When Jen Howe woke up on Monday, she wasn’t planning on being back in the surgeon’s office. She’s laid out on a table, and the nurse reminds her to relax, and breathe.
Howe had an abdominal surgery two weeks ago. The incision is just below her waistline. Dr Krzysztof Plociennik is probing two inches into the wound, poking at a hard spot until blood squirts out of the wound.
"So you could see that firmness which is better now was a collection of old blood. It could turn into the pocket of pus. You okay?"
"Oh yeah, I’m sweating. "
Howe is a regular patient at Indian Stream Health Center, the northernmost clinic in the state. She had to walk across the street to Upper Connecticut Valley Hospital for this procedure. Together, the two facilities serve about 8,000 people who live across 850-sqaure miles. Indian Stream is so remote, the federal government classifies it as “frontier medicine,” says Dr. John Fothergill.
"I hope our techniques and our skills don’t suggest we’re frontier, but I guess by the federal government we’re frontier medicine. "
Indian Stream is one of about 1,200 federally qualified health centers. Those centers get extra federal dollars because they serve lots of people on Medicaid or with no insurance. Everything’s under one roof here – dental, mental health, a pharmacy.
The expanded Medicaid program, or the New Hampshire Health Protection Program, started in 2014, and now covers 48,000 people. In Coos County, 5.4% of people are covered under it – more than any other county, and more than double the rate of Rockingham County. Such numbers have given the program broad, but not universal, political support.
Neal Kurk is the Republican chair of the House Fiscal Committee.
"I don’t believe expanded Medicaid is a desirable entitlement. And I think that it discourages people from working. It is at odds with the culture of America and the American dream."
When the New Hampshire House voted on a deal to continue the program earlier this month, two North Country reps voted against it – Leon Rideout from Lancaster and Larry Rappaport from Colebrook. Rappaport has said he thinks the program is unconstitutional.
Twelve others voted for it, including Republic John Fothergill, who’s also that doctor from Indian Stream. He says most of his patients want to work.
"I don’t think that’s a good argument. I don’t think people really want to be in that spot."
Patient Jen Howe is one of about 1,800 people on the expanded Medicaid program in Coos County. And for her, she says it makes what is already a tough life a little bit easier.
Howe’s health is complicated. She’s got high blood pressure and frequent kidney stones. She smokes. Plus she’s had six abdominal surgeries: four C-section babies, then a partial hysterectomy, then an ovary removed two weeks ago. Her husband is a chef, and a mechanic, and he works in retail, and she farms. She’s often too busy to stop and deal with her health. She’s 36 years old.
"With this surgery they wanted me there for four to five days. I refused. So I got to go home the next morning and I was cleaning the house."
NHPR: "You had abdominal surgery and you were cleaning your house the next morning?"
"Yes sir, yep. You have to have a tough skin, especially up here. There is no help."
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And some people in Coos County don’t want the help. Sharon Bellville is an outreach supervisor at Indian Stream. She’s says most people are happy for the insurance coverage, but she’s had a few who were eligible refuse to sign up.
"They feel like it’s a handout and they’re working and they shouldn’t be getting that."
There’s lots of data that shows people in Coos County are less healthy than any other county in the state. In the 27 years he’s lived here, Dr. Fothergill has done every medical job you can think of: he’s run the nursing home, the health clinic, the hospital and the medical examiner’s office. He says part of the reason people are less healthy here is from habits like smoking and drinking, and some is a combination of geography and poverty. The lifestyle here makes people tough – and the toughness works against their health too. He has absolute war stories about patients neglecting their health…like the woman who told him she had a lump on her breast.
"When in fact her breast was a solid mass, just a solid cancer. I’ve had women come in with breast cancer, they did nothing. And so their breasts were literally consumed. They had no more breast, they just had raw tissue sitting on their chest. And they would wrap gauze around their chest every day. It happens – I had a gentleman, a pretty smart guy. This gentleman let a basal cell cancer on the top of his skull go to the point where it had eaten through his skull bone."
Fothergill says there’s no data yet to suggest Medicaid is getting people healthier in the North Country. But he hopes that’s just what happens. And he hopes Senators back the Medicaid deal and send it to the Governor’s desk.
"Thank you! Whoo! It’s like being in labor, haha."
Jennifer Howe’s little procedure was a success. She’s trying hard to not neglect her health. She’s got the insurance, and she’s using it.
"You don’t realize just how many little appointments make a huge difference that you can’t afford without the insurance."
And with that, Howe walks to her car and heads home to clean, cook dinner for six, and take her kids to dance practice.