Thursday, April 23, 2020

Coronavirus in rural America (Part XXVIII): Montana's hi-line

Hi-Line is the moniker Montanans use for the strip of northern counties that border Canada, and one of those counties, Toole, population 5,324, is featured in a radio story that ran on NPR this morning.  The story was actually reported last week by Nate Hegyi, but just picked up nationally today as part of the America Amplified 2020 series.

Four of Montana's 10 coronavirus deaths have occurred in Toole County's seat, Shelby; these are mostly attributable to an outbreak at the county's only assisted living facility, called Marias.  Here's an excerpt focusing on the good news:  the county's preparedness, attributable to the fact that the Chicago to Seattle (and vice versa) Amtrak train stops in Shelby, the county seat, twice daily.  This means that, even though Shelby might seem like the middle of nowhere, it is connected by mass transportation to the rest of the world, and therefore vulnerable to coronavirus.  Hegyi quotes William Kiefer, CEO of Marias Medical Center:
We believe that everyone staying in their homes and following the guidance of the CDC is incredibly important.  To this point it's been very successful in Toole County.
Hegyi also addresses small-town ingenuity:
There's also something else that Marias Medical Center did that other U.S. hospitals should all take note of for future pandemics. It planned ahead before the virus even reached our shores. 
We have a group of dedicated people here that thought, 'Wow, if it does hit the United States, we're a very rural frontier facility and we should do everything in our power now."
Hegyi clarifies:
Back in January, Marias began purchasing and storing personal protective equipment. The excess masks, face shields and gowns reduced the chances of exposure for their staff after the outbreak in the hospital's assisted living facility took hold. However, Kiefer says he wishes they were wearing them regularly before the virus arrived in Shelby because once the first patient tested positive, many of the medical center's employees were unwittingly exposed to the virus. 
Thus Marias Medical Center in Shelby has been left short-staffed.  Further, it has just 21 beds and two ventilators, but it has formed an alliance with medical centers in other hi-line counties, including those in Kalispell, Browning, Conrad and Cut Bank.  Marias also has plans to air evac patients to Helena, as necessary. 

Kiefer comments:
Although we're small, we're not isolated.  People do move around quite a bit.
And as Hegyi concludes, in the context of a pandemic, "it's that movement that can kill." And that is why orders limiting movement --or at least screening those who are moving--are appropriate at times like these.

Here's the Billings Gazette's April 19 coverage of what is happening in Shelby and Toole County.  It's a very deeply reported story by Jeff Welsch, heavy on lack of anonymity and history, among other rural themes.  An excerpt quoting Dwaine Iverson, a CPA in Shelby, follows:
When you drive down Main Street and don’t see a car, it’s frightening.  Impacts are everywhere. And if we don’t do something to keep (businesses) alive, when we get all done with this ... Main Street now, with the shutdown, is going to look like that all the
The story continues:
Iverson recalls his wife, Barbara, who works at the Heritage Center, and three daughters, all nurses in other Montana communities, initially warning him he "wasn't taking it seriously enough" when COVID-19 first gripped Seattle and surged toward Montana. Soon after, Barbara was in quarantine at home, even though she was off-duty when the virus hit.

Then the first three residents died.
More from Iverson: 
It feels real because you know the people who died.  They’re prominent people around here. They come from large families. They were personal friends of mine, clients of mine. That brings it home.
* * *
The biggest issue is families can’t even get together to grieve. That type of thing makes it so tough because the whole grieving process is so critical to go through and could affect the rest of your life. When you can’t give somebody a hug, how important is that?
Another resident, Michael Bashor, commented: "We all pretty much know who they are."

This Billings Gazette story features great photos, too, from Larry Mayer.

And here's a Montana Public Radio story from 1 April indicating that Governor Steve Bullock ordered health screenings of those arriving in Montana via train or plane.  An earlier post about coronavirus impacts in Montana is here, and an even earlier one is here.

My own very long 2010 law review article, featuring lots about Montana's human, political and physical geography in relation to the delivery of health and human services to children is discussed here.  What a treat it was for me to give talks at the University of Montana in Missoula in 2009 and 2016, and to vacation there in 2011 (Glacier National Park, Missoula, Ravalli County/Darby) and 2017 (Bozeman, Livingston, Gardiner).

I'm a huge fan of "the last best place" and Governor Bullock.  For still more on the Big Sky state, search "Montana" here on Legal Ruralism.

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