Medicine, Islands & Education #253

Scott Planting:

What I'm proud about is we respond to needs and concerns as we see them. We often don't initiate things, but we respond.

Dr. Peter Bates:

But we're really looking for applicants who are not only high performers, but really understand what we're trying to accomplish. And it all goes back to improving population health in the state of Maine.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to Love Maine radio show number 253, Medicine Islands and Education, airing for the first time on Sunday, July 24, 2016. How do Mainers access medical care? This depends on many factors including geographic location and the availability of providers. The diversity of geography from urban settings to offshore islands presents some interesting challenges in Maine today. We speak with several individuals who are rising to this Scott Planting and Sharon Daly of the Maine seacoast mission and Dr. Peter Bates and India Stewart of the Maine Medical Center Tufts University School of Medicine Medical School Program. Thank you for joining us.

Dr. Lisa Belisle:

Today with us we have two individuals who are doing very interesting work up the coast. We have Scott Planting and Sharon Daley. Scott has been the President of the Maine seacoast Mission since 2010. During that time, his key accomplishments have included expanding EDGE the mission's academic and enrichment program, serving over 700 Downey's children, establishing a comprehensive family development program to support low income Washington county families, and organizing a college support program for nearly 100 mission scholarship recipients. Prior to the mission, Scott was a minister for a three church parish in west central Maine for 35 years, overseeing a multi person staff and coordinating a larger parish composed of churches and outreach ministries. Thanks for coming in today.

Scott Planting:

Scott, thank you for having me.

Dr. Lisa Belisle:

And you brought with you Sharon Daley, who grew up on a farm in Missouri and after attending nursing School in St. Louis, moved east. She has worked at many various nursing jobs and loved them all. They include pediatrics at Mass General and Boston Children's Home Health in Boston and rural Maine rehab nursing, a doctor's office, hyperbaric chamber and hospice nursing before joining the Maine Seacoast Mission to start the Telemedicine and island Health Program 15 years ago. She lives on Islesboro, Maine, and is married with two grown daughters and one grandchild. Thank you for coming in today.

Sharon Daley:

Thank you for asking us.

Dr. Lisa Belisle:

I love the fact that you both have a Midwest connection, you both have a St. Louis connection. That doesn't always happen that we have even one person from St. Louis in the studio. Never mind. Too. But you didn't know each other when you were both there at the same time.

Sharon Daley:

No, I was in nursing school.

Scott Planting:

I was in high school growing up.

Dr. Lisa Belisle:

And Scott, you're originally from Long Beach, California, so somehow you've kind of worked your way gradually east.

Scott Planting:

Yeah, our family, my dad, you know, Post World War II, moving around, trying to find work careers. And it was a time when families where people were on the move a lot.

Dr. Lisa Belisle:

And your family, Sharon, wasn't so much on the move. It sounds like you were pretty settled.

Sharon Daley:

No, they're still where they were. I came to Boston Children's to work and planned on going west and met my husband the first night I was in Boston.

Dr. Lisa Belisle:

So somehow it was meant to be.

Sharon Daley:

It was.

Dr. Lisa Belisle:

I'm interested in the main Seacoast mission because it's been around a long time and it has really needed to evolve. I think 1905 was when it was founded.

Scott Planting:

Yes. We're 111 years old. And what's really interesting, Lisa, is we do basically the same kind of work we did when we began. Two brothers on Mount Desert island founded the mission, two ministers, and their primary concern was people living on islands, lighthouses. And in 1905 it was pretty rugged. There were. There were no schools, health facilities, no services at all. So the two brothers, this was sort of a period of exploration and doing kind of big things. They bought a 20 foot sloop, the Hope, and started sailing out to islands and providing, you know, very basic kinds of services, you know, providing health care. Sharon, her work as a nurse is what we've always done. We've always had nurses going out to islands. And it's interesting. The islands go west to Monhegan, but we've also included Down East Maine, Washington county, the peninsulas that go down in those years were also island pretty remote communities. So we have covered basically the same footprint from Down East Maine to Mid coast for 110 years, doing basically the same thing. Obviously modernized with telemedicine and sort of state of the art technology, but the same very close connection to people, families, communities. That hasn't changed at all. In my six years with the mission. The one thing I've learned is the one thing we have is trust. That's the only thing we have to offer is trust. And that's been built up over a long time. So it's very powerful to go to an island or a down east community and talk to people whose parents and grandparents and great grandparents had a connection with the mission.

Dr. Lisa Belisle:

Sharon, when you were growing up in Missouri and going to nursing school and really doing a broad variety of things, did you ever think that you might be doing telemedicine on the Sunbeam?

Sharon Daley:

No, no, it certainly wasn't my life plan. But I do think growing up on a farm in the area that I did was very similar to island living because farmers and fishermen, you know, one's working on the lands, one's working on the water, but the lifestyle is really similar. And it was a very rural, isolated community. So I do see a lot of similarities and I think it's helped me in my job.

Dr. Lisa Belisle:

The Seacoast Mission is known for. I believe this is the seventh boat that started with. This is the fifth boat. Okay. So starting with the Hope back in the beginning of the last century and now you're on the Sunbeam, you've become known for helping people with their health care, but you also have done a lot with education, you've done a lot with sort of basic human needs. Talk to me a little bit about that, Scott.

Scott Planting:

What I'm proud about is we respond to needs and concerns as we see them. We often don't initiate things, but we respond. You know, the whole impetus for telemedicine is you have people, you know, fishermen living out on Matinicus, 30 miles out to sea. And to get to see a doctor or healthcare just means a lot of travel and days off of work. So we working with them provided this sort of state of the art technology. So everything we do kind of is in response to people. Our work in Washington county with, with children is again, schools were able to offer so much and there was a real concern for kind of the enrichment activities that our after school program edged us. So again, we were embraced we just didn't move into Washington county and say, well, we're going to provide these things for you. It was, again, this long century of knowing people, knowing concerns, knowing people's strengths and. And responding to them. So that's how we have always grown. If, you know Sharon. Sharon is a listener, and what I love about our staff, people are listeners, and they take a lot of time. We don't move into things quickly. We take a lot of time to ask questions, to kind of, you know, what do you think about this? Does this seem right? So we have a very deliberative style of working.

Dr. Lisa Belisle:

Sharon, as a nurse, you have a pretty kind of solid understanding that everything that people engage in in their lives could possibly have an impact in their health. So it's not just they have a lung infection, it's what they do for work. It's how they socialize with other people. I mean, there's really so many elements to person's health. That must be an interesting place for you, because you're not just, here, let me put a band aid on it. You're. Let's find some foundational solution to what's going on.

Sharon Daley:

I guess it's one of the things I really love about my job is, you know, if you're in a doctor's office and you hand somebody a prescription, they go home. You don't know if they've gotten that prescription filled or if they have the money to get that prescription filled. I think my hospice work before this is a lot of what I do now, because it's looking at the whole person. And on this job, not only is it the whole person, it's the whole community. So we're very involved in the communities. The crew of the boat is very involved in the communities without being enmeshed, which allows us to come be sounding boards, maybe offer some suggestions and help, but then we leave. So we're like the safe people. We're the safe part of the community. And I love that. Being able to know the patient, their uncle, their aunt, their grandparents, their pets, and just the whole thing.

Dr. Lisa Belisle:

That lends a lot of important perspective, I think. I mean, as a family doctor, I get to hear what one person tells me, unless they bring their children or their grandparents with them, but I get to hear what one person tells me about their health and their perspective on their health. So for you to be able to say, oh, well, I've met your brother, or I've met your. Your friend, and, you know, I have the sense that you're part of this greater Fabric that must be very useful

Sharon Daley:

and getting to know people over this length of time. And one thing, you know, I've watched is you see that person that maybe said, oh, I'm, you know, I'm pre diabetic, I'm going to do something about it. And you see the people that have done something and the changes that's brought forth and then unfortunately, the people that haven't. So you. It's been new for me to really watch the progression of people's health.

Scott Planting:

One of my favorite images from the Sunbeam is when we dock. Sharon and Douglas Cornman, who is the director of outreach and he's a counselor and does provides pastoral care. The two of them leave the boat with beanbags full of whatever it is they need. Sharon will bring medical things. Douglas. Or food.

Sharon Daley:

Puzzles.

[Unidentified voice]:

Puzzles.

Scott Planting:

And they go two by two and they will visit over the course of a few hours. Literally every family on the island making house calls. And that's how they know what's going on on these communities. And you do that time after time after time. It builds up kind of just almost sort of a soil of richness in understanding what's going on in the life of the community.

Sharon Daley:

I always say I do house calls and truck calls because when you're walking, that's when people, you know, the lobstermen stop with their trucks and pull over and just talk. And, you know, you don't get that if you don't go off the boat.

Dr. Lisa Belisle:

The Sunbeam goes out, from what I understand, a couple times a month for maybe three days, three, four days at a time.

Sharon Daley:

Yeah. Our normal schedule for telemedicine is pretty much every other week. And we leave on Tuesday morning from northeast harbor around 8 and we go Frenchborough, Idaho, Matinicus. Not always in that order because at Matinicus we can only get in at high tide. So we have to plan all of our visits around the tide. We usually spend a night on Idaho and one on Matinicus. And then we get in sometime Thursday. Last Thursday, I think we got in around 10 o' clock because we had a potluck dinner and an event on French Borough. So we came in late.

Scott Planting:

And then on the alternate week we have a lot of special events. The kiddos who live on these islands, the schools are K through 8 and they go to high school on the mainland. So we will have a middle school retreat or several during the course of years to get all the middle schoolers from all the islands and take them to the mainland and kind of introduce them. This is what school is going to be like. It's going to be really different than a class of three. So we do lots of kind of events. Sometimes we use the boat as a taxi cab. We had a photographer and artist out on Frenchboro who lights up objects at night with flashlights. And so literally the entire French borough community gathered at a dock with flashlights in the dark, in the cold. And we lit up and it was just then we all went over to the school for a reception. So we do lots of those sort of, you know, just sort of, you know, fun things. We. We bring a steel drum band out, we're bringing a jazz band out from a high school.

Sharon Daley:

And next week is one of the providers I work with, Dr. Dale Schneider, and he's doing a talk on the islands on communication, personal and community communication, which on an island can be difficult. So we do educational things and fun things.

Dr. Lisa Belisle:

How has technology enabled you to shift or improve the way that you're able to offer both healthcare, but also educational outreach?

Sharon Daley:

For the healthcare part, it has enabled people to see a primary care physician with specialized equipment. So I think it's the best of both worlds. It's high, you know, the best of technology and then me is a personal touch and the boat is a personal touch. So it's the primary care, but it also allows them to have counseling. We do a lot of counseling for depression, marriage counseling, drug and alcohol. And that's been a really big use of it. So that's opened up something. And then we do things like smoking, cessation classes, educational things for the kids, talks on Lyme disease. So as Scott said earlier, we really try to listen to where people's interests are and then provide what it is that they would like.

Dr. Lisa Belisle:

So for people who aren't familiar with telemedicine, what does telemedicine mean?

Sharon Daley:

The simplified version of it. And I don't ever get too complex with the it. Part of it is there's a room on the boat with a flat screen TV on the wall. People come in to see the provider. And I do just what an office nurse would do. I would take the vital signs, take the history, do that provider's paperwork, fax it to the provider, Then I'm able to call the provider. It's like fancy Skyping, only it's very HIPAA compliant and all of that. So the provider's on the TV and all of our interaction is live. And the easiest example is if the person has a sore throat, earache and a cough after the provider talks to the patient, they might Say to me we would like to see how their throat looks. So I have something called a Gen camera, so I'm able to take show them the person's throat and actually freeze the image. So in some ways it's better than being in the office because it's magnified and he can look at it as long as they want. Then if they have an earache and I have an otoscope, so I'm able to show them the inner ear and I have a stethoscope. So if they want to listen to heart and lung sounds. And then after the visit if the provider said, well, I wonder if they might have strep throat, I can do a quick strep screen. They wanted some lab work, I can draw some labs and store those until we get back into the mainland to take it to the hospital for testing and then getting medication to the islands. I always say the way I get them there depends on what day of the week it is, what island it is and what the weather is. But people on islands know how to figure things out. So we work that out. It's usually they can get it that day or the next day.

Scott Planting:

The telemedicine system is part of a regional system called a New England Telemedicine Consortium. And that consortium links about 320 sites, hospitals, all kinds of healthcare facilities, a boat together with very high speed Internet that is again HIPAA protected. So we also have a bridge system so we can basically connect to anybody in the world. And we occasionally do that with specialists and that's sort of the growing side of that. So we could connect with you in your office. So it's a large, very well functioning system. Last week I was at a New England Rural Health Network meeting and Wendy Wolf, who was really one of the stars in health in Maine, she gave us a really nice shout out. And I think what delivery of healthcare in rural areas is so complicated. Just, you know, docs and providers, especially places where we live, are very few. So having this system really provides much more accessibility for people. And what the key to it is not just saying here, sit in front of a television screen and talk to a doctor. But you sit in an, front of a television screen and you talk to Sharon. And having a real live human being who can kind of introduce you and say this is okay, this is not weird, it's safe, you'll be fine. And you see Sharon, the doctors that we connect with and again there are, this is not for everybody. But we deal with some great docs who work on the other end. And they're fabulous people. Sharon works really hard to try to get them out to the islands at least annually. So the person you see on the TV screen you can actually meet in real life. And that helps. So the technology is really important, but also the human side of having Sharon to say it's okay or show up.

Sharon Daley:

Why aren't you at your appointment? I know where you live.

Dr. Lisa Belisle:

Yeah, that's a really strong statement that you could actually bring the boat in and you can actually walk to their house and. And say, hey, what's going on with you?

Sharon Daley:

And I do.

Scott Planting:

And she does. And she does. And I've seen this many times. And you know, fishermen are. These are big, strong, very active men for the most part, some women, but most, mostly guys. And Sharon is so good to going up to them and saying, I need to check your blood pressure right now. Right now. And. And they say, yes, ma'. Am. Yes, ma'.

Dr. Lisa Belisle:

Am.

Scott Planting:

We all say yes, ma' am to Sharon. And she really has that. And that's very unusual with these communities to have that kind of entrance into everybody's lives. So when Sharon tells us all to do something, we do it so really important in a nice way.

Sharon Daley:

Yeah, I would say, you know, it's a real honor to be able to be part of people's lives on the islands or anywhere, but.

Dr. Lisa Belisle:

Well, you're describing something that is really why many of us went into medicine in the first place. I'm sure it has something to do with why you went into medicine. And that really is that connection with people and their families and their communities. And it's interesting that the way medicine seems to have been going for a while is kind of. Is away from that touch and that connection and that we're able to do a lot of very high tech stuff. Stuff. But we somehow that relationship piece has been. I guess the importance of it has been downplayed somewhat.

Sharon Daley:

Or all of the paperwork and forms and all of that and rules and regulations have gotten in the way of it. And that's one wonderful thing about my job is there's not a lot of paperwork. There's a lot of coordination, but there's not a lot of paperwork. And when I was. Had left my last job, one form, it is admission was 36 pages. So this was a great change for me. And your last job was doing hospice.

Dr. Lisa Belisle:

And that's a little ironic, isn't it?

Sharon Daley:

Yeah. The Medicare form was 36 pages. That was one admission form.

Dr. Lisa Belisle:

So at the end of somebody's life, when you are Bringing them to a place where they are getting ready to die. You actually have to fill out a 36 page form. That seems weird to me, but I guess that's why you're doing this now.

Sharon Daley:

Yep.

Dr. Lisa Belisle:

Well, and not to say anything bad about Medicare or hospice because I think it's very complicated and there's a lot of reasons why things are the way that they are. But it really does, it does my heart good and it makes me feel a little wistful, honestly, that you have the kind of access that you do and Scott, that you have the ability to work within this very collaborative community. And it reminds me a little bit of Life Flight, although the work that they do is more acute, but that they are reaching out into the communities that need higher level and emergent care. But they're not waiting for people to come to them, they're going to those people.

Scott Planting:

It's interesting. The Sunbeam years ago was Life Flight and we were the one who transported people from islands. And now our boat goes 9 or 10 knots with the wind pushing us. We are really a slow boat and what lobster boats go at least twice that more. So it's interesting, islanders have this sort of uncanny sense when they know when they need to get to the mainland if there's an emergency. And Life Flight provides a lot of that. But they also know whose boats are available to get them to the mainland at 18 knots. But they do have an uncanny sense that they've learned that you don't wait for things, you gotta move.

Sharon Daley:

And the one time I had an emergency on the island, Life Flight couldn't come. And that's what we said was what's the fastest way to get this person off this island? And so they knew right away whose boat was fastest. And that's what we did.

Dr. Lisa Belisle:

Well, it speaks to an interesting self reliance and an interesting, I think, lack of willingness to give up one's own knowledge of surroundings, of boat speeds, of health. And I think that that's the, you know, this great independence that you're describing can actually be. Maybe it's not so good if they don't want to come in and get their blood pressure checked. But it can also be really an asset because they're willing to really take responsibility for what needs to happen in some cases, you know.

Scott Planting:

And I lived in rural Maine for 40 years now and I saw that in the early 70s, communities had a lot of that kind of self reliance, interdependence because it had to. This is in western Maine and now on the coast. And you Know, people had, you know, jobs, families, they could make a living. There was a quality of life. And sadly, over a long, long time now in Maine, a lot of these small towns have lost a lot of that. Jobs have gone away. And you're probably right, island communities are probably the last sort of holdout just because of the way they are and the way the fishing works of that kind of resilience and self sufficiency. It's a good point.

Sharon Daley:

And they pull together really well in bad times. Better than good times sometimes.

Dr. Lisa Belisle:

What you do is all part of the main Seacoast Mission. And you were founded in 1905 with this idea of spiritual, I don't know, guidance perhaps, but certainly the idea of a mission, there was a spiritual aspect to it. There's still a spiritual aspect to it. But that does not interfere with the ability to offer care to anybody regardless of their spiritual inclination.

Scott Planting:

Absolutely. And our definition of spirituality is, what we've been talking about is wellness in that whole cluster of words that includes health and wholeness in heal. That's how we, we work that entirety that clusters. And so for us, health is both a singularity in your person, but also the well being of the community that you're part of. And we have a strong sense. You don't have those apart, you have to be well in yourself, but also the community itself around you. And that includes the natural world. All aspects have to sort of work together. So our sense of spirituality is very inclusive that way.

Sharon Daley:

And I think, you know, everybody that I work with on the boat, we're just, I feel like we're never judgmental. We're very non judgmental and accepting of wherever that person is and whatever their beliefs are.

Dr. Lisa Belisle:

How many people does it take to run the Sunbeam?

Sharon Daley:

There's five. There's a captain, an engineer, a steward who does all of the cooking and greeting and welcoming and Douglas Corman, who's our spiritual person and he also has a background in counseling.

Dr. Lisa Belisle:

And how many people does the Maine Seacoast Mission in total employ?

Scott Planting:

We have about 30 full time people and with Edge, the after school program, we employ a lot of teachers on a part time and there's about 80 teachers we employ on a part time basis.

Sharon Daley:

So a little over 100 and a lot of volunteers.

Dr. Lisa Belisle:

I'm sure that people who are listening will be interested in learning more about the main Seacoast Mission and about the Sunbeam. Do you have a website they might go to?

Scott Planting:

We do. Seacoast Mission www.www.seacoastmission.org so please and I've

Dr. Lisa Belisle:

had the good fortune, I think twice now to go on board the Sunbeam because it seems as if when you're not out with the islands, you actually do some docking at various places and letting people tour. So that's a nice opportunity for people as well. We've been speaking with Scott Planting and with Sharon Daly who both are with the main Sea Coast Mission. Scott is the President and Sharon is the head of the telemedicine program. Thanks so much for coming in and talking with us today.

Scott Planting:

Very enjoyable.

Dr. Peter Bates:

Thank you.

Dr. Lisa Belisle:

to spend time with an individual that I knew from way back when, probably more than a decade, and also an individual I've never met before, but I'm really happy to get to know her. The first individual is Dr. Peter Bates, who serves as Maine Medical Center Senior Vice President of Academic Affairs, Chief Academic Officer and the Academic Dean for the Maine Medical Center Tufts University School of Medicine Medical School program. Thanks for coming in today.

Dr. Peter Bates:

My pleasure. Thank you.

Dr. Lisa Belisle:

And of course, as one of my former teachers, I have to give you credit because a lot of the things that you taught me have been really good for me as a doctor. So thank you for that too.

Dr. Peter Bates:

My pleasure. Did you turn out okay?

Dr. Lisa Belisle:

You'll have to ask my patients. Okay, well I'll give you some names, maybe if HIPAA says it's okay. And then I have with me also India Stewart, who is a main track medical student. She is from Harmony, Maine and graduated from the University of Maine with a Biology major and she hopes to go into OB gyn. Thanks for coming in India.

India Stewart:

Thank you for having me.

Dr. Lisa Belisle:

So I'm excited about this because I went through as a medical student with the University of Vermont and this was sort of the predecessor to Maine Tufts. And I think Maine Tufts has just really done a great job generating interest and bringing medical students back and kind of getting them back into the fabric of Maine. What do you think?

Dr. Peter Bates:

Well, we couldn't be happier actually with the success of the program and the quality of people we attracted, like India to be medical students here.

Dr. Lisa Belisle:

So tell me a little bit about the process. I know that my son Campbell, he's going to take a year off. He went to the University of Maine like you did India, and he's going to go to the Tufts program. So I had a little bit of an inside view of all of that and his interviewing. But if I was a say if I was at the University of Maine now and I wanted to go through this process of interviewing, what does that look like?

Dr. Peter Bates:

Well, there's really two avenues. India took one and there's an opportunity called early assurance where a high performing student at the end of his or her sophomore year can actually apply to the program and be accepted. And it's a great opportunity because it allows them to bypass certain standardized examinations which no one enjoys, and have a commitment to go to medical school when they complete their undergraduate degree. And then there's the standard regular admissions after four years of college. But we're really looking for applicants who are not only high performers, but really understand what we're trying to accomplish. And it all goes back to improving population health in the state of Maine.

Dr. Lisa Belisle:

India, you told me that Harmony is north of Skowhegan.

India Stewart:

That is correct.

Dr. Lisa Belisle:

So you have a pretty good sense of what it means to be in the heart of Maine. How did that influence your decision to go into medicine? Well,

India Stewart:

growing up in a really small town, you are sort of given the opportunities to see what is needed when it comes to healthcare. Some of the things that are lacking and some of the things that need improvement. I was inspired by my father to go into medicine. He told me when I was very young that I had to be a doctor so I could take care of him when he got old. And since that time, I have had that. I've had that drive. It's been what I've known and it's what I plan to do. So I have, I feel like I've been given the opportunity to have an inside look to what a lot of our communities need. And that has really guided me in my experience throughout this entire process.

Dr. Lisa Belisle:

So you're going into your fourth year of medical school.

India Stewart:

Yes.

Dr. Lisa Belisle:

Your final year, and you're planning to specialize in obstetrics and gynecology.

India Stewart:

Yes.

Dr. Lisa Belisle:

And you think that you might bring this specialty back to the state of Maine when you're done your residency program?

India Stewart:

I feel like right now there is. Well, there's going to be a large demand for new OBGYNs because we have an older population of physicians right now that are going to be retiring. So there's definitely a need for OB's here. And I've been really given the opportunity to sort of see different aspects of OB in the state of Maine through the midwifery programs and the nurse midwives, the doulas, and on top of that, the OB's as well. So I've kind of had this really nice experience of seeing all the different aspects of the specialty and how it. And how it benefits the state of Maine.

Dr. Lisa Belisle:

And so do you have thoughts? Do you think that you might actually come back and practice, or is it too early to say?

India Stewart:

I think there is a very, very good chance that I will be coming back to practice. I would love to have the opportunity to do my residency program here, but it's a very competitive field, and Maine Medical center has. Has a very competitive program, so we'll see.

Dr. Lisa Belisle:

This must be music to your ears, Dr. Bates.

Dr. Peter Bates:

It really is great. I had a big smile on my face just listening to India right now because she has captured really, the. Both the challenge and the opportunity in her own words, which is really all that we want. You know, we know she's gonna be a great doctor, but I think for her to really have an understanding of what Maine's needs are in her chosen field and think about how she can help make a difference, that feels pretty good.

Dr. Lisa Belisle:

I remember when I was a medical student and a resident in the family medicine program at Maine Medical, they really did offer. Maine Medical offers this really great chance to get out there into the communities and everything from working with the New Mainer's immigrant population to the public health population, indigent, homeless. And it really. You can get it here in Portland, but also you can go out and do things at rural sites. And it seems like that's something that you want the medical students in the Tufts track program to really have the chance to experience.

Dr. Peter Bates:

That's absolutely true. And our theme right now is educating for societal needs. And it's difficult to understand those unless you're learning your craft, how to be a good physician in the context of where those societal needs are Actually, most pronounced. So we're really focusing on urban underserved in the city of Portland, and we're focusing on rural underserved in various communities around the state. And India spent nine months of her third year. It's really a signature feature of the program in a clerkship setting in a rural community in the state of Maine. And we think that's formative for them to really understand what those careers are like.

Dr. Lisa Belisle:

India, tell me about that. Where did you go?

India Stewart:

So I had the opportunity to work at Pen Bay Hospital in Rockport, and I was there for nine months, part of the program. One of the, I mean, one of the best aspects of our program is that we're able to work one on one with professionals in each of the different rotations, Family medicine, surgery, ob, psychiatry, pediatrics, and have a one on one relationship directly with the mentors, learning from them, working with them. And Pen Bay gave me the opportunity to not only see what it's like to work in a rural community, in a rural hospital, but also to go out into the community and do homework visits with some of the physicians. I have many stories I could tell you about some of the different home visits that I did, but that is an opportunity that you don't necessarily get in a big urban hospital like Tufts. So I feel very fortunate to be able to see that aspect of patient care and that side of care.

Dr. Lisa Belisle:

So the first two years of your education as a medical student is spent doing basic science in Boston. In Boston. So you actually are right in the middle of a big city doing basic

India Stewart:

science stuff right in the middle of Chinatown.

Dr. Lisa Belisle:

And what is the connection to Maine? How do you maintain that connection over the first two years?

India Stewart:

So our program always makes sure that. So there's a group of about 38 of us in my class, and before we even go down to Tufts, we have sort of a team building retreat. So we meet all of us, we meet each other, develop nice relationships with each other, and then once we go down to Boston, we're in a classroom full of 200 people, but we already know 40 of them. So that was in and of itself, really comforting to already know a group of people. And then throughout the year, we have the opportunity to travel back to Maine during our second year and we do something called cap, which is we work with in a family med practice around the state. So I had the opportunity to be in Portland and Scarborough, and we come and visit a mentor each week or every other week and work with them and keep that connection.

Dr. Lisa Belisle:

How Is this different, Dr. Bates? Or similar to the education you received when you went through, which was a

Dr. Peter Bates:

few years ago now, wasn't it just a few now? You know, in many ways I think the quality is the same or higher than my experience. And I had a great medical education. But I would really point to the nine month rural experience Indy described, which we call the Longitudinal Integrated Clerkship, or lic. And OB is a good example of that. When I was a medical student taking ob, the currency of your experience was how many deliveries you participated in. And I was at Madigan Army Hospital and so I was involved in a lot of deliveries. But I think in the LIC there's an opportunity to follow a woman and her family through the entire sequence of pregnancy and delivery. A very different experience. Everything I learned about prenatal care really came through reading a textbook or getting a lecture and then being witnessing or participating in the delivery. But I think to actually follow a woman through the entire experience or a person with a cancer or any other chronic illness through the entire duration and understand that person and their needs as well as the more pure medical or scientific aspects, that's very different than what I experienced. And that's really what we're trying to get at here. I think for people like India to be well rounded physicians and really serve their community, they have to understand and appreciate the people they take care of as well as bring great scientific skills.

Dr. Lisa Belisle:

I know that when I as a medical student, I spent roughly two and a half years because our preclinical was a year and a half at UVM at the time at Maine Med and outside of Portland. And one of the things that was really great about that was making connections with the doctors so that when I went into practice, I then had connections with the doctors in the state. Do you feel like that might be a useful thing for you, India, as you continue to move through this process?

India Stewart:

Do you mean as far as knowing physicians already here?

Dr. Lisa Belisle:

Yeah.

India Stewart:

I'm not sure I understand the question.

Dr. Lisa Belisle:

Yeah, the connections that you made when you were up at Penn Bay or connections that you're making now when you're in the Portland area?

India Stewart:

Oh, yeah, these will be lifelong connections. I have a really great relationship with OB GYN that I met in Rockport and she has agreed to talk with me every month throughout my application process into residency and guide me and give me really great advice on how to look at different programs. And so I truly believe that that will be a relationship that I will continue to have for a very long time. And just working with the staff at Maine Medical Center. They have such a love for the program and they really inspire their students, students to be the best that they are. And they have always made it very clear that we can always turn to them if we ever have questions or need help or anything.

Dr. Lisa Belisle:

You've been doing this how many years now, the Tufts program, Dr. Bates?

Dr. Peter Bates:

We admitted our first class in fall of 2009, and this spring we graduated a fourth class. It's amazing how quickly it's gone.

Dr. Lisa Belisle:

And what are some of the things that you feel like you've learned? Are there surprises that have cropped up for you, or has this been pretty much the what you expected?

Dr. Peter Bates:

Well, I think when you do anything new, there's always surprises, and they've almost all been really positive, favorable kind of surprises. I think we always had a great experience with students from the University of Vermont like yourself, great students, but many weren't really committed to the state of Maine unless they grew up here or had a love for Maine like you do. So seeing the students who really love the state also come to learn here has been very different. And it's inspiring to work with young people. I think part of the joy of being a faculty member is you not only get to share what you know, but you learn from the people you're educating. And it's for a very demanding profession right now. I think many of our clinicians, and it's not just doctors, I think nurses, pharmacists, others really enjoy having medical students around and being part of that process. So that's something we've learned. Many of our faculty are excellent teachers. We have several that have won teaching awards. And I think to see Maine Medical center kind of blossom as an academic health center, be highly regarded in the Tufts community, which is a premier medical school, and seeing that this is something we can do and do very, very well has actually been a really nice surprise, perhaps, but definitely a nice outcome.

Dr. Lisa Belisle:

One of the things that I have noticed as my son at the University of Maine went through the process, is that they actually started. He started making connections with people who are kind of on the pre med track even further back. So he, he has a friend who is going to go next year to medical school. He's going to go after taking a gap year. My son is to medical school. So he actually is already making these connections. Did you have that same experience at the University of Maine?

India Stewart:

Yes, absolutely. There is somebody there, Chris Ann Blackie, who I want to thank especially for helping me in my search to go to medical school. I was in her Office probably one day a week, my entire first and second year at U Main, and asking her questions, she would connect me with students that had already been accepted into the program who gave helpful advice on what the program's looking for and just overall, you know, support and help throughout the process. So she was very much influential in that. For me.

Dr. Lisa Belisle:

I think it's a. I think that I'm really glad to hear that that is true. And I was also glad to know that my son had a similar experience at the University of Maine. And I know that the University of Maine system has really upped its game, just as you're saying Maine Medical center has. And it's really nice to know that within the state of Maine we have this great high quality education that can be afforded by both private and public institutions. And there's an excitement about it, you know, with the honors college at the University of Maine and the biology and the biochemistry departments and all the research going on and Maine Medical Center. And it's something that I think was evolving when I was getting my education, but it's nice to see that it has continued to move forward.

Dr. Peter Bates:

I think the aspirational part about this is a little bit soft and hard to quantify, but really important. I believe very strongly there are really highly qualified and talented young people in the state who maybe haven't thought about a higher education or a profession for themselves that would be terrific. Clinicians, doctors, nurses. And it's not all about healthcare, but it is a big need we have. And I think we actually have the talent right here if we can reach them and help them. And India is an example of someone who can succeed very, very well even though she comes from a small community. And I think there's a lot of young people in small community who maybe weren't encouraged by their parents or had other tracks in mind if they just had an epiphany. And for many of them, it's a chance to meet a young person like India and say, gee, I think maybe I could be like that. The other part that's been great is we've committed to provide financial support for the students to make sure they're not encumbered by excessive debt when they finish their education. And I have been really amazed at how generous mean people and foundations and corporations are in supporting this program. We've raised over $30 million, and I think that's been a great feature of the program.

Dr. Lisa Belisle:

$30 million, that's. That's pretty significant.

Dr. Peter Bates:

It's been a lot of money. Our goal is 40 million. When we started, I wasn't sure we'd make it, but I think now we're definitely going to make and that's going to make sure the scholarship program exists in perpetuity. It's very important. I think if you're a young person and you really finish medical school with a lot of debt, that tends to affect your choice of residency. And if you may want to do primary care in a rural community but perhaps feel you can't afford to do that because of those issues, that's a decision we don't want to have graduates face.

Dr. Lisa Belisle:

Well, as a family practice doctor, I know that we are seeing, we have a lot of really great mid levels who are working with us, but we're seeing that there's a huge need for primary care. And I think that you're right, that's a big consideration. I mean I'm still paying off my own medical school loans as my son is getting ready to go to medical school himself. And to have that be a factor, it's an unfortunate reality, but it's really there.

Dr. Peter Bates:

Yeah, it's definitely true and it's played out and there's a whole, Cynthia said there's a whole generation of really good primary care physicians and other specialists in our rural communities are within five years of retirement and it's not really clear who's going to succeed them. So it's really the whole package for us, getting high quality applicants, scholarships to diminish the debt, impact the rural education, the experiential part of living in a rural community. So you really understand what that life increase.

Dr. Lisa Belisle:

Dr. Bates, I know that you are one of the, you were the co founder actually of the South Portland based Chest Medicine Associates and you were doing clinical care for many, many years. You had your own patient panel. You told me you just finished doing this a couple years ago, much to your kind of semi regret, I think, right?

Dr. Peter Bates:

For sure.

Dr. Lisa Belisle:

What did you learn as a clinician in Maine over that period of time?

Dr. Peter Bates:

Well, I learned how terrific people are and Maine people in particular. I think as a young person I maybe underestimated how important to me it was to form personal relationships with people in the process of delivering health care. When I was young I was attracted to the critical care environment and it's very exciting and very scientific and you can do a lot of good. But over time I think the allure of that faded a little bit for me and what I became interested in was people I'd seen for decades with chronic illnesses who kind of beat the odds. They Maybe had emphysema, been able to quit smoking, discovered a new aspect of their life that was fulfilling through this new kind of view of themselves. And the opportunity to have a relationship with someone like that, provide healthcare, help them move forward in their lives, is a real privilege. So as we talked earlier, when my practice closed, it was really necessary to sort of preserve my time demands. But it was kind of a heart wrenching moment and I really miss those people.

Dr. Lisa Belisle:

India. Having myself been a primary care provider within different parts of the state over the years, I knew that people who do specialty practices are called to do primary care. And especially in obgyn, obstetrics and gynecology. What was your experience when you were at Pen Bay?

India Stewart:

Okay, so obgyn to me really is a primary care specialty with the addition of the surgical aspect of it. So we provide all aspects of women's health in preventative medicine through pap smears, breast exams, There are even some aspects of mental health that we touch on family dynamics. So in that sense, it's a primary care specialty. And then when a woman needs to have a surgical procedure, we're able to truly understand them as a patient and a person and then provide to them the surgery aspect of what they need as well.

Dr. Lisa Belisle:

Dr. Bates, one final question for you. You've now been around for a little while. I've been around for a little while too, and I've seen medicine change quite a bit. I'm guessing you've seen medicine change quite a bit. What are some of the good things that you've seen coming out of the changes that we've gone through?

Dr. Peter Bates:

Well, I still think it's the greatest career that a person could enter. I know many, many people in my age group tend to sound a little jaded and concerned about day to day or even longer term concerns, but it's a terrific field and I think the chance to be close to people at the most vulnerable times of their lives and still practice a craft that requires a high degree of scientific knowledge and skill is a really unique thing. And that's still here. In fact, I think a lot of the recent push through the Affordable Care act and other societal pressures to focus on people and their needs and the quality of their experience in the healthcare system has been really positive. So for many people there's a lot of changes, the reimbursement systems change, there is excessive documentation, there's a lot of kind of hassles that make the day to day experience not always that great. But I think as a career, it's hard to imagine a better one for a young person right now.

Dr. Lisa Belisle:

Well, it's been really a pleasure to speak with the two of you today. I'm assuming that if one would be listening and is a medical student or a budding medical student or has any interest in this field at all, they can find a website for them to look at. Would you know what that is?

Dr. Peter Bates:

Dr. B. Yeah, there's two ways. They can go to the Tufts University website and go into the School of Medicine and find the main track program and they can go to Maine Medical center and do the same thing. And we definitely want to hear from young people who think they might be interested in health careers. That'd be a great opportunity for us to chat with them.

Dr. Lisa Belisle:

Well, as a former Maine Medical center resident, I can say that you do offer the highest quality of education. I really learned a lot when when I was there. I'm sure, India, you are finding the same thing and your affiliation with Tufts, it sounds like it's quite wonderful. I can't wait for my own son to experience it. I appreciate the both of you coming in today. We've been speaking with Dr. Peter Bates, who is Maine Medical Center Senior Vice President of Academic Affairs, Chief Academic Officer and the Academic Dean for the Maine Medical Center Tufts University School of Medicine Medical School program. And also with India Stewart, who is a main track medical student from Harmony, Maine who graduated from the University of Maine and hopes to go into obstetrics and gynecology. I appreciate you both taking the time out of your very busy schedules to come in and speak with us today.

India Stewart:

Thank you very much for having us.

Dr. Peter Bates:

Thanks for the opportunity.

Dr. Lisa Belisle:

You've been listening to Love Maine radio show number 253, medicine, islands and Education. Our guests have included Scott planting, Sharon Daly, Dr. Peter Bates, and Amy Adam Stewart. We love to hear from you, so please let us know know what you think of lovemain Radio. We welcome your suggestions for future shows. Also let our sponsors know that you have heard about them here. We are privileged that they enable us to bring Love Maine Radio to you each week. This is Dr. Lisa Bellio. I hope that you have enjoyed our Medicine Islands and Education show. Thank you for allowing me to be a part of your day. May you have a bountiful life.

Dr. Lisa Belisle:

You were inspired to write a book about a ship that actually, a true ship that actually capsized in, I believe, a large storm that happened off the coast of Maine, leaving an entire circus and all the animals in it stranded and kind of swimming for their lives. But after reading this real story that occurred and I'm not sure exactly when, but in 1836. 1836. So there are times when you take things from reality and you actually make something out of them.

[Unidentified voice]:

Yeah, and I actually really like to do that. I'm always searching for the next hidden main story or a little gem that might be fleshed out to a story. Yeah, that's. The book you're referring to is called the Circus Ship, and it came out in 2009. And it's probably my most popular book of all the books I've written and illustrated. A lot of people really, really respond to that book. And you're right, it was. I read about this, you know, in a magazine about 30 years ago, this story about this shipwreck and. Or actually a ship caught fire. It caught fire off of Vinalhaven and it was carrying a full circus. And it was a huge story at the time. I mean, it made headlines all over the. All over the world, really, because it was so unusual to have, you know, an elephant swimming in Penobscot Bay. But it was also a real tragic story. And I wasn't sure I was going to be able to turn it into a story that was appropriate for kids. In fact, I have a funny story. I live in Camden, and I was walking down the street one day and I ran into a friend of mine, Matt, and he grew up on, I think he spent some time on Vinylhaven. And he said, what are you working on? I said, well, I'm working on a new book about a shipwreck that happened off the coast of Maine. It's based on a true shipwreck. And he goes, it's not the Royal Tar, is it? That's the name of the boat that sank. And I said, yeah, how'd you know? And he said, well, I grew up on Vinylhaven. That's still part of their things. He said, how are you going to do that? And I said, well, I've changed it around a lot. So basically what I did, I just took the idea of a ship carrying a circus sinking off the coast of Maine and then I sort of. Sort of approached it like, well, what if instead of, you know, the ship catching fire, what if it. What if the animal swam to an island? And so I sort of, you know, took the basic idea and built a story more appropriate for kids around that.

Dr. Lisa Belisle:

And you have some. You actually have memorized some of this story. Can you?

[Unidentified voice]:

Sure.

Scott Planting:

See if I remember. Yeah.

[Unidentified voice]:

It starts five miles off the coast of Maine and slightly overdue. A circus ship was steaming south east in fog as thick as stew. On board were 15 animals who traveled to and fro. The next day, it was Boston for another circus show. The captain, Mr. Carrington, was honest and sincere. He thought that they should drop the hook and wait for things to clear. But Mr. Payne, the circus boss, was terribly demanding. He stomped up to the helm where Captain Carrington was standing and screamed, don't stop. Keep going. I've got a show to do. Just get me down to Boston town tomorrow, sir, by two. And it goes on from there.

Dr. Lisa Belisle:

I love it. And I can just like picture you actually sharing the story with children, which is something that you do a lot of.

[Unidentified voice]:

You do a lot of school visits. I do, yeah. I do a lot of school visits, a lot of library visits, and actually my Mr. Payne voice, I didn't want to blow out your microphone here, but my Mr. Payne voice can get really loud. And the kids in the front row, their hair goes back. But no, it's really fun. It's a fun read aloud book. And if you're not familiar with the book, there's like one of the last illustrations is a giant. It's almost like a game within this book because it's a large double spread illustration, a spread illustration of this town scene. And all the people on the island have hidden the animals from the. The mean circus boss who came. Came back to the island to claim his animals. And kids just love to find all the animals hidden in this one picture.

Dr. Lisa Belisle:

So you were born, from what I understand, on St. Patrick's Day in 1960

[Unidentified voice]:

in Portland, Maine Med.

Dr. Lisa Belisle:

So did you think when you were younger. Obviously not when you were born. That's a little too young. But did you think when you were younger that doing illustration and writing books would be in your future?

[Unidentified voice]:

Well, drawing was one of the things I always did, and it was. And the more I did it, I realized that it was the one thing I could do with a little bit of success. And so when I was in elementary school, middle school, high school, I mean, I kept drawing while a lot of my friends didn't think drawing was cool anymore. So I just kept drawing and I was the guy.