TRI-COUNTY — The Big Bend Regional Hospital District (BBRHD) recently announced that Terlingua and Presidio were the recipients of a $5.5 million grant from the United States Department of Agriculture (USDA) to expand healthcare access in the remote reaches of Presidio and Brewster counties. The funding will go to establishing a clinic in Terlingua, expanding the existing Presidio clinic to include after-hours care, and providing funding for both communities’ EMS services.
“It’s going to be a huge infusion of healthcare dollars that we’ve never had before,” said BBRHD Executive Director J.D. Newsom.
The Big Bend area grant represents one of only 13 such grants awarded nationwide. Newsom pinned the success of the proposal on the strength of the coalition that formed to apply for the grant. “It’s all in the strength of our partnerships that we created with all the different entities solving this problem — the City of Presidio, Terlingua Fire and EMS, the Big Bend Regional Hospital District, Preventative Care Health Services and others,” he explained. “It’s a complicated grant. Not many rural communities have the capacity to put an initiative like this together.”
The demographics of the communities along FM 170 — extremely rural, lower income, minority-majority and primarily Spanish-speaking — helped communicate the urgency of the problem to grant screeners in Washington, D.C. “I would say that the demographics of Presidio and Terlingua put us at the top of the pile,” Newsom explained.
The Biden administration’s American Rescue Plan Act (ARPA) allotted $500 million to the USDA for a one-time infusion of cash into rural emergency healthcare systems. Much of the funding went to COVID mitigation efforts, but the money leftover for “sustainable rural healthcare models” fit the Big Bend coalition’s needs and strengths perfectly. “It helped, of course, that the hospital district is bi-county, so we’re already thinking about healthcare regionally,” Newsom said.
In Terlingua, the large infusion of cash will mean that the remote South Brewster County community can open a clinic for the first time in over 20 years.
“The difference between then and now is that our population has exploded and also our population has aged,” said Brewster County Commissioner Sara Allen Colando, who represents Terlingua. “There’s more demand, and there’s more need. Because we don’t have access to primary care locally, a lot of times treatable conditions go undetected until it’s too late.”
The 80-plus mile trip to Alpine for a primary care appointment can be prohibitive for many Terlingua residents, especially working parents. “If a kid gets sick, parents basically have to take an entire day off of work, schedule the appointment and drive to Alpine to go to the doctor,” Newsom explained. Parents of multiple children often have to pull everyone out of school for the day in order to avoid missing pick-up after the final bell.
“There’s been numerous efforts throughout the years to provide healthcare in Terlingua, but I think what’s different with this effort is that we’ve got some funding behind it,” Newsom said. “The problem with clinics in small communities is just getting them established and having volume to sustain them. With all the growth that Terlingua has had over the past couple of years, I’m hoping that this time around, we’ll create a sustainable operation.”
In Presidio, the grant money will go to creating an after-hours clinic that can offer care to Presidio residents after typical working hours and over the weekend. “We’re hoping that the after-hours clinic is going to reduce the burden on EMS and will be really transformative for the city,” Newsom told Presidio City Council in May.
He’s hoping that the new facility will be completed relatively quickly, but Presidians won’t have to wait for the new clinic to open to receive care. “Preventative Health Care Services is the partner that’s going to be doing the clinic,” Newsom explained. “So initially, the after-hours [clinic] is going to be run out of their existing building.”
Both Terlingua and Presidio will receive funding toward creating a community paramedicine program — essentially an additional layer of training for local EMS personnel that will help divert routine health concerns from Big Bend Regional Medical Center. The long ambulance ride from either community is expensive, time-consuming and can prevent people with life-threatening emergencies from receiving care, should they call while an ambulance is out on a run.
For many South County residents, emergency medical care is the only kind of medical care they can hope to receive, so precious ambulance services get dispatched to treat conditions that would be handily treated at a walk-in clinic anywhere else in the country. “There’s no hospital in Presidio, there’s no healthcare in Terlingua,” Newsom explained. “So the EMS personnel provide medicine that an EMT would never provide in a city.”
Some of Colando’s constituents have experienced this first-hand. “One thing I hear from the Terlingua Fire and EMS people is that they get calls for people who have high blood pressure,” she said. “It’s not really an emergency situation, so they don’t want to take their ambulance out of service to get this person to a doctor.”
Community paramedicine programs give EMTs the tools to treat and educate local people about their chronic conditions without having to transport them to a hospital. “Community paramedics are trained to do home visits, to go and help patients directly with managing chronic medical conditions, instead of just seeing that person when there’s an emergency or going to the emergency room,” Newsom explained. “The focus is a little bit more on education and outreach. It’s not emergency medicine, per se — it’s a lot more preventative maintenance.”
Because community paramedicine is its own specialty within paramedic certification — a few steps beyond what entry-level EMTs are trained to provide — their training can be expensive and isn’t typically required of urban practitioners. The USDA grant will fill in the gaps, and also provide funding to expand a collaboration with the Texas Tech University Health Science Center out of El Paso for further support.
“Their Emergency Medicine Department is going to be partnering with us to create an EMS institute to further train our EMS personnel,” Newsom said. “They’ll help us with the medical protocols for our community paramedicine program and help us with medical direction as needed. I really think that this program is going to have measurable impacts on people’s health.”
Newsom anticipates that the biggest challenge will be recruiting — and retaining — new healthcare professionals to staff the new clinics in the region. “We know that it’s already a challenge to recruit medical personnel, even here in Alpine,” he said. “It’s going to be even harder in Presidio. We did budget some pretty heavy recruitment dollars, because I think that we’re going to need that.”
Another huge gap in the region’s healthcare services is social workers, but the Big Bend consortium planned ahead. “There’s going to be a full time social worker that’s going to help coordinate and provide medical case management for folks,” Newsom said. “There are virtually no social workers in the tri-county area that are able to focus on that. But we did budget for that, and I think it’s going to be really important for this grant.”
All in all, news of the funding is a cause for celebration for many in the region, who have long accepted that neglecting one’s health is a fact of life in the lower reaches of the Big Bend. “It’ll be a huge benefit to the residents out here,” Colando said. “It’s a new, cutting-edge thing for us. We’re excited.”
