Many of the farmers were loath to seek medical attention, in part because they were too busy trying to keep their operations solvent, and in part because they were in denial that anything medically might be wrong. And many of them were not insured for preventive care, if at all.
So ThedaCare figured out a way to take medical attention to them in the form of personalized care through simple house calls.
"We listened to what these farm families were telling us, especially the wives," said Rhonda Strebel, executive director of Shawano Rural Health Initiative . "They told us, 'Look, everyone comes to us, the veterinarian, or the company that brings tires or fuel. Even the milk that's produced gets picked up at the farm. If you want to see our farmers, you will have to come to them too.'"
So she did.
Strebel, a health professional with credentials in sports medicine, is not a nurse. But she said she's especially qualified to reach this community because she understands the farmer's lifestyle. She herself was born and raised on a dairy farm until she was 18-years-old. "I have a comfort level with these people," she said, adding that she was not averse to "tiptoeing through the manure" to get to these families.
Another provider who is a nurse practitioner works part-time with the initiative.
ThedaCare hired Rhonda in 2004 after ThedaCare had conducted a "plunge," in which teams of community leaders from the area got on a bus to visit these small farmers, explained Paula Morgen, ThedaCare's director of Community Affairs.
Morgen said the system realized many of them were walking around with diabetes or heart conditions or arthritis, but not knowing it.
Many of these farmers are getting older and developing medical problems associated with lifestyle. Some of the men, especially, had developed high blood pressure or had high blood sugar levels, or were getting up frequently at night to use the bathroom, a potential sign of prostate difficulties, Strebel and Morgen said. But much of it went largely undiagnosed.
"If these farmers, the backbone of the region's economy, aren't taking care of their health, what's the chance they'll be able to continue?" Morgen asked.
They just couldn't go to the doctor. "Who would get the work done?" Strebel said.
The plunge team realized "these farmers work extremely long hours, and many of them work alone, with large animals, equipment, and chemicals and no occupational safety and health requirement."
She added, "There was no one there to remind them to wear hearing protection, respiratory masks, goggles, or steel-toed shoes. They could drop heavy equipment, or when milking, a cow might step on their feet," Strebel said. "They'd say their parents and their grandparents never wore protection so they didn't think it was important." In fact, regionally, many providers had seen many such injuries.
"At the end of the day, we realized that we needed to do something in Shawano," Morgen said.
At one focus group meeting to address the problem, one farm woman spoke up. "If you want to see our husbands, you're going to need to come to the farms," Strebel recalled. She said that the initiative does not just target men, but in reality, they're the ones that need it most. Women are just more comfortable with the idea of getting healthcare.
Many farmers had limited health insurance with no coverage for preventive care, added Strebel. In these lean times, she said, it the expense is seen by many farmers as unnecessary.
Strebel said she probably wouldn't get the trust she needs except for how she enters their lives. "I rode out to their homes with the milkman and the veterinarian, and went into the bank to meet them," she said. She became active in Future Farmers of America events such as picnics, and quietly explained the program to many wives she met.
"Can you come out to see my husband? I can't get him to come in to see a doctor," one woman asked Strebel.
When inside the home, Strebel tries to organize a family discussion around the kitchen table. She listens to their questions and draws blood for lipid and blood sugar tests, takes blood pressure, assesses body mass index and body fat, conducts pulmonary function, hearing and skin cancer screenings. She also advises on tetanus shots and views the farm's surroundings.
What she helped launch five years ago has helped deliver needed health interventions to about 300 families, or 670 individuals a year, she said.
The project is, by big city standards, extremely cheap.
The effort has been funded with about $120,000 a year for each of the past five years. Two federal grants provided a total of $192,000, but the rest came from ThedaCare and the Shawano Medical Center, a 25-bed critical access hospital in Shawano.
Strebel advises other community hospitals to make sure that the effort starts with the community.
Strebel said that once alerted that they may have a medical problem, "the first thing they say is 'Oh my gosh. What can I do about this? I don't have time to be sick.'"
And many have been successful following advice to lose weight and eat a better diet.
Ron Hillmann, chairman of the Rural Health Initiative said the program has exceeded all expectations. "It's the old concept of the typical country doctor going out to the patient," he said. "That's what has worked for us, and gained the confidence of the people. Rhonda has done that."
He added that farm women say "I got my husband to listen to her, and he hasn't listened to anyone in more than 20 years."
Hillmann, who also is the president of the Mid-County Cooperative that supplies feed and fuel for the farmers, said that in his years of working in the community, "we tried five other initiatives and every one has failed.
He said the program has also brought patients in to the area medical centers. "There's no question that the health of community is far better today because of this program," he said.
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