Keeping Rural Communities Healthy and Strong

Paige Heitman recently sat down on The Scope podcast with Phelps Health Pharmacist Jason Medows to discuss the unique physical and mental health needs of people living in rural communities. Jason had a lot to say about how we are all responsible to help our neighbors and friends to get healthy and stay healthy.

Paige Heitman: Today we're talking about making rural America healthy again. Our guest is Jason Medows, a pharmacist at Phelps Health. Welcome, Jason.

Jason Medows: Thank you for having me.

PH: Before we get started, I would love if you would tell us a little bit about yourself and your background.

JM: Sure. Well, I'm from the area. I was born and raised outside of Cuba, [Missouri], so just down the road. My family has a lot of history in the area. My dad owned a sale barn in Cuba. If you sold cattle around here from the '70s through the '90s, you would probably know my dad. My brother worked with my dad too. So, we have a history in the area of being cattle producers, but we also have a history of [working in] pharmacy. My brother-in-law owned a pharmacy in Cuba for several years, where I worked through high school, and that [experience] was the reason I went to pharmacy school in the first place.

JM: When I wasn't working on the farm for my dad [during the summers], I was delivering medicine for my brother-in-law. I've had this connection with both [farming and pharmacy] for such a long time. [After] I graduated from college in 2008, I came back and worked at the hospital. That's actually where I met my wife. My wife was a nurse in the ICU at the time. We were married about a year later. I actually left, worked for my brother-in-law as a pharmacist for a year, then came back. I've been back at Phelps Health since 2010.

PH: One of the things you do outside of work on top of everything else is you have a podcast called Ag State of Mind, which I think is really cool. Tell us about the focus of that podcast and what inspired you to begin it. You have over 50 episodes now.  

JM: 75 this week.

PH: Amazing. Congratulations.

JM: Thank you. I have wanted to combine my perspective on agriculture and my perspective on healthcare for a long time. [The podcast] was something I wanted to start when I was in college, but I never really could figure out how. Then, I became really interested in mental health and mental healthcare. I thought, "What's the best way I can reach the most amount of people with a single effort, but [in a way that would] also be coming solely from me?" I think the podcast was the best way I found to do that. I started the podcast in 2019. I thought I would do maybe eight or 10 episodes and then see after that, but it took off. It got so much traction, [and] people [started] paying a lot of attention.

PH: Yes, it has really blown up.

JM: It really has. That was never something I anticipated, and it led to meeting some great people and having some really interesting and insightful conversations. I think [Ag State of Mind] is helping people out. Not only is it helping people out, it has helped me out too. I have been very frank in my podcast and in my writing that I have had struggles with my own mental health. [Mental health] is a hard thing to talk about, which I'm sure we'll get into in a little bit. [The podcast has helped] to connect me with [other] people, connect me with resources and connect me with some sound tactics to make myself better.

PH: Whenever I was looking into what type of questions that I was going to ask for this podcast, [about] "How do we make rural America healthy?" [I realized the] topic is so broad. So, I started looking up specific questions about farmers and rural America in general, and it was difficult to find resources. I am from a small town as well, so I think what you are doing is resonating with a lot of people who [come from] similar situations as you and me. So, to start, what are some of the challenges healthcare settings in rural communities often face?

JM: I think the biggest thing is [the idea that a] small community, or small town, doesn't need that many [healthcare] providers. Let's take the city of Rolla, for example. It's [roughly] 20,000 people for one hospital. [Maybe] that seems like it's enough, but [that hospital also] serves [several] outlying areas and [all of these people use the same resources]. So, it's not hard to run out of providers. In an urban area, [often] the provider load matches the population. I feel that one of the biggest things that we are dealing with [is the need for more providers in rural areas]. Another thing that we're dealing with as far as mental healthcare is concerned, is the willingness to be treated for it, because there's such a stigma surrounding [mental health], and people don't necessarily know how they should go about [getting help]. [Mental health stigma] is a huge obstacle that healthcare providers in a rural setting have to face. We’ve been taught and conditioned to believe that we have to take care of ourselves.

JM: [People living in rural communities] have a very independent, strong spirit and that is good. [This spirit] should not be discounted, because it has gotten us through a lot of hard times, but it doesn't lend itself to trying to get outside help. It’s almost like a paradox.

PH: Whenever you talk about the stigma in rural healthcare and mental health, I can think of dozens of people, because I also have struggled with mental health. I often will just tell people, "Yeah, I go to a therapist and I think it's amazing." I love seeing the looks on people's faces because it takes them aback, especially in these types of communities. People struggle with just being able to have these types of conversations as well. It's not a bad thing to want to take care of your mental health.

JM: I’ll take it a step further. People do not even necessarily know what counseling or therapy looks like. I was having a conversation with a woman who reached out to me. She lives in Denver now, but she is from a small farming community in Kansas. She said something needed in the rural population is for someone to lay out what therapy or counseling may look like, because it’s probably a bit different than [people] have in their minds. I didn’t think of that perspective until I talked to her.

JM: I also like how you [tell people] you have been to see [a therapist], and talk about that experience. [I think the] more people talk like that, it will [help other people] see, "Hey, normal people do this, right?"

PH: [Therapy] should be normalized.

JM: Exactly.

PH: [Therapy] should be just like going to your primary care provider to make sure that your body is functioning correctly, because your mind is part of your body.

JM: Well, that’s the thing about it. You wouldn’t fault somebody for going to see their primary care [provider] for high blood pressure, diabetes or high cholesterol, and behavioral health is no different. In fact, [mental health] may be even more integral, because it controls everything else. A lot of things are [connected to mental health], and it should be paid as close attention to.

PH: Yes. One example I always love to talk about is how we did a podcast last year with Pam Gray [a Phelps Health physician assistant in internal medicine], and she talked about stress and anxiety and [how] they directly affect your weight, how much you eat or how much you exercise. If you don't take care of your mental health, it's going to affect your physical health at some point in time.

JM: Sure. That's what I've been trying to get across in the Ag State of Mind podcast too. Health is a holistic topic. It's not something you can separate such as, "Let’s take care of our mental health now. We'll take care of our physical health in a little bit or vice versa."

PH: You can't put [mental health and physical health] in boxes.

JM: It's an interconnected system where everything works together.

PH: As you've been doing these podcasts, because you just said that you've done your 75th one, you've gained knowledge from all of these rural communities and farmers. From talking to other people, what are some of their examples of how rural areas can help improve the health of their communities?

JM: Well, be a leader. I think [being a leader] is a big part of it. [Imagine that] we're rolling a snow ball up a mountain. It’s going to get a little bit easier every time we get somebody [else] behind that ball and keep rolling it. People have to get behind that [snowball], and there has to be one person [willing to lead and] start it out. Eventually, [more and more people will join, and] it's going to keep going. We're a long way from there, but we're getting more people who are [getting] behind it. And I think the key is showing people, normal people like you and me, showing them that these [topics] are normal things to talk about. It's okay to talk about [mental health], and it's okay to share your struggles. I think a big part of the problem [is] that people aren't comfortable sharing their struggles. They're comfortable sharing the easy parts, but [not] the hard parts, [because] it makes them feel vulnerable. At the same time, if they know that [talking about these things] can really help somebody [else] out, [then] I think the community spirit of rural America will shine through.

PH: You make a great point, and that also makes me think about [the Phelps Health] system and how unique and special it is. Often, whenever you go to a primary care provider, you know them personally, [and] you don't get that [familiarity] in large, urban areas. I think that really makes a difference, which leads me to my next question: What can hospital systems do to help educate the public on mental health issues?

JM: Find people who are willing to talk about it. Again, find people from the community. I think rural America is really good at ‘sniffing out a phony.’ Find people who are part of the [rural] culture, part of the demographic, who are willing to speak out about [mental health], and willing to share their story. For healthcare systems to find those types of people and then get them to put their story out there [is] huge for community effort.

PH: Whenever we talk about community effort, my mind immediately goes to farm families, because you're a farm family guy. I think about how many of my own family members probably don't have access to health insurance, or they don't [go to the doctor] until it's too late. [Maybe] they've already had a major [health] event, which they possibly could have prevented if they would have taken care of their mental health, or if they would have just gone in to see a primary care provider. How do we prevent these types of circumstances from happening?

JM: [I have a friend] from Illinois, and she does a lot of work in the same area as me. In fact, I'd say she's 10 times better than me because she's so good at it. She told me once, when [thinking about] farm families, or people who are on the farm, they're very familiar with maintenance, right? [They do] maintenance on their cow herd, maintenance on their machinery, maintenance on everything. Why [should they treat] themselves any different? I think when you start getting people into that mindset, to [help them see] that they are an asset to their farms, an asset to their families, then they can start taking care of themselves a little bit better. They [know] that everything doesn't work right if it’s not taken care of, just like a tractor. If you don't change the oil in the tractor, it's going to burn out. If you don't vaccinate your cow herd, they're going to have disease. [It’s the] same thing with you. If you don't [provide] maintenance for yourself, [and] take care of yourself both physically and mentally, then you're going to burn out. You aren't going to be at your peak performance.

PH: Why are farm handlers such an asset to rural America? What value do they provide?

JM: Oh my gosh! I keep coming back to this idea of community, and that's what they create. Farm families are the ones who are volunteering at your schools, volunteering after church. They're coaching your little league games; they're cooking at the concession stands. They don't [volunteer] because it's an obligation. They do it because they enjoy it, and they enjoy the community that they bring to it. Like you said, generations of people passing down those traditions [is] what keeps that spirit alive.

PH: I think that's so special, and to me it's almost like they do [these extra activities] to the detriment of their health sometimes. I think it's important that we help educate [people by saying], "Hey, you're an asset, if you want to keep coming and [volunteering], if you want to keep working on your farm and doing all of these things, you have to take care of yourself. You can't fill from an empty cup." Right?

JM: Exactly.

PH: On one of your podcasts, you talk to this guy named Dave Pratt, who owned Ranching For Profit Schools, which I think is really cool. We don't have time for that tonight, but he mentioned a concept that I think applies to healthcare called owner-value, which is who, what, when, where and why. I think this [concept] is unique to healthcare. I think it's so cool to listen to all of these farming podcasts and say, "This [topic also is] applicable in healthcare."

JM: Right. I did a podcast on agriculture, because that's where my passion is; that's what I love; that's what I do, and what my family does. I care about [people in agriculture and], that's who I want to serve. However, the lessons that are learned [within these topics] are applicable for everyone, not just rural people. Across the board, all the people that I talk to have such incredible value to bring [to other] people. Anybody can pay attention to [the message]. I know of people in cities that listen to the podcast, because they found valuable information in the guest.

JM: And that's something that we can all apply to ourselves. [Going back to] owner-value, [it] talks about the things that bring not just monetary value but joy in your life and makes you feel good and happy. That’s a part of health too, right? Making sure that you're enjoying yourself, because if you do things that you enjoy, then you are going to be healthier.

PH: How does that work in your personal life, if you can give an example? I know that you do a lot of different things. How do you find this intrinsic value in—what I'm going to call contentedness? For me, a great definition of happiness and joy is finding contentedness in the average, everyday things.

JM: That's a good question, because it's something I struggle with from time to time. [I think] it goes back to what we talked about in the very beginning [of this conversation]. It’s not really balance, [because] everything takes the appropriate attention at the appropriate time. I have a wife, and [I have] four kids who are starting baseball season right now. It's crazy. We live 12 miles outside of town, so my wife's going back and forth doing that, and I have a farm, and a job [at Phelps Health] where I work 40 hours a week.

JM: [There’s also my] podcast, and we opened a yoga studio in Cuba.

PH: Wow.

JM: So, we're doing a lot of things, but we make sure that we take the time [we need]. I always say you have to take some breaks. Breaks can be five minutes, five seconds or sometimes five days. You have to work some breaks in there. You have to. I think the word that comes to mind is “intentional.” You have to be intentional with your time. We all have the same amount of time in our day. Every single one of us has 24 hours a day, seven days a week. It's up to us how we spend [that time]. I found myself being much more intentional with how I spend it. I don't know the last time I watched TV. I can't say I don't have time for it, but I don't want to make the time for it. There's other things that are more important to me. There’s this anecdote that Dr. Stephen Covey talks about, the big rocks and the sand. Have you ever heard of this?

PH: Yes.

JM: You know what I'm talking about, then. The only way that you can make sure you get the big rocks in [your] bucket is to put them in first. The big rocks for me are my work, family, farm, podcast, yoga studio and church. All those are my six big things, [or rocks]. I make sure those fit in first, [and] then the little things can slide in between. Every single person has to decide what's important to them. The great thing is everybody gets to decide what their rocks are.

PH: Everybody has their own value set.

JM: For sure.

PH: What are some of the stressors you think farmers have faced over the past few years [or are] facing right now?

JM: There’s a lot of things. I talk about these things [on my podcast], and I'm going to try and remember them. Trade is a big thing. Who is going to buy the products? What are the prices going to be, or look like? All of that. Weather [is another stressor]. Weather has been a nightmare over the last few years. I don't know if it's [really] any different, but it seems like these last couple of years have been really tough. Then, there’s the disconnect between consumer and producer, where people on the consumer side of the supply chain are not understanding what's happening on the producer side and vice versa. [For instance], somebody who is eating a steak in New York probably doesn't understand the life of someone who's raising beef in the middle of Missouri. That’s a big [stressor] unique to [our current times] in agriculture. The ’80s were really tough for farmers, but I don't think they had to contend with that as much as we do now. I think the world has [become] more disconnected, more polarizing.

PH: [I want to] go back to this idea of mental fortitude. [When adverse or difficult circumstances occur, I think] a lot of farmers, [rationalize], "Well, it's fine. We'll get through it. We've always gotten through it.” [However], I think it's okay to take a moment and [acknowledge], "This is really tough, and this is really difficult, and our family isn't okay right now.”

JM: Yes, I’ve had to do this myself. I wasn't involved in the military, but there’s this saying called, "Embrace the Suck." You have to recognize when things are tough, and if you recognize that things are tough, [you shouldn’t] sugar-coat it. Recognize that it's tough, acknowledge that, and then get through it anyway. I don't want to say [this makes the process] easier, but you seem to get through it better.

PH: It's interesting listening to you say, "Embrace the Suck," because I have a list of some farm family stressors. [These include the following]: physical and mental chronic health problems, not just for the person, but for their whole family; depression; anxiety; suicide; injuries; opioid misuse; loneliness; social isolation, because a lot of times you're out [working] by yourself; inhibited decision making; lack of access to healthcare; postponement of preventive care; and concern of inability to pay for medical care costs. [Not to mention those farmers like you who are] juggling on and off work, because not only do you own a farm, you also work a 40-hour a week [job], your wife runs a business, and you have kids [and] are managing sports at the same time. As I’m reading this, I’m [thinking], "How do you do it?"

JM: You just do it. You accept the lifestyle. There are sacrifices that are involved in it.

JM: [For me,] it's all about having boundaries. Boundaries are a huge thing. [Again], it's a lifestyle. There are sacrifices involved.

PH: So, how do you know when [someone] needs interventional health? How do you know when to have that conversation?

JM: You have to pay attention. I did a podcast with Nathan Brown, a good friend of mine from Ohio, and he talked about [a] situation where he had a friend call him to help. [Nathan’s friend] needed help loading some hogs, or something like that. Nathan knew that it was out of the ordinary for [this friend] to ask for help, because [his friend] doesn’t [ever do that]. [As] it turned out, loading the hogs wasn't that big [of] a deal, but [his friend] wanted to talk about his stressors. He wanted to talk about the things that had been bothering him, [such as] family issues, financial issues, etc. Nathan [could have easily told] him, "Oh, man, my kids got stuff [going on, and] I'm busy. I don't know if I can help," but [Nathan] answered that call. He recognized that something was different with [this friend], because he was asking for help. I think that's a good lesson [for] all of us. If there's something out of the ordinary that somebody's talking about, [or] you just notice [something] is just a little bit off with them, pay attention, follow up on that. You never know what kind of conversation [may come from it].

JM: As it turns out, [Nathan’s friend] went and got some help, and [now] he's a spokesperson for their local counseling service in Ohio. [Something great came out of that situation], because Nathan recognized the need to help out a friend. I think [this is something] we can all do. [We can all] recognize when somebody's in need, [and] answer the call.

PH: I love that. So, what I hear you say[ing] is recognize the need, answer the call, and always follow up.

JM: Always follow up, yes.

PH: I think that's really fantastic advice. My last question to wrap up is, how do we build resilient, healthy, rural communities? I know that's a really broad question.

JM: It is a broad question, but it [can be accomplished] a number of different ways. Be as active in those communities as you can. Be a friend to your neighbors; be a friend to strangers in town. Let everybody know that you're here to help, because that's what it takes. [We need] people who have [a] community spirit to continue the tradition of strong, rural communities. I know more and more people are moving to urban areas, but I feel like the foundation of modern American life was built on rural communities.

PH: I lived in Springfield, [Missouri], and moved back here. [I think] it’s really cool to grow up in these types of communities. I think it’s really special.

JM: You made a point for me there. [We need to work on] getting people who go away to somehow come back. [People] go away, [maybe to] get an education, but oftentimes they stay away. [We need] to draw those people back into these rural communities. [Wouldn’t it] be great if all these mental healthcare professionals [moved back and practiced in rural areas]?

JM: We know that's, not [feasible], but [we should be working] to attract as many people back to rural communities after they obtain training of some sort. I think that's going to be a big key going forward.

PH: Yes, I agree. Thank you so much for being here for this conversation.

JM: Of course. Thank you. I appreciate the opportunity.