GRAND COULEE — Coulee Medical Center is one of those places that highlights the challenges and opportunities of rural medicine.

“We’re just really looking to see what can we do that makes sense. That’s financially viable, that meets our mission and the needs of the community,” said Chief Executive Officer (and Chief Nursing Officer) Roberta Hicks.

One of the examples is the Grand Coulee-based hospital’s obstetrics department, the only one in the area with the exception of Mid-Valley Hospital in Omak. Hicks said it’s a necessary service.

“If you can make it to Omak from here, it’s 58 miles,” she said.

The nearest facility offering OB care is at least 70-100 miles away, and other options are farther than that.

“So it’s critical, and it’s something that we struggle with because it’s low volume. We certainly aren’t making that up in payments. And it takes five full-time people on call, or present, to be available 24 hours a day, seven days a week, to offer safe OB care,” she said. “You don’t think about that infrastructure.”

Emergencies and emergency situations, whether it’s cesarean section or an accident on Banks Lake, are no respecters of time or place. As a result, CMC staff have to be ready for a lot of different possibilities that they won’t see very often. The hospital has come up with an innovative solution to help its staff get that training.

“We opened a simulation lab,” Hicks said. “One of the things we struggle with is low volume in very high-risk areas — we don’t have a C-section every day. We have a nurse that’s just been awesome at receiving grants for simulation equipment. We have a lab set up for that.”

Hicks has been at CMC for 30 years and said things have changed.

“I remember the days of using a cardboard box, (saying) ‘this is the liver.’ (The simulators) are so lifelike. We bring the team in, they function as a team – just like any other emergency, you have a team that know what each person’s job is, what they need to be doing, and then you can drill on it,” she said.

Coulee Medical Center has 19 medical providers, doctors, physician assistants and nurse practitioners. To ensure there’s a next generation of doctors, it brings in medical students from the University of Washington and Washington State University.

“We host medical students in their quest to become rural medical providers. They’re on a track to become a family practice in a rural environment,” Hicks said. “So we host students anywhere from a week to five-month rotations, so they learn to become rural doctors.”

The hospital also hosts nursing and radiology tech students, people training to become nurse practitioners and others working on medical careers. That includes finding housing and helping students learn about the Grand Coulee area.

“It’s really good. Having students here keeps our game up,” Hicks said.

The hospital provides surgery, including cataract surgery from a visiting physician one day a month. It’s got room for up to 25 overnight patients, and averages 10-15 patients per day, she said.

There’s a unit for long-term patients and a number of other services including behavioral health.

“We knew behavioral health was critical. It became very apparent during COVID,” she said.

There are two family practice clinics, one at the hospital and the second in Coulee City.

Coulee Medical Center employs about 230 people full-time, which makes it one of the largest employers in the Grand Coulee area. It’s funded in part through a hospital district that covers four counties – but one of the challenges is that most of the land in the district is owned by the federal or state government and thus exempt from taxes.

The existing hospital opened in 2011 and was built around the previous hospital, which stayed open during construction. It was demolished when the building was finished.

Hicks said medicine in a rural setting is different from a city.

“It’s a specialty,” she said.

Cheryl Schweizer can be reached via email at [email protected].