Monday, July 8, 2013

Preparing for “Pitch the Commissioner” 2013

The late afternoon sun was nearing the crest of the Rocky Mountains 70 miles to the west as we drove into Shelby, Montana on a hot mid-summer Sunday. After 12 hours in an old non-air conditioned car, my 7-month pregnant wife and I were anxious to be done with our day’s travels, find our new apartment, and collapse into bed. Because we had never been in the town before, we were diligently checking every sign to make sure we didn’t miss any clues that would direct us to the apartment that would be our home for the next 2 years.  
A few blocks inside the city limits we noted a sign: “Toole County Rodeo – Finals Today!” Having never experienced a rodeo and figuring this might also be a place where we could find something to eat on a Sunday evening, we decided to stop and check it out. Not wanting to spend a lot of money for what I thought would be a quick visit I asked the woman at the gate what it cost to get in. I was taken aback when she replied, “For you doc, admission is free.”
“This is the first time I’ve been in this town,” I said with a bit of surprise. “How do you know who I am?”
“Oh, one of the county commissioners said you’d probably be coming into town today and that you might stop here on your way. He said that if I saw some young guy with a goatee and a pregnant wife, it would probably be the new doc and that I should give them a good Toole County welcome.”
Before I could respond, I was approached by a burly, smiling, middle-aged man in cowboy boots who extended his hand and said, “Welcome to Shelby. I’m John Nesbo, one of the Toole County Commissioners. Come on, let me show you around and introduce you to a few folks.”
My wife and I were immediately escorted into the rodeo grounds where, for the next two hours, we were introduced to the Who’s Who of the Montana Hi-line, to the fine points of rodeo, and to rodeo cuisine. While watching bull and saddle bronc riding, barrel racing, and calf roping, we also learned about how the county had worked to become a designated physician-shortage area so that they could qualify for a National Health Service Corps physician like me. We heard stories about how the county had worked with various constituencies in the state and community to build a hospital, clinic, and nursing home. We were given an overview of the public health, social service, housing, education, and economic issues facing the county.  
Near the end of our conversation Robert Tomcheck, another Commissioner, remarked, “I probably spend more time dealing with health issues than any doc in Montana. And I’m not unique.”
As the rodeo continued, it became evident to our guests that my wife and I were fading. Commissioner Nesbo stated the obvious, “You need to get home and get some rest. Tomorrow’s going to be a busy day.”
“Can you give us directions to our new apartment?” I asked.
“I can do better than that,” replied the Commissioner. “I forgot to mention that we just upgraded our ambulance service. Our new rig is parked close to where you came in. I’ll have the crew escort you to your apartment.”
As we followed the ambulance to our new residence, I realized for the first time the major role that counties play in assuring adequate health care for their residents. It was an epiphany for me. That brief rodeo grounds visit opened my eyes to the vital role of counties in a wide array of health and human services. But, it was just the beginning of my on-going education into how much time, energy, and resources are dedicated at the local level in protecting and improving the health of our communities. It was the first step in my eventual understanding the importance of an effective collaborative among strong federal, state, and local public health partners.
I thought about this long-ago introduction to county health and human services when I wrote my first article for the Association of Minnesota Counties (AMC) shortly after becoming commissioner. I also thought of it when I attended my first State Community Health Services Advisory (SCHSAC) meeting and saw the number of county commissioners actively and effectively involved in improving our state’s public health system. I thought of it again today as I’m preparing to embark on my 2013 Pitch the Commissioner visits throughout Minnesota.
As I go around the state, I hope to learn more about how cities and counties can help assure good health for their citizens. I also hope to get some ideas about how MDH and state government can best support, facilitate, and sustain those local efforts.  And, in the process, I hope to make some new acquaintances, have some fun, and perhaps throw a few ringers.
On the hall tree by my back door hangs a 40 year old tattered and torn yellow jacket. It was given to me by the Toole County Ambulance crew for my work in helping them become a top notch ambulance service. It should have been thrown out long ago but I hang on to it as reminder of the role Toole County played in my development as a physician and as a public health professional. It’s sort of a daily “tip of the hat” to our “local partners” in public health – a partnership that I hope to celebrate and enhance as county commissioners and others Pitch the Commissioner in communities throughout our state.

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