Recently I had the opportunity to work as a locums tenens physician in a small town in Maine, and it helped me gain a new perspective on community, health care, and living. While providing a service to the area, I received valuable lessons in return. The folks in Maine can teach the rest of the country a few lessons also. While Maine has the highest median age (45) in the country, it has continued to have some of the lowest rates of COVID-19 infection and mortality. The state and local governments have been proactive, but I think this is partly related to what makes Maine and Mainers unique. The comedy television show Northern Exposure debuted thirty years ago following an urban physician who left New York City to work in rural Alaska. While Maine is not as remote as Alaska, it is also known for its natural beauty, coastline, wildlife, and people. Maine’s jagged coastline is larger than California’s, and the state is filled with vast areas of wilderness, including lakes, ponds, and mountains. Since starting medical school 22 years ago, almost all of my medical professional experiences had been entirely in cities. Despite obtaining excellent clinical training, I had never worked or lived in a rural area. And honestly, I never saw this as a drawback in my medical training until I started doing locums work. Many people in Maine can trace their heritage for generations and are referred to as Mainers. Mainers are resilient, hardworking, and have a unique connection to the land and sea. In Maine, if you are not born there, you are “from away.” These are three lessons I learned as a doctor “from away”: 1. Get outside. Spending more time outdoors has been associated with being less sedentary, more time involved in moderate to vigorous physical activity, and having a lower risk of chronic diseases. Adults and, importantly, children in the US aren’t spending a lot of time outdoors, and this has become worse during the pandemic. According to a recent 2019 Common Sense Media report, U.S. tweens (8 to 12 years old) used screens an average of 5 hours and teens 7.5 hours per day. This study was before the COVID-19 pandemic and did not include time using screens for school or homework. Mainers spend more time in nature than most of us, and they are outside whatever the weather. There is an appreciation of all four seasons. Maine is known as “Vacationland” as tourists come in droves during the summer months, but Mainers still find plenty to do outside during their cold winters with less sunlight. Popular activities like hiking, biking, sailing, kayaking, skiing, snowshoeing, and snowmobiling are notable also for not being associated with large crowds. Mainers also prepare better for what nature has in store. I experienced this on a small scale at my daughter’s Maine daycare. Parents are required to leave snow boots, gloves, and snow pants so kids can play outside whatever the weather. At her school in New York City, outside time would often get canceled with a mild dip in the temperature. While there are plenty of local Maine stores that cater to the outdoors, Mainers help each other out with numerous community clothes donation drives throughout the state. Maine also has nonprofit organizations (WinterKids and Teen to Trails) dedicated to getting children, teens, and families outside. While in-person events have been canceled during the pandemic, these organizations continue to provide educational resources and encourage outdoor experiences. 2. Community. Strong social connections have been associated with increased longevity and protection against dementia, inflammation, and depression. There is definitely a strong sense of community in Maine and pride in their heritage. Mainers are actively involved in their communities and find solutions to problems at local religious organizations, schools, cultural, and trade organizations. They work together and are remarkably resourceful. The Island Institute is one nonprofit supporting island and coastal community sustainability while collaborating with other island communities as far away as Alaska and Maryland. Mainers in certain industries work together for common goals, and lobstering is a good example. Most would agree Maine has the most delicious lobster, but most outsiders don’t realize the challenges lobstermen and lobsterwomen work through together for their livelihood. These include international trade tariffs, bait and staff shortages, warming waters, and changing regulations, to name a few. 3. Appreciate the dark and quiet. Noise pollution has been associated with sleep difficulties, increased stress, and increased cardiovascular events, such as heart attack and stroke in epidemiological studies. Light pollution interrupts our circadian rhythms and disturbs sleep. Living in the city, I was so accustomed to the din of traffic and the glare of lights. Kids in cities aren’t able to see a starry sky. Maine has lots of dark and quiet. Although uncomfortable at first, I became more accustomed to the darkness and quiet and grew even to appreciate it. It also helped that Maine has the lowest crime rate in the country, but I slept better and experienced less stress. My locums tenens experience in Maine taught me we have a lot to learn from each other if we are open to listening. This year Maine celebrates 200 years of statehood, and we can all learn something from Mainer’s history and way of life. Christina Tennyson is a gastroenterologist Source
