Making a World of Difference in Rural Maine

Twenty weeks into her pregnancy, Jenn learned that her daughter, Elsa, would be born with spina bifida, a condition where the spinal cord doesn’t develop properly. For the rest of her high-risk pregnancy and for the first few years of her daughter’s life, she would need to make weekly trips to Bangor, Maine, in addition to trips to Boston every three months.

Jenn, whose last name has been omitted to protect the family’s privacy, has been making the 400-mile drive to Boston Children’s Hospital alone for almost a year, while her husband works and cares for their other two children. The costly and time-consuming trips have been the only way to reach the care she needs. Now, with help from Tufts University School of Medicine student Madison Jandreau, M27, Jenn and baby Elsa will be able to fly to Boston for free instead. 

“Hearing her story brought me to tears,” Jandreau said. “I’m just glad I was able to use my voice as a medical student to advocate for her and hopefully make a difference.”

This summer, Jandreau was working in the community around Presque Isle, a city in northern Maine with around 9,000 residents, as an intern with the Maine Rural Graduate Education (MERGE) Collaborative. The MERGE Collaborative aims to increase the number of physicians in Maine’s rural areas by providing opportunities for students and medical residents to learn in a rural setting. Jandreau, who was born in Presque Isle and is enrolled in the School of Medicine’s Maine Track, was investigating health care-related transportation resources and barriers in parts of Aroostook County, the northernmost county in Maine.

In rural Maine, health care transportation options can be limited. There is a small bus system and people who are covered by MaineCare, which provides health insurance for people who are elderly, disabled, or have low incomes, can schedule individual rides to medical appointments. But those who don’t have easy access to a car or don’t qualify for MaineCare can fall through the cracks, Jandreau said. 

“A lot of people end up relying on family and friends in the area, but I’ve heard many stories of, for example, people on dialysis who have to go to the clinic two or three times each week. If they don't have a ride, they don’t go,” Jandreau said. “It just comes down to that—either you have transportation or you don’t go to your appointments. And that can be life-threatening.”

For more specialized care and in some emergencies, patients need to be transported to hospitals in Bangor, Portland, or Boston. Bangor is at least two and a half hours from Presque Isle and the trip to Portland takes closer to four and a half. The drive to Boston takes around six hours, assuming there’s no traffic. And ambulances aren’t always available right away, Jandreau said. People have had to wait a full day in the local emergency room for an ambulance to take them to a larger hospital. 

Over the summer, Jandreau spoke with local physicians, social workers, and other community members about health care transportation in the community. She had heard about Jenn’s situation—Presque Isle is a small community and Jenn was a family friend—and reached out to speak with her about the challenges Jenn was facing. She learned that Jenn qualified for free air transportation with Angel Flight New England—a 501(c)3 nonprofit organization that leverages the generosity and talents of volunteer pilots who own small planes to provide free flights to medical facilities—but Jenn was terrified of flying in small planes. 

“She has been so resilient and so strong,” Jandreau said. “I thought, if I could only do one thing with this project, I would love to be able to give this family a little bit of ease and help with their situation.”

On her own initiative, Jandreau reached out to Angel Flight New England to see if there was any other option to get Jenn to Boston. And as it turned out, there was. JetBlue, which is a corporate partner of Angel Flight New England, was recently awarded an Essential Air Service contract enabling them to launch daily flights between Presque Isle and Boston starting in September. Angel Flight New England agreed to arrange seats for Jenn and Elsa on those flights for free, whenever and as often as they needed. 

“I was able to go to her house and share that with her, and she was thrilled. It was such a big relief,” Jandreau said. “My goal—through this research, through medical school, and after as well—is to advocate for people who either are unable to advocate for themselves or just don’t know who to talk to. Hopefully I can help people navigate the system and be a kind of middleman for that.”

At the end of her internship, Jandreau wrote up a policy brief with recommendations for ways to improve health care transportation in the community around Presque Isle. Her suggestions included investing more funding into emergency medical services to attract more people to the field, expanding the local public transportation services, and making those services more affordable. She hopes her work will help raise awareness about the unique challenges and barriers to care faced in remote parts of the country.

“If your patient can’t get to your clinic, how are you supposed to provide care?” Jandreau said. “The population demographics, economic barriers, and geographic challenges here are vastly different from southern Maine and I’m very grateful to the MERGE internship for providing me the opportunity to advocate for my own community, as well as other rural communities in the state of Maine.”