A Rural Connection

This Rural Mission

We spoke with experts on bringing fiber internet to rural Michigan. Bringing fiber internet to rural Michigan can reduce major barriers to educational, healthcare, and economic opportunities and benefit whole communities and families. We also speak to Dr. Edward Smith on why advocating for remote areas as a physician is so important when decisions are being made based off of what can be done in urban areas.

Transcript:

This Rural Mission is a podcast brought to you by Michigan State University College of Human Medicine. The podcast is produced with funds from the Herbert H and Grace A. Dow Foundation and the Michigan State University College of Human Medicine Family Medicine Department. Welcome to Season Two. I'm your host Julia Terhune and I hope you enjoy this episode.

So I was sitting with my spouse talking about jobs, and life, and he got off on a tangent, considering our connection to the internet and the current state of our rural communities in light of our current internet connection. And it struck a chord with me, and it became the impetus for this whole episode. So, I had to start recording him.

The reoccurring theme that he brought up and the one that will be reinforced throughout this podcast is that access to the internet in rural America, including rural Michigan, is bad, plain and simple. It's bad.

Many rural residents are currently living with limited or no access to the internet and being left behind. Sometimes when I bring up this point, I get push back, and I have people who argue that technology is a choice or a privilege. But where did you get your last bit of news from? How did you access this podcast? How did you apply for your last job? This last point was significant to my spouse because of what he does. He helps connect and mentor low income and transitioning persons to careers and jobs. And this limited access to the internet has been keeping him in business.

What happens to them? They get all this information about applying for jobs, and access to jobs and they have these fantastic resumes, and they're motivated, and they have accountability through your program, but then they go home. What are they going to do? How do they, what is their experience when they go home?

That everything stops, they get motivated, they get excited, they get interested, and they actually are looking for ways to apply for jobs, looking for ways to get jobs, but you can't go online and study for your driver's test. You can't go online and study for your-

GRE.

GRE-

Well, no, GRE's graduate, but GED?

GED. Yeah, and that's where a lot of people are.

Yeah, you were talking about occupations, but I would take that even to just being a functional member of society. You can't engage with other thought processes. You can't engage with other opinions. You can't engage with current events without being connected to something digital in this point in human history.

I don't want us to make it sound like everybody in rural communities are in the dark ages.

That's not true.

Because they're not, but I believe that they will be soon. That's not good enough.

After the repeal of the Obama era net neutrality regulations in June of 2018, the chairman of the United States federal communications commission, or the FCC, was quoted by the Washington Post as stating, "And in the medium to long term, I think we're going to see more investment in high-speed networks, particularly in rural areas that are difficult to serve."

This is our hope too. Rural America accounts for 97% of our country's total landmass. That's 2.23 billion acres of land, and 20% of our population according to the United States Department of Agriculture. But those stats actually are quite worrisome. We're talking 20% of our population spread out over 2 billion acres of land, which makes connecting them to the internet expensive, difficult, cumbersome, sometimes impossible. So because of that, it's not always a key priority for many for-profit or private internet providers.

Historically, much of this expansion has been funded by the government and carried out by nonprofit agencies, meaning that historically and currently rural internet access is a federal and state concern.

Since 2011, the federal government has funded the Connect America Fund, and it has worked to expand and increase internet and broadband access to millions of Americans. The FCC stated on their website the following quote, and I'm reading it, "The Connect America Fund aims to connect 7 million unserved rural Americans to broadband in 6 years and puts the nation on a path to connect all 19 million unserved rural residents by 2020."

The FCC launched this unprecedented broadband expansion in 2011 when it reformed and modernized the Universal Service Fund, which connected rural America to the telephone network in the 20th century. The commission created the Connect America Fund to unleash the benefit of broadband for all Americans in the 21st century.

In the first phase, about 115 million of public funding will be coupled with tens of millions more in private investment to quickly expand broadband infrastructure to rural communities in every region of the nation.

Joe McCue is the manager for Fiber Assets for Great Lakes Energy. The energy co-op that supplies most of northern lower Michigan, Kalamazoo all the way to the Mackinac bridge. Great Lakes Energy has taken charge of installing, managing, and maintaining fiber connections for all nine of their service areas. They are starting with their Petosky service area and as Joe puts it, writing the book on how to connect their rural communities to fiber internet.

So, how we fit into this is, we're an electric cooperative. Cooperatives were started back during the depression. The farmers didn't have electricity. It wasn't cost-effective to run electricity out to the farms.

So President Roosevelt came up with the Rural Electrification Act, I think it was of 1935, and all it did is it guaranteed loans for the farmers to start cooperatives to build electric facilities, the poles, the wires, everything out to them and start electrifying the farms. And so that took hold. And that's why you have all of the electric cooperatives in America.

Still to this day.

Still to this day, yeah.

So how does that feed into what you're doing now?

We kind of look at it as like the second evolution of our purpose, I think, is what it comes to. It's like, your generation, kind of at the start of my generation, is like, if you heard nobody didn't have electricity, you'd be like, what? Everybody's got electricity. How has that even possible? We want electricity everywhere.

But, we're going to be the ones that remember people not having internet. And in 20 years from now, everybody's going to have high-speed internet.

So that's where we see this as we own a lot of the infrastructure needed to do it already. We have all the poles, we have the right of ways. And so, it's another wire up on the pole, shall you say.

And I always tell everybody, you're never going to find a better organization than Electric Cooperative to build and maintain wire and pole infrastructure.

And so prior to this, what has the infrastructure of Northern Michigan or rural Michigan looked like?

Pretty much you were down to cellular communication, and then also they call it fixed wireless that you can put in, very limited due to the hills and the trees. You can't get the signals through the trees with wireless. And then you had the phone companies, you had telephone service on copper line that was out, but you could not use that for this high data traffic output that you need. You'd have to have fiber for that, and the volume, the amount you want.

And then in the cities, in the towns, you had cable companies come in, and they would start putting that cable in, co-ax cable, and they're able to use that, and then give high-speed internet to their subscribers. It's very expensive for them to go build out into the country.

And while what Joe is describing might seem like "enough" for rural communities, it's a very different story when it comes to actually working and functioning within the current infrastructure.

The problem is, is a lot of times what everybody gauges is good and acceptable. And I always equate it to, if you had a bicycle and you had to ride to work every day, you'd say, this is great. I don't have to walk. But if I come in and then bring a car in, and give you a car to drive to work, you're going to think, well yeah, this bicycle was terrible. Why did I ever have that? But it was better than walking.

So that's what I think everybody out in rural Michigan is going to find out when we bring this high-speed internet to them. A lot of people know it already, that come up here, we have a lot of transient them come up here, and part-time residents who have it down in the cities and they come up here and realize, Oh my gosh, it's not even available. You can't even get it.

So with all these grants and these funds being allocated by the government for this specific task, it must be an important aspect of society to have internet.

Oh yeah. Yeah. When we started looking at this, and like I said, I've even lived in, so... Boyne City schools, which is rural school here in Northern Michigan and many others, I just know this, my kids go to school. Elementary school to get an iPad, middle school, they get a Chromebook. High school, they get an Apple actual computer and all of their books you'd think, Oh, they're loaded up in the computer. They're not. They're out in the cloud. Everything's going out in the cloud.

So they need to have a link to look at their textbook. It's not actually loaded up on the device itself.

But, what did kids do? Who are way out in the country?

You have to go either get the cellular connection, which is expensive, very expensive. Or you go to the library, schedule time at school, go to grandma's house. My kids go to grandma's house because she lives in town, and they can get a high-speed internet connection there. So, I've actually had to sit at the library with my kids linked up so they could do their homework.

So, that's really interesting because there might be some people who don't have those.

No, but there are people that don't have that. And then to try to come in, it's hard. Mom and dad are working shift work, or they only have one car. You can see where you start to get the massive disadvantage. And that's just education.

So my parents, they're both in their seventies and have to go to doctors and everything, and they're down in Ohio. They go to the Cleveland clinic. I remember my mom called me. It wasn't more than, not a year ago. She could no longer call somebody to schedule her doctor's appointments. It all has to be done online. Now they have internet access, and that's not a big problem for them. But that situation is here. So your interaction with your doctor is going to require a high-speed internet connection.

And I mean interaction with the government, anything you do with the government right now is, you need internet connection. Taxes, social security-

Your Bridge Card-

Your Bridge Card, any forms that you need done that is all done through internet.

So without this, essentially we could perpetuate that cycle of poverty.

What I heard at one of the symposiums I went to was that, if we did not do this, rural America could slide back 20 years.

There are bigger issues with that 20 year slide because it doesn't just change how we connect to our social media accounts or apply for jobs. It's a systematic issue that could impact all of our rural counties in Michigan who are run by the same state and federal government. And some of these policies are very inequitable, but that's why Great Lakes Energy is doing what they're doing.

But, the standard for education, what we're deciding to do at the state level with education, for rural education, is being based off of what's going on, what we're capable of doing in Grand Rapids.

Correct.

Or what we're capable of doing in Lansing.

Yep. Even in the suburbs, and in Boyne City itself, if you lived in Boyne City, there is the cable company, there's Charter, and then there's the phone company.

This effort I think is going to be just a huge changer especially for the rural society, for rural America out there. So I think this is going to just again, not let rural America slide into 20 years ago.

And then business-wise, small business-wise, I mean we've seen that already from people who A, can work from home now. The small home businesses now have access to global market. You can sell your stuff on an eBay or Amazon, or whatever you want to do. But, you have to have a really good communication system set up with high-speed.

Education-wise, when I was a kid an encyclopedia was awesome. I can only imagine having high-speed internet, and if you didn't offer that to a kid that had to go to an encyclopedia, and another kid that had access to everything on the world wide web, it's night and day difference. They're just going to get left in the dust.

Dr. Edward Smith is a rural hematologist oncologist in St. Ignes, Michigan. That's the city just passed the Mackinac bridge. He serves cancer patients from all over the Upper Peninsula, patients who are not only very underserved but also with very limited access to healthcare and resources like modern technology.

A few years ago, Dr. Smith worked with a team from Blue Cross that was trying to develop treatment and quality assessments for patients across Michigan, and Dr. Smith spoke up about what he was facing in the Upper Peninsula. What came next, was two oncologists from the University of Michigan who took the time to come up and understand what barriers the patients they were living with.

A lot of what they were trying to do such as contacting patients by phone for follow up, or having them call in, or go through internet portals and stuff, sounds real good except we have patients that live in places in the Upper Peninsula that they don't have internet, or they don't have telephones. And even some of them, some patients, even to make a cell phone call, they have to drive a couple miles to the top of a hill to get cell coverage.

And, there's places in West Makinac and in Lewis County where there aren't power lines, and there aren't internet. That's just how it is. Some people live in very remote, isolated areas.

And so my contribution, so to speak, to that whole thing is on as well as the Michigan Oncology Quality Consortium, which I'm part of is to say, look, not everybody has these things. And to people that practice in major metropolitan areas, they just don't picture the fact that not everybody has a computer, and people don't have internet. So I mean, you have to realize that not everybody has the resources to do all this kind of stuff.

And so when insurance companies or the government want to start making rules and involve this, they really need to take into consideration not everybody has these resources.

At one of the meetings, I was telling them about the challenges that I face doing oncology in rural areas. And to their credit, they came to St. Ignes, and they spent a day and a half with me, seeing the facilities, understanding what was here. I took them to Newbury and to St. Marie, and took them to the places where people live so they had a better picture of how far people have to travel for stuff.

The fact that not everybody has phones, and internet, and many people drive the total of four hours a day if they need radiation therapy, and it just isn't that easy for the people that live in these remote areas. And even when they do get to a hospital, that's very, very limited.

And to their credit, they came up and went with me so they could see it. And on top of it, they actually interviewed the patients that had to do this stuff. So they probably interviewed six people that had to get some of their treatment, not just locally, but people that I had to coordinate it with through the University of Michigan.

And when I asked Dr. Smith about the outcome of his advocacy, I found that he really did make an impact.

Yeah. They were very appreciative of the challenges we face. And then when we have been at these Michigan Oncology Quality Consortium meetings, looking at standards and stuff, we'll refer to things as what we learned when we spend time with Ed was...

And they're finding out that some places in the Upper Peninsula, one of the other providers, they have no hospice in their county. One of the big things is when we refer patients to hospice that doesn't exist, or the hospice people might take a week to get out there.

So they're, they're finding out that the distance that people travel, and the resources made available are very different. And so you have to think about that when you start coming up with quality measures in deciding when you're going to pay for value-based reimbursement.

Now, not everyone can take a two day trip to the UP, and interview patients in order to understand the importance of equitable policies and the need for adequate infrastructure for rural communities, which unfortunately leaves many people who live in these remote places in the dark. Sometimes literally.

Dr. Smith was an advocate for his rural communities, and it brought about awareness to the needs of his patients. Great Lakes Energy is making decisions every day that is going to bring about significant changes to Northern Lower Michigan.

But as I say in almost every episode, there is still so much work to be done. The work right now, in regards to what we've been talking about, is bringing rural Michigan and rural America on an equal resource plane as urban America.

It starts with leaders like Dr. Smith advocating for their rural constituents, but it also includes policy makers. And policy makers that are considering the most underserved and resource-poor communities when making changes in manifestos. Right now is a crucial moment for rural communities, and if it's going to work, we are going to have to work together.

Thank you for listening to this Rural Mission. I would like to thank Dr. Ed Smith and Joe McCue for agreeing to be interviewed for this podcast, and I'd also like to thank my husband, Daniel, for letting me take over our Sunday afternoon conversation. As always. I want to thank Dr. Andrea Wendling, the director of the Leadership and Rural Medicine Programs at Michigan State University for making this podcast happen.

This is our first episode of Season Two. We are so very excited to bring you more episodes this year. We hope you'll tune in every week this fall. I'm your host, Julia Trehune, and I hope that this podcast inspires you to make rural your mission.

Wherever you send me, I will go. Wherever you send me, wherever you send me, wherever you send me I will go. Alexandria to Baltimore, Statton Island to New Jersey shore, to Ohoma or to Pigeon Forge, Lord, I will go. Montebella down to Oceanside. Pasadena or to Paradise. Sacramento up to Anaheim. Lord, I will go. Wherever you send me, wherever you send me, wherever you send me I will go. Wherever you send me, wherever you send me, wherever you send me, I will go.

Albuquerque down to Sante Fe. San Antonio to Monterey. New York City down to Tampa Bay. Lord, I will go. Anaconda down to Evergreen. Broken Arrow to Abilene. Independence or to [inaudible 00:23:00] Lord, I will go. Wherever you send me, wherever you send me, wherever you send me, I will go. Wherever you send me, wherever you send me, wherever you send me, I will go. Wherever you send me, I will go.

Music today was brought to you by Bryan Eggers. We are always grateful to Bryan for his tunes that make our podcast better. Check him out on Facebook!