NMU Rural Health Center Strengthens Connections, Outreach and Education

by Kristi Evans

Geographical isolation. Rugged terrain. Abundant wilderness. Challenging weather. These distinguishing qualities of the Upper Peninsula compel many of its residents to summon a rare blend of hardiness, tenacity and resilience conveyed by the Finnish term “sisu.” They also represent some of the challenges in delivering adequate health care and other needed services in rural areas. 

Rural populations are more likely to travel long distances for care, increasing the burdens associated with cost and time away from the workplace. In the Upper Peninsula, this is exacerbated by unpredictable winter weather and limited public transit options. According to RuralHealthInfo.org, there are other common barriers to access, which can contribute to health disparities. These include:

  • Limited job opportunities and lower socioeconomic status, with more residents relying on Medicaid and fewer likely to have employer-sponsored health insurance.
  • Challenges recruiting and retaining an adequate number of qualified health care workers. 
  • A limited number of specialists and subspecialists in reasonable proximity, which might lead some residents to substitute local primary care providers or postpone/forego care.
  • Higher rates of health risk behaviors.
  • Increased difficulty accessing the following: home health, hospice and palliative care; mental health services to combat loneliness and isolation; substance abuse services; obstetrics; and oral health.

The new NMU Center for Rural Health was established to support an integrated network that better serves U.P. residents and improves their health outcomes. It will also identify related academic programs to meet regional workforce demands. It is a collaborating center of the Michigan Center for Rural Health (MCRH) and based on campus, with some programs delivered using distance technology. The NMU Board of Trustees approved the initiative last December. 

“A lot of people are doing great things, but residents don’t always know what’s available, how to access it and if insurance will cover it,” said NMU Provost Kerri Schuiling ’73 BSN, who completed groundwork on the initiative with board liaison James Haveman, former director of the Michigan Department of Health and Human Services. “One of the goals will be to better coordinate those activities. This collaborating center of the MCRH is modeled after the collaborating centers of the World Health Organization and is the first of its kind.

“The $100,000 development grant the center received from the Health Resources & Services Administration will assist in that effort the first year, particularly related to diabetes prevention and treatment and emergency medical services. It was the maximum amount that could be requested and NMU scored a perfect 100 from the reviewers. I’ve never seen a score like that with no identified weaknesses, in my experience.”

Network partners in the effort are NMU, the Bay Mills Indian Community, the Lac Vieux Desert Band of Lake Superior Chippewa Indians, the U.P. Diabetes Outreach Network (UPDON), Upper Great Lakes Family Health and the MCRH.

Elise Bur is implementing the grant as the director of the NMU Center for Rural Health, a role she assumed in July. 

Bur said the incidence of Type 2 diabetes is higher in the Upper Peninsula.

“From what I’m told by UPDON, at least a third of all adults and one out of two seniors have prediabetes and 90% don’t even know it,” Bur said. “That led us to question screening at doctors’ offices. People can decline a blood test if they don’t want one. When people don’t do regular screenings that should be conducted at certain ages, they won’t be diagnosed. That’s unfortunate, because when someone is told they’re in a prediabetes state, there’s still time to do something about it in terms of nutrition and exercise. It can be reversed so it doesn’t progress to full-blown Type 2 diabetes.”

EMS services are also a focus of the NMU Center for Rural Health and will be addressed through the development grant. In the Upper Peninsula, they range from volunteer-based services to positions paid only to a limited degree based on the number of calls received, to full-time personnel. Bur says a goal will be to educate, train and certify more people in the field, particularly because a number of EMS professionals will retire over the next decade. 

Among Bur’s early priorities have been outreach and education. She is introducing herself to relevant entities across the region and processing various perspectives regarding health-care challenges. That will help to facilitate collaboration with others to develop and implement solutions. One theme that has surfaced several times early on is the need to increase awareness of the importance of preventative care to reduce the risk of illness and chronic disease. 


“People have the mentality that they don’t need to go to a doctor until they’re sick,” she said. “But it’s like changing the oil in a car so the car won’t break down. Preventative care can help people avoid future health issues. Cost can be a factor in that sometimes. Residents may be unaware of locations with sliding fee scales based on household income or free dental days offered in some communities. If people were able to address their health-care needs in the earlier stages, it could prevent disease from progressing to the level it impacts their long-term health. Getting a filling for a cavity is better than waiting until the entire tooth has to be extracted.”

Before joining NMU, Bur spent six years as administrative director of Upper Great Lakes Family Health Center. She developed professional relationships with organizations, foundations, agencies and legislators. She previously served as executive secretary and assisted the center’s vice president with oversight and day-to-day operations of six outpatient clinics. 

The Covid-19 virus has somewhat restricted Bur’s travels and outreach capabilities, but it has also confirmed for her that telehealth is an increasingly viable option for patients to receive services from remote locations—something highly relevant to rural areas such as the
Upper Peninsula.

“Government officials are listening to information provided to them and have further supported reimbursement models and coding/billing for telehealth services,” Bur said. “There had been a push for that before, but the Covid-19 situation has helped convince them. If anything positive is coming out of this pandemic, it’s showing how telehealth can improve lives.”

Bur will develop a strategic plan for the center, seek out other grant opportunities, use NMU’s Educational Access Network to extend the reach of continuing education programs and identify workforce needs in the region.

“There are unique characteristics of the U.P., compared with other rural areas in the state, that need to be taken into consideration as we further strengthen and develop a health-care workforce. Rather than entities working independently to recruit people, perhaps we might collectively promote the strengths we have as a region. It’s a great place to live and work, raise a family and engage in outdoor activities. Too often, medical school graduates go to a rural setting, get their loan forgiveness and move on. We want to improve retention. We also want to build a cohesive network where providers can interact and collaborate with each other.” 

Looking ahead, Bur envisions more initiatives related to another prominent health issue in the Upper Peninsula: substance use. As residential treatment options are limited in the region, Bur said the center will provide certification pathways for individuals to work in this area, both in the outpatient and inpatient arenas, including counseling and peer recovery coaching.

One of the center’s partners in addressing substance abuse prevention and treatment will certainly be Great Lakes Recovery Centers, led by CEO and recent NMU Alumni Service Award winner Greg Toutant ’94 BS. Based on per-capita consumption, Toutant said the rates of alcohol and drug use in the Upper Peninsula outdistance other areas in lower Michigan and elsewhere. Isolation is a factor among rural populations, he said. So is the interrelationship between poverty and the lack of adequate, affordable housing. 

“In the U.P., familial systems tend to keep relatives in close proximity to each other, so if people start using/abusing chemicals at a younger age, it’s harder to break free from unhealthy behaviors that are firmly entrenched. They’re also more likely to progress to harder drugs, from opioids to injecting to meth, and develop more severe issues with continued use throughout adulthood. We need to build mechanisms to strengthen service systems, and that’s one way the NMU Center for Rural Health can help our region.”

“I applaud NMU for bringing this center to campus to address workforce and funding gaps, and to promote policy initiatives. One issue we face in an over-regulatory environment is that Lansing and others hand down guidelines for how programs and services need to be delivered, but they’re built on a high volume of urban delivery and don’t accommodate rural issues such as transportation and scarcity of people to support fee-for-service programs. The center can lend a voice to the nonprofit and health care communities to enhance what we’re capable of doing on a local level.” 

In its first year, the NMU Center for Rural Health has engaged in more than fact-finding to chart a future strategic direction. It recently launched its first initiative involving all U.P. universities: Northern, Finlandia, Michigan Tech and Lake Superior State. The schools are participating in a friendly “Fight the Flu” competition to see which can get the highest percentage of its total population vaccinated against influenza.

The center also partnered with the Michigan Center for Rural Health on an essay scholarship contest for U.P. high school seniors who will begin college in fall 2021 and plan to pursue a health care career. The essay topic addressed was this: “In your rural region of the Upper Peninsula of Michigan, identify two challenges people encounter when it comes to preventative healthcare and then explain two solutions for overcoming these challenges.” The contest was held in advance of National Rural Health Day, recognized on Nov. 19. 

Read the winning entries and keep up to date on Center for Rural Health developments at nmu.edu/ruralhealth