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Amid the agricultural and manufacturing towns of southeastern Iowa, Mahaska Health is a small hospital, and it's worried about the Trump administration's funding cuts. Despite its remote location, its patients can access cancer specialists from around the state, and losing federal funds could affect that as NPR's Yuki Noguchi reports.
YUKI NOGUCHI, BYLINE: What Kathie Evenhouse loves about rural life is how people care for one another - driving a neighbor to doctors' appointments, for example.
KATHIE EVENHOUSE: We've set up a team of people who drive her to Des Moine or to wherever she needs to go. I mean, that's what small communities do for each other.
NOGUCHI: Evenhouse herself is 73 and has had multiple cancers - near her spine, in her thyroid, blood, and left leg. Most of her doctors work in Iowa City - an hour and a half's drive from Pella, where she lives.
EVENHOUSE: For me to go to Iowa City, my whole day is gone.
NOGUCHI: Mahaska Health, on the other hand, is a 25-bed hospital that's relatively close to home. And from there, Evenhouse can remotely access doctors from around the state to help her decide her care. Recently, for example, a team determined surgery on her back could be performed locally.
EVENHOUSE: It's really an advantage for me because I can see the experts. I can get their input.
NOGUCHI: Dr. Daniel Kollmorgen is Mahaska Health's surgical oncologist. He moved to rural Oskaloosa two years ago, hoping to fight Iowa's cancer rate, which is the second highest in the country and rising. To do that, Kollmorgen uses databases funded by the National Cancer Institute that track local disease statistics. Those allow him to know which hot spots to target outreach about screenings, for example. Kollmorgen also worked to expand the Iowa Cancer Affiliate Network - teams of disease experts who help him with Evenhouse's care, for example.
DANIEL KOLLMORGEN: We review complex cancer cases at our small hospital on a regular basis, but we can Zoom in pathologists and specialty surgeons and others from around the state. And we're starting to try to build that so we can bring that care to the patients locally.
NOGUCHI: Various Trump administration cuts, from contract freezes to a $4 billion cut to research institutions, could hamper or shut down such efforts, and Kollmorgen says that would mean Iowans would fall further behind on cancer.
KOLLMORGEN: The reason we have more Stage 3 and 4 cancers in rural Iowa is oftentimes due to lack of screening, lack of awareness, lack of transportation. And when we don't have these funds to help reach out to those patients, I think we'll see the numbers continue their upward trend.
NOGUCHI: Mark Burkard directs the Holden Comprehensive Cancer Center at the University of Iowa. He had been hoping to expand use of centralized cancer specialists to patients in rural hospitals around the state.
MARK BURKARD: That process of advancing that network to deliver quality care will be interrupted if we need to focus on our immediate budgetary needs.
NOGUCHI: That poses a conflict for Kathie Evenhouse. She voted for President Trump and supports, in concept, federal spending cuts. But now she sees the downsides.
EVENHOUSE: It is hurtful just to the good things to cut it off, but I do think that we had to do something. I think it could have been done with a scalpel instead of a hatchet.
NOGUCHI: She says the cuts ought to be, like surgery, more precise.
Yuki Noguchi, NPR News. Transcript provided by NPR, Copyright NPR.
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