Many of the farmers were loath to seek medical attention, in part because they were too busy trying to keep their operations solvent, and in part because they were in denial that anything medically might be wrong. And many of them were not insured for preventive care, if at all.
So ThedaCare figured out a way to take medical attention to them in the form of personalized care through simple house calls.
"We listened to what these farm families were telling us, especially the wives," said Rhonda Strebel, executive director of Shawano Rural Health Initiative . "They told us, 'Look, everyone comes to us, the veterinarian, or the company that brings tires or fuel. Even the milk that's produced gets picked up at the farm. If you want to see our farmers, you will have to come to them too.'"
So she did.
Strebel, a health professional with credentials in sports medicine, is not a nurse. But she said she's especially qualified to reach this community because she understands the farmer's lifestyle. She herself was born and raised on a dairy farm until she was 18-years-old. "I have a comfort level with these people," she said, adding that she was not averse to "tiptoeing through the manure" to get to these families.
Another provider who is a nurse practitioner works part-time with the initiative.
ThedaCare hired Rhonda in 2004 after ThedaCare had conducted a "plunge," in which teams of community leaders from the area got on a bus to visit these small farmers, explained Paula Morgen, ThedaCare's director of Community Affairs.
Morgen said the system realized many of them were walking around with diabetes or heart conditions or arthritis, but not knowing it.
Many of these farmers are getting older and developing medical problems associated with lifestyle. Some of the men, especially, had developed high blood pressure or had high blood sugar levels, or were getting up frequently at night to use the bathroom, a potential sign of prostate difficulties, Strebel and Morgen said. But much of it went largely undiagnosed.
"If these farmers, the backbone of the region's economy, aren't taking care of their health, what's the chance they'll be able to continue?" Morgen asked.
They just couldn't go to the doctor. "Who would get the work done?" Strebel said.
The plunge team realized "these farmers work extremely long hours, and many of them work alone, with large animals, equipment, and chemicals and no occupational safety and health requirement."
She added, "There was no one there to remind them to wear hearing protection, respiratory masks, goggles, or steel-toed shoes. They could drop heavy equipment, or when milking, a cow might step on their feet," Strebel said. "They'd say their parents and their grandparents never wore protection so they didn't think it was important." In fact, regionally, many providers had seen many such injuries.
"At the end of the day, we realized that we needed to do something in Shawano," Morgen said.