…We’re Not In Chicago Anymore!

Collage of pictures from the adventures of leaving Chicago and exploring Rochester and its surrounding small towns

If there was any doubt about that back in December, it’s been dispelled. Here’s why:

People will give you the time of day here.

And not just that. They’ll instantly invite you right into their offices, their work, and their lives. If something’s important to you, a Minnesotan’s reaction seems to be, “Well hey, it’ll probably be important to me too.” Whether it’s business cards, connections, introductions, restaurant recommendations, dog-sitting services, people here give you a truly warm welcome to the community. In the course of exploring both within Rochester and out to about 15 miles west in Dodge County, we’ve found a real, in-the-moment willingness to engage.

In case you didn’t know, we’re the pre-medical students who visited back in December to ogle the amazing work CFI was doing around community health. Since then, we’ve graduated and gotten one-year contracts here at the Mayo Clinic to actually *do* this amazing work. We’re five weeks in, and everything we see and do still has that rosy glow that makes us smile quietly when we walk into the Gonda lobby. Things have really moved in the six months we’ve been gone, so we’re jumping in head first. Our mission: build and evaluate a social service triage and referral service integrated into outpatient practice in Kasson, Minnesota.

That’s right. We’re back in the small towns.

We’re in the process of doing some detailed resource exploration in the county, and perhaps the most interesting finding so far is that a) the population is small enough and/or b) people are nice enough to allow for real outreach and advocacy to be done by the community organizations. As far as we can tell, there’s no run-around required to access public benefits, and more likely than not, an organization is going to take the time to refer clients to other services they might want or need.

This isn’t to bash on the social service landscape in Chicago. Far from it. It’s just interesting to think about what population density means for resource strain, not just for the availability of deliverable goods and services but also a social service worker’s ability to usher clients to those goods and services compassionately and kindly. Certainly, organizations have expressed their frustrations with how needs still exceed resources. But people really seem to go the extra mile here - to draw on their personal time and personal connections with other community organizations to get a client what they need.

How else we know we’re not in Chicago: the Rochester skyline is made of four (4!) buildings. We can name them. Mayo, Mayo, Mayo, and, uh...what was the last one? Mayo.

We’ve been commuting regularly between Mayo’s main campus (where CFI’s headquarters are) and Kasson Clinic (where we’re going to implement social service integration) so we can’t help but notice something about the different spaces we’re occupying. On a few home visits with patients, we’ve been lulled on the drive by miles and miles of farm fields. The roads are often old and bumpy, and sometimes, if we’re not paying close enough attention, we’ll pass through a town before we even realize we’ve arrived.

Unsurprisingly, transportation is a huge problem.

Kajsa learned this in a very personal way her first weekend here without a car...without groceries, without bedding, without prescription refills. When resources tell us that transportation is a problem around here, in the inside of our heads we scream, “I KNOW!” Getting the things you know you need -- even if you actually want them -- is a challenge without transportation resources. And for us, that’s in Rochester, a city with a relatively high store density and some buses. The problem only gets worse the further out you travel.

But that makes sense. The only significant movement of people is commuting to and from Mayo (or IBM). So there isn’t a high enough density of non-residential spaces to justify a useful transportation system within rural Dodge County itself. Combine this with an aging population and the fact that sidewalks don’t seem important to put in when the county moves more corn than people - and there you have it: people stuck at home, and adjusting their lifestyle to accommodate that.

It’s not just a healthcare access problem; issues of how to get around ripple through everyday life as well. Grocery shopping might happen only once a month, and that either means you get groceries delivered to your door -- at an extra cost -- and/or you buy the frozen stuff. These are often not the healthiest foods. And we all know once you get used to the convenience of frozen foods, regaining the motivation to prepare a home-cooked meal can be very hard.

Transportation is only one of many pressing needs we are going to have to address. From utilities to emotional health to creative ways to find affordable and convenient exercise options, we’ve got our hands full. But even more interesting and complicated than understanding resource landscape is understanding community networks: how people interact with and frame their world, and how they want us to fit into their world. It’s a daunting task, but we’re diving right in -- and the first step is just listening.

Really, I shouldn’t say “just.” Immersing ourselves fully enough into our patients’ lives to see their needs the way they do is an intricate and difficult process. Yet if we don’t understand how this community operates, how it sees itself, and how it sees and defines “others,” we can’t possibly understand

1. What they actually need, or

2. How to give that to them in a way they want.
So we started our work this July by visiting patient homes, visiting community resources, eating in restaurants here, shopping at the grocery store down the street...and that’s what we’re going to keep doing until the end. Often we’ll gain specific insights from these immersions, like “insurance can subsidize gym memberships, but people frequently don’t know that or are intimidated by that process / being rejected.” But more importantly, each time we visit, we gain another imperceptibly thin layer of awareness, slowly building up to the point where that awareness can be tangible. Where even though we can’t quite explain why something would or wouldn’t be a good idea, we can instinctually feel it. That’s the point we’d like to be at by the end of all this.

We will never be able to grasp every nuance of every individual perspective within this community, but that’s the limit we’re approaching. That’s the intangible insight we’re going to need to build a program works the best it possibly can for our community.

See? We’re already saying “our.” The Chicagoans are starting to get attached to the small town. It’s just the start, but the community and us, we’re on our way...