In parts of rural Colorado, where the cattle and antelope often far outnumber the people, doctors are few and far between.
To help fill that gap in health care coverage, the federal government started a program more than five decades ago catering to rural residents, one free checkup at a time.
The Colorado Area Health Education Center does community outreach events around the state, including free health screenings at the National Western Stock Show during its two-week run this month.
The program in Colorado was founded in 1977, and “we’ve been going ever since,” said Josina Romero O’Connell, the state’s AHEC director.
The federal government started the overarching AHEC program six years earlier in an attempt to address health care disparities in rural regions of the U.S. It then expanded state by state.
Colorado’s rural areas make up about 12% of the state’s total population, with 47 of its 64 counties considered rural or “frontier” — a designation indicating a population of six or fewer residents per square mile — according to the 2022 Snapshot of Rural Health in Colorado.
Rural adults suffer almost twice the probability of tooth loss compared to those in urban areas, the 2022 Snapshot reported. Out of Colorado’s 64 counties, 24 are deemed “maternal care deserts,” where no obstetric providers, hospitals or birthing centers with obstetric care are found.
There’s even a scarcity of intensive care unit beds in 37 counties.
That’s where Colorado AHEC comes in. The program is operating in its latest grant cycle, which runs from 2022 to 2027. It’s associated with the University of Colorado Anschutz Medical Campus, and students are placed in clinical rotations to get comfortable serving rural areas.
The program divides the state into six regional centers, as each area contains different demographics with varying needs, O’Connell said.
During its screenings at the stock show, students from medical schools, such as Colorado State University, serve as facilitators, with licensed clinicians available on-site to oversee them.
The examination reviews patients’ health issues, vaccinations and dental care, then connects them with primary care providers if necessary.
“These have proven so successful that we have, in this new grant, launched an initiative to hold these health screens at least once per year in the six different regions of Colorado, bringing them closer to communities there,” Romero O’Connell said in a phone interview.
And they catch serious health problems, too. Romero O’Connell recalls one instance when a student couldn’t track the pulse of a patient with very high blood pressure. He was experiencing atrial fibrillation, or heart arrhythmia that can result in blood clots, and they rushed him to nearby emergency medical technicians.
Colorado AHEC has partnered with the stock show for more than 15 years, with upwards of 400 volunteers at the program’s booth each time, said Patti Jo Wagner, senior administrative and program specialist.
The team screens between 1,000 and 1,800 people annually at the stock show, with some patients, including event vendors, using the opportunity for their yearly checkups, she added. “A lot of them just don’t know where to go to find health care in their area.”
Wagner’s spoken to patients who’ve said, “I’m just going to go to the vet because it’s cheaper.”
The Denver event allows them to serve residents from all over Colorado and other states, with the typical age demographic at 50 years old and beyond.
Sam Hanson, IT coordinator and evaluator for Colorado AHEC, notes that patients often “find the students really approachable.” The experience not only gives students a chance to learn bedside manners, but also lets them debunk any urban myths or legends about medicine.
The program plans to take its health screens on the road, hitting each Colorado region at least once a year.
Hurdles around rural health care
Romero O’Connell, a physician, described her two typical categories of patients as either “urban underserved” — often uninsured or undocumented immigrants in the Denver area — or folks in rural communities.
“Rural is its own culture,” she said, with a set of challenges around health care, including access to doctors. “I know of a couple whose daughter had cancer, and they were traveling six hours four times a week for treatments.”
Rural providers need to take care of every ache and pain, but that lack of specialization isn’t appealing to all doctors. Romero O’Connell emphasized the need for greater training that lets providers both build their careers and reside in rural areas, which means recruiting more community residents to join the medical field.
Romero O’Connell recognizes that her rural patients hold less trust for the medical profession, and she’s “seeing a greater amount of that distrust globally” after the COVID-19 pandemic.
Self-employed ranchers, farmers and other rural residents often live without health insurance. “The last thing they want to think about is, ‘I’ve gotta spend money to go see a doctor when I need money to keep my ranch going.’ ”
As immigrants settle in rural areas, cultural and language barriers are also developing.
While telehealth is now an option, it’s impacted by the lack of reliable broadband, knowledge about technology and access to necessary hardware, like iPads.
Colorado ranks No. 25 out of the 50 states for broadband access, the 2022 Snapshot of Rural Health in Colorado said. The six counties with the worst coverage include Ouray, Lincoln, Washington, Park, Jackson and Kiowa.
Wagner spent 20 years in Cañon City, and struggled with broadband herself. “Even if we did get internet, it was very spotty,” she said.
Rancher Janie VanWinkle, past president of the Colorado Cattlemen’s Association, considers herself an outlier because she resides in the Grand Junction area, which is a regional medical hub.
But she’s frustrated by the dearth of health insurance options, pointing to just one company that covers customers in western Colorado.
Between VanWinkle and her husband, they’ve gone through four knee replacements, using a doctor on the Front Range. “But now, our insurance doesn’t cover that.”
For many rural residents, it ultimately comes down to worry.
“When you have to drive 80 to 100 miles, but you can’t get an appointment for two to three months, that makes life difficult,” VanWinkle said. “And the concern always is, ‘Well, what if something happens?’”
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