Lyme Disease Awareness Month: The great tick off!

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The vast Minnesota wilderness is one of the reasons so many choose this state as their home. Living in Minnesota is like being one with nature. You can find a bounty of natural beauty just a short distance from your home. From lakes to wildlife, Minnesota has everything that makes our world special. However, nature also includes ticks and the bacteria they may or may not be carrying. May is National Lyme Disease Awareness Month, and Tri-County Health Care wants you to enjoy the outdoors safely this summer.

What is Lyme disease?

According to the Minnesota Department of Health, Lyme disease is a bacterial infection spread by tick bites. Primarily, this disease is spread by blacklegged ticks, commonly referred to as deer or bear ticks.

In the spring and summer, ticks begin searching for their first blood meal, which usually consists of rodents. Ticks are commonly associated with forests, but they can easily find their way into residential neighborhoods on the backs of mice and even pets. Luckily a tick needs to be stuck to the skin for several hours to transmit disease. Diseases carried by ticks include:

  • Lyme disease
  • Anaplasmosis
  • Babesiosis
  • Ehrlichiosis
  • Powassan virus disease
  • Borrelia miyamotoi disease
  • Borrelia mayonii disease
  • Rocky Mountain Spotted Fever
  • Tularemia

By far, Lyme disease is the most prevalent tick-borne disease. Experts are closely monitoring the spread of this disease and have noticed its frequency steadily increasing.

This video by Minnesota Lyme Disease Association puts the issue of Lyme Disease in Minnesota into perspective.


Lyme Disease Awareness Month is about learning the causes.

Symptoms and treatment

Symptoms usually appear within 30 days of the initial bite. One of the most common symptoms is a rash at the site of the bite. Sometimes it may appear to be a bulls-eye with a raised red sore in the middle and a circular patch of red skin around it. People may also experience chills, muscle pain, headaches, and fatigue.

If these symptoms appear, seek medical attention immediately. The chances of treating Lyme disease are better with early detection. After thorough examination and testing, treatment for Lyme disease includes antibiotics.


The best way to prevent Lyme disease is to avoid ticks. Wear appropriate clothing that covers your body when exploring the outdoors. Also, make sure to use insect repellent. Additionally, when you return home, do a tick inspection. For example, use a mirror to examine your body for the tiny pests. If you discover one, remove it with tweezers. Submerging ticks in alcohol is a way to kill them.

Throughout Lyme Disease Awareness Month, Tri-County Health Care aims to make this summer safe for everyone. If you suspect you might have Lyme disease, please meet with your care provider as soon as possible. For scheduling, please call 218-631-3510.

Why I’m a nurse

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Generational care

I decided to work at Tri-County Health Care as I enjoy the small-town atmosphere. I am a native of Wadena, so it’s even more special because I’m taking care of the people I’ve known my entire life. With almost every patient I meet, there is a connection. I love to chat and calm the patient. Often people come into our facility feeling very nervous. Calming those nerves and reminding those patients of their value is important. Empowerment is a great tool I use every day. I cannot do the job I love without patients! They are a huge part of why I’m a nurse.

Tri-County Health Care is a fun, fast-paced clinic loaded with teamwork! You are never working alone, and there is always a staff member around to answer your questions. We are always smiling, even behind our masks. I work with multiple providers regularly. Each of them goes out of their way to make work a fun, efficient place.

Fun scrubs

Why I'm a nurse.

Amber Block, LPN

I started my nursing career in the hospital 15 years ago. The hospital taught me a lot, but I knew I wanted a day job. It took me about ten years to realize that I belonged at Tri-County. So here I am; I’ve been a nurse at the Wadena campus for almost four years. I couldn’t be happier! I always knew I belonged here.

Tri-County Health Care offers flexibility with scheduling and understanding when circumstances are out of your control. You also get to wear fun, bright-colored scrubs that patients love! I love picking out my outfit, knowing that I can turn a patient’s bad day into a good day with just my fun scrubs.

I’m proud to be part of the Tri-County Health Care team. Come join me; you won’t be disappointed!

A good fit for you

Tri-County Health Care has several openings for nurses. For more information, please visit our Careers page.

Meet Ashley Steen

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Meet Ashley Steen, FNP, DNP. Ashley works in ReadyCare and is no stranger to a fast-paced work environment after working in similar roles for nearly a decade. Her experience ranges from correctional medicine to dementia care.

“I was so amazed at how friendly everyone is and welcoming! I have truly walked into one big happy family. The culture is outstanding, better than any other organization I’ve been with. “– Ashley Steen

 Where it all started

Ashley received a big career push early on in life at her first job caring for people with dementia. In this home, she assisted people with their bedtime routines, which can be very challenging. Dementia behavior often made the job difficult, forcing Ashley to grasp new care techniques quickly. According to Ashley, this was the job that sparked her interest in the healthcare field.

 Care for everyone 

Ashley’s father was a police officer, and her mother worked in court corrections. She got used to hearing stories about her father arresting the same people and her mother processing them. This experience made Ashley curious about the criminal justice system, and the impact healthcare can have on repeat offenders.

“My nurse practitioner program focused on social justice and transcultural nursing.  As part of our scholarly project, we focused on a culture. I chose the culture of corrections and how we could help with recidivism. I found we are releasing people back to their communities with little to no resources,” explained Ashley. Her research led to her developing a reentry program at the local jail. This program involved interviewing inmates and gathering data. From the data collected, she came up with ten resources that people need upon being released. After this experience, Ashley kept volunteering in the medical unit at the facility. She has been doing this for three years now

 “I can read all the journals, books, attend all the conferences, but until I took the time to sit down and work in corrections and be with inmates on a daily basis, I never truly understood the disparity we serve them at times. “– Ashley Steen


For minor injuries and symptoms, consider using ReadyCare at Tri-County Health Care. ReadyCare is open Monday through Saturday. Patients should enter through the North Emergency Room entrance. Follow Tri-County Health Care on social media for future updates.

Dr. Britton and skin care for Central MN

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The following is a Q & A with Kristina Britton, MD, a dermatologist offering services throughout Central Minnesota. In this interview, she shares fun facts and a little about herself.

Skincare is self-care

Dr. Britton

Kristina Britton, MD

Q: When will you officially start seeing patients in the Tri-County Health Care Verndale Clinic?

A: We started seeing patients on April 14 and will typically be in Verndale two days per month.

Q: Have you worked around this area previously?

A: Yes. I previously worked for Dermatology Professionals and had also been providing outreach services for Tri-County Health Care once per month.

Q: What is the most exciting aspect of offering your services to the area?

A: The ability to provide dermatology services to patients in their community for those who have travel restrictions.

Q: Why did you choose your career?

A: I have always wanted to be a physician, and dermatology interested me. What drew me to it was the ability to treat patients from infants to the elderly. I enjoy building long-term relationships with patients who suffer from chronic diseases. The challenge of procedures and diagnosing complicated cases is very rewarding.

Dr. Britton versus the sun

Q: What are the benefits of maintaining healthy skin?

A: Taking care of your skin decreases the risk of skin infections and getting rashes. Often dermatologic conditions are visible and can result in lower self-esteem. Utilizing a dermatologist to manage and resolve these conditions can help patients feel better about their appearance, positively impacting their lives. Lastly, the better you protect your skin from the sun, the less likely you will get skin cancer.

Q: What are some basic things people can do to improve their dermatological health?

A: I am a strong proponent of sun protection when you are outside, including hats, sunglasses, sun-protective clothing, and sunscreen. I strongly recommend mild cleansers when bathing and applying a good moisturizer daily to the entire body.

Q: Why do you think there is a shortage of dermatologists in Central Minnesota?

A: In general, few new dermatologists graduate every year, and they typically choose to practice in metropolitan areas. Many dermatologists don’t work full-time, limiting their availability to see patients.

Q: What do you do for fun? Do you have any interesting hobbies?

A: I enjoy gardening, hiking, reading books, and playing with my three Great Danes.

Q: Do you have a family?

A: I have been married to my high school sweetheart for over 25 years. We have two grown sons. Our oldest is an electrician working in the Brainerd Lakes Area, and our youngest is a firefighter in the Army, currently stationed at Fort Carson in Colorado Springs, CO.

For scheduling with Dr. Britton, please call 218-454-3376. A self-scheduling option is also available. For more updates, follow Tri-County Health Care on social media.

The mission so far: Bobbi Adams

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I have received the great honor of being the next Chief Medical Officer at Tri-County Health Care. I want to thank my many coworkers and predecessor Benjamin Hess, MD. My Tri-County family has trusted me, and I won’t let them down! The mission has been challenging so far, but we can overcome anything together.

The pandemic has been stressful for our healthcare system. I’m glad that I’m beginning my tenure while it is declining. I hope with all of my heart that trends continue downward so we can return to the things we love. The biggest challenge in my new position is helping our medical team navigate the ever-changing COVID-19 landscape. I’m proud to be a part of a great team working to balance our current risks while maintaining a high level of precaution for any future threats.

Ushering in the new

In addition to combating COVID-19, I have the task of helping dozens of medical professionals acclimate to a new building. This task will require more work and attention to detail to make a safe and seamless transition for our staff and our community. We will make the big move in about a year, and I couldn’t be more excited.

Change is scary, but it can also be therapeutic. Some much-needed changes are on the horizon, and some of those changes generate anxiety. These are the kind of nerves that preface something great. As we make the change to Astera Health, our mission to be your trusted partner for life will not.

Dr. Adams and the mission so far.

Bobbi Adams, MD

About Dr. Adams

Dr. Adams has been a family medicine provider at Tri-County Health Care since 2000. Her 22 years of dedicated service are marked by a strong desire to help others while bringing new life into the world. When she isn’t in the hospital or clinic, she enjoys being with her family and tending to her garden. She’s also a big Minnesota Wild and Vikings fan.

Donate Life 2022: Kidneys and care

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Tri-County Health Care welcomed guests and donors to Donate Life 2022! Lois Miller, a Registered Nurse at Tri-County Health Care, organizes the event. The ceremony is the product of several months of organizing. Because of this, Lois takes great pride in the event and views it as a means of keeping organ donation in the minds of potential donors.

After a kickoff by Lois, LifeSource Representative Barb Nelson-Agnew took to the podium. She explained the importance of organ donation with the help of a special bee mascot. The bee danced and encouraged the crowd to sign up for organ donation. According to Nelson-Agnew, the bee represented the giving power of nature itself and was the perfect mascot to show how vital organ donation is. Cathy Dudley, a hospital liaison at Mayo Clinic, dawned the bee uniform. Tri-County Health Care was only one stop on her mission to get people to “bee a donor!”

The mascot was a fun aspect of Donate Life 2022

Dawn and Julia

This year’s ceremony included two speakers, Julia Snyder, a living organ donor, and Dawn Kemper, an organ donation recipient. The pair guided the small crowd through their personal journeys with organ donation.

Dawn Kemper participated in Donate Life 2022.

Dawn Kemper

In 2011, Dawn Kemper found out she suffered from polycystic kidney disease, a genetic disease that causes cysts to form on the kidneys. In 2014, she contracted a kidney infection that placed her on dialysis. She was able to recover from the infection and get off dialysis. However, her hope was short-lived. In 2016, after meeting with a nephrologist, Dawn learned she might need to be placed back on dialysis due to her declining kidney health. According to her doctor, she was at 6 percent kidney health. Dawn needed a new kidney and quick. She was eventually contacted for a kidney transplant, but that opportunity fell through. After an emotional journey to receive this kidney, she found out the kidney went to another recipient who required multiple organs. “God had different plans,” said Dawn.

Julia is a living organ donor, which means she is willing to donate organs or tissues while still living. During her tearful speech, she explained that she had never suffered from any health complications in her life. Julia changed after the death of a close friend who was also an avid believer in organ donation. This friend was always trying to get others to check the little organ donation box. This loss made Julia an advocate for the cause.

Kidney swap

Later on, after a failed attempt to donate to her nephew, Julia found the National Pair Exchange for organ donation. This system helps recipients pair with donors faster after experiencing compatibility issues. Through this system, Julia and Dawn met. The pair participated in a cross transplant with an unknown donor in Georgia. Essentially, Snyder wanted to donate a kidney directly to Kemper, but they were incompatible. After this, Snyder donated a kidney to the individual in Georgia and Kemper received a kidney from the compatible donor. This process is also known as a “kidney swap.”

Julia Snyder commented on her journey during Donate Life 2022.

Julia Snyder

Donate and live better

“The most amazing part was watching Dawn become healthy again,” remarked Julia. Furthermore, the pair shared the hope that others will consider organ donation. In conclusion, guests draped the Donate Life flag from a railing above, Drawing Donate Life 2022 to a close.

To learn more about Tri-County Health Care’s Garden of Hope or how to become an organ donor, please visit

Urology at Tri-County Health Care

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We believe care should be close to home and Sheila Gemar, MD, embodies that approach to health. No one should have to travel hours to receive specialty care, especially for individuals experiencing sensitive urological issues. A urologist is a specialist that focuses on medical issues affecting the urinary system. They are typically visiting specialists that serve several health systems. Urology at Tri-County Health Care will now be even more convenient with her addition to the team.

Finding passion

Dr. Gemar comes to Tri-County Health Care with over two decades of experience in urology. For the majority of her career, she has been an asset to small communities and the people that make them special. As a young girl, she grew up in a rural town in South Dakota where her father worked in healthcare. Because of this, she spent most of her adolescence immersed in the care setting.

Early in her career, Dr. Gemar discovered her love for helping others while exploring surgical specialties. She encountered urological specialists that always seemed to love coming into work. Their love for the field would lead Dr. Gemar down a path of urological excellence.


“With an older population, you need to have a special place in your heart to care for these people.” – Dr. Sheila Gemar

Dr. Gemar is extremely passionate about caring for the elderly with most of her patients being older. In an interview, she went on to explain how someday we will all be old so it’s important to have compassion for the elderly now. Respect for them is respect for ourselves.

Urologists diagnose kidney stones, prostate issues, and various cancers. Dr. Gemar understands the sensitive nature of the medical issues her patients face and she wants everyone to understand the value of regular appointments. Its important to not put off care out of embarrassment or shame.

For more information about urology at Tri-County Health Care, please visit and make an appointment by calling 218-631-3510. Also, follow Tri-County Health Care on social media for regular updates.

About Sheila Gemar, MD

Dr. Gemar loves the outdoors and when she isn’t in the office, she can be found outside taking in everything Minnesota has to offer. Hiking, biking and water skiing are some of her favorite ways to get moving.


COVID-19 endemic: hoping for change

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Tri-County Health Care has gone through some noticeable changes over the past weeks. Some plexiglass dividers have come down, visitors and guests have been invited back into the hospital setting, everything seems to be slowly returning to normal. Are we entering the COVID-19 endemic phase?

As the winter cold has left us, so has COVID-19 for the most part. According to the Centers for Disease Control, our area and the entire nation have seen a steady decline of COVID-19. On February 3, the CDC data tracker listed 351,465 new cases of COVID-19 in the United States. Less than two months later, that number has dropped to 9,011 new cases on March 20. Also, on February 3, the CDC data tracker showed 2,693 deaths, but on March 20, that number plummeted to 77 new deaths. At least for now, we are in a far better place going into spring.

COVID-19 Endemic

The drop in community prevalence has many throwing their masks away and returning to bars, concerts, and shopping centers. The decline has many experts speculating if the spread of omicron was the precursor to an endemic phase of the virus. An endemic phase would imply that COVID-19 is still present but localized to certain areas. Health organizations have not officially announced a transition to an endemic phase of the virus. People should still be taking precautions like avoiding crowds and social distancing.

The calm after the storm

We all want the pandemic to end, but we shouldn’t drop our guard just yet. Of course, breathe a sigh of relief. It was a hard winter fraught with illness and death. We all deserve some time to relax and hope for a better future, but we have to be steadfast in our mitigation to get there.

According to statistics gathered by the Joint Commission, on a county level, we have seen a slight increase in community spread. This could only be the natural rising and falling of data or a signal of the next surge. Over the last two years, we have experienced intense waves followed by lull periods. These moments of decreased activity were a welcome change of pace but ultimately fleeting. Cases rocketed upward only a short time later.

Active adjustments

Tri-County Health Care holds patient safety above all else. We have reformulated our standards of mitigation to offer increased protection while allowing for a certain level of convenience in our care. Our level of mitigation will rise and fall with the community prevalence of COVID-19. Numbers are on the downswing, so we are opening up, but we are ready to swiftly reinstate the same level of mitigation techniques in the event of a surge.

The only way to end the pandemic is with collective effort. Mitigation needs to be at the forefront of our efforts. COVID-19 vaccination needs to be fully embraced if we are to finally end the pandemic. As of now, Wadena County is far below the vaccination rate required to achieve herd immunity. We are at 47.3 percent, according to the Minnesota Department of Health statistics prepared on March 17. 70 percent of our county residents need to be vaccinated to achieve herd immunity.

What do you think?

Do you think COVID-19 will ever end? Ask yourself that question and be reasonable in your answer. Do you think we are entering a COVID-19 endemic phase? We are curious about your thoughts on the current state of our pandemic. Feel free to share in the comment section.

To schedule vaccination, call 218-631-3510. Patients can also receive the COVID-19 vaccine during a regular appointment with their provider. Please follow Tri-County Health Care on social media or visit for regular updates.

PeriWatch Vigilance: Keep an eye on baby!

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Technology and medical care go hand in hand. The obstetrics department is no different. Bringing new life into the world is facilitated by skilled staff and high-end equipment. Those staff members need a way to harness the full potential of information technology so they can observe babies from anywhere! In June 2022, Tri-County Health Care will begin using PeriWatch Vigilance, an automated early warning system and support tool.

Continuous observation

This new technology is all about helping staff keep a closer eye on the babies they’re monitoring. Additionally, the software allows nurses to better cross observe each other’s patients and view fetal monitoring strips from anywhere. Furthermore, by using artificial intelligence and constant analysis, medical staff can be immediately notified of an issue with a baby. Now an OB provider can provide feedback and monitoring for a newborn in a completely different area of the facility.

The early detection system relies on color-coding. When the software detects an abnormality, information displays in orange. This color change prompts nurses and doctors to be on high alert. If the color changes to red, something is wrong, and the baby could be in danger.

Thoughts from Sarah

Obstetrics Supervisor Sarah Riedel was excited to demo the new PeriWatch system. She and her team are always on the lookout for ways to provide an even safer care environment. To them, the early detection system seemed to be a great way to always keep an eye on the babies, even from a distance! “It will be safer for babies. We can intervene quicker if we are aware of the problem,” explained Sarah. She predicts the PeriWatch system will be fully operational in early June 2022.

For more information about birthing services at Tri-County Health Care, please visit

Watch the video below for more background information on PeriWatch Vigilance.

Nutrition Month 2022: A message from our dietitians

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Nutrition month is upon us! Take this month to assess the food going in your body. Registered Dietitian Shelby Hunke shines a light on diabetes management during this month of nutritional awareness.

Understanding diabetes

There are multiple forms of diabetes. Type 1 diabetes is purely genetic and occurs when the body cannot produce insulin, a hormone crucial in converting blood glucose into energy. Type 2 diabetes is also genetic but heavily influenced by lifestyle choices. With type 2 diabetes, the body doesn’t utilize insulin properly, so medical intervention is necessary. Diet, exercise and proper management with the help of a care team are essential components of living with diabetes.

The third form of diabetes is gestational diabetes. This kind of diabetes occurs in some individuals during pregnancy. It can be dangerous for the mother and baby, so it’s important to monitor sugar levels while regularly meeting with a doctor.


Prediabetes refers to the time before a person develops type 2 diabetes. Many people are prediabetic and don’t realize it. Some of the signs and symptoms may exist, like elevated sugar levels. Being diagnosed with prediabetes can often lead to a significant turning point in nutritional behaviors. By following a plan, it is possible to prevent diabetes.

A message from Shelby

If you’ve been diagnosed with diabetes, don’t panic. I’m here to help! For starters, it’s important to work with your provider and a dietitian to craft a plan that works for you. For many people, I will recommend the “Diabetes Plate Method,” promoted by the American Diabetes Association. Its sometimes referred to as the Mediterranean Diet. This diet involves making half your plate non-starchy vegetables, ¼ protein and ¼ carbohydrate foods. Also, try really hard to avoid sweet drinks. Choose water and low calories drinks as much as possible.

I’ve been digging through my recipes and found a really fun one for you to try during Nutrition Month. Having diabetes doesn’t mean you can’t enjoy good food; it means you have to get a little creative. Happy nutrition month, and stay healthy!

Soppy JanesDiet is a crucial part of managing diabetes.

Source: Sloppy Janes (

Required items:

  • nonstick cooking pan
  • a diced medium onion
  • 1 seeded and diced medium red bell pepper
  • 1 clove of minced garlic
  • a pound of lean ground turkey
  • 1 tablespoon of tomato paste
  • 2 tablespoon Dijon mustard
  • 1 tablespoon of hot sauce
  • 2 cups of canned crushed tomatoes
  • 1 tablespoon of honey
  • ½ teaspoon of black pepper
  • 8 whole-wheat hamburger buns


  • Apply cooking spray to the nonstick pan over medium-high heat
  • Put the onion, red bell pepper and garlic into the pan. Sauté for 5 minutes while stirring regularly.
  • Add the turkey and continue to sauté for 5-7 minutes. Stir regularly until the turkey is cooked.
  • Add the tomato paste, Dijon mustard, hot sauce, tomatoes, and black pepper. Let it simmer for 5 minutes and stir frequently.
  • Fill each bun with the mix and enjoy. This recipe should make around 8 Sloppy Janes.

About the author

Shelby Hunke RD, LD, CDCES, lives in Wadena with her husband and kids. She is passionate about nutrition and spreading her knowledge and experience with others to make healthier lifestyle choices. She works in the dietary department at Tri-County Health Care and sees patients at the Wadena clinic location.

Blood Crisis: The worst shortage in a decade

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The pandemic has caused a whirlwind of changes throughout our nation, supply chain issues being one of the most observable. No one can ignore bare shelves at the grocery store, a lack of consumer electronics, or not being able to purchase a new car because the inventory simply isn’t there. To a certain extent, we can make do with those shortages, but we can’t ignore blood. Having a reserve of this vital fluid is necessary for medical care. Without it, the blood crisis could lead to needless death.

Crisis and cancellations

According to the American Red Cross, their organization faces the worst blood shortage in over a decade. This shortage forces care providers to prioritize transfusions—all on top of combating an ongoing pandemic. The Red Cross reports that blood donation has dropped by 10 percent since March 2020. This drop can be attributed to many things, mainly staffing shortages, canceled drives, and issues stemming from the COVID-19 pandemic.

The Red Cross is in serious need of blood types like O positive and type O negative. O positive is the most common blood type. Furthermore, O negative is considered a universal blood type and is readily given out in emergencies. Additionally, valuable platelets responsible for clotting are in high demand.

Hitting close to home

The blood crisis is causing anxiety for medical staff.

Molly Tabery

Manager of Strategic Marketing for Tri-County Health Care, Molly Tabery, is responsible for coordinating Tri-County Health Care partnered blood drives. Staffing issues led to two blood drives being canceled in the last few months. A lack of blood doesn’t just affect large communities; it impacts small-town hospitals, too. “Having access to blood is such an important thing for a hospital. I can only imagine how stressed doctors and nurses are right now! We really need people to donate,” explained Molly.

Upcoming drives

Please use the scheduling feature to view upcoming drives. Donors should schedule additional appointments when drives are canceled. Take time to consider donating to help the Red Cross out of the crisis. If you’re a first-time donor, please use the American Red Cross website for helpful information.

Maslowski Wellness & Research Center

March 3, 9 a.m. – 3 p.m.

17 5th Street SW

Wadena, MN 56482

Bluffton Community

March 8, 1 p.m. – 7 p.m.

202 Center St

Bluffton, MN 56518

Verndale High School

March 16, 9 a.m. – 3 p.m.

411 SW Brown St

Verndale, MN 56481

The value of rural healthcare

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I’ve spent over three decades engaged in almost every conceivable aspect of healthcare. Since the late 1980s, I’ve been involved in the business, finance, recruitment and general operations of hospitals all around the United States. I’m no stranger to waxed floors and white lab coats. I know from firsthand experience that having a local clinic or hospital extends far beyond having medical services within reach. A hospital is a foundational institution that marks the growth, stability, and vitality of a community. The presence of a medical facility means an established community placing a strong value on health and wellness. My experiences do give me an interesting perspective on the value of rural healthcare.

In my career, I’ve had the opportunity to open or expand exceptional facilities that would go on to be public fixtures for better living, but I’ve closed facilities as well. I want to share some personal experiences regarding opening and closing, hoping they will reinforce the value of rural healthcare, especially in smaller communities.

Opening and maintaining

In 1990, I assisted in reestablishing a community hospital in Nevada that was on the verge of closing down. Almost immediately, I could see this facility’s value for the surrounding community. Luckily, the management company I worked for at the time helped the community set up a new not-for-profit corporation. A board was organized, and we negotiated separation from the regional health care system that was planning to close the facility. We helped secure financing for operating capital and recruited new leadership to officially reopen the facility.

Today they are a thriving small community health system much like Tri-County Health Care. The takeaway from this situation is that avenues do exist to maintain a healthcare system. Opening a new facility is tough, but so is closing one. A community rallying together to maintain a hospital is necessary, so my advice is to foster deep relationships with the community. Remember that we serve our neighbors, friends and families. We all have the same goal in the end.

Closing down

A year after the Nevada facility noted earlier, I shifted my focus to another small community. Unfortunately, I wasn’t called upon to reorganize and reopen but to close a small community-owned hospital in North Dakota. We spent approximately three months in our analysis and managing the facility to help stabilize the situation. Unfortunately, our analysis did not prove to offer much of a solution; it was the beginning of the end. We couldn’t do much due to a challenging rural health financial environment and receiving the call several months too late.

Shutting down a hospital or clinic is a very methodical and tiring process because a hospital is ingrained in every aspect of the community. The amount of financial and legal hurdles that need clearing in even a small facility can be staggering. The process included a review of staffing, financial considerations, market considerations and community perception issues. Considering all of this, circumstances dictated the decisions, not by anyone’s expectations or resolve to make it better. We guided the shutdown process along with a bankruptcy attorney and trustee. We would finish one project, only to reveal ten more. Informing the community and organizing transition plans proved to be the most gut-wrenching.


Impact on the community was, of course, difficult. The loss of services meant that most community members had to travel 15 miles or more to receive care. The local economy also suffered; the hospital had provided over 70 jobs. When you close down an organization like this, you not only lose jobs, but also the commerce invested in the community. Such a closure also brings unforeseen circumstances like the local nursing home having to find another medical partner for various services like lab work.

This isn’t discussed in board rooms or bank offices, but the loss of community pride is inherently noticeable. It isn’t like a coffee shop or hotel shutting down; you can’t just start a new hospital down the street. If a community can’t even protect its own well-being, are they a community at all? Something to think about.

The new building

Another aspect I have much experience with is the construction of new facilities. The key steps to successful projects are identifying the needs, evaluating various options, performing financial feasibility studies, and planning the project with input from the individuals closest to the work. Engaging a solid team of planners, architects, engineers, and contractors is important to bring about a new vision. I don’t know everything, and I know when it’s time to lean on others.

I want to touch on something that doesn’t often get brought up, which is moving day. Setting up a new hospital isn’t as simple as cutting a ribbon and ushering staff and patients through the door. Setting up a proper, efficient hospital requires working with internal leaders and external advisors to orient the new space. This step is critical to ensure a smooth transition. Methodical move-in practices combined with specialized training should be paramount before operations start or resume. The worst thing is having a beautiful new hospital, but it’s filled with staff who can’t find the supplies and equipment they need. A well-organized and choreographed move-in is first and foremost about patient safety.

Current status

The first portion of construction on our new building just drew to a close. The walls went up relatively quickly, and we now have a fully enclosed structure. Seeing its development step by step has been a beautifully enlightening process. New buildings are great, but the new building is only as good as the staff you put in it. I’m fortunate to have a wonderful group of professionals working with me at all times. The staff combined with this new facility will bring a new era of wellness to the City of Wadena and, in many ways, the entire central part of the state.

Thank you for reading and please try to remember the value of rural healthcare.

Joel Beiswenger understands the value of rural heatlhcare.

About Joel

Joel received his Bachelor in Business Administration degree from the University of North Dakota in 1986, and his Master of Health Care Administration degree from the University of Minnesota in 2010. He is also a Certified Public Accountant. He has been in the health care management field since 1986. Joel has been a part of the Tri-County Health Care family since 1998. Joel is passionate about conveying the value of rural healthcare while giving back to the community.


What is Shoulder Replacement?

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What is shoulder replacement? Many patients have asked about shoulder replacement, wondering if they are a candidate for this procedure. There are several causes of shoulder pain, and not all shoulder pain requires surgery.

The shoulder and its components

The shoulder is a complex joint. It is considered a ball and socket joint, similar to the hip joint. However, the socket for the shoulder is very shallow. The shallow socket allows our shoulders to have such incredible range of motion. This same range of motion makes the shoulder intrinsically unstable. The shoulder is highly complex, with multiple tendons and structures that make movements possible. This complexity means there can be several causes of shoulder pain.

When a patient presents to the orthopedic clinic for shoulder pain, we look for these different sources:

  1. Rotator cuff tendonitis, bursitis or a tear
  2. Neck pathology
  3. Labrum tears
  4. Shoulder joint arthritis
  5. Combination of rotator cuff tear and arthritis

Assessment and treatment

We use medical history, a physical examination, x-rays and occasionally an MRI or CT scan to help us understand the cause of the pain. Shoulder arthritis and a combination of a rotator cuff tear and shoulder arthritis are the main indications for shoulder replacement. Before considering surgery, we explore other options like medication, steroid injections, activity modification and physical therapy.

When conservative measures are not helping, then we consider surgical treatment. Surgical treatment includes a total shoulder arthroplasty (shoulder replacement) or a reverse total shoulder arthroplasty. The difference between these two surgeries involves the ball and socket. When a patient has arthritis of the shoulder joint with a rotator cuff that is intact and functioning well, we can do a standard shoulder replacement. For this type of surgery, we attach a small shallow plastic socket to the worn-out socket. We remove the worn-out ball and replace it with a new metal ball attached to a stem. This new ball and socket joint is still unstable, so we rely on the functioning rotator cuff to provide stability, just like a healthy shoulder. This allows for a nearly normal, pain-free range of motion and strength.


We cannot do a standard shoulder replacement when a patient has arthritis combined with a large irreparable rotator cuff tear. In these cases, we do a reverse total shoulder replacement. This surgery involves attaching a ball to the worn-out socket and removing the worn-out ball, then replacing it with a deeper socket. This replacement creates a more stable ball and socket joint. It also allows the ball to become the fulcrum so the arm can rotate. It alleviates pain and improves function. The trade-off with a reverse total shoulder replacement is reduced range of motion. Therefore, we do this surgery only when the rotator cuff is not functional or repairable.

The surgery usually takes a little over an hour, so most patients spend one night in the hospital and are discharged the next day. Recovery involves six weeks of physical therapy. The patient has to wear a sling during recovery. Following this initial period of immobilization, we progress to active range of motion, then strength conditioning. Total recovery time is approximately 4-6 months. Most patients feel their pain is improved within a few days to weeks.

About the author

Dr. Robertson is an expert in shoulder replacement.

Ben Robertson, MD

Ben Robertson, M.D. is an orthopedic surgeon at Tri-County Health Care serving patients in Wadena and Baxter. He attended medical school at the Medical College of Wisconsin and completed his residency at the University of Minnesota. Additionally, he also completed a sports medicine fellowship in Oslo, Norway. He specializes in sports injuries, knee ligament reconstruction, and shoulder, hip, and knee replacement. Outside of work, Dr. Robertson enjoys bicycling, reading and spending time with his wife and three children.