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'Toxic Individualism': Pandemic Politics Driving Health Care Workers From Small Towns

Dec 28, 2020
Originally published on December 28, 2020 7:04 pm

The virus infecting thousands of Americans a day is also attacking the country's social fabric. The coronavirus has exposed a weakness in many rural communities, where divisive pandemic politics are alienating some of their most critical residents — health care workers.

A wave of departing medical professionals would leave gaping holes in the rural health care system, and small-town economies, triggering a death spiral in some of these areas that may be hard to stop.

Ten years ago, Dr. Kristina Darnauer and her husband, Jeff, moved to tiny Sterling, Kan., to raise their kids steeped in small-town values.

"The values of hard work, the value of community, taking care of your neighbor, that's what small towns shout from the rooftops, this is what we're good at. We are salt of the earth people who care about each other," Darnauer says. "And here I am saying, then wear a mask because that protects your precious neighbor."

But Darnauer's medical advice and moral admonition were met with contempt from some of her friends, neighbors and patients. People who had routinely buttonholed her for quick medical advice at church and kids' ballgames were suddenly treating her as the enemy and regarding her professional opinion as suspect and offensive.

"Heartbreaking"

COVID-19 cases in the county started to climb. Meanwhile, other small Kansas towns flared into some of the pandemic's hottest hot spots.

"It's heartbreaking," Darnauer says. "Because we say, this is what we value. And then when we actually had the chance to walk it out, we did it really poorly."

The pushback was too much. Darnauer resigned her position as Rice County medical director in July. Some friends reached out to support her, and her bonds with other local health care professionals strengthened, but she felt disrespected and betrayed by the ascendant anti-mask portion of the community. Darnauer says the pandemic has exposed a rift that won't be forgotten.

"Hard things should bring us together," Darnauer says. "And instead, this hard thing has driven a wedge between us."

That wedge is splitting off health care workers from communities that desperately need them.

More than a quarter of all the public health administrators in Kansas quit, retired or got fired this year, according to Vicki Collie-Akers, an associate professor of population health at the University of Kansas. Some of them got death threats. Some had to hire armed guards.

"These are leaders in their community," Collie-Akers says. "And they are leaving broken." Collie-Akers notes these professionals also leaving at a terrible time. The pandemic is still raging. Vaccines still need to get from cities to small towns and into people's arms; public health officers are as important as ever.

And who, she asks, is going to take the jobs health care directors are leaving?

"It's not a secret that the position is open because of extreme tension between the health department director and the city commissioner, county commission, or because the person has required a guard," Collie-Akers says.

"No good year for rural health"

And it's not just Kansas. Alan Morgan, CEO of the National Rural Health Association, says this is happening across a lot of rural America.

"It's been a terrible, an absolute terrible, no good year for rural health," Morgan says.

Morgan worries that the loss of county health directors in the middle of a pandemic will lead to sicker rural populations and still more pressure on rural hospitals.

Rural hospitals were in deep trouble before the pandemic. Morgan says 132 of them have closed since 2010. COVID-19 made matters worse. The surge of desperately sick and highly contagious patients stopped hospitals from doing the lucrative elective outpatient procedures that keep them in business. Their small staffs have been run ragged. And the pandemic has filled the air with vitriol against medical expertise.

Rural health care jobs can be hard to fill in the best of times; now, Morgan says many rural hospitals he represents are growing desperate.

"In community after community, after community, all I hear about is workforce, workforce, workforce losing clinical staff, trying to attract clinical staff into these communities. It is taking up the full time of our members right now," Morgan says.

Closing rural hospitals, Morgan says, cuts health care to places where residents tend to be older, sicker and poorer than average.

Lifeblood of community

It also undermines the rural economy. Hospitals are often the biggest employers in small towns, according to Chris Merrett, director of the Illinois Institute for Rural Affairs. And Merrett says health care workers are absolutely vital.

"They are really the lifeblood of any community and a rural community in particular," Merrett says. "These are well-paid individuals who are the ones who are buying cars, buying homes, and really part of that economic anchor of your community."

Merrett says towns that let pandemic politics drive medical professionals away are choosing what he calls "toxic individualism" over the common good.

There are signs that months of pushback against rural health care providers may be starting to slack. Morgan says mask compliance has soared in small towns with major COVID-19 outbreaks.

And though Darnauer has stepped away from the county health department, and thought long and hard about moving out of Sterling this summer, she's decided to stay and practice medicine there, at least for now.

"There were enough people that sort of reached out to give me hope that some of the values and of this small town were still there," Darnauer says. "And that's what's keeping me going."

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AILSA CHANG, HOST:

The virus infecting thousands of Americans a day is also attacking the country's social fabric, especially in some small towns. As Frank Morris of member station KCUR reports, the sometimes divisive politics surrounding the coronavirus is roiling rural communities and threatening to alienate some of their most critical residents - health care workers.

FRANK MORRIS, BYLINE: Ten years ago, Dr. Kristi Darnauer and her husband moved to tiny Sterling, Kan., to raise their kids steeped in small-town values.

KRISTI DARNAUER: The values of hard work, the value of community, taking care of your neighbor. Like, that's what small towns shout from the rooftops. Like, this is what we're good at. We are salt-of-the-earth people who care about each other. And here I am saying, then wear a mask because that protects your precious neighbor.

MORRIS: But Darnauer's medical advice was met with contempt from some friends, neighbors and patients. COVID cases in the county started to climb. Other small Kansas towns turned into some of the pandemic's hottest hot spots.

DARNAUER: It's heartbreaking because we say this is what we value, and then when we actually had the chance to walk it out, we did it really poorly.

MORRIS: The pushback was too much. Darnauer resigned her job as Rice County medical director. She felt disrespected, even betrayed.

DARNAUER: Hard things should bring us together. And instead, this hard thing has driven a wedge between us.

MORRIS: And that wedge is splitting off health care workers from some communities that desperately need them. More than a quarter of all public health administrators in Kansas quit, retired or got fired this year. Some got death threats. Some had to hire armed guards.

VICKI COLLIE-AKERS: These are leaders in their community, and they are leaving broken.

MORRIS: That's Vicki Collie-Akers, a population health professor at the University of Kansas. And she says they're leaving at a terrible time. The pandemic is still raging. Vaccines need to get from cities to small towns and into people's arms. And who - who is going to take the jobs that health care directors are leaving?

COLLIE-AKERS: We think it will have a profound effect on recruitment. It's not a secret that the position is open because of extreme tension between the health department director and the city commission or county commission or because the person required a guard.

MORRIS: Alan Morgan, who runs the National Rural Health Association, says this is happening across a lot of rural America.

ALAN MORGAN: It's been a terrible, an absolute terrible, no-good year for rural health.

MORRIS: Rural hospitals were in deep trouble before the pandemic. COVID made matters worse, filling hospitals with desperately sick, highly contagious patients, running staff ragged and filling the air with vitriol against medical expertise. Rural health care jobs can be hard to fill in the best of times. Now, Morgan says, many rural hospitals are downright desperate.

MORGAN: Community after community after community, all I hear about is workforce, workforce, workforce - losing clinical staff, trying to attract clinical staff into these communities. It is taking up the full time of our members right now.

MORRIS: Closing rural hospitals cuts access to health care in places where more residents are older, sicker and poorer. It also undermines the rural economy. Hospitals are often the biggest employers in small towns that have them. And Chris Merrett, director of the Illinois Institute for Rural Affairs, says the people they employ are absolutely vital.

CHRIS MERRETT: They are really the lifeblood of any community, and a rural community in particular.

MORRIS: Well-paid, life-saving experts in extremely short supply, Merrett says towns that let pandemic politics drive medical professionals away are choosing rugged individualism over the common good. For NPR News, I'm Frank Morris.

(SOUNDBITE OF CLOGS'S "COLONY THEME") Transcript provided by NPR, Copyright NPR.