Sowing Resources

Tending the garden of rural health care

by Rosalyn Graham

For four years, Rob Trachtenberg has run the Champlain Valley Area Health Education Center in St. Albans, one of three such centers in Vermont whose goals are to promote and supply rural health care and health-care initiatives.

It's interesting how a seemingly random mix of education and career choices can add up to the perfect preparation for a career. For example: a degree in psychology; work as a mental health counselor and research assistant in schizophrenia studies; graduate studies in social work and public health; a job teaching people with learning disabilities; a master's degree in administration; and four years directing an adult learning program.

Rob Trachtenberg took this winding path to his current position as head of the Champlain Valley Area Health Education Center, an organization working to improve access to quality health care through recruiting, educating and supporting health-care professionals. He has been the organization's executive director since January 2001.

"Education and health have taken parallel paths in my life," he says. "This is a perfect integration of health care with a chance to affect health for local communities and education, because while we're not standing in front of students all that often, we're bringing educational resources to health-care providers, medical students, nursing students, physical therapy students, and to students who might someday be interested in a health-care career. For me, being able to do something in the world of service is a good fit."

Trachtenberg admits he had "never heard of an AHEC" until a few months before he applied for the job. That puts him with the vast majority of the public outside health care circles.

In the early 1970s, Congress authorized forming such centers to help promote and supply rural health care and health-care initiatives. The first one was established in Arkansas; today there are 201 centers in 46 states. Vermont has three: in the Northeast Kingdom since 1997; in southern Vermont since 1999; and the Champlain Valley center, founded in 1998. Each state has at least one academic medical center, which is called the "program office." In Vermont's case, it's the University of Vermont College of Medicine. The centers are private nonprofits spawned from the program office.

All are designed to be responsive to the health needs of the community they service; but as Trachtenberg likes to quote, with a grin that's never far from his face: "When you've seen one AHEC, you've seen one AHEC." He means that, although all are focused on the same goal and collaboration is a strength, each center has its own "pet projects."

The Champlain Valley Area Health Education Center, with its office in a little cottage across from the main entrance of Northwestern Medical Center in St. Albans, serves Chittenden, Franklin, Addison and Grand Isle counties. It works with Northwestern Medical Center, Fletcher Allen Health Care, Porter Medical Center, the Department of Health, community health centers and other nonprofits with projects as diverse as administering hospital libraries to training on bioterrorism and emergency preparedness. "We don't do the training, but we get the people to the table both the trainers and those who need the education," Trachtenberg says.

He takes special pride in the programs that introduce everyone from kindergartners to adults to health careers, from summer camps and shadowing experiences to after-school activities. The Champlain Valley center won a $42,652 Adopt a School grant from the federal Health Resource Service Administration to support a program that provides Missisquoi Valley Union High School students with hands-on learning opportunities, taking them behind the scenes at hospitals and giving them a sense of what's required to enter a career in health care. "We can be the link between the school and its needs and the needs of the health-care industry," Trachtenberg says.

Another project that lights up Trachtenberg's eyes is MedQuest, residential summer camps at the University of Vermont where 35 to 45 high-performing ninth- and 10th-graders get a close-up look at health-care careers, spending time in the operating room and emergency department, learning skills and raising their awareness.

There is also an advanced MedQuest camp for students who want to learn more. The center charges a fee, but subsidizes the $600 to $700 per-student cost "to the degree we can," says Trachtenberg; provides vans to shuttle campers from all over the four-county area; and pays the medical student counselors.

The rewards after three years of MedQuest are quantifiable, Trachtenberg says. "We know that the students have a greater awareness of health care and a greater understanding of health-care careers and are pursuing health-care degrees when they go to college. It's one of the highlights of our workforce development effort."

The organization also supports health-care professionals who are already in careers by providing continuing education programs, sponsoring conferences, ensuring that resources and documents they need are available in their libraries, even going into doctors' offices for lunch-time training on such subjects as smoking cessation and diabetes.

An example of the practical approach the organization takes to solving problems facing the health-care profession is the support it provides to health profession students, supplying beepers and laptops for those already enrolled in school, even travel reimbursement for rotations in rural area.

In her job as education resource coordinator, Deb Eckert (left) administers hospital libraries and oversees programs that help health-care providers understand the diverse cultures they serve. Tammy Johnson is the center's data manager and public relations coordinator.

"Our focus is to get those students out of the urban area and into the areas where the folks have the least access to health care," Trachtenberg says. "We want them to get into those communities, get involved, set up homes, set up shop, become providers in those communities."

An educational loan repayment plan that provides money to reduce the crushing educational debt burden that can drive new health-care professionals, especially doctors, away from rural Vermont to big cities has the same goal: to direct health-care professionals into rural areas in the hope that they will put down roots. It seems to be working the retention rate is about 90 percent.

Funding is a challenge, Trachtenberg acknowledges. Centers receive federal funding for their first six years, then are cut off from federal funding in the seventh year, left to prove that they have built the support systems, partnerships, contracts that will keep their doors open. In the eighth year some federal funding comes back, but Trachtenberg and his board of directors are becoming familiar with strategies for fund raising and talking to decision makers in Montpelier about state support.

Another challenge is raising public awareness of the organization in the community. "We don't have a constituency who walk through the door and say they need food or clothing or shelter," he says. "It makes it a huge challenge to get our name out and convince people that what we do has real value. We need to make people aware of what the landscape would be if we didn't exist. Maybe there'd be fewer rural doctors or a continued nursing shortage, or health-care providers wouldn't get the resources they need."

The members of the organization's team providing service and coordination are Tammy Johnson, who oversees databases and is in charge of marketing and public relations; Jenney Samuelson, in charge of workforce development activities such as the MedQuest Camps; Erin Latulip, who oversees bioterrorism and emergency preparedness training and HIV/AIDS training, and writes grants; Deb Eckert, who administers hospital libraries and oversees programs that help health-care providers understand the diverse cultures they serve; and Glenda Paradee, the financial coordinator and office administrator. Trachtenberg finds it satisfying to have grown the Champlain valley center to six employees and expanded its capacity and outreach in the community.

"We get weekly calls asking for partnering, asking for help with a grant," says Trachtenberg, "and we have an incredible staff willing to do whatever is needed at any time."

Tacy Lincoln, director of student services for the college of nursing and health services at UVM, has worked with Trachtenberg on a number of projects, including the MedQuest camps. "I have come to admire Rob's ability to keep the big picture in focus while ensuring the smaller details are not overlooked," Lincoln says.

Jonathan Billings, director of planning at Northwestern Medical Center and chairman of the board of the Champlain Valley center, says Trachtenberg's position on the national board and as a member of the center- director constituency group, which supports and oversees the center directors, has had great benefits for the Vermont centers. "It provides a voice for Vermont on a national level and also prevents us from operating in isolation. In a small, rural state you can fall into the trap of only doing what you know instead of taking advantage of what other people have thought of."

Billings describes Trachtenberg as "a visionary who can imagine where we ought to be in terms of health care in Vermont. His vision and passion have helped to make AHEC grow into an important player."

Trachtenberg's winding path continues to unfurl. At press time, he announced a move that will focus his vision and passion on a new challenge. He and his wife, Catherine Winchild, and their two children will leave Vermont for Brown University in Providence, R.I., where he will establish a statewide network of health education centers using the Vermont model he helped create.

While his own roots will not stay planted in Vermont soil, Trachtenberg has sown the seeds for meeting the needs of under-served people here by ensuring that support programs, educational outreach, energetic recruiting and the synergy of interested parties work together to keep health-care professionals in the communities that need them. •


Under Trachtenberg's watch, the center has grown to six employees and expanded its capacity and outreach in the community. Glenda Paradee (left) is the financial coordinator and office administrator; Erin Latulip writes grants and oversees bioterrorism and emergency preparedness training and HIV/AIDS training.

Originally published in March 2005 Business People-Vermont