FEATURE and ethnic minorities , according to the Medicaid and CHIP Payment and Access Commission ( MACPAC ).
Rural residents also tend to be older , poorer and sicker . Access to care barriers include a lack of health care specialists and reliable transportation that is often needed to drive long distances to seek out care , according to MACPAC .
In Montana , many hospitals lack laboratory resources to complete the testing needed . “ A lot of the rural hospitals are critical access and provide limited services ,” said Deborah Gibson , MPH , laboratory services bureau chief for the Montana Department of Public Health and Human Services Laboratory Services Bureau . “ So at the state laboratory , we do try to provide support to fill the gaps .”
For example , she said , many of the hospitals and clinics only provide basic microbiology . “ They rely heavily on rapid testing with limited or no culture-based testing available . We often receive those isolates and / or specimens for further testing and identification . We also provide a lot of confirmatory testing services .”
And while Montana has a courier service , it doesn ’ t reach the most remote northeastern parts of the state . “ The courier service can hit about 80 % of the state , but there ’ s still areas that are so far out there that they can ’ t even provide overnight service . So , we miss about 20 % of the state ,” Gibson said .
For those areas , the laboratory provides prepaid FedEx or UPS labels for overnight shipping . However , that still presents challenges — sometimes hospital staffers have to drive to a neighboring town that has FedEx or UPS service . And in Montana , “ neighboring ” might mean an hour ’ s drive away or more .
In states such as New Mexico and South Dakota , laboratory scientists work closely with the Indian Health Service ( IHS ), indigenous communities representing 23 tribes and independent tribal health clinics . Nearly 11 % of the population in New Mexico is American Indian . Every state agency has a tribal liaison , Edwards explained . The relationship between the tribes and agencies is unique .
“ It ’ s not like you ’ re dealing with a local jurisdiction ; you ’ re dealing with this autonomous group of people that don ’ t necessarily fall within your jurisdiction . It ’ s about offering partnership and being there for them ,” Edwards said . “ They don ’ t have the resources that we might have , so it ’ s about offering our capacity as an extension of theirs and sharing data and sharing our laboratory services .”
In South Dakota , where about 8.5 % of the population is American Indian , 1 in 11 residents is served by one of the state ’ s nine tribes , Southern said .
“ We try to provide services to those communities by reinforcing the scientists that work and live in those communities ,” Southern said . That has included hosting packaging and shipping classes so the tribal clinics can send the samples to the state public health laboratory . “ We try to provide options for them so that they don ’ t have to send their samples out of state to other laboratories .” One of the laboratory ’ s goals , he said , is to provide the tribal communities the highest quality testing at the lowest price possible .
These partnerships are particularly vital when there ’ s a public health crisis . In 2016 , one of the largest foodborne disease outbreaks in South Dakota was traced back to a meal service at a powwow , a traditional celebratory gathering that includes dancing and singing . A total of 112 cases were identified in the Salmonella outbreak .
While IHS took the lead on the response , the South Dakota Department of Health ( SDDOH ) provided support , according to an SDDOH presentation at the 2017 conference of Council of State and Territorial Epidemiologists . SDDOH provided outbreak investigation guidance , laboratory testing , data management , data analysis and traceback .
Recruiting and Retaining a Workforce
Recruiting for public health laboratories , especially for clinical microbiologists , is a challenge across the country — especially
We have noticed that young people graduating from college would prefer a job where they can telework and where they get a good salary . And we can ’ t offer either those things in laboratory work .”
Edward Desmond , PhD
as state laboratories can rarely compete with salaries offered by private laboratories . But rural or more remote public health laboratories may face an additional burden , as they need to lure people to states and communities with seemingly fewer amenities and resources .
It may not seem like it would take much to lure people to Hawaii , but the state has its challenges , including the high cost of living and the remoteness from the rest of the US .
The Hawaii State Laboratories Division is headquartered on Oahu and has district health laboratories on three other islands : Hawaii , Kauai and Maui . Some of the communities on the smaller islands are quiet , remote and isolated .
“ We have a problem with recruitment and retention for the district health laboratories on our neighbor islands and for the hospitals on those islands ,” said Edward Desmond , PhD , Hawaii ’ s laboratory director and State Laboratories Division administrator .
In addition , he said , “ It ’ s gotten worse since the pandemic . We have noticed that young people graduating from college would prefer a job where they can telework and where they get a good salary . And we can ’ t offer either those things in laboratory work .”
One program that could help with recruitment is the medical technology program at the University of Hawaii John A . Burns School of Medicine , he said . The program , which is the only undergraduate program in the School of Medicine , begins with a medical laboratory technician associate degree at a community college and culminates in a bachelor of science degree in medical technology . In addition , the State of Hawaii announced in September 2023 the new Healthcare Education Loan Repayment Program , which will pay off educational loans for health care professionals who stay in the state and work for at least two years . Laboratory professionals are eligible .