The Big Four Oh (part two)
Through several directors since 2000, the UND Center for Rural Health continues to be a national leader in rural health policymaking and research.
The following is the second in a two-part history of UND’s Center for Rural Health, which turned 40 years old this year. Part one focused on the Center’s early history while this article focuses on the Center’s more recent past. Interviews for this story were conducted with former CRH Director L. Gary Hart shortly before he passed away in April 2020.
The CRH continued to grow after 1996 when former Director Jack Geller left. Brad Gibbens, who’d been serving as associate director, stepped in as the interim director, a position he’d hold for about five years until Mary Wakefield was named director in 2001.
“My agenda was basically to maintain operations and continue to expand based on our core programs, which is what we did,” Gibbens said. “I think one of the things that has always been part of the landscape for rural health has been the viability of rural hospitals, so we continued our work in addressing rural hospital issues, doing assessments, doing strategic planning.”
“In the late 1980s and early 1990s, a number of rural hospitals across the country closed, including 10 in rural North Dakota,” Gibbens explained. “So I was really doing a lot of national work with our congressional offices and helping them understand what the issues were and looking at various options and trying to build momentum around what we’ve commonly called an alternative hospital model. That’s really what the Critical Access Hospital was.”
During this same period, the CRH secured funding to start a rural Emergency Medical Services (EMS) program.
“EMS has always been a focus within the Center for Rural Health,” Gibbens said. “It has a lot of impact right now, but really our work in EMS goes back to the late 1980s.”
EMS notwithstanding, many other issues have remained a focus of the CRH since its inception.
“Health workforce was [important from] day one at the Center for Rural Health forty years ago, and it still is today one of our dominant issues in terms of the viability of maintaining rural health systems, particularly the hospitals and clinic structure,” Gibbens said.
Picking up the pace
Mary Wakefield was named CRH director in 2001. Her connections at the national level, including having served for senators Quentin Burdick and Kent Conrad, proved invaluable to the CRH.
“We thought we’d been clipping along at a pretty fast pace until Mary got here, and then we discovered what fast meant,” Gibbens added with a smile. “That was an amazing seven-year period for the Center and also for myself, working for Dr. Wakefield—a truly amazing, intelligent person who was looking for the next big thing to address. We spent a fair amount of time just trying to keep up with her and trying to put in place some of the things she was looking at.”
“I was really interested in strengthening ties within the state to rural communities and to rural health care infrastructure,” Wakefield said. “That presence was already there, but I really wanted to execute on that agenda of being a real resource to the communities and to the health care infrastructure.”
She also wanted to focus on education.
“When we could, we would talk with health profession students about opportunities in medicine, nursing, and other health careers to try to strengthen those interests in working in rural communities,” Wakefield said. “And research scholarship was a big focus. We really amped up in that area doing research that focused on some issues right here in North Dakota.”
But the Center didn’t focus just on North Dakota. Wakefield said the CRH expanded into regional, national, and international research efforts as well. Just one example is federal funding secured for veterans’ health issues. Another is the Rural Health Information Hub.
“Through a lot of hard work of staff, we really strengthened our national presence through some key programmatic areas, one of them being the Rural Assistance Center, now the Rural Health Information Hub,” Wakefield said. “That was a major foray into really positioning this Center for Rural Health, this university, and this rural state as a go-to place for a rich repository of information that was national and had expertise to be used by people across the United States—from policymakers in Washington to individuals in Alaska who might be interested in information about rural policy, new rural research findings, and so on.”
Even though she moved on from the CRH in 2009, Wakefield said the Center is still a valuable resource for her. “I think the Center is incredibly fortunate to have the experts that they have, the technology, the support from the state, and the support from the University of North Dakota to do the really important work that they do,” she said. “Not just for people in North Dakota, although that to me was always first priority, but to inform health across the country.”
A respected organization
When he was named director of the CRH in 2010, L. Gary Hart was already familiar with the organization and its staff, which now numbers more than 50. Knowing the CRH’s reputation, deciding to come here was easy.
“I’d had a long history of working with people here through several directors and, of course, this rural center clearly was one of the preeminent centers in the country,” Hart said. “I knew it would be a good place.”
Gibbens added that he’s not only proud of the success of the CRH, but also that the center’s work has been seen as so valuable that it’s been replicated in other places.
“In 1986 we received a grant from the Bush Foundation, $500,000, that we used to create our first research efforts at the Center for Rural Health,” Gibbens recalled. “Somebody from the Federal Office of Rural Health Policy had come out after that and started looking at what we were developing here in North Dakota. It was Jerry Coopey, who is really one of the true superheroes and architects of rural health at the national level. So Jerry really liked the idea, and he brought it back to the feds, and they said, ‘Research in rural health, there’s something there.’ And it was from that idea, by looking at what we were doing here, they came up with the structure for the Rural Health Research Center grants, and again the Center for Rural Health was first generation. But Jerry always gave us credit for really starting that idea.”
Coopey also looked at what the CRH was doing at the state level. He and Hart mapped out what the core functions would be for an office of rural health and that became the State Office of Rural Health grant program, Gibbens said.
“So we’ve been given credit, because of the efforts that got started in North Dakota first, with developing or being the impetus for the creation of the Rural Health Research Program and the State Office of Rural Health program,” Gibbens said. “So I’m pretty proud of that.”
He’s also proud of the fact that the CRH has gained a reputation for getting things done. “Success breeds success,” Gibbens said. “So you go from a period where you’re constantly trying to find a funder to a point where sometimes funders come to you. We’ve done things for the Commonwealth Fund and other groups where they have come to us and said, ‘We have an idea. Do you think you guys can carry it out?’ That’s a nice position to be in.”