When 15-year-old Kade Shumway Lyman told staff at San Juan High School that he wanted to be a doctor, their response was not the verbal high five he expected.
It had been 10 years since a student from the Blanding, Utah, high school had gone to medical school, they told him in 2004, and it was an expensive and demanding career. Consider podiatry or becoming a physician assistant instead, was their advice.
A small town midway between red-rock tourism mecca Moab and the desolate beauty of Monument Valley and the Navajo Nation territory, Blanding struggles with poverty and isolation. Teen Lyman had to drive 90 minutes to Cortez, Colorado, just to buy a pair of socks. While now, more than a decade on, there are a few shops, other issues remain the same: with no specialist care, a serious medical problem still requires an AirMed flight to the University of Utah.
Two years after Lyman shelved his physician plans, several University of Utah medical students visited Blanding to meet with juniors and seniors. They were volunteers with the Utah Rural Outreach Program (UROP), which recruits medical students to crisscross the state during the winter and spring breaks. Their mission is to address a long-standing dearth of doctors in rural counties by encouraging local high schoolers to consider the rewards of health care careers.
According to health care advocacy nonprofit the Lown Institute, about 20 percent of Americans live in rural areas, yet only 11.4 percent of physicians practice in rural locations. And while in 2016, Massachusetts had 134.4 primary care doctors per 100,000 people, Utah had only 64.7, marginally ahead of Mississippi with 64.4.
One UROP volunteer visiting Lyman’s class was from the central Utah town of Beaver and had played football against San Juan High. Talking to him, Lyman realized that medical students were, he says, “normal people, not geniuses. All medical school takes is dedication and hard work.”
Lyman MD’16 went on to med school at the U, returning to Blanding himself as a UROP representative to promote medicine to students including his little brothers, sister, and friends. “I felt like I could really connect with students there because I knew their teachers, all the doctors that were providing them care, and even other students they knew who had been able to get into health care,” he recalls.
IT HAD BEEN 10 YEARS SINCE A STUDENT FROM THE BLANDING, UTAH, HIGH SCHOOL HAD GONE TO MEDICAL SCHOOL. THEY TOLD HIM IN 2004, AND IT WAS AN EXPENSIVE AND DEMANDING CAREER.
The idea behind UROP, he says, is that contrary to Thomas Wolfe’s famous dictum, you actually can go home again. While big city residents might turn their noses up at small-town practice, a fifth-generation Blandingite like Lyman knows the beauty of rural life and the benefits of working in such locations: good money, a wide variety of procedures, and a broader scope of practice.
Indeed, Lyman is a poster child for UROP. He, his registered nurse wife, and their two small children currently live in Los Angeles, where he is a third-year resident at a Level 1 trauma center. He plans to return to Blanding as an orthopedic surgeon. “I want my children to grow up in the same close-knit and supportive community I did,” he says.
From a small basement office housed in the U’s Department of Family and Preventive Medicine building, longtime UROP advisor Bob Quinn BS’86 keeps a watchful eye on the 17-year-old program, which runs on an $8,000 annual budget. In 2017, first-and second-year medical students visited 40 high schools in 15 different counties, accumulating more than 70 hours of classroom presentations for a total of 1,566 students. Medical students sign up for all sorts of reasons, ranging from wanting to go home for the holidays to seeing a national park.
In late 2018, 40 students signed up to spend much of their winter break visiting as many high schools as they could in the state’s rural and frontier counties. That included two first-year students, Jen Christiansen and Kassie Amann. They picked visiting some of the state’s most isolated schools during a four-day road trip from Salt Lake City to the epic splendor of Monument Valley.
Christiansen and Amann’s journey in the latter’s silver SUV, with a cooler full of cow hearts and pig lungs in the trunk, revealed the challenges distance imposes on rural communities and the importance of UROP in terms of encouraging students to pursue medicine. Christiansen summed up the trip’s meaning for her and Amann over a late-evening burger in a family-run diner. “I just want them to look at Kassie and me and know that, ‘No matter what I want to do in life, regardless of if that is medicine, it’s worth the work.’ ”
A one-stop town
At 5 a.m. on Monday, Dec. 15, Amann had stopped to pick up Christiansen in Salt Lake. They needed to make Moab’s Grand County High before the 9:53 a.m. bell to meet their first class, anatomy students. There are two key elements to UROP’s pitch: one is a presentation, the other dissections.
Their presentation began by asking, “Why medicine?” Then they detailed the wide variety of health careers, comparing the average debt to become a doctor ($161,000) against average salaries ($189,000 for a family doctor, $450,000 for a surgeon). When Christiansen and Amann pulled out the organs for dissection, excited students pulled out their phones to take pictures.
Afterwards, Christiansen and Amann drove to their lodgings at Bullfrog, Utah, near Lake Powell. Daylight revealed few houses but many dry-docked house boats. At Lake Powell, their class was seven male students from the seventh and eighth grade, half of whom were Navajo.
Next on the itinerary was San Juan High School in Blanding. And while it turned out to be larger than they expected, Blanding still amounted to a small town with one blinking red light swaying over the main intersection.
“How did you want to handle this?” Christiansen asked Amann as 130 students filed into San Juan High’s auditorium, a quarter from Tracy Johnson’s anatomy class. After the seven students of Lake Powell, it took the visitors a moment to adjust to the shift in scale.
“The point we’re trying to get across is, there’s a shortage of medical practices across the state,” Christiansen told the hall. “We’re trying to inspire you guys to fill this need.”
It turned out that some had already heard the call. When Christiansen asked how many wanted to be medical students, a dozen students raised their hands, citing career interests ranging from becoming a family practice doctor to an anesthesiologist.
Such ambitions reflected how many of them had relatives working for the 19-year-old Utah Navajo Health System (UNHS), which currently has multiple clinics and hospitals in the region.
“It has totally changed the landscape,” says Monument Valley High principal Spencer Singer, whose mother, Donna, founded the nonprofit. “The majority of boys [on the reservation] aspire to be welders, or in the construction trade. Why? That’s what dad does, what their uncle did. Now their aunts and uncles work for UNHS, and it’s created a different avenue for jobs. ‘I can do that,’ the students say. ‘I can be a nurse or a doctor that works in the clinic.’ ”
Despite the burgeoning local medical industry, the value of UROP remains the same: letting high schoolers know medicine is within their reach.
Tugging on (a cow’s) heart strings
When Christiansen and Amann put out cow hearts, 50 students lined up for the dissection. Amann struggled with the scalpel as she cut open the muscle. “They gave us the world’s smallest scalpel to do this with,” she laughed.
As teenagers pulled on purple plastic gloves, the quips came hot and fast. “They’ve stolen my heart,” said a native student. “This is the definition of playing with someone’s heart,” joked another. One student was more concerned about his impending lunch. “This has ruined my appetite,” he muttered.
Roughly half of those considering medicine thought they’d return to practice in Blanding. “I think there are deep family ties that make you want to come back,” Johnson says.
Christiansen and Amann left for Whitehorse High in Montezuma Creek, 45 minutes away, to find 40 tired students who’d just finished their state exams. Once the organs came out of the cooler, eyes widened in interest, especially among the female students.
Amann enjoyed the buzz students got from the dissections. She had one question she wanted the students to take away from their visit: “Do you want to do this more than just today?”
Caring for their own
The U students stayed at a motel in Mexican Hat perched on the red-rock banks of the San Juan River. As they dined on beef stew and Navajo fry bread, they reflected on how the trip was “about giving these kids an intro to things,” Amann said. “This is a slice of how cool medicine can be.” Both valued modeling health care careers for young women. “You can’t be what you can’t see,” Amann says.
The next morning’s drive out to Monument Valley High took them over the river and through a bleak landscape of black rock towering over tiny, one-story houses with concrete floors and wood stoves, standing unprotected against the weather. Very few of these homes have electricity or running water.
Despite the challenges of getting and keeping teachers in what is a deeply isolated, poorly resourced location, Monument Valley High has seen a dramatic turnaround under Principal Singer, going from a long-standing F to a C in the 2017-18 academic year. That’s with a 220-strong student body of whom 70 percent are classified by the state as homeless and 60 percent with English as their second language. Many of them live in situations where trauma from abuse, alcoholism, drugs, and neglect is ongoing.
In the school auditorium, Amann and Christiansen made their last presentation to 12 Navajo students. None of the students had questions, but when they moved to the cafeteria for the dissections, their standoffishness dissolved into enthusiasm and inquisitiveness. Not that handling animal organs was necessarily novel to them. Recently, a live sheep had been brought to the school, its throat slit in front of the hogan and the students taught butchering so that every piece of the animal was used.
COMMUNITY WAS THE THREAD THAT WOULD DRAW THEM BACK.
As the students passed a pig trachea from one fingertip to another’s, most said they wanted to go into medicine. For some, it was relatives pushing them to go into health care. For others, it was personal.
Kaelo Atene talked about being offered a football scholarship to Lewis & Clark College in Oregon. He was weighing whether that would help him achieve his long-term goal of studying medicine. His drive to become a medical provider is driven by illness within his family. His grandfather has Parkinson’s, he says, and he’d like to know its cause. Another close relative has medical issues that mean he faces going into a nursing home. Atene plans to return post-residency to practice medicine in his own community so he can care for him at home.
In between palpating the memory foam-like texture of the pig’s lungs, other students agreed that community was the thread that would draw them back. “This is our home,” said one.
Third-year resident Lyman argues that, much like the rest of the state, there continues to be a deep need for UROP in San Juan County. “You don’t have the same resources as a larger school,” he says. “So, when a well-respected institution like the University of Utah decides to devote resources to you, I think it’s really impactful.” Especially since what Blanding high schoolers know about the U comes mostly from visiting relatives who’ve gone there by AirMed.
As the med students packed up the cooler for the last time, school counselor Jeff Fitzgerald asked them to pass on a message to future generations of UROP ambassadors.
“We appreciate it,” he said, “every year. Please come.”
—Stephen Dark is a writer for University of Utah Health.