eam Members of the surgical team serving Tioga Medical Center, from left, Jeff Olson, Certified Registered Nurse; Ardis Stewart, Registered Nurse; Mandy Houim, surgical technologist; Jordan Nielsen, RN, surgical supervisor; Dr. Mary Aaland, surgeon; Karen Johnson, CRNA; Terri Brown, CRNA; Sarah Rice and Rayann Vande Sandt, both RN, pre- and post-op.

TIOGA – When a surgical team inaugurated the new operating room at Tioga Medical Center last Nov. 5, it ended nearly 20 years of a surgical drought for the rural hospital.

Tioga is one of several hospitals participating in the Rural Surgery Support Program of the University of North Dakota’s Department of Surgery. The program is providing surgeons on a part-time basis to rural hospitals in an effort to re-launch or sustain surgery programs in smaller communities.

“There’s a huge shortage of rural surgeons,” said Dr. Mary Aaland, a surgeon with the program. “It’s a big problem – access to surgical care.”

Aaland comes to Tioga two days each month to perform hernia surgeries, conduct pre- and post-op visits and do educational outreach.

The Rural Surgery Support Program started about four and a half years ago, led by Dr. Robert Sticca, UND surgery department chairman. Aaland courted communities on behalf of the program to look for local interest.

“Literally, I knocked on doors. When I started, it was just an idea,” she said. “What I learned is every community is different. It has different resources, different patient populations. So we are trying to make it specific for the community.”

It takes vision, commitment and an analysis of local resources to develop a surgical program from scratch, Aaland said.

“We have to build the infrastructure and the team. Surgery is a team approach,” she said.

Jordan Nielsen, surgical supervisor in Tioga, said most of the surgical team consists of staff members who already had been working at the medical center and trained for the new roles. Trinity Health in Minot supported the program with training and also provides anesthesiology services for surgeries.

“We spent a lot of hours working on policies, making sure we knew exactly what we were doing before we had our first procedure,” Nielsen said.

Tioga spent more than $600,000 to build a state-of-the-art operating center.

Unlike visiting a bigger center, when patients come to Tioga, they see the same caregivers for their pre-op, admission, operating room, recovery, post-op and follow-up visits.

“Getting to know us, I think, helps with the comfort level,” Nielsen said.

“That’s unique here,” Aaland said. “That is totally unique to what we can do in a community like this, and I think that’s so being lost in medicine nowadays in the big city.”

Forty years ago, every one of North Dakota’s approximately 30 critical access hospitals did surgery, Aaland said. That number dwindled to almost none. Hettinger had continued to provide surgeries at times.

“There were basically big deserts,” Aaland said. “Now, 65 percent-plus of all surgery is done as an out-patient. The model that we are taking is, let’s build community-based, out-patient surgery centers.”

General surgeries, such as for gall bladders and hernias, as well as orthopedics, ophthalmology, podiatry or plastic surgery fit the out-patient model.

The rule of thumb is a community needs about 10,000 people to support a general surgeon, Aaland said. Most towns aren’t that large, but their regional service areas are, she said.

Her goal is for no one in North Dakota to have to drive more than 60 miles to see a surgeon. The surgery still may need to be referred on, but having that surgeon consult is important in keeping the rural patients from being forgotten, she said.

In her role with Tioga Medical Center, she can go to bat for a patient needing a referral to a larger center, she said. If it’s a rancher up against calving season, she can help ensure that patient gets seen sooner rather than later.

“To be a champion for the rural people is important,” Aaland said. “You have to be a patient advocate. Hopefully, I am seen as an advocate for the surgical diseases in rural America.”

Aaland expects to eventually spend more time in Tioga as the surgical program grows and includes more procedures, although it will never be full-time. She also has provided surgeries in Watford City, Hettinger and Linton and helped out in Dickinson’s existing surgical program. Two other surgeons with the Rural Surgery Support Program assist in the program, which has brought surgeries back to Devils Lake, Carrington, Hazen and Wishek and supported the program in Jamestown.

She stresses the surgeons in the rural support program are not visiting physicians but an active part of the hospitals they serve and a consistent face for patients.

“It’s a local commitment,” she said. “That’s the only way you build a team. That’s, again, what surgery is.”

The program that started with a vision and no guarantee that it would work has been a challenge, but it is working, Aaland said.

Nielsen said Tioga-area residents are pleased to be able to have surgery locally and not have to travel to Minot, and that’s particularly true of the senior population.

“The older people really like being closer to home,” she said.