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The Arizona Center for Rural Health’s mission to improve the health and wellness of Arizona’s rural and vulnerable populations through its state and federally designated and funded State Office of Rural Health program will continue thanks to a $4.4 million grant from the U.S. Health Resources and Services Administration (HRSA).

Daniel Derksen, MD, is the director of the Arizona Center for Rural Health.

“We are very honored and excited to receive competitive continuation funding from the HRSA over the next five years to build on the more than 30-year history of the State Office of Rural Health Program here in Arizona,” said Dan Derksen, MD, director of the Center for Rural Health in the Mel and Enid Zuckerman College of Public Health at UArizona Health Sciences. “This program shows how federal, state and community collaboration can really make a difference in the lives of rural Arizonans.”

Arizona is the sixth-largest state by land mass, with 55% of the the state’s 114,000-square-mile area owned by the federal and state government, 28% owned by 22 federally recognized Native American tribes, and 17% owned privately and fragmented by large swaths of sparsely populated public and tribal areas.

This distribution results in many rural communities being isolated from human services and health care providers, which are concentrated in urban areas surrounding Phoenix and Tucson. As a result, rural Arizonans have unique challenges that result in significant health disparities, particularly for Native American and Latinx populations.

The goal of the State Office of Rural Health program is to assist states in strengthening rural health care delivery systems by maintaining a focal point for rural health within each state. The Center for Rural Health has been federally designated as the Arizona State Office of Rural Health since 1990. The Arizona State Office of Rural Health has three core areas of focus:

1. Collect and disseminate information to rural health care providers and agencies regarding grant opportunities, research findings, policy updates, best practices and other rural health issues;
2. Coordinate rural health care activities in the state to avoid redundancies to include community, regional, statewide and national partnerships;
3. Provide technical assistance to public and nonprofit entities to increase capacity in rural communities to develop and sustain successful rural health programs and services.

This new funding will enable the continuation of programming to serve the state’s rural, underserved communities and deliver the most up-to-date research, practices and resources to support health services providers in rural Arizona.

The Christian Science Monitor | By Francine Kiefer Staff writer | June 24, 2021

Last week, as millions of people from New Mexico to California to Montana wilted under an early and record-breaking heat wave, I posed a question to a few friends in the West: What have you noticed about the heat in your area over the years? I’m still a relative newcomer to “SoCal,” and was curious about changes over time, how folks were coping, and whether they noticed a sense of urgency around the subject of climate change.

Most of the responses came from Arizona, where heat is a serious health risk. Last year, Maricopa County, which includes Phoenix, reported 323 heat-related deaths – its most ever recorded. Excessive heat warning days doubled from the year before. Together, Arizona, California, and Texas account for about a third of the 700 average heat deaths a year in the United States. 

My friends tell of a different world from their childhood. “I played softball in the summer for so many years. I don’t remember it being 100-in-the-teens in June. It could be 102, and that would be a normal day. Not 110, or 111, or 115,” recalls Rosemary Mitchell, who grew up in Phoenix and now lives in Bethesda, Maryland. Last week she was back in Phoenix to help her mother move into a senior living community. She was shocked at the record-setting heat. (Last Thursday topped out at a record 118 degrees.) She could also smell the smoke from wildfires about 60 to 70 miles away – now a more frequent occurrence in the West.

“The sky on Monday was a dark gray, and the sun looked like this orb of flaming red in the sky. I felt like I was in a post-apocalyptic dystopia. It is so disturbing to me,” Rosemary says. The summer time warp from her childhood in the 1960s and ’70s – when Phoenix had roughly a fifth of its current population and a lot less asphalt and concrete – set off her inner alarm bell. 

But she doesn’t see that happening with Arizonans for whom the change has been more gradual. “There is no conservation mentality here,” she observes, upset at outdoor sprinklers running in the afternoon, streets lined with two-story mansions three times the size of the low-slung houses of her childhood, and so many gas-guzzler Suburbans. “I see more solar panels on home roofs in Bethesda.”

Changes in temperatures – and in attitudes?

Phoenix-area writer Kimberly Hosey moved from Buffalo, New York, to Arizona before she started grade school. It was definitely hot in summer. She grew up hearing “you don’t have to shovel the heat,” every time she whined about the temperatures. They would sit in front of box fans draped with wet dish towels in their mobile home until they eventually got a one-window air conditioner. Record-setting days stand out – like the 122-degree scorcher on June 26, 1990 – when three sweaty kids were waiting with their mom in a car with no AC to pick up their dad.

But fast-forward. Now, she writes, dangerous heat waves are almost becoming the norm. The hot part of the year lasts longer, there are more days over 100 degrees, and it’s been drier than normal. The West is in a severe drought, which contributes to the heat. No summer monsoon season refreshed Arizona last year, its second “nonsoon” in a row. Lake Mead, which supplies water to 25 million people in the Southwest and Mexico, is at 36% capacity, its lowest since it was filled in the 1930s. 

“This is a trend [that] should be obvious to a lot of people, but I don’t think it always is – though that could be partly my personal experience,” she writes. Abnormally hot days blur together, and between the temperature bubbles of air-conditioned buildings and political bubbles of partisanship, she explains, “there isn’t always the sense of urgency that there should be.”

But that’s rapidly changing – nationwide and in Arizona. Last year, the Pew Research Center found that 52% of American adults think global climate change should be a top priority for the president and Congress, up significantly from 34% just six years before. And 62% say climate change is affecting their local community at least some. 

In Arizona, although a partisan divide persists, about 70% believe the federal government and the state need to do more to combat climate change, according to a 2020 poll commissioned by the Nina Mason Pullium Charitable Trust. And increasingly they don’t just “agree” but “strongly agree” with that objective.

“Still time” to act

Urgency is necessary for action, says climate scientist Veerabhadran Ramanathan, at the Scripps Institution of Oceanography at the University of California, San Diego. He believes that urgency will intensify over the next decade as Earth crosses the threshold into average temperatures that are 1.5 degrees Celsius warmer than in the pre-industrial age. Climate scientists say the shift means worsening drought, wildfires, flooding, and heat.  

But it’s not hopeless, emphasizes this scientist, who was just awarded the prestigious Blue Planet Prize. There is “still time” to act, especially if drastic measures are taken to reduce “super pollutant” contributors along with carbon dioxide. Almost all of the focus is on carbon dioxide emissions, but these super pollutants – black carbon from diesel engines, methane from fracking, and hydrofluorocarbon refrigerants – make up almost half of greenhouse gases, he explains.

They are far more potent than carbon dioxide and also much more short-lived, lasting from weeks to 10 to 15 years. “If you cut these super pollutants, the warming curve will start to bend right away,” Dr. Ramanathan says. Fortunately, the world has the technology and know-how to do this, he says, including off-the-shelf filters for diesel trucks and options for reducing food waste. In the meantime, “we need to prepare people, build resilience,” because the heat waves will get worse, he says.

Helping people stay safe

On the blistering streets of Maricopa County, the most populous county in Arizona, government officials and nonprofits are trying to do that by building out their network of 240 heat-relief locations, says Brande Mead, human services director for the Maricopa Association of Governments. 

One of the main providers is the Salvation Army, which has 11 emergency hydration and cooling centers with air conditioning and shaded outdoor misters and “swamp coolers.” They offer water, sunscreen, and bandanas to soak in water and place around the neck, plus lip balm, lotions, and baby powder for skin care. They provide help to seniors and encampments of homeless people – two particularly vulnerable groups for heat. 

Heat-related illness and deaths are a “very big deal” in Arizona, which unfortunately leads the nation in the number of migrants who die in the desert, says Daniel Derksen, a health policy expert at the University of Arizona in Tucson. People often don’t realize they need to drink much more water, even after the sun sets and folks go out to play tennis or baseball, he says. 

Dr. Derksen remembers growing up in Phoenix, running barefoot to the neighborhood pool, touching down quickly on pavement to get to the next stretch of grassy lawn or shade tree. Now hospitals are treating significant burn cases from contact with asphalt and cement. 

In the rainy season when he was in college and medical school, he would drive through a quarter mile or so of lightly flooded dirt road to hunt duck and quail in a playa east of Tucson. That road water has been gone for 20 years, he remarks, and he rarely sees water in the playa. Quail and deer are hard to find, though ranchers provide water for animals. 

As for urgency, he sees it in a new administration in Washington that is pushing, for instance, to convert the postal fleet to electric vehicles and in his students, who are energized to contribute to problems that seem intractable, but are not. He points to telehealth – how pandemic necessity accelerated its use and turned a futuristic anomaly into a common practice.

“The same kind of energy can be applied to our drive to protect our environment,” he says. “It’s definitely within our reach.”

By Brooke Newman/Cronkite News - Arizona PBS

WASHINGTON – Arizona residents should feel comfortable celebrating Memorial Day this year, but health experts said they still need to be careful to keep from repeating last year’s mistakes, when unguarded partying led to a “lethal July.”

Restrictions on businesses and individuals were relaxed in the weeks before Memorial Day 2020, and state recommendations that people maintain social distancing and that businesses sanitize, provide protective equipment and ensure physical distance were largely ignored.

Crowds turned out in Scottsdale and Lake Havasu, among other spots, and people packed bars, parties and cookouts as if “the pandemic is behind us, let’s party,” said Will Humble, executive director for the Arizona Public Health Association. 

“Two incubation periods after last year’s Memorial Day, hospitals were full and people were dying left and right,” Humble said.

He and others expect the situation on the ground to be much the same this holiday weekend, but with one key difference – this year there’s a vaccine and COVID-19 numbers continue to trend sharply downward.

More than 5.8 million doses of the COVID-19 vaccine had been administered as of Friday, with more than 2.75 million Arizonans, or 45.9% of the state population, fully vaccinated. New cases, deaths and hospitalizations have all fallen.

But that does not mean the state is in the clear: Half of Arizona’s population is still not vaccinated and the transmission rate is “substantial” – more than 50 new cases a week per 100,000 residents, the second-highest of four transmission categories. Only Cochise and Greenlee counties were in the low transmission category, with fewer than 10 new cases per 100,000.

“Having 45.3 percent of Arizona’s population vaccinated reduces the chances of a spike in cases and stress on the healthcare system, but unvaccinated people remain at risk of severe outcomes from COVID-19,” said Steve Elliott, communications director for the Arizona Department of Health Services, said earlier this week.

While the Centers for Disease Control and Prevention and the state have eased health restrictions for those who are vaccinated, nothing has changed for those who are not vaccinated.

“Those that decided not to get the vaccine, they really need to protect themselves and avoid situations where they’re at an increased risk, like large events and indoor gatherings,” said Dr. Daniel Derksen, a professor of public health at the University of Arizona.

For those people, the guidance is pretty much the same they have been hearing for the past year: wash hands frequently, wear a mask in public, maintain physical distance from others and stay home if sick.

“We can’t predict what people will and won’t do in social settings, but for those that are unvaccinated we hope they follow CDC guidance to prevent infection and further spread of this virus,” said David Lozano, associate director with Banner Health Marketing.

He said Banner Health is not worried about huge spikes in hospitalizations following Memorial Day, but that COVID-19 transmission among non-vaccinated individuals remains a concern. 

Humble said that vaccination rates among younger people in Arizona are not nearly as high as vaccination rates among people 60 and older. But the fact that younger people are less likely to suffer serious illness from COVID-19 means the chances for a repeat of Memorial Day 2020 are slim, he said.

“Vaccination rates of people in their 20s and 30s is not great, it would be great to have it higher,” Humble said. “But the fact it’s not higher doesn’t mean we’ll have a public health crisis as a result of Memorial Day behavior.”

Amy Bolton, spokesperson with the Maricopa County Joint Information Center, which distributes COVID-19 information, agreed, saying that with almost half of eligible Maricopa County residents vaccinated, typical Memorial Day celebrations will be safer this year.

“While we have much to celebrate this Memorial Day, we should continue practices that have kept us safer this past year including washing your hands, staying home when sick and wearing a mask if not fully vaccinated or at high risk for severe COVID-19,” Bolton said.

Alison Hughes has been awarded the Louis Gorin Award for Outstanding Achievement in Rural Health Care by the National Rural Health Association. Now retired, Hughes previously served as director of the Arizona Office of Rural Health. During her career, she helped build Arizona’s rural health care infrastructure, promote the rural health workforce, and encourage early adoption of telemedicine. “She led the charge for the health and wellness of rural Arizonans and rallied many people who followed her along the way,” says Susan Kunz of Susan Kunz Consulting. “Alison achieved what great leaders achieve – she inspired many others who continue the work.”

» View award video

Congratulations to Alison for this well-deserved honor!

By Rick Ruggles rruggles@sfnewmexican.com | May 21, 2021

Close to 600 New Mexico residents have endured the bad luck of getting fully vaccinated and later testing positive for the coronavirus.

The state Department of Health reported Friday that 597 of those “breakthrough cases” had been recorded as of Wednesday. If that sounds like a lot, it’s about 0.07 percent of the 897,510 in New Mexico who have been fully vaccinated.

That tiny portion, doctors say, provides powerful testimony to the effectiveness of the vaccines. They also say those who get the two-shot Moderna or Pfizer and the one-shot Johnson & Johnson vaccines tend not to become terribly ill even if they do acquire the disease.

“If you get vaccinated, you’re very well protected,” said Dr. Jason Mitchell, chief medical officer of Albuquerque-based Presbyterian Healthcare Services. “The take-home message is the vaccine is super-effective at preventing you from getting COVID.”

Dr. Daniel Derksen, director of the University of Arizona Center for Rural Health, called the development and distribution of the vaccines “a real public health miracle.”

Derksen said the vaccines have made a huge difference in combating the disease in New Mexico, Arizona and the U.S.

“It’s just so impressive how quickly they’ve been able to develop this,” Derksen said. “If you look at where we were a couple months ago and where we are now, it’s just astounding.”

Centers for Disease Control and Prevention statistics indicate the seven-day rolling average of American deaths Wednesday was 497 a day, down by 39 percent from the seven-day average March 19 of 813.

James Barron received his second Pfizer vaccination in mid-March. But he developed a runny nose while caring for his girlfriend, who was ill with COVID-19, more than a month later. A test indicated Barron had it, too.

He went into quarantine for 10 days but never felt terrible. “It really wasn’t debilitating,” said Barron, a 45-year-old sports columnist and reporter for The New Mexican. “I could just tell that I wasn’t normal.”

A few days later, Barron felt fine. “It strengthens my belief that the vaccine is effective even if it doesn’t prevent the virus,” he said.

His girlfriend had acquired only one Pfizer shot when she contracted the disease and had a tougher time. She had some breathing problems, trouble sleeping, minimal appetite, coughing and congestion.

At one point, they considered taking her to the emergency room. “I was scared,” Barron said. “I really was.” But with the exception of some coughing and shortness of breath, she has bounced back.

Statistics from the state Health Department show the following about “breakthrough cases,” in which fully vaccinated people contracted the coronavirus:

• Of the 597 who tested positive, 55 required hospitalization. Ten of those were likely related to the coronavirus. For 14 others, it wasn’t known if there was a correlation with the coronavirus.
• In cases per 100,000 people, there were 117.3 involving the single-dose Johnson and Johnson vaccine, 73.1 the Pfizer and 64.9 the Moderna.
• Just over 45 percent of the patients were 40 to 64 years old, 27.3 percent were 65 and older, 21.6 percent were 25 to 39, 5 percent were 18 to 24 and 0.2 percent were 16 to 17.

Presbyterian’s Mitchell made an impassioned call for people to get their vaccinations. Doing so “does not change your DNA. It does not cause infertility,” he said. It doesn’t kill you and it doesn’t give you the coronavirus, he said. It does trigger an appropriate immune response.

Mitchell said statistics indicate the Johnson & Johnson vaccine comes with a two-in-a-million chance of giving a person a certain kind of blood clot. But if a person gets coronavirus, there is a 40 times greater chance the person will get that kind of blood clot, he said.

As of Friday, there had been 4,126 coronavirus deaths in New Mexico and 14,305 cumulative hospitalizations. About 64 percent of people eligible for the vaccines in the state had received at least one shot.

Whether to get the vaccinations is not a hard choice, Mitchell said. “The truth is, the pandemic is over for vaccinated people.”

It persists among those without vaccinations.

“Fortunately, it’s really easy to fix that,” Mitchell said. “You just go get your shot.”

Health Sciences Connect | May 19, 2021

A new mobile health unit initiative is getting more vaccines in the arms of rural, Hispanic and other hard-to-reach populations in southern Arizona.

Since February, a University of Arizona Health Sciences coordinated effort to get the COVID-19 vaccine to hard-to-reach communities in Arizona has administered about 10,000 shots as part of the Mobile Outreach Vaccination and Education for Underserved Populations (MOVE UP) program.

Most counties are already vaccinating people via drive-up and other fixed-site COVID-19 vaccine points of distribution (PODs) in urban areas. Ongoing outreach through more targeted community efforts like MOVE UP will be increasingly important for getting more people vaccinated, said Cecilia Rosales, MD, MS, who heads the MOVE UP initiative and is associate dean of Phoenix programs as well as community outreach and engagement at the UArizona Mel and Enid Zuckerman College of Public Health.

“MOVE UP’s overarching goal is to reach people in communities who won’t go to the big vaccine PODs because they have transportation issues, they have language issues, they have technology issues,” Dr. Rosales said, adding that the program started in Maricopa County and has expanded from there. “Most people when they think of Maricopa County, they think of Phoenix and this dense urban area – but it has rural areas there, too. These are small farming communities where we’ve hosted a number of mobile vaccine clinics.”

The first MOVE UP event outside of Maricopa County was held April 23 at the Consulate of Mexico in Douglas. The event, held in partnership with the Cochise County Health Department, began vaccinating agricultural laborers crossing the border to work at 3 a.m., and opened to the general public at 7 a.m. About 75 vaccines were administered.

About 200 people were vaccinated at a second MOVE UP vaccine clinic April 28 at the Consulate of Mexico in Nogales, Arizona, held in partnership with the Santa Cruz County Health Department. It focused on vaccinating truck drivers who transport produce across the border. Future clinics are being planned in Palominas – a town off Arizona Highway 92 in Cochise County with a population of just over 200 – as well as others in conjunction with the Graham County Health Department.

The clinics are staffed by faculty and student volunteers from the College of Medicine – Tucson, College of Medicine – Phoenix, College of Nursing and College of Pharmacy, as well as staff and volunteers from the College of Public Health.

Daniel Derksen, MD, UArizona Health Sciences associate vice president for health equity, outreach and interprofessional activities, and director of the UArizona Center for Rural Health, said that in addition to serving needs of rural and diverse communities, the MOVE UP clinics also meet the educational and training missions of the five Health Sciences colleges.

“We’ve been incorporating elements of our Area Health Education Center program to give all our health profession students opportunities to participate in this as an applied public health effort,” Dr. Derksen said. “Public health, pharmacy, nursing and medical students from Tucson and Phoenix – these mobile vaccine clinics use them all.”

Upcoming MOVE UP vaccine sites include senior housing complexes in Phoenix, Peoria and Gilbert, schools in Gila Bend, Maryvale and Glendale, and farms in Aguila and Arlington. It’s anticipated MOVE UP soon will be running at least three to four mobile vaccine clinics a week, including at community centers, schools, senior housing and long-term care facilities.

“For these farm events, we’ll reach out to other farms in the area and ask if they’d like to bring their folks to get vaccinated, too,” said Jeff Hanna, MPH, clinical research coordinator for the Zuckerman College of Public Health and manager for the Primary Prevention Mobile Health Unit based in Phoenix. “The farms bring workers in from the fields in buses. The people come through 60 to 80 at a time. We have like 14 to 15 vaccinators, so lines move really fast. We’ve done them at produce farms, dairy farms and chicken farms.”

Sheila Soto, MPH, manager for the Primary Prevention Mobile Health Unit based in Tucson, added that these clinics aren’t just for administering vaccines. They also include the mobile health unit’s standard health screenings for blood pressure, cholesterol, diabetes and body mass index, along with referrals for cardiovascular, respiratory and other medical conditions.

“I’m really excited about MOVE UP,” Soto said. “This is the community we’ve been serving the last several years. We’re people they know and trust. We got calls, especially when vaccines were first rolled out, from people checking to see where the vaccinations were and should they get them. I think that will make a difference, especially in rural areas.”

Staff from the UArizona College of Medicine – Tucson’s Department of Family and Community Medicine, which has its own Mobile Health Unit Program for primary care, have been training with Dr. Rosales’ team and are assisting with MOVE UP efforts. Ron Sorenson, the department’s mobile health program director, is coordinating UArizona Health Sciences volunteers for the vaccine clinics in southern Arizona, and College of Public Health mobile health staff and volunteers manage registration, check-in, screening, observation and follow-up scheduling.

“This is the first time our mobile health program has done something like this, so it’s been helpful to work together. I think it’ll be a beneficial partnership. And we’ll meet a need for our rural communities to get the vaccine out there,” Sorenson said.