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OHSU-St. Charles Three Sisters Rural Track Program trains family medicine physicians, aims to improve health care access in rural Oregon

PORTLAND, Oregon -- Two newly minted physicians are the first trainees of the Three Sisters Rural Track Program, or RTP, a three-year family medicine residency program that is Central Oregon’s first graduate medical education program.

Oregon Health & Science University and St. Charles Health System jointly established Three Sisters RTP to help grow Central Oregon’s health care workforce and meet the unique health needs of rural Oregonians. Organizers hope many of the new program’s participants will continue to live and work in Central Oregon after they complete their residency.

The residents began their advanced medical training at OHSU this month. Next summer, the residents will head to St. Charles Madras — a 25-bed critical access hospital located about 50 miles north of Bend — for two more years of training.

“We are excited to welcome the first residents of the Three Sisters Rural Track Program, and eager to help them provide thoughtful, comprehensive health care for the people of Central Oregon,” said Three Sisters Rural Track Program Director Jinnell Lewis, M.D., who is also a family medicine physician with St. Charles. “Once at St. Charles, the residents will immediately help fill a need in the region, providing care for an estimated 900 patients a year.”

The program creates a pathway for specially trained physicians to dramatically improve health care access in Central Oregon, where many towns have a shortage of providers. Research has shown that about 55% of physicians stay within a 100-mile radius of their residency site. This means, within 10 years, Three Sisters RTP is estimated to produce 23 physicians who would reside in Central Oregon and provide care for 20,000 to 40,000 patients in the region.

“It’s hard to overstate the powerful positive impact this program can have,” Lewis said.

Lewis moved to Central Oregon about a decade ago, after she completed another OHSU residency program that is focused on rural health: the Cascades East Family Medicine Residency in Klamath Falls. Three Sisters RTP is partly modeled after Cascades East’s more than three decades of success.

Residency programs provide additional training for physicians who recently completed medical school. Three Sisters RTP focuses on family medicine, a primary care medical specialty that involves caring for the whole family, ranging from children to pregnant people to seniors. Family medicine physicians offer broad care, and help patients both manage existing health conditions and prevent others. In rural areas where there are fewer physicians, primary care providers play a particularly important role in keeping their communities healthy. In addition to primary care, Three Sisters RTP residents will also train in family birthing, emergency medicine, behavioral health and hospital medicine.

One of the new Three Sisters RTP residents, Callie Krewson, D.O., was born at St. Charles Bend and graduated from Bend’s Mountain View High School in 2008. Krewson said she is excited to be part of the program’s inaugural class and would like to stay in Central Oregon after her residency.

“I look forward to returning to the places that I know and love,” Krewson said. “I want to give back to the community that raised me.”

During the residents’ first year in Portland, they will work and learn at OHSU hospitals and various outpatient clinics, as well as at the VA Portland Health Care System. And when the residents move to Madras for the final two years of their training, they will care for patients at the St. Charles Family Care Clinic in Madras and Mosaic Community Health’s Madras Health Center. They will also have learning opportunities at the Indian Health Services’ Warm Springs Health and Wellness Center.

OHSU is the host institution for Three Sisters RTP, and St. Charles is its primary training site. The program’s launch was made possible by a $750,000 grant from the U.S Department of Health and Human Services’ Health Resources & Service Administration, and a $1 million Healthy Oregon Workforce Training Opportunity grant. Donations to St. Charles Foundation will support ongoing training and recruitment efforts, technology upgrades and additional needs as the residency program grows.

The program’s launch is part of larger efforts to expand residency programs statewide. OHSU recently achieved the milestone of having more than 100 accredited residency and fellowship programs.

Meet the residents

Name: Callie Krewson, D.O.

  • Age: 33

  • Hometown: Bend, Oregon

  • Family: Husband, two dogs

  • Medical school: Pacific Northwest University of Health Sciences, Yakima, Washington

  • Looking forward to: Returning to and working in Central Oregon, including working at the Indian Health Services clinic on the Confederated Tribes of the Warm Springs Reservation.

  • Miscellaneous: She has helped lead rafting trips on the Deschutes River with her husband, who is a river guide.

Name: Ben Khalil, M.D.

  • Age: 34

  • Hometown: Richland, Washington

  • Family: Wife, two cats

  • Medical school: Oregon Health & Science University, Portland, Oregon

  • Looking forward to: Combining love of outdoors with passion for providing comprehensive health care.

  • Miscellaneous: While he enjoys trying new things, his favorite dessert will always be ice cream.

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When October Grimes was born in September of 2018, she arrived 14 weeks early and weighed just over 14 ounces.

Immediately, nurses in St. Charles Bend’s Family Birthing Center wheeled her away to the nearby Neonatal Intensive Care Unit, where they could give October the highly specialized and around-the-clock care she needed.

She would spend the next 126 days in the NICU, with her mother, Lindsey Beaver of Bend, by her side for four to 12 hours per day, said Grimes’ father, Olen Grimes.

“The staff and the doctors were super amazing, super transparent and super caring. They truly cared for all of us,” Beaver said. “They kept us updated at all times. They helped me feed her and helped me change her diaper. They’d get her out of bed and bring her to me — anything to help make me comfortable in what was a really trying time.”

So when a friend told Beaver and Grimes about St. Charles’ NICU Reunion — held on a sunny recent Sunday afternoon at the Bend hospital — the couple RSVP’d immediately.

“We’re forever grateful for this staff,” Olen Grimes said. “Anytime they’re going to do anything for the community, we’re going to support that.”

The NICU Reunion was an annual event for years before the COVID-19 pandemic shut down gatherings in 2020. This year’s version was the first since 2019, and organizers created a fun and family friendly atmosphere by bringing in interactive games, crafts, face painting, a photobooth, refreshments, a bouncy house and more. Dozens of former patients — known affectionately as “NICU grads” — attended along with their families, as well as doctors, nurses and other staff from the unit.

The goal: To bring together families and the people who cared for their babies for a time of reconnection and celebration, said Stephanie West, a CNA and unit secretary in the NICU.

“It’s really rewarding to see the kids and see how much they’ve grown since they left us,” she said. “It’s just a lot of fun and it brings us all a bit of joy.”

Rochelle Simonds has worked as a registered nurse in the Bend NICU for 18 years. She spent most of the reunion giving kids fake tattoos — and smiling.

“When I discharge patients and they’re going leave the NICU … I say, ‘I’ll see you at Costco’ or ‘I’ll see you at Target’ and that’s really why we’re doing this,” she said. “The whole point of our job is to partner with parents to give their babies a jumpstart, and then to see them grow up and thrive and meet their potential. So it’s really nice that the parents are willing to bring their kids to this so we can connect with them again.”

Two of the children Simonds tattooed were Colby Wilson, 5, and his younger brother Owen Wilson, 1. Colby spent 30 days in the NICU in 2018; Owen spent 49 days there last year, said their mother, Kristi Wilson.

“We got to know everyone here really well and we had such a good experience, so it’s fun to be able to come back and see the doctors and nurses and staff,” she said. “We’re excited to see some familiar faces and to show them these healthy, happy kids.”

The feeling is mutual, said Eric Stuemke, a transport RN in the NICU who was born at 34 weeks on the fifth floor of St. Charles Bend in 1979 — before there was a NICU.

“The unknown is hard sometimes when a kid leaves and you don’t get an update on them,” he said. “It’s nice to see the families you took care of.”

Standing in a room full of glittery stickers, stuffed animals, ice cream and extremely active kids, Lindsey Beaver and Olen Grimes said the reunion event was a good reminder that their tribe expanded by more than just one member when October, soon to turn 6 years old, spent four months in the NICU back in 2018.

“Even though I don’t see the staff all the time anymore, they’re still dear in my heart and I think about them all the time,” Beaver said. “They became family in a way, you know?”

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I recently received a heartwarming letter from a patient of St. Charles’ Bend hospital who had spent time in our Emergency Department, Imaging department, Medical Diagnostic Unit and Progressive Care Unit, encountering dozens of our caregivers along the way. He was grateful for the excellent care he received and highly complimentary of our staff – from the intake team to the doctors and nurses to the folks who cooked the food and cleaned the room.

We always appreciate hearing from patients here at St. Charles, but this letter particularly resonated with me because it came from a former colleague who spent decades working in health care at all levels, from the front line to executive leadership. He knows the industry inside and out, and he knows what it takes to provide high-quality care and a high-quality experience for patients.

This was, in other words, an especially informed patient. And he highlighted one experience at St. Charles that I want to share with you:

The nurse who had been caring for me for 12 hours was going home. She and the new nurse came into the room and the new nurse was introduced to me. Then the nurse who had been caring for me reached out to shake my hand and wish me all the best as I recovered. This small gesture has stuck with me, of all things. That simple gesture of respect during a vulnerable time for me was so kind and greatly needed. Shift change is a confusing time and this introduction helped greatly.

At St. Charles, we have the privilege of changing lives – even saving lives – every day. And when we tell our story, we have a tendency to focus on heroics in health care. But these moments of greatness wouldn’t be possible without all the small moments that make up each day – the warm smiles, the comforting words, the handshakes at shift change. These small acts of kindness create a culture of caring and compassion, and they accumulate to make St. Charles a force for good in Central Oregon.

As Michael Dowling, president and CEO of Northwell Health, wrote in an essay in early 2023, we must, “help ensure the value of health care is not defined by its highest highs or lowest lows, but by the millions of moments between the two in which lives are improved, health is restored and suffering is spared.”

There is extraordinary power in the ordinary, everyday work that often goes unsung. Please know that we value that work highly at St. Charles.

Sincerely,
Steve

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Community members are invited to join cancer survivors, local leaders, patients and caregivers from St. Charles to celebrate the groundbreaking for the new Cancer Center in Redmond on Wednesday, June 26 at 10 a.m.

“We are thrilled to celebrate this milestone for our new Cancer Center, which shows our commitment to providing world class care to cancer patients throughout the region,” said Dr. Steve Gordon, President and CEO for St. Charles. “This new facility will have a tremendous positive impact on our community, as it will expand access and services to Redmond and surrounding communities, serving 300 or more cancer patients every day.”

In addition to the groundbreaking ceremony, attendees will be able to walk the footprint of the new 53,000-square-foot building and learn about the services provided, including radiation oncology, chemotherapy infusion, surgical oncology, expanded support services and much more. Those in attendance will also have the opportunity to contribute to an art display that will be part of the new center.

St. Charles board member and longtime Redmond resident Jon Bullock says that this cancer center is a positive development not just for cancer patients and their families, but for Redmond overall.

“We have the chance to be a special place in the world, where families can get the compassionate care they need at the most difficult time of their life. Our community can be there to take care of them,” said Bullock. “This could be a catalyst to positively impact the culture of Redmond forever. I’m so excited about it and look forward to kicking off the celebration together.”

Light refreshments will be provided.

Attendees should be aware that this is an active construction area and should wear closed toed shoes and dress accordingly.

More about the new Cancer Center in Redmond

The new two-story facility will be approximately nine times the size of the current Cancer Center in Redmond. It will include 36 exam rooms. The facility will include a 5,000 square-foot chemotherapy infusion room with 24 infusion chairs. It will also include world class technology including a high-dose brachytherapy suite (brachytherapy delivers localized cancer treatment through internal radiation) and a True Beam Linear Accelerator (which uses photon or electron beams to target and treat cancerous tumors). Visit our Cancer Care pages to see updates and view renderings.

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St. Charles’ Neonatal Intensive Care Unit will host a reunion for current and former patients and their families with current and former caregivers on Sunday, June 23 from 1 to 4 p.m. at St. Charles Bend. This free family-friendly event will include interactive games, refreshments, crafts, a bouncy house, a photobooth, face painting and a visit from Airlink helicopters.

“We want this to be a time of celebration and connection for our NICU patients and their families. Our caregivers love to see how the infants we helped care for have grown, healed and thrived in the months and years since they were in the NICU. It’s also a ton of fun,” said Brooke Jensen, director of women and children’s services for St. Charles Health System.

Attendees are encouraged to wear a favorite superhero costume.

“We see these patients and their families as our superheroes, as they have shown so much strength and bring so much joy,” said Jensen.

The reunion will be held in Conference Rooms A-D at St. Charles Bend (enter through the main lobby.) Those planning to attend are encouraged to RSVP at stcharleshealthcare.org/nicureunion

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When surgeons remove cancerous tissue during breast cancer surgery, they want to ensure they have removed all the cancer. Surgeons want to see clean margins, which means no cancer cells can be found at the edge of the tissue, suggesting that all the cancer has been removed.

Thanks to two new specially designed machines funded by St. Charles Foundation, checking for margins now takes mere seconds and reduces the time patients need to be under anesthesia during breast cancer surgery by 30 minutes or more. Redmond received its first Trident machine this winter and Bend received a replacement for a Trident machine at the end of its life.

Scott Nelson, director of Imaging services for St. Charles, explains that the change is huge, especially for patients undergoing surgery in Redmond. Previously, once the surgeon removed the tissue, another caregiver would take the tissue in a biohazard bag out of the operating room and run it across the parking lot to Central Oregon Radiology Associates, who would scan it for margins. This process took 30 to 40 minutes – all while the patient remained under anesthesia.

“Now, the Trident can be wheeled into the operating room and the surgeon can see within seconds whether they have all the margins or not. It’s easy to use and it’s a big win for doctors and for patients,” said Nelson.

The Trident machines are designed specifically for breast tissue. They do not emit any radiation and are easy to use, according to Nelson. The funding for the $110,000 machines came specifically from Sara’s Project, a special fund within the Foundation dedicated to breast cancer.

Breast cancer patients benefit because they will spend less time in surgery. Additionally, the time saved allows more surgeries to take place in the operating rooms, which is a benefit to patients and doctors across the region.

“This will have a huge impact on people’s lives,” said Nelson.

Jenny O’Bryan, executive director of the Foundation, said, “Our donors are committed to ensuring St. Charles caregivers have the best technology on hand to support our cancer patients. We are grateful to all the community members who have supported Sara’s Project over the years, as that fund continues to provide support and resources for breast cancer treatment.”

Sara’s Project was created in 1992 to honor Sara Fisher, a local teacher, counselor, volunteer and advocate for women’s health and breast cancer research and treatment. Learn more about the background and efforts of Sara’s Project on the Foundation’s website

 

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Members of the public can expect increase in first responder vehicles and personnel at the Prineville facility June 12

St. Charles Prineville will host an emergency preparedness training event in partnership with local law enforcement, Fire/EMS and public health on the evening of June 12. Members of the public can expect to see an increased presence of first responder vehicles and personnel at the hospital and Family Care Clinic June 12 as part of this training exercise.

Due to the training event, the Prineville Urgent Care and Family Care Clinic will close at 5 p.m. June 12. Visitors who come to the hospital after 5 p.m. will be escorted to the room of the patient they wish to visit by hospital staff. During the drill, visitors may experience increased noise and will hear announcements overhead to test internal systems (these announcements will always include the word “drill”).

Emergency Department in Prineville will not be impacted during this drill.

NOTE: The drill is not open to the public or media.

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Did you know that St. Charles has a support group for people with new or established ostomies? The St. Charles Ostomy Support Group (OSG) has been providing ostomates with education, peer-to-peer support, community collaboration, and other resources for more than 13 years. This group meets quarterly, and is open to anyone with a colostomy, ileostomy, urostomy or nephrostomy; family members, spouses and caregivers also attend. Information provided at the meeting includes: 

  • educational topics such as peristomal health, travel and recreation tips, and use of products 
  • presentations by ostomy product representatives and supply companies, and 
  • presentations by ostomates sharing their personal experiences. 

There is always ample time at the end of the meeting for members to share their stories and gain insight from other ostomates. 

The St. Charles OSG is now under the umbrella of the United Ostomy Associations of America (UOAA, ostomy.org), a well-established ostomy organization that provides an amazing amount of support for ostomates, their families and caregivers, and health care professionals. UOAA provides free educational materials (online and print) and information about attending their national conferences. 

If you or someone you know would benefit from this support group, please contact Leah Witmer who will provide you with more information. 

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Lower extremity venous disease (LEVD) covers several dysfunctional disorders of the venous system, including the superficial veins, deep veins, and perforating veins. Damage or abnormalities in any part of the venous system can increase sustained pressure within the system. Symptoms of LEVD can include: 

  • Aching and heaviness 
  • Shallow wound(s) with irregular edges 
  • High exudate (drainage) 
  • Edema (swelling of the legs) 
  • Pain and swelling often relieved by leg elevation 
  • Hemosiderin staining (brownish discoloration of lower legs) 

Treatment for LEVD can include exams to evaluate the blood flow in your legs (Ankle Brachial Index, or ABI), topical wound care, and compression therapy. Learn more about the ABI exam and compression therapy. 

At the St. Charles Outpatient clinics, treatment for LEVD often begins with a non-invasive exam called an Ankle Brachial Index (ABI). ABI is an easy test to check the blood flow to your legs and feet. It can be done in 30 minutes by your wound care clinician. 

On the day of your ABI appointment, we will have you lay as flat as possible for 10 minutes. Then your wound care clinician will check the blood pressure in your arms and legs using a manual blood pressure cuff and Doppler, or with an automatic ABI machine. This will feel the same as checking your blood pressure at the doctor’s office except you will be able to hear the sounds (the Doppler is louder than the stethoscope) and we use a gel on your skin where we place the Doppler. We compare the numbers for six different arteries to determine your ABI. This means we will check your blood pressure six times in different places on your arms and legs. 

We will share the final results with you and your doctor so together we can better guide your care. The ABI will be used to determine the safe amount of compression to help your swelling and wound healing. If you have abnormal results, we will refer you for further testing with a vascular surgeon. 

An ABI >1.3 indicates calcified arteries and patient should be referred to vascular surgeon for further assessment 

An ABI of 0.9-1.3 indicates the patient can probably tolerate full compression (30-40mmHg) 

An ABI of 0.5-0.8 indicates lower extremity arterial disease (LEAD); light compression is recommended (20-30mmHg) 

An ABI < 0.5 is indicative of severe ischemia and should be emergently referred to a vascular surgeon to avoid loss of limb 

(Link to Compression Therapy) 

The use of compression to treat LEVD is the gold standard of treatment. Compression assists with improving venous return, reducing edema, reducing the diameter of vessels, and supporting the calf muscle pump. In addition, compression improves healing rates of venous leg ulcers. Options for compression that will be explored with your wound care clinician include multi-layer compression systems, compression socks, and adjustable wraps with Velcro straps. The table below shows different classifications of compression, and the indications for use. 

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Lower extremity arterial disease (LEAD) is a progressive disease caused by systemic atherosclerosis, hardening of arteries caused by buildup of fats and cholesterol, combined with inflammation. This leads to stenosis and possible occlusion of the artery. Symptoms of LEAD can include: 

  • In early stages, may have no symptoms 
  • Red discoloration when legs are down, paleness of legs when elevated 
  • Pain that increases with elevation and activity 
  • Nocturnal pain (occurs at night) 
  • Shiny, taut, and fragile skin; minimal or absent hair on lower extremity 
  • ABI <0.9 

Treatment for LEAD is based on vascular test results (Ankle Brachial Index, or ABI). A referral for evaluation by a vascular specialist may also be indicated. Learn more about the ABI exam. 

At the St. Charles Outpatient clinics, treatment for LEAD often begins with a non-invasive exam called an Ankle Brachial Index (ABI). ABI is an easy test to check the blood flow to your legs and feet. It can be done in 30 minutes by your wound care clinician. 

On the day of your ABI appointment, we will have you lay as flat as possible for 10 minutes. Then your wound care clinician will check the blood pressure in your arms and legs using a manual blood pressure cuff and Doppler, or with an automatic ABI machine. This will feel the same as checking your blood pressure at the doctor’s office except you will be able to hear the sounds (the Doppler is louder than the stethoscope) and we use a gel on your skin where we place the Doppler. We compare the numbers for six different arteries to determine your ABI. This means we will check your blood pressure six times in different places on your arms and legs. 

We will share the final results with you and your doctor so together we can better guide your care. The ABI will be used to determine the safe amount of compression to help your swelling and wound healing. If you have abnormal results, we will refer you for further testing with a vascular surgeon. 

  • An ABI >1.3 indicates calcified arteries and patient should be referred to vascular surgeon for further assessment 

  • An ABI of 0.9-1.3 indicates the patient can probably tolerate full compression (30-40mmHg) 

  • An ABI of 0.5-0.8 indicates lower extremity arterial disease (LEAD); light compression is recommended (20-30mmHg) 

  • An ABI < 0.5 is indicative of severe ischemia and should be emergently referred to a vascular surgeon to avoid loss of limb 

Source:
Wound, Ostomy, and Continence Nurses Society. (2021). Core curriculum: Wound management (2nd ed.).