Maintaining health in a climate of failing rural hospitals
By Kelly Ottinger
For the past 87 years, the small beachside city of Frankfort—notably the only city in Benzie County and home to nearly 1,500 year-round residents—has had its own hospital, though the name and location has changed a bit over the years.
“Through time, an interesting mixture of locals and summer residents have come together to support the hospital staying right here [in Frankfort],” says Ralph Jackson, the step-son of nurse Ena Kraft Jackson, who—along with her parents, Lula and Herbert Powers—worked to establish the Anna Markham Memorial Hospital in November 1937.
Pre-dating this hospital, however, there was already a rich and varied story of medical care in the Frankfort-Elberta area; and after Markham came what we now know to be Paul Oliver Memorial Hospital, which ranked last year among the 15 top-performing rural hospitals in Michigan. Coupled with new equipment and programming, it seems clear that this venerable Frankfort institution is only improving with age.
Dr. Frank La Rue and his wife, Ellen, came to Elberta in 1906. Dr. LaRue had been born in Empire, Michigan, in 1872, and his parents were the first non-native settlers in the area. Ellen, having been born in Norway, came to the United States with her family when she was 16 years old. Originally working as a maid, Ellen eventually became trained as a registered nurse.
In what is now known as the La Rue House Bed & Breakfast, the husband-and-wife team cared for patients for many years—delivering babies, tending to accident victims, and performing surgeries. The first floor of the home served as the doctor’s office and infirmary, and in-patients were cared for on the second floor. The La Rue’s services extended to the entire Frankfort-Elberta area, via house calls to citizens all throughout the countryside.
The La Rues were known not only for being ahead of their time with medical expertise (successfully treating many cases of pneumonia before antibiotics were readily available), but they were also known for their humanitarianism and generosity. A June 16, 1949, edition of the Benzie County Record Patriot stated that, at the end of his career, Dr. LaRue had “about $100,000 outstanding on his books,” an astronomical amount for those times.
Meanwhile, in the 1920s, a woman named Lenore Herban became licensed by the state to care for as many as three maternity patients and their babies at a time, and she did so in her home on Frankfort’s James Street. Herban’s care was limited to maternity patients, with the exception of one gallbladder surgery that was performed on her kitchen table.
Then, in 1931, Adele McKinnon Haldeman, along with help from the local Rotary Club, built a home at 107 Park Avenue that could accommodate a small number of maternity and surgery patients—newly widowed, Haldeman received her license for care of maternity patients and opened “Haldeman Hospital,” in memory of her late husband.
In 1933, Ena Kraft Jackson became one of the part-time nurses working at the Haldeman Hospital. When Haldeman Hospital fell victim to the financial woes that were typical of small community hospitals, the decision was made to shutter the doors in 1937.
By this time, the community was becoming increasingly aware of the need to continue maternity and hospital services in the area, and so Ena Jackson worked to continue Haldeman’s work by—along with her parents, Lula and Herbert Powers—establishing the Anna Markham Memorial Hospital at 611 Forest Avenue. The new hospital (named for Herbert Powers’s late mother) continued the work of Haldeman Hospital, even using some if its original equipment, through the time when today’s Paul Oliver Memorial Hospital opened its doors in 1951.
As the patient load increased at the Anna Markham Hospital, Ena Jackson and her parents were literally pushed out of their home—the family found a small cottage for sale, which was moved and attached to the back of the hospital. There they lived, running the hospital from that cottage, until moving to another home on Leelanau Avenue at a later time.
Dr. Fredrick Trautman, assisted by Ena Jackson (who also administered anesthesia under doctor supervision) welcomed Anna Markham Memorial Hospital’s first patient in November 1937, and a healthy baby girl was born before day’s end.
Over time, the Anna Markham Hospital tended to surgical cases, in addition to the maternity focus. Surgical instruments were donated by the physicians and were sterilized in pans of boiling water on the kitchen stove, until a steam sterilizer was purchased from a company in Grand Rapids.
Ralph Jackson’s wife, the former Peggy Bennett, who grew up in Frankfort, recalls being a surgery patient at Anna Markham.
“I had my tonsils removed there when I was about five. And then, when I was in third grade, I needed to have my appendix removed,” she says. “What I remember most about that is, after the surgery, Dr. Trautman carried me up the stairs to my room.”
By the close of World War II, the Anna Markham Hospital was also in financial distress, just as its predecessor had been. Although the hospital was considered a vital component of the community, by 1944, closure seemed inevitable.
Many concerned citizens—spearheaded by A.P. Peterson, owner-editor of the Record Patriot at the time, and Dr. Paul and Mrs. Elizabeth Oliver from Chicago—worked to form the Benzie Hospital Association, a non-profit organization that was dedicated to planning and raising the funds for a larger, more sustainable hospital. (Note: The Elizabeth Lane Oliver Center for the Arts, or the OAC for short, was formerly the Crystal Lake Art Center and is now celebrating its 70th year as a cultural cornerstone of Benzie County; the art center was renamed recently after Elizabeth Lane Oliver, an artist and a patron of the arts.)
Land and financial pledges were obtained, with Elizabeth Oliver getting the ball rolling with her own pledge of $25,000. A business manager was appointed to the Anna Markham Hospital, so that it could continue in its capacity until all equipment and assets were turned over to the new hospital in 1951, at the time of transfer of patients.
Ena Jackson was asked to be the director of nursing at the new hospital, and in her book A Nurse Remembers: Generations of Loving Care, Birth Bandages, & Bedpans, she recalls moving day to the new hospital:
“We contacted George and Cyril Bennett [owners of the local mortuary and ambulance service] beforehand. Patients and staff were fed their noon meal, and shortly afterward George and Cyril arrived with their ambulances.”
By late afternoon, all 10 adult patients and five newborn babies were in their beds in the new hospital.
It was decided that the new Frankfort hospital, located at 224 Park Avenue, should be named after Dr. Paul Oliver, thanks to his contribution of so much time and financial support to the hospital.
Rural Community Hospitals
A new era had begun for Frankfort with the burgeoning Paul Oliver Memorial Hospital in 1951, but the work of keeping a hospital operating in a small community was far from over—although the American Hospital Association recognizes that rural hospitals are “economic drivers in their communities,” oftentimes, the hospitals themselves struggle to survive.
Cecil G. Shep’s Center for Health Services Research at the University of North Carolina found that, between 2010 and 2018, 83 rural North American hospitals had closed and nearly 700 more are at risk. The most recent Northern Michigan rural hospital closing was Cheboygan’s in April 2018.
One month later, in May of this year, George Pink, deputy director of the North Carolina Rural Health Research Program, released a statement saying, in part: “Rural closures affect patients who are older, sicker, poorer, and less likely to be insured, leaving already-vulnerable people at increased risk. Many patients must then travel 25 miles or more for medical services. This distance can be a very real barrier to obtaining needed care.”
What keeps Paul Oliver Memorial Hospital—a now 67-year-old, full-service medical facility with 39 beds—securely anchored in the small City of Frankfort, population of barely 1,500 year-round residents?
“We’re very committed to being a presence in the community,” says Stephanie Williams, manager of community outreach for POMH. “We’re not just here for emergency services and convenience, but also for wellness and nutrition services and connection to the schools.”
Williams goes on to say that the hospital, which became part of Munson Healthcare in 1985, works to grow community partnerships and to stay current on services that are typically offered in more populated areas.
For example, Paul Oliver has begun offering baseline concussion testing for student athletes—all student-athletes at Benzie Central High School are tested during their first season (typically freshman year), and all high school students at Frankfort are tested in physical education class, regardless if they participate in school sports. (Other area schools and students are invited to get testing done also, for a small fee.)
“POMH Sports Medicine has a heavy focus on injury prevention and prides itself on being up to date on current evidence for return-to-play for student-athletes,” says Adrienne Jones, a sports-med-focused physical therapist who is also POMH’s rehab manager.
Other examples of school connections include providing athletic training services for Benzie County Central Schools for the past four years, and a new contract beginning this fall with Frankfort High School, as well as free off-season strength-and-conditioning work-outs for student-athletes at the Betsie Hosick Health and Fitness Center. Additionally, more than 300 local students received trauma prevention and water safety education in 2018.
For the adults, Paul Oliver is dedicated to tackling some of the top-rated health and social challenges that were identified for Benzie County in the Munson Community Health Needs Assessment from 2017.
Of Michigan’s 83 counties, Benzie ranks 38th overall for the categories including length of life, quality of life, health behaviors, clinical care, social and economic factors, and physical environment. The top three identified health issues are high blood pressure, diabetes, and obesity.
POMH is the provider for Benzie’s “Fruit & Vegetable Prescription Program,” working in partnership with Grow Benzie, Crystal Lake Health Center, Benzie Area Christian Neighbors (BACN), and Benzie Senior Resources. During the summer of 2017, more than 500 people attended 30 cooking demonstrations that highlighted recipes which were focused on healthy eating for maximum nutrition. Moreover, 240 hours of support is given annually for “Active Steps,” a free exercise class for individuals with diabetes, and for “Journey,” a free exercise class for individuals with cancer.
The hospital also offers free movement and balance classes for seniors in seven locations county-wide, as well as the “Parkinson’s Bravery Brigade” support group, which uses evidence-based exercise programs and showcases a speaker series.
In the summer—when Benzie County hosts its annual plethora of visitors—Paul Oliver sponsors a variety of outdoor summer programs, including trail biking, beach volleyball, free walking groups, and fitness-equipment instruction, in partnership with the Elberta Greenspace Grant. These types of activities help to keep summer guests engaged in the desire to keep the hospital’s presence available to all—local and seasonal residents alike.
In addition to community outreach, the hospital has worked to continually expand its breadth of medical services. Benzie County residents no longer have to travel to Traverse City or downstate for many services, such as diagnostic imaging, dialysis, skilled rehabilitation, and cardiac and pulmonary rehab.
The Paul Oliver Memorial Hospital Auxiliary, currently under the direction of Sharon Grajcar, is a volunteer-based fundraising organization that works to promote and support healthcare in Benzie County. The group runs the hospital’s gift shop and hosts several fundraising events each year, including the beloved annual Tour of Interesting Places. Over their 67 years of service, the Auxiliary has raised more than $1.2 million, which has provided for state-of-the art imaging and a variety of other equipment needs for the hospital.
The hospital also invested $300,000 in the purchase of the 30-year-old Frankfort fitness center a decade ago and has provided more than $90,000 in subsequent gifts to purchase and maintain equipment, as well as providing programs. To encourage greater use, the fitness center is looking into using an income-based fee structure and offering scholarship programs, so that all local families can take advantage of the fitness opportunities, Fit Kids wellness program, and youth exercise space and activities. (Of note: when POMH purchased the fitness center, it was renamed from the Betsie Valley Fitness Center to the Betsie Hosick Health and Fitness Center, named after Betsie Hosick, the granddaughter of Dr. Paul and Mrs. Elizabeth Oliver.)
The Long Haul
Not yet in place, some initiatives that are being studied for the hospital’s future offering include:
- Local schools and Traverse Bay Area Intermediate School District (TBAISD) career development and internship opportunities
- Expansion of athletic-training services to additional local school districts
- Fitness center program outreach to additional locations
- Diabetes education outreach to additional locations
- Expansion of opioid treatment and prevention
Will Paul Oliver be able to remain the vital community cog that it is today, when so many other small hospitals have failed? History—and hard work on both the part of the hospital and of our community—says yes. That supportive “interesting mixture of locals and summer residents” is still going strong.
“The hospital has worked to significantly expand [its] capability,” Ralph Jackson says. ”For example, the new cardiac rehab [center that will open this fall]. We continue to enjoy good, strong leadership in this community. We all want this hospital to stay.”