We are excited to have Joyce Feltrow, project director of the North Michigan Opioid Response Consortium, join us on today’s episode of Rural Health Today. Opioid use continues to be prevalent in rural communities, especially those lacking the resources to address it with sustainable solutions. Joyce is here to share her perspective as a leader in the field of opioid response. We’ll talk about effective programming, prevention methods, and of course, what it all has to do with rural health.
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Transcript
Jeremiah Hodshire (Host): It’s great to be in the studio today with a very special guest. I am, for the very first time, welcoming Joyce Fetrow, project director for the North Michigan Opioid Response Consortium, and this is an issue that is very, very heavy on the minds and hearts of hospital administrators, and community leaders across the country. This is not just an issue restricted to Michigan or any of our respective states. It’s an impact globally even, in issues that we face with opioids. Today we’re going to be talking about some of the programs. We’re going to talk about some of the initiatives and efforts done in this project and I’m excited to learn more.
So, today, having Joyce in the studio is a welcomed guest for us, because we’ve never tackled this issue on our podcast. In all of the years we’ve danced around it a little bit, but really, from someone who’s leading this initiative for the state, it’s exciting to have you here with us. So, first of all, Joyce, welcome to the podcast for your very first time it’s great to have you and second of all, why don’t you tell our listeners a little bit about your role with the Michigan Center for Rural Health and the work that you do there, as well as, what brought you to that organization and why did you choose that particular field?
Joyce Fetrow (Guest): Well, I my involvement with Michigan Center for Rural Health started in a volunteer capacity back in 2018, and in 2018, I was notified by my current employer that there was going to be some collaborative work. We were going to start seeing some opioid grants coming down through HRSA, and she really encouraged me to start participating in these collaborative events. So, once every month, Michigan Center for Rural Health would come up to Grayling, Michigan, and they brought some staff with them, and we did some coordinated work with other key players in northern Michigan. So, sectors from law enforcement and hospitals, healthcare treatment centers, recovery community centers, anything that touched the lives of mental health or substance use disorder was involved in this planning process, and we started to lay out some groundwork. We were given some money. It was a planning grant through HRSA, so we were going to take some money from HRSA and start planning out a work plan that would last for 3 to 4 years. So, what does that work plan look like? Where are we going to touch? Where are we going to spend this money?
As we got near to the end of this planning grant, John Barnas, who is now my supervisor came up to me during this collaborative planning process and said, “if we get awarded implementation, it’s going to mean that we’re going to be creating some new staffing roles”. He had asked me to write the job description of someone who is highly involved in the recovery community, somebody who had maybe some credentials. I came to this collaboration with some lived experience with my own recovery from addiction, and that was why I was so passionate and highly involved in this planning process. It took me a couple of weeks, but I presented him with the job description, and he notably pointed out that I pretty much wrote the job description for myself. Then handed it to him and I was currently employed, so he’s said, “I can’t help but notice these are all of your experiences and credentials”, and I said, “well, you know, if it works out like that, it works out like that. I just think that’s the best person”. So, I started with Michigan Center for Health as a project associate. I had a great leader as a project director when at the beginning of this and then she did things that most women do and start a family, and then found that maybe this role wasn’t for her anymore. We greatly appreciated that, and we wished her the best. Then I slid into this role as project director.
As I mentioned, why I got into this work is because of my own lived experience, and I had struggled for years with alcohol use disorder and I had found recovery and wellness and sustainable recovery and wellness and had just immersed myself in all things substance use related, substance use recovery related. I was in the process of opening a women’s recovery home in Petoskey. I had a lot going on, but I wanted to take on this new role and start this new venture with the Michigan Center for Rural Health. So, it’s been six years that I’ve been in this role and just love it every day. I’m sure you’ve heard the phrase, if you love what you do, you never have to work a day in your life and I find that to be not entirely true. I think you work harder than ever for something that you greatly love and you give your blood, sweat and tears.
JH: Yeah, you’re right. I often use that phrase, but never in that context. It’s what we give, 100% of our all, which is pretty evident in what you have done and what you are doing and which we’re going to jump into in just a minute. Before we do that and really get into the meat of our discussion today, we have listeners across the country, as I shared earlier, and we like to humanize our guest. They’re not just talking heads; they’re not just bureaucrats. So, one of the questions that we find, very, very relaxing for not only our guests but our listeners is to ask the question of our guest, what is something most interesting about yourself, something you’ve done. A fun fact about you that can relate you to our listener? Could you share that with us?
JF: As I shared, I’ve been in recovery 4489 days today. I think the interesting thing is, I don’t count every single one of those days like that. I use an app. So, I found an app that does that, instead of just sticking a penny in a jar. I think, in my early years of addiction, I used to chase that neon rainbow and my new passion is everything outside, everything nature. I still chase a neon rainbow, but it’s the aurora borealis, or the northern light. So, it makes quite a few appearances in northern Michigan and I follow a bunch of different apps to catch its beauty, and I don’t know if you’re aware but there were two times last year where anyone with a camera or a cell phone could have captured the aurora it was so strong, and I hate those days because I spent so much time and energy chasing that. For the right opportunities you can’t have clouds; it can’t have a full moon. You’ve got to have perfect conditions and the strength has to be there. So, when everyone can capture it, those are my most disappointing moments because it takes away, I think, from the effort and time that I put into it.
JH: Very interesting fact, very interesting. My wife and I travel every year up north, and she always is looking for the northern lights. I’ve never seen them. She does. I can never see them, and I’m like, well let me get my phone out. I’ve taken pictures before where I can actually see the northern lights on the phone. I guess it’s not the same, but it works for me. Certainly, in your line of work, what a great analogy. To see the beauty of nature and to chase after that is pretty incredible and something that you’re doing that is also incredible is opioid education awareness because this is something that is plaguing our country right now. We’re going to talk about that in just a minute.
So, what you know today’s focus is that, we analyze, we look at the opioid use, and we look at what its continuation is and its prevalence in rural communities and in those communities lacking the resources to address it with sustainable solutions and we find that in rural communities across this country that, this is an epidemic. We’re talking about specific issues that are relative to almost every life, in every family, is touched by this at some level. So, we’re going to talk today a little bit about those strategies that can be deployed in rural communities. What can you do? To say that you’re in an island and that there’s no help is not the case today. There are resources available.
So, Joyce is here to share her perspective as a leader in the field of opioid response. We’ll talk about effective programing, prevention methods, and of course what all this has to do with rural health. So, first let’s talk a little bit about the specific work done and let’s talk about the North Michigan Opioid Response Consortium itself; how it fits into the Michigan Center for Rural Health. What are your primary goals with this program? If you were to say today, you know that you’ve achieved nirvana, what does that look like? What are you what are you trying to achieve with. So, take us through the journey if you would.
JF: So, again, back when we started, we selected our first original 16 northern Michigan counties. Today we have grown to 25 and hopefully we will expand even further, but those 16 northern Michigan counties with that original work started because of some things that were identified. We looked at a lot of data. We look at evidence-based information. Those 16 northern Michigan counties had high prevalence of overdose occurrences and overdose deaths. They also had a coinciding high prescribing patterns of opioids with our medical providers due to not being totally informed that these products were highly addictive. That’s where we came into play today with opioid settlement dollars. We did find out that they are highly addictive. They did create problems in our communities. The other thing was some of those communities lacked a lot of resources, resources across all sectors; prevention, treatment and recovery, and that is what we aim to do is improve practices.
So, today are our work focuses across prevention, treatment, workforce, and recovery. Workforce is twofold, we identified a lot of behavioral health gaps, gaps in psychiatry, gaps with social workers, and just anything that would touch that we started to look to improve those practices. Then we also found a lot of individuals like myself that had found and achieved long term recovery. How do we use their new skill sets, get them trained, and today you’ll see a lot of peer recovery coaches, individuals with lived experience of their own that have found sustainable wellness and recovery, who are now working in emergency rooms to help guide other people into recovery. We have them working in public safety departments. When there is a call with EMS, they’re going out and responding to those calls and instead of being someone of law enforcement, where individuals in recovery have found there just wasn’t a good working relationship with law enforcement or health care professionals, maybe they were treated poorly in some of those instances, that that peer recovery coach who is not dressed in a uniform, who’s not wearing a white lab coat, can now talk to this person one on one and motivate them towards a level of wellness and recovery for their own.
We also have peer recovery coaches now working in health departments and treatment centers and detox centers and community centers, central hubs where people are showing up for food insecurity or housing insecurity. Sometimes those same individuals may be suffering from some level of addiction. So, how can we guide them into that path of yes, we can help you with your utility bills, but how do we move you forward and catapult you into a better future? So, we’re pairing them with peer recovery coaches or wellness coaches and getting them on track with whatever they need; social services, therapy, a connection to the community in a positive way, versus how they maybe have been reacting before. So, workforces have been hugely impacted and we’re still identifying a few gaps and shortages.
Things continue to change. We’re looking at increasing capacity of providers here in northern Michigan to expand medications for opiate use disorders, and new residents in their practice might be encouraged to go to northern Michigan, but then they find out that northern Michigan might not be for them because of the weather that we experience and things like that. So, it’s kind of like always turning over and we’re always chasing those things, but we’re really looking at some attraction and how we can keep them and make those practices more sustainable, but we also work across 50 different collaborating partners. We’ve implemented naloxone in schools, which is the lifesaving overdose reversal drug for opioids. We’ve implemented that in libraries because we know our unhoused population sometimes go to the libraries to get warm, grab a cup of coffee, connect with friends, or job search on a computer.
We’re just looking at different ways that we can improve practices for everyone and treatment expansion, access to treatment. There’s always been a gap and a delay. If I found someone that wanted to go to treatment and get help for their addiction, we often find a week’s wait time for them to get in. We’re trying to smooth that over with, looking at other options for treatment centers. Transportation being another big barrier. How can we fix that? Well, we’ve partnered with a transportation organization in Traverse City that will help transport people to get them to treatment, and they have a peer recovery coach that rides in that car and keeps them engaged the entire way so that they don’t feel threatened or want to back out.
JH: Wow, the work that you’re doing is phenomenal. The points that you bring up about social determinants of health and how that plays a role in substance abuse, food insecurity, housing. We’re starting to ask some of those questions at intake when we see patients at primary care, you know, do you have access to food? Are you able to pay your rent? It sounds like, the work that you have engaged in here is addressing some of those social determinants of health, because some of it stems from those issues. Let’s transition a little bit and talk about communities that are impacted by opioids. So, I guess if you could identify, and maybe there are none, what makes a population more at risk to opioid abuse? Or are all populations just at risk of it? If there is that population that’s more at risk, what are the long-term effects that substance abuse disorder has on those respective communities? So, are there communities that are at higher risk?
JF: It’s not just even opioids, but addiction overall. So, alcohol is a number one killer of all drugs or substances combined. What exists in communities is a lot of stigma. Stigma within the person who’s suffering, and stigma within the families and the community that surround that person. There’s a lot of stigma in willingness to seek treatment and get treatment. Often, they’ve maybe hinted or presented themselves in an emergency room, but emergency rooms are not equipped to handle detox care or long-term substance use disorder care. So, when you want when an emergency room or a hospital or health care wants to get to that person into treatment right away when they’re ready, often, we were met with barriers and gaps of accessibility within the treatment center itself.
So, there’s not one thing that I think makes communities more susceptible to substance use disorder or opiate use disorder. We’ve improved so many practices since 2018, when we first started, that there’s very few things that still exist, but we’re still working through each one of those bumps and hurdles. We’ve implemented peer recovery coaches in several different ways. We’re increasing capacity of recovery housing so that they do have safe, stable recovery housing regardless of what substance they misuse. Recovery community organizations; we’re starting to see a growing trend of those popping up in our communities.
So, what we want to do is we know that there are going to people will be people that fall into a habitual addiction or something that is making them unwell. What are the positive things that we can do in that community to protect and give them a landing place to go to? That’s these recovery community organizations or recovery community centers, where there was a group of people who are now living in wellness and recovery that can help, show that we do fun activities. We have sober bowling, which we do in the winter, and we have sled riding and we have euchre tournaments and we have fishing tournaments, and we have rock bands where there’s no substances involved and people can now engage back into those healthy activities with their families and not have to worry about that. What I have seen in northern Michigan and across the state is that often there are festivals, and at those festivals and fairs, there’s still the opportunity for alcohol consumption. That no longer makes it 100% family friendly, but what can we do to work alongside that and have like a picnic in the park or an Aurora chasing night or something like that. So, we’re always going to face those hurdles, but we need to provide those safe landing places for people where they can regroup and find wellness again.
JH: Great work, great work. I mean, all of this comes at a cost obviously of time, effort, and energy opportunity cost. There’s also just the financial burden of transportation, arranging for events, facilitating events, hosting those events. Let’s talk a little bit about funding in this area of substance abuse, specifically as we look at opioids. Where’s the government at today with this? Is it help from the state or the federal government? I want to talk about not only the funding if we could please, but let’s talk about the regulation. What’s going on in regulatory bodies throughout the country, whether it’s a federal or state government to address some of these issues? So, let’s start with funding. This does not come cheap. Where do those funding sources come from? What advocacy would you recommend so we can continue these great resources that you’re offering in other communities throughout the country and then what is the regulation looking like across the nation?
JF: Funding comes at all levels these days. So, we are federally funded through HRSA. There’s another federal funder in that, SAMSA. The state is heavily involved in tracking this as well. So, we have explored funding opportunities at the state level and we continue to do that. We do everything that we can to even maintain our own sustainability so that what we’re doing doesn’t get lost in the mix. When the funding ends, what’s our next step? So, we’re always constantly moving, planning and looking ahead to the future and what we’ve never had before, which started just a few years ago, is funding at the county level.
So, we had all the lawsuits with Big Pharma and Purdue and Pfizer. All those dollars are now rolling in at the county level and there’s a process for reviewing those grant opportunities by just visiting your county website. So, even at the smallest level, you can find dollars to impact your own individual local community. You visit your county’s website, you look at when that grant opportunity is open, and you look at the parameters and make sure that your activities or work plan fall within those parameters and if you’re stuck or you need assistance there is another organization at the state level called Michigan Association of Counties, Amy Dolinky spearheads that organization and she is a great resource for not just helping people who want to apply for these grants, and helping organizations who want to apply for these grants, and does this fit within the parameters, but she’s also advising and guiding at the county level, who’s never had to work with any of our prevention treatment recovery organizations before. That’s never been in their wheelhouse. So, you can imagine how they’re like, if we do this what are the repercussions for funding the wrong thing? Amy is a great resource and guide for being able to guide those counties into the right direction that’s not going to have any adverse effects later in the future.
JH: It’s a lot of work. Let’s have a conversation a little bit about advocacy if we could. Do you spend any time in Lansing in Washington trying to educate our elected officials about these significant problems?
JF: I don’t specifically, but John does and we do have a lobbyist that advocates on our behalf, as you know, with federal funds, we can’t do that ourselves. So, it has to be another additional party.
JH: What would you say to the CEO, the administrator across the country, listening, what can they do to raise awareness? Where do they start? You know, there are some communities today that do not have programs like this, we know that. In fact, my community is limited. If someone’s listening today, where is the starting point? Could you help us understand that?
JF: I would rally the troops and find your key stakeholders within your community that work across all of those sector’s prevention, treatment, workforce recovery, conduct a community needs assessment. What are the needs of the community? I often hear individuals wanting to put recovery housing in the smallest community ever that does not have adequate employment or transportation opportunities, and what we found with people with lived experience is that they often have lost their operator’s license or driver’s license. So, equipping them with a vehicle isn’t going to be as helpful. Sometimes there’s no community bus transportation, but when you conduct a community needs assessment, you can determine whether recovery housing is going to be something that’s going to be viable for that community and even if it’s at the smallest level, is there a way that you can backfill that transportation part by maybe purchasing a vehicle under a grant and provide transportation at that recovery housing level and that’s certainly something that we see often. I’m in contact with recovery leaders that have started and implemented recovery housing, and they have had a car donated from a rental car agency that reached a certain number of miles, and they were able to purchase it at a very low cost that made it equitable for them to continue that process.
So, community needs assessment; find out who who’s interested in your community, find out what those gaps are, and then look to some of the other leaders and find out what they’re doing in their communities that have made things successful. Implementation of peer recovery coaches, helping to move that needle from all the people that maybe do suffer from addiction, how do we start to encourage them? That has a ripple effect. When you start seeing your friends and family find recovery, you’re more inclined to also start to engage in some level of wellness and recovery. We’ve implemented practices within law enforcement where there’s diversion programs for people that they come into contact with, that they didn’t necessarily commit a crime, so they’re not going to jail, but it’s maybe not safe to leave them in the home at that moment. What are some safe options for them? So, they’re connecting those individuals with contacts and resources.
Today in Michigan, anyone can surrender themselves to the Michigan State Police post and get access to treatment that very same day and a peer recovery coach is called in, they’re called an angel. So, there’s a Michigan State Police Angel Program. That angel knows the process of navigating someone to get them authorized for treatment, and then they help transport them to treatment. So, it’s not just like one thing at a hospital or a health care or clinic level. We’ve got law enforcement doing the same things at a different level of diverting people into treatment options or sharing resources. We have a program in some of there’s a statewide organization called Face Addiction Now, and they have a program called Hope Not Handcuffs. It’s a diversion program where they’re working with 128 police districts where they’re diverting people to treatment versus a jail cell and getting them access to treatment and then when they return from that treatment process they’re paired with someone with lived experience that can help connect them to all the community resources where they’re going to live or work or reside.
JH: A couple of follow up questions before we conclude today. So, those individuals that do find themselves incarcerated. They’ve had the fourth OUIL, they’re really struggling. They’ve never really sought help. They get into the system. Many times, we lose people in the system. Are there any efforts right now, whether it’s local, state, or federal, there are any efforts to mandate any type of certain programing like this and peer recovery in our jails or institutions like that. Are you hearing of any of that and what’s the progress?
JF: So, there’s a couple other things I’ll share. At the court level we have treatment court programs. We have treatment court programs for mental health, for people that have found themselves in the system because of mental health challenges. We have DUI or drug courts where people are given support and access to treatment and recovery, supportive resources to guide them through that program. We do have peer recovery going into jails. We also have therapists and social workers going into jails and doing substance use disorder assessment. So, even if they found themselves incarceration for a DUI and they’re there for three days, maybe it’s their second or their third, they’re doing a needs assessment on that person or a risk assessment to see if they meet criteria to leave jail in lieu of going into a treatment provider or a residential treatment program. So, there’s even work being done within the jails. For opiate use disorder we have quite a few of our jails now starting to offer or implement medications for opioid use disorder. So, they’re implementing Suboxone or Sublocade at the jail level so that when they discharge, there are already stabilized in a recovery supportive program. All they need now is connection to resources and to continue that program.
JH: As we conclude today, I want to try to make sure I summarize this appropriately so our listeners understand. Outside of all of the things you’ve identified, and you got really into the weeds, which was important, are there any other barriers that you’re just frustrated with right now, and the work that you’re doing to getting this out there, to getting the information, the message, are there any barriers at all in those areas? Maybe you just see community barriers as a barrier. Could you share that with us a little bit if there’s anything else? I know we’ve talked about a lot.
JF: Despite some of the great work that we’ve done, we still have some organizations that we’ll start the collaboration efforts, and then they start to fade off a little bit and then those organizations go back to working within their silos, or we’ll have new leadership changes that come in, and we kind of lose those contacts of what we’ve already built upon. That’s probably one of the biggest ones, is the turnover within the different infrastructures with the organizations we collaborate with. When there’s change, it takes trust to buy into, and redevelop those relationships. So, it’s a work in progress and it’s just something that just continues to change.
JH: We’re going to put some contact information in our show notes so that if someone’s listening today and they’re looking at in their respective state starting something. Obviously, you have it not only off the ground, but this this thing is flying high in the air. I want to commend you for the work that you’ve done. Obviously, your passion comes out in the first three minutes of our conversation. it’s evident and I think, you know, what’s most important is you’ve lived it. So, you talk from a perspective of experience, which is unique to a lot of programs and so, I think that’s a benefit.
We’re going to put your contact information in our show notes, our listeners who may want to start a program in their respective state or community would have the access to reach out to you to say, all right, how do we start doing this? So, we’re going to do that. It’s always a pleasure to have an expert on our podcast who can address some serious issues that our rural communities are facing, and not only address those, but also, give us some helpful hints, tips and suggestions about how we can improve the quality of living in those rural communities and you have done an exceptional job today explaining what you’ve done in those rural communities and I look forward to having you back again into the future to talk about some of the successes. We’d love to have a success story to present with you. Someone who has been through that program recently, our focus is on opioids but it can be substance abuse in general, really, just to talk about what are the benefits of programing like that. So, we hope to get you back here in the very near future to maybe tout some of those successes that you’re seeing. Before we close today, do you have a favorite success story that something that you’ve done?
JF: I do, I think one of the things that we face the most is lack of trust with individuals who have found themselves in the criminal justice system, against law enforcement, and there is a gentleman who was traveling 45 miles to Gaylord, Michigan, from Roscommon to receive his medication. So, as he was traveling to a clinic where he has to report every single day just to get his medication to stay stabilized in his recovery. He was one of those individuals who had lost his license previously. He should not have been operating a vehicle, but that day he had to make a choice of either being very sick without his medication or driving on an expired, revoked license. Lo and behold, he gets pulled over by law enforcement about midway and he tells the officer, “I know I shouldn’t have drove, but if I don’t get to Gaylord, I am going to be very sick, and if I’m very sick? I’m going to probably have to go to the E.R. who’s just going to maybe turn me away because there’s nothing they can do for me, but give me the medication that I need.” And (the officer) says, “I can’t let you drive any further, but I’m going to take you there, and I need you to find someone else who is going to pick up this vehicle, and I’ll get you to where you need to go.”
That is a success story where we built the relationship, that these people are human, they are still going to make mistakes, but they made that mistake out of survival and trying to stay engaged in their long-term recovery, and it just shows the work that we’ve done, because six years ago, eight years ago, that person would have been in jail without his medication and most likely would also have been terminated from the treatment program he was in. For one, having contact with law enforcement, violation of that treatment protocol, and then not being there for X-amount of days. It just would have greatly impacted him, and if he would have had to have gone to jail for that that day, he probably would have lost his employment. He probably would have lost his children because he couldn’t care for him. It would have had this major ripple effect and one change with one officer changed that gentleman’s life. He shares that story so widely that I think it’s starting to catch on with other law enforcement.
JH: That’s incredible. It’s a heartwarming story, but it gets to the heart of the issue, and that is access and understanding. It could have been very easy for that police officer just to, quote unquote, “do their job”, which was, a criminal act occurred, let’s put them in cuffs, and then they’re done. There is no transportation. There is no making sure they get it right back. There’s no worrying about transferring the car. The car is towed. They go to jail. That is the type of work that we need to do across this state, across the country, to be able to educate everyone, to understand that they can be part of the solution to this and not compound the problem. So, great work to you and your team, I appreciate the efforts that you’ve put together for Michigan. And I can speak as a michigander for that, and hopefully we can allow this podcast to serve for each of those rural communities that may not have programs like this to serve as inspiration and maybe a kick start to their own programing.
So, we’ll put your information in the show notes. That way individuals can reach out to you. Before we close today, we always do a segment. It’s called Rural Health Recommendations. We have people that listen across the country and some are new leaders, and if you’re a new leader in health care today, it’s quite a bit of a challenge. We have payer issues. We have government involvement issues; we have physician shortage areas. We’ve got major, major financial and workforce problems and yet, individuals are trying to find a way to still make it work in rural America. So, you’ve been in the industry. You’ve had real life experience. What piece of advice, sage advice, maybe some wisdom would you give to a new leader today? Or maybe it’s a seasoned leader that’s just struggling through today’s times. Of all the tumultuous times that are on their shoulders. What tip would you give them to continue doing what they’re doing?
JF: Well, I have to go with my passion here and speak about recovery. What I know about recovery is when our communities invest in recovery the ROI is $7 for every $1 they spend, and anytime we can get that person into a level of wellness and recovery, that person goes on to be a productive citizen in their community. They pay their taxes. They often go on to own their own homes, and they vote, and that is what a successful contributing person in every community probably strives to do. We need more focus on recovery components so that not only the individuals find recovery, but they raise their children in a life of wellness and recovery so that we can protect our youth more than anything, because that’s where our future is.
JH: Joyce, it’s been great to have you. What sage advice that is, and may we just have others in communities across the country that are like Joyce, who are out there just spreading some great light into a very dark world and a very dark subject. So, thank you for the work that you’re doing. Joyce, thanks for joining us on Rural Health Today. It’s been great to learn about the great things that are happening, and to learn about your story and your journey. It makes it real. It humanizes it and I want to thank you for being a guest today.
JF: Thank you for the opportunity.
JH: And thank you to our listeners for tuning in to Rural Health today. Catch our next segment, Rural Health News, to stay up to date on the current state of rural health every Monday, wherever you get your podcast. Don’t forget to check out our latest updates and resources from Rural Health Today at ruralhealthtoday.com, and make sure you subscribe so you never miss an episode. Until next time, remember Rural Health Strong.
