Food Insecurity in Our Community

Susan Dupler, RN, thinks about food all the time.

As care manager for Belfast Public Health Nursing Association (BPHNA), a non-profit agency supported by the Coastal Healthcare Alliance (CHA) and the City of Belfast, Dupler participates in a wide range of efforts to confront food insecurity, from food banks to soup kitchens.

“Quality food – or the lack of it – has a profound effect on the health and well-being of so many in our community,” said Dupler. “At BPHNA, we share in CHA’s vision of making our communities the healthiest in America. Addressing food insecurity is a  critical part of making that a reality.”

One of the efforts that Dupler participates in focuses on food insecure students.  These students often receive free or price-reduced meals at school during the academic year. The Feeding Opportunities & Outreach Directive (FOOD) program seeks to provide meals when school is out of session during the summer months.

To make sure FOOD served as many children as possible during a time made more challenging by COVID-19, Dupler worked closely with Cherie Merrill, the nutrition coordinator for Waldo Community Action Partners  (Waldo CAP). Started in 2019, the USDA funded FOOD program typically runs for eight weeks in July and August and serves an estimated 75 to 100 children. This past year, volunteers and Waldo CAP staff packaged the food at the Waldo County Technical Center kitchen and distributed seven days’ worth of breakfasts and lunches to 150 children each week.  Midcoast Transportation delivered it to nine distribution sites in Belfast, Searsport, Swanville and Stockton Springs.

“We know that food insecurity can affect a young person’s ability to learn,” Dupler said. “In just a short time, the FOOD program has made a real difference by ensuring that our children have ongoing access to high-quality, nutritious food all year long. We believe this dramatically increases their chances of growing into adults who will live healthy and constructive lives for years to come. We’re helping children now, but this also represents a long-term investment in the health of the community.”

The FOOD program is an initiative of the Community Food for Children committee and Waldo CAP. Other members include Literacy Volunteers of Waldo County, the University of Maine Cooperative Extension, the Belfast Garden Club and local church groups.

The energy these agencies devote to food insecurity highlights the scale of the problem in the communities we serve. In Waldo County, 59 percent of all students are eligible for free and price-reduced meals based on family income. In Knox County, more than 46 percent of students are eligible.Those numbers were recorded before COVID-19. Recognizing that the economic fallout from the pandemic has increased food insecurity not just for children but for adults, too, PBMC and WCGH donated $50,000 to local food pantries in 2020 to help them respond to the increased demand for food assistance.

In Knox County, grant recipients included: Bread for the Journey Food Pantry, Camden Food Pantry, Come Spring Food Pantry, Friendship/Cushing Food Pantry, Knox County Homeless Coalition, Rockland Salvation Army, St. Bernard Catholic Parish Soup Kitchen, Thomaston Food Pantry, Waldoboro Food Pantry and Washington Food Pantry.

In Waldo County, the CHA gift was boosted by a $20,000 donation from the Belfast Rotary Club. Recipients included: The Good Shepherd Food Bank of Maine, Belfast Soup  Kitchen, Little River Baptist Church, Greater Belfast Area Ministerial Food Cupboard, No Greater Love Food Pantry, Searsport Congo/Methodist Food Cupboard, Northport Food Pantry and Jackson Food Pantry.

Dupler’s work along with the financial support for local food pantries is part of CHA’s long-standing commitment to improving the health of our communities. We know that many non-medical conditions influence our well-being, including where we live, learn, work, play, worship and age. These social determinants of health account for up to 60 percent of a person’s health. We believe that addressing these social determinants through efforts like that of Dupler’s is one of the best ways to improve the health of our communities now and for generations to come.

Going Virtual

The Community Health & Wellness team was not about to let COVID-19 prevent them from fulfilling their mission of improving the health of our coastal communities.

With in-person classes canceled to ensure the safety of patients and care team members during the pandemic, the team developed a comprehensive schedule of virtual classes that used the latest videoconferencing technology.

“Despite the pandemic, we knew that people were counting on us to guide them to a healthier life,” says Rachael McCormick, director of community health improvement. “We were committed to finding a way to support them.”

The Community Health & Wellness team helps community members and businesses improve their health and wellness by providing health education classes, screenings, events and outreach programs.

Once the team decided to develop virtual class offerings, it set out to learn about the technology around videoconferencing as well as best practices for using it effectively. They then developed a list of courses that they thought would work best in a videoconferencing environment.

In the first four months of COVID-19, Community Health & Wellness offered 15 virtual classes, with topics ranging from nutrition to meditation to fall prevention. The year before, the team offered more than 40 classes and other programs during the same time period.

 “We were encouraged by the response,” says Megan Day, community health outreach coordinator. “We offered fewer virtual classes, but the classes we offered were as well attended as they were when we offered them in a classroom.”

The virtual offerings allowed Community Health & Wellness to expand its geographic reach as well, with some participants clicking into classes from as far away as Portland. “People who couldn’t get to our classroom programs are now able to participate from home,” Day says. “It has inspired us to think about how to best use virtual classes even after COVID subsides.”

Says McCormick: “I’m so proud of this team for rising above the pandemic to find new ways of delivering our health and wellness programs. Their creativity and commitment to our communities demonstrate the power of MaineHealth’s core values to inspire us all to make a difference.”

Opioid Response

With opioid overdose deaths rising across Maine, PBMC has developed two important programs designed to save lives and connect those suffering opioid use disorder with the help they need.

One program makes the life-saving drug naloxone available without a prescription to anyone who wants it: the drug, a simple nasal spray which reverses the effects of an opioid overdose. The other program offers medication that provides immediate relief to those suffering opioid withdrawal symptoms and connects them to effective treatment.

Naloxone

The Pharmacy at Pen Bay Medical Center now makes naloxone available without a prescription to anyone who feels they may need it.

The goal is to make it easier for as many people as possible to carry the life-saving drug, said Community Health Medical Director Kendra Emery, DO, a family practice physician who oversees PBMC’s response to the opioid crisis. “In this crisis, none of us knows when we may have to respond to someone suffering an overdose, whether it be a loved one or a complete stranger. The more people who carry naloxone, the more lives we will save.”

Purchasing naloxone at the Pharmacy at Pen Bay Medical Center is a simple process, even with COVID-19 restrictions in place. The first step is to call The Pharmacy at 301-8585 before coming into the hospital. “If you call ahead of time and ask to speak to one of our pharmacists, we can have everything ready for you before you get here,” said Tom Edge, PharmD, manager of the retail pharmacy at PBMC.  “Once you arrive, we can bring it right out to your car.  You don’t even need to come in.”

Dispensing naloxone requires the recipient be trained to identify an overdose and administer the nasal spray version of the drug. Normally this is done in person. However, to accommodate social distancing guidelines around COVID-19, Edge and his colleagues now conduct the training over the telephone.

“The COVID-19 crisis has required us to be a little bit creative,” Edge said. “This training is so important. When you’re in an emergency and the adrenaline is flowing, you want to know how to use it.”

Rapid Induction

The Rapid Induction program provides buprenorphine, also known as Suboxone, to patients who come to the Emergency Department at PBMC with opiate withdrawal symptoms. Patients are then referred to Maine Behavioral Healthcare in Rockland. Its Integrated Medication Assisted Treatment (IMAT) program combines medication to reduce the cravings and talk therapy.

The goal is for the patient to be seen by a physician who provides IMAT within 24 hours while there is still momentum toward recovery, said Elizabeth Lawrence, MD, medical director of the Department of Emergency Medicine at PBMC. “Studies show that combining medication with group and individualized therapy works better, with fewer relapses and overdoses, than therapy alone to treat opioid use disorder,” Dr. Lawrence said.

To take advantage of the Rapid Induction program, a patient needs only go to the PBMC Emergency Department where they will be screened to determine if they are a candidate for buprenorphine. This involves a urine test to make sure there are no opioids in their system and a series of questions that help determine how much buprenorphine to administer.

“We test a patient’s urine to avoid complications when we administer buprenorphine,” Dr. Lawrence said. “Usually, buprenorphine reduces or eliminates withdrawal symptoms. But if patients have opioids in their system, buprenorphine can make withdrawal symptoms worse.”

With buprenorphine administered and the cravings tamped down, the patient is counseled on the benefits of the IMAT program. With the patient’s consent, the Emergency Department will submit a referral and a representative from the IMAT program will reach out to make an appointment.

“These patients need relief from the cravings so they can focus on therapy and rebuilding their lives,” Dr. Lawrence said.