Caring for the Plain community

When Leon Zook contracted COVID, the Virginia Beach, Va., resident found himself in a hospital room, isolated from family — and with scarce contact from his healthcare providers.

Relationship building

Historically, Geisinger’s relationship with the local Plain community has been complex because its people live under widely varying circumstances. Members include Amish people who drive buggies and don’t have phones or electricity in their homes. Family groups who share one phone at the end of a lane. And Mennonites who drive cars and use most modern technology.

Communication can be difficult — and not just because of language and tech issues. For example, the standard healthcare question “Do you feel safe at home?” is meant to assess domestic violence risk. But it can seem intrusive and even threatening to an Amish patient, who may fear they’re facing scrutiny for living “differently.”

And members of the self-reliant communities tend to view healthcare differently from non-Plain people, says Lowell Stoltzfus, MD, a family doctor who sees many Amish and Mennonite patients at Geisinger’s Belleville clinic. “The idea of going in for a checkup when there’s nothing wrong doesn’t necessarily make sense to them,” says Dr. Stoltzfus, whose ethnic background is Amish. “And a large number don’t want to go to the hospital at all.”

He notes that he’s often the first to spot a potential health problem, like a mass on an X-ray, that would send most patients to a specialist. But members of the Plain community may choose to monitor it themselves.

“I discuss all the possibilities and try to give ‘best chances,’” Dr. Stoltzfus says. “It may take more persuading to get them to pursue more care.”

Starting better communication at birth

One area that’s seen tremendous improvement? Communication with midwives, according to Jay Bringman, MD, maternal-fetal medicine specialist and vice chair of women’s health, and Elissa Concini, MSN, obstetrics clinical nurse educator.

In 2020, the two learned that over a period of time, several pregnant women from the Plain community had been brought into the Geisinger Lewistown emergency room. All had complications with their home births, assisted by midwives — and the results were sometimes disastrous.

“Lay midwives were transporting patients too late for good outcomes,” Ms. Concini says. “It creates a real challenge when providers have to pick up the pieces with little or no knowledge of the situation.”

Seeking to remedy a “broken relationship,” the team invited local midwives to a meeting. “We ripped the Band-Aid off,” Ms. Concini recalls. “We confronted issues for everyone’s safety — and we learned a lot.”

Key to their approach was building a respectful relationship, as opposed to telling the midwives that Geisinger experts were here to solve a problem.

“We told them, ‘We’re not here to change your practice, discourage home births or turn you in to the government,’” Dr. Bringman says. “There were a lot of fear and trust issues.”

The initial meeting expanded into long-term outreach. That allows Geisinger providers to learn from Plain community midwives, such as potential ways to relieve pain naturally and techniques to free a baby’s shoulders during vaginal births.

“This community reveals some of the things we lose sight of in a medical setting,” Ms. Concini says.

Expanding a reputation for fair, respectful care

When COVID patient Leon Zook arrived at Geisinger Lewistown hospital, he didn’t just recover. He found a new home for his healthcare, even though most Geisinger providers are about eight hours from his house.

“There was a big difference there,” Mr. Zook says. “My wife was allowed to be with me, order my meals and bring me healthy food like smoothies.”

He also discovered that Geisinger is friendly to the Plain community regarding payment. Most Amish and Mennonite people aren’t covered by commercial insurance. They’re used to negotiating for services. But Geisinger offers a payment structure that allows members of the Plain community to pay reasonable rates without bargaining.

“We’re not looking for a handout,” Mr. Zook says. “We understand that hospitals need to make money. We just want a reasonable price.”

Thanks to the care he received at Geisinger, Mr. Zook tells other members of the Plain community in Virginia to consider making the trip to Pennsylvania, too.

“Geisinger considers the way we live, and the way we don’t use commercial insurance,” he says. “If people find out there’s a hospital that’s considerate to the Plain community, they’ll go there.”

Ms. Concini says Geisinger benefits from its connections to the Amish and Mennonite communities, too — especially the midwives.

“They’re a pretty remarkable group,” she says. “It would’ve been a great loss if we hadn’t gotten to know them.”