AAP Voices Blog

The Healing Power of Partnership: Pediatricians Avoid Burnout while Addressing Opioids Crisis in a Rural Community  

Veronica Parker, MD, FAAP and I started talking a few years ago when she was only two years out of residency training and excited to be one of the few pediatricians practicing in the beautiful, mountainous community of Taos, New Mexico.  

I was connected with Dr. Parker as her mentor through a program that matched experts in academic and urban medical centers with rural providers. 

We were both committed to reducing health disparities in medically underserved areas, and our professional relationship deepened as we stayed in touch throughout the COVID –19 pandemic. Together, we identified ways Dr. Parker could engage with the neonatal opioid withdrawal syndrome program that I lead at the University of New Mexico in Albuquerque.  

The university, the state’s academic medical center, sits 300 miles away from Taos, a culturally rich yet geographically isolated community.  The program, Neonatal Opioid Withdrawal Syndrome-New Mexico or NOWS-NM, is an educational outreach and quality improvement program specifically for rural healthcare clinicians to implement best practices for caring for babies with the syndrome. To support family engagement with the medical system, the program provides de-stigmatizing, non-judgmental approaches to care.  

Now, even a couple of years removed from the height of the pandemic, the weight of Dr. Parker’s role remains heavy, with her two pediatric partners moving and retiring respectively. She is the sole pediatrician living in Taos, covering a busy hospital-based outpatient clinic, newborn and pediatric hospital calls, and departmental administrative duties. After a series of particularly challenging cases including pregnant patients with complex substance use disorder, those without prenatal care, traumatic births, difficult infant stabilization and stressful patient transfers to the NICU in Albuquerque, Dr. Parker is approaching ‘burn-out.’  

Taos is a rural county spread over a large geographic area, boasting mountain ranges with the highest peaks in the state. Dr. Parker cares for patients there and within three other surrounding counties – covering a total catchment population of more than 50,000 residents. Northeastern New Mexican communities have high rates of poverty and poor child health outcomes, and Taos County is designated as medically underserved by Health Resources and Services Administration. Taos County also has some of the highest rates of neonatal opioid withdrawal syndrome in the state and the opioid epidemic has had long-lasting effects on the community.  

Taos also has deep cultural roots and strengths. The population of Taos County is over 50% Hispanic according to 2020 U.S Census data, with many families tracing their lineage back for hundreds of years to some of the first Spanish colonists. Taos Pueblo, a UNESCO World Heritage Site, is a living Native American community that has been continually inhabited for approximately the last 1,000 years. Through historical trauma, colonialism, and racism, northern New Mexico communities continue to demonstrate ongoing resilience and persistence.  

Throughout the COVID-19 pandemic, Dr. Parker and I scheduled monthly Zoom meetings to process, set goals, and support each other in uncertain times, with anticipation of the woes that would follow such a trying time for New Mexicans. Every month, we reinforced our commitment to action to address health disparities in  New Mexico's medically underserved areas. Our spheres of influence can seem small, but together we make a bigger impact. These regular encounters helped ease the mental exhaustion and compassion fatigue that was trying to settle in. 

Collaboration with pediatricians in urban centers provides community clinicians with support for their specific needs. As we moved through our meetings, we began to focus on stigmatizing language that surrounds substance use disorder. We discussed complex generational trauma and family systems. We explored the truths of the history of colonialism and mistrust of the medical system for the people of Taos.

Showing respect and listening to our community, and then sharing these stories amongst committed colleagues, shapes our approach to excellent care in underserved areas.  

Understanding disparities in more detail provides a roadmap of where change can happen.  The NOWS-NM program, in collaboration with Dr. Parker and the team in Taos, has already motivated some changes in processes and procedures in their nursery. The program introduced the healing power of using de-stigmatizing language and trauma-informed approaches to patients affected by substance use disorder. As we continue our quality improvement program, I look forward to supporting the Taos team as we work toward this goal of implementing best practices and committing to exceptional care. 

Underlying this story is the importance of the re-invigorating effects of relationships.  Dr. Parker and I have a lovely mentor-mentee relationship. The NOWS-NM Program, the University of New Mexico and the Taos medical community collaboration is strengthening, and our work fosters more relationships within the community. I implore you to consider approaching your rural medical communities and their unique needs with the intention of improving disparities in care. We can’t do the work alone. 

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.