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Rural closure of the hospital complicates the care of cancer: photos



When the cancer clinic at Mersey Hospital Fort Scott closed in January, Karen Endokott-Coyan and other cancer patients had to continue their treatment outside the city.

Christopher Smith for Kaiser Health News


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Christopher Smith for Kaiser Health News

When the cancer clinic at Mercy Fort Scott Hospital closed in January, Karen Endokott-Coyan and other cancer patients had to continue their treatment outside the city.

Christopher Smith for the Kaiser Health News

One Monday in February, 65-year-old Karen Enicott-Coyan took the wheel of his black Ford Taurk in 2014 with both his hands as he drove his hours from his farm to Fort Scott, Cannes.

In a rare form of multiple myeloma, it requires weekly chemotherapy to keep the cancer.

She made the trip with pain by jumping off her morphine for the day so she could drive safely. Since she sometimes "gets cares" after treatment, she is her neighbor and friend Shirley Palmer, 76, coming together to repel her. Continuity of care is crucial for cancer patients in the middle of treatment, often requiring frequent ambulatory visits. So, when Fort Scott Mercy Hospital, the rural hospital in the hometown of Endokot-Coyan, had to close its doors at the end of 2018, the hospital staff arranged for his cancer clinic called the "Hope Unit" to remain open. 19659008] "I received the email on January 15," said Reta Baker, chief executive officer of the hospital. She informed her that the Kansas Cancer Center, the contractor who worked and had the team, also decided to stop him, two weeks later.

"There are too many changes in this city" to keep the cancer center open. Later, Johann Abe Abraham, Chief Operating Officer of Kansas Cancer Center, later said KHN. He added that patients would be "OK" because they could be treated at the offices of the center in Chanut and Parsons.

From Fort Scott, these facilities are respectively 50 and 63 miles

For Enicott-Coyan and dozens. in other cancer patients, distance meant new challenges for life-saving treatment. "You have a tire, and there's nothing here," said Endokott-Coyan, and waved his hand to the open sky, and the pastures of black Angus and sheepfold from Hereford on both sides of the bottomless, narrow highway. Karen Endike-Coyan has a rare form of multiple myeloma and now has to drive an hour from his farm near Fort Scott, Kan., For weekly chemotherapy injections.

Christopher Smith for Kaiser Health News


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Christopher Smith for Kaiser Health News

More than 100 rural hospitals across the country have been closed since 2010. In any case, there is a unique but familiar loss.

Residents, of course, lose health care because the wards are closed and doctors and nurses are starting to move away

But the effects of the pulsation can be just as devastating. The economic vitality of a community is taking off without the high-paying jobs of the hospital, and it is becoming increasingly difficult for other industries to attract workers who want to live in a city with a hospital. Whatever remains, he risks dying without the support of the stabilizing institution.

7,800 Fort Scott residents withdraw from the loss of their 132-year-old hospital, which was closed at the end of December by Mercy, a health care facility based in St. Louis. Founded on the border in the 19th century and restored as a modern facility with 69 beds in 2002, the hospital has outdone its use, and for the most part stationary beds are quite empty, the mother company said.

For the next year, Kaiser Health News and NPR will track how citizens cope with it after closing in hopes of responding to national national issues: Citizens in small communities like Fort Scott need a traditional hospital for their health needs? If not a hospital, then what? Race Baker, Chief Executive Officer of the Hospital, grew up on a farm south of Fort Scott. She understood that the closure of the hospital was inevitable.

Merci agreed to keep the building open and shine until 2021. And Baker appointed a federal health center to take over four outpatient clinics, including one at the hospital. ; former employees are redeemed and continue to work in a rehabilitation center; [6] and the Ascension Via Christi hospital in Pittsburgh again opened the emergency room in February.

But care for cancer, which requires specialists and the purchase and storage of a number of cancer drugs, is a unique challenge in rural areas. : How a Kansas City fights to close the hospital "/>
         

Rural cancer patients typically spend 66% more time traveling on treatment than those living in more urban areas, according to a recent national study by ASCO, the American Society of Clinical Oncology. Dr Monica Bertanhole, a cattle daughter who is now chairman of the ASCO board, called it "a huge burden". Caring for cancer, she explained, is "not just a visit and you're done."

ASCO uses federal data to find that while around 19% of Americans live in rural areas, only 7% of oncologists practice there.

People in rural areas of America are more likely to die of cancer than those in the country's county districts, according to a report by the Centers for Disease Control and Prevention in 2017. He found that 180 deaths of cancer 100,000 people per year in rural areas, compared to 158 deaths per 100,000 people in populated areas of metropolitan areas.

The inconsistency is partly due to the fact that habits such as smoking are more common among rural residents, but the risk of death goes beyond that, says Jane Henley, an epidemiologist and lead author of the report. "We know that geography can influence your risk factors, but we do not expect it to affect mortality."

From an office at a former Mercy clinic, Fort Scott's cancer care support group, Care to Share, continues its efforts to meet some of the community's needs – which have increased in some respects after the closing of the Hope Unit. It provides Providing nutritional supplements, gas vouchers and emotional support to cancer patients.

Laveta Simmons, one of the founders of the support group, said she would have to raise more money to help people pay for gas so they could go further to treatments. Last year, in this poor corner of southeastern Kansas, Care to Share spent more than $ 17,000 to provide gas for residents of the area who had to travel to the Mercy Hospital or beyond for care.

The group expects to spend more on gas

And the reserves of the Mercy Merchant Grant donated leave, so Simmons reaches hospitals in nearby counties for help. Closed, the likelihood that residents will die from their cancer will increase, experts worry because it is much harder to gain access to specialists and treatment.

Christa Posty, who took over the four clinics at Fort Scott's hospital, said it was not unusual for someone to go into end-stage cancer to postpone because they had no money, no insurance, or so …. "Terry, 71, a farmer and veteran in Vietnam, was one of them, and the doctors discovered Terry's cancer after breaking a rib while saving hay." When they found a mass under their arm, there was already a breast cancer at a later stage that metastasized to his bones.

Art Terry, a center, and his family members for a photograph at the Hospital's Scott's Hospital, closed in January. days prior to closure.

Dwight Terry


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Dwight Terry

With her chemotherapy twice a week at "The Hope Unit," Terry spends hours there with her son and grandchildren telling stories and jokes as if they were in her own living room. The sisters began to feel like a family, and Terry brought them fresh eggs from their farm.

"Dad could not have better or more personalized care anywhere," said his son Dwight, a grim look after a factory shift. Terry knew it was hard to find reliable cancer care. The shortage of cancer specialists in southeastern Kansas meant that many, including the patients at the Fort Scott Hospital of Mersey, were relying on traveling oncologists to visit their communities once or twice a week. He began renting space in the basement of the Fort Scott hospital in the mid-2000s, Abraham said. The hospital has provided the staff while the Kansas Cancer Center paid rent and sent robbing oncologists to withdraw and treat patients.

Upon closure, the Hope Department serves nearly 200 patients, with about 40% of them receiving chemotherapy. When Art Terry was diagnosed, his son Dwight tried to talk to him about seeking treatment at the larger hospitals and academic centers in Joplin, Mo. The older Terry did not care. "It's like" No, "Dwight Terry remembers," I'm going right to Fort Scott, if they can not cure me, I'm ready. "After all, when the older Terry struggled to stay alive, that it would make her father go to Chanute for treatment.Gas – it's a big expense as they traveled 20 miles from the farm near Little Prescott, Cannes, to Fort Scott – it would be even more expensive. to prove to his father, who traveled so little in his life that he had been visiting Kansas City only twice in the last 25 years.

As it turned out, the seed The art of Terry Cancer had reached his brain and killed him a few days before the cancer of the hospital was closed. about how the closure of the hospital changed Fort Scott. "" People started selling their houses, "Palmer said.

Like many in Fort Scott, both of them had spent their days at Fort Scott Hospital. Endocot-Coyan has been in the administration for more than 23 years; Palmer voluntarily joined the auxiliary staff for six years.

The hospital grows with the community. But as the fate of the city fell, perhaps it is no surprise that the hospital can not survive. But the intertwined story of Mercy and Fort Scott is also the reason that his loss has affected so many residents so heavily.

Fort Scott began in 1842 when the US government built a military fortress to help expand the nation to the west. Historians say Fort Scott was a boom in the years immediately following the Civil War, with the registered population rising to over 10,000 as the city competed with Kansas City to become the largest railway center west of Mississippi

The hospital is an integral part of the community after the Holocaust nurses opened a 10-bed hospital in 1886 with a mission to serve the needy and the poor.

The Mercy Hospital Cancer Clinic Fort Scott had windows overlooking the front parking lot and the wooded land beyond.

Christopher Smith About Kaiser Health News


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Christopher Smith for Kaiser Health News

The Hope Department started working from the hospital's newest basement building, which was "pretty tight," Baker said. As cancer treatment improved, it became so fast that Merci's managers moved him to a spacious place on the first floor, which was previously a business office.

"Our whole goal, when we were designing, was to be a place where someone who came to have something unpleasant that could actually caress and be in a pleasant environment," said Baker.

The center, with its muffled natural gray and brown, had windows overlooking the front parking lot and the wooded land beyond.Each patient can watch through the windows or watch a personal TV terminal.Any treatment chair has enough room for family members to pull their chairs [19659008] When Endokot-Coyan and Pal a lot of people arrived at the Cancer Center in the Cannes clinic in February, and the patients entered a small room through the rusty back door, and on each side of the front door were three brown chairs for infusion, two television sets

One nurse checked Endocott-Coyan's blood pressure and took her back to a private room to get a stomach stroke. She is about to leave about 15 minutes later

Abraham at the center says that Chanute's facility is "good for patients at the moment" rather than "Taj Mahal" like the building of Mercy's Fort Scott Hospital he thinks it is too expensive. to maintain. Cancer Center in Kansas plans to open a clinic at a hospital in Girard, which is about 30 miles from Fort Scott, he said. In fact, several healthcare systems in the country, such as Sanford Health in South Dakota and Thomas Jefferson University Hospitals in Pennsylvania, administer some chemotherapy in patients' homes. Oncologist Adam Binder, who is practicing in Thomas Jefferson in Philadelphia, says that "over 50% of chemotherapy will be safe to use at home if there is an appropriate infrastructure." But the infrastructure – these are the nurses who will travel to treat patients and a cost recovery model to pay for these cares within our comprehensive healthcare system – is not yet available.

In the car, Palmer took the wheel and Endokott-Coyan began planning future cancer treatments in the gap left by the closure of Fort Scott's hospital. "Today I put a note on Facebook and said" Okay, I have drivers for the rest of February, I need drivers for March! "

Kaiser Health News is a not-for-profit information service covering health issues, an independent Kaiser Permanente Foundation independent program


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