013 study found.

Researchers found that improving access to health care could help close the gap.

Schimmer understood this. He organized a meeting in June centered on nurse practitioner Jill Martin, who had worked at the Berne doctor’s office since 2016, and was willing to start her own practice in the same building —  at 1772 Helderberg Trail, next to the Berne-Knox-Westerlo campus — a place she thought she would retire from.

The company that was closing the office, Community Care, has over 70 offices and was going to funnel the 1,900 displaced patients into its two closest offices, in Slingerlands and Guilderland.

Many rural residents were reluctant to go off the Hill for medical carer. The only other Hilltown provider is a doctor in Westerlo who runs a micro practice, unable to absorb the many displaced patients. 

Some anger was expressed at that first meeting. One woman quietly invoked the 19th-Century Anti-Rent Wars when Helderberg farmers protested a feudal system that had them paying rent to a patroon. They dressed as “Calico Indians” and sounded tin horns to warn of the sheriff’s approach.

Schimmer created an email list called “Tinhorn Health.” He said then, “The people rose up … We’re descendents of those people.”

But Schimmer eschewed the anger that spilled over onto our opinion pages in letters to the editor.

He wrote to us on June 27, “Those of us now committed to supporting Ms. Martin’s initiative now face a challenge common to all such movements: Can we transition our initial enthusiasm into effective and ultimately successful task-based activity? Can we let go of our anger and disappointment about the closing of the office and instead begin to focus positively on the challenges and opportunities in front of us?”

Those are two essential elements in any successful citizens’ movement — channeling the initial spark of excitement into productive work, and letting go of anger and divisiveness to work for the common good. When people are hurt or disappointed, it is easy to make them angry. It is harder and far more worthwhile to lead them to a solution.

In leaving, Dr. Mack had said in her message to the community through our news story, “I know everyone shares in my sadness for the end of an era of excellent care in the Hilltowns … .”

We had urged in our June 6 editorial that Berne do what Westerlo had done after the corporate practice that had occupied the office of the pioneering Dr. Anna Perkins had closed: Form a committee, and search with persistence for a doctor who will work independently of what one of Berne’s former doctors called “the beancounters” to put patients at the center of the practice.

“So, Berne, your work is cut out for you,” we wrote then. “Resolve that this is not the end of an era of excellent care in the Hilltowns. Find a doctor who cares. It could be a matter of life and death.”

Berne found its own way because of the courage of a nurse practitioner. Doctors are in short supply across the nation but Jill Martin, who is certified through the American Nurses Credentialing Center, is able to run a practice on her own.

She said at that first June meeting, speaking of homebound patients she had helped, “A lot of these people have no family left — except for us.”

Volunteers stepped forward from that very first meeting, offering to create a Facebook page, to set up a GoFundMe page, to speed-dial media outlets, to reach out to politicians, and more.

And the support kept coming. Hannay Reels in Westerlo, for example, donated $10,000 to form a bridge until the labyrinth needed for insurance coverage could be navigated so that all patients would be welcome at the new Hilltown Healthcare practice.

At the same time, citizens, working with politicians, made progress in getting the Helderbergs designated as a Medically Underserved Area, a designation made by the federal Health Resources and Services Administration. Just two months after the application was made, the designation was granted on Oct. 2.

 This would allow Hilltown Healthcare, if it so chooses, to hire foreign medical staff who would be able to apply for a visa waiver that allows them to circumvent certain exchange visitor requirements. 

It would also allow the potential for designation as a Rural Health Clinic by the state’s Department of Health, which comes with benefits — like grants and loan-forgiveness — as well as drawbacks because of the complex application and reporting processes.

Schimmer kept citizens informed through emailed updates, many published as letters in The Enterprise. His last update is running in this week’s edition with the splendid news that Hilltown Healthcare opens this week.

An important need was filled because it was clearly defined. A brave woman, backed by her family, stepped forward to take a risk because she cared about the people she had treated. A community, led by a modest man with great energy and dedication, rallied others to the cause in an organized and positive way.

As Schimmer wrote earlier,  “The success achieved to date depended in large part from the community’s own support and participation … It was also clear from the beginning that as a single professional and her family were stepping forward to assume a huge business challenge and great personal risk, they were doing so with the support of their neighbors across the Helderberg towns.

“The relationship between communities, governments, and businesses doesn’t always work out the way it should,” Schimmer continued, “but I think this time it might have.”

It has, indeed. We hope residents are well served in a practice that grows and flourishes.

Meanwhile, the process serves as a model for the rest of us in solving problems.

We are reminded of Alexis de Tocqueville, the French historian, who traveled to America in the early 18th Century, and wrote about the unique brand of American democracy, contrasting it to governments in Europe.

One truth about American democracy that Tocqueville documented was how local liberties and local self-government are more highly regarded than associations with states or the nation at large. Unlike in France, he wrote, each town forms its own sort of Republic, used to governing itself.

While today, with internet and television and radio, the nation is connected in ways never imagined by Tocqueville, we believe citizens still feel most effective in and most connected to their local domains.

The example set by the citizens of Berne shows us how problems can be solved on a local level even when larger forces nationwide — like a shortage of doctors or poor rural health care — are at play.

“Among a democratic people, where there is no hereditary wealth, every man works to earn a living…,” Tocqueville wrote of America. “Labor is held in honor; the prejudice is not against but in its favor.”

That, after all, is what the Anti-Rent Wars, in the century after Tocqueville’s visit, were about. The Helderberg farmers who labored in the fields knew the worth of their work as opposed to the patroon who felt entitled merely because of his inherited position.

Pulling yourself up by the bootstraps is an American ideal. Democracy in America, as Tocqueville pointed out two centuries ago, balanced liberty and equality; the common man enjoyed unprecedented dignity.

And the citizens of the Hilltowns have just illustrated that principle. They have solved an important problem through their own hard work and showed us a way to come together locally in defining and solving other problems.

 

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