In rural America, where funding cuts and hospital closures threaten access to health care, programs like Simulation in Motion-Iowa, or SIM-IA, mobile trucks providing clinical training to local communities in Iowa, are stepping in to fill the void.
With a recent five-year $5.3 million funding boost from the Wellmark Foundation, a nonprofit funding projects tackling health barriers in Iowa and South Dakota, SIM-IA will continue its mission to provide lifesaving training and resources to underserved
communities across the state.
According to the National Institutes of Health, rural Americans face higher risks of premature death from heart disease, cancer, stroke, and other major illnesses.
Many rural areas lack access to health care and enough doctors, the agency adds, forcing residents to travel long distances for care.
Rural health care facilities often have outdated technology or access to CT scanners and magnetic resonance imaging, or MRIs, and rural hospital closures are growing, leaving communities without nearby emergency care.
In Iowa in 2024, 57 percent of counties have no hospitals offering obstetric services, and a third of counties are now considered maternal care deserts, according to the Iowa Coalition for Reproductive Freedom.
Additionally, federal Medicaid spending in rural communities is projected to decline by $137 billion over the next decade under the reconciliation package enacted in July. Kaiser Family Foundation, or KFF, a non-profit, nonpartisan organization providing information on national and global health policy issues, reports exceeding the $50 billion allocated through the Rural Health
Transformation Program.
“Senators from both parties have raised concerns about potential impacts on rural hospitals and other providers, particularly given the ongoing trend of rural hospital closures,” the
organization reports.
Reaching maternal care deserts and beyond
Launched in 2022, SIM-IA has sent trucks to 86 counties in Iowa annually, 32 of which are maternal care deserts, meaning they lack labor, delivery, or postpartum care.
“We want to get better patient outcomes in the state of Iowa,” said SIM-IA program director, Brian Rechkemmer. “We [want to] do those trainings and be able to make them feel a little bit more comfortable.”
The program’s funding will help continue to train people in rural areas like LeRoy, Iowa, a town with a population of 11 according to the 2020 census, and other isolated communities where emergency services are scarce or reliant on volunteers, he adds.
“We want to make sure that the person in LeRoy gets the same training that the person in Des Moines gets,” Rechkemmer said. “We want everybody to get that same standard of care. And that’s why it’s so important to have this Wellmark donation to go out to these local communities and do that training.”
Training that saves lives
SIM-IA operates three trucks stationed in Swisher, Des Moines, and Sioux City, covering the eastern, central, and western parts of the state, according to SIM-IA senior advisor Cormac O’Sullivan.
“We can go to schools, we can go to community centers and let people practice CPR,” he said. “We can teach them how to stop bleeding if they have an accident at home. We can work with high school, community college,
or university students.”
Since its launch, O’Sullivan added, the trucks have traveled over 80,000 miles across the state, although there can be hurdles, like weather and scheduling times, to reaching people in rural areas.
“All the EMS out there are volunteers,” he said. “Trying to get a common time when they’re all available and can all benefit from the training is one of our biggest challenges.”
Funding the future of rural training
SIM-IA Senior Advisor Jacinda Bunch said the $5.3 million provided from the Wellmark Foundation will help keep the program going strong, covering the cost of staff, supplies, and fuel for the next five years.
“Without that money, we wouldn’t have the income to be able to offer free training to EMS and to critical access
hospitals,” she said.
SIM-IA training has been a benefit to UI students as well, offering real-world experience in rural health care settings,
Jeff Artioli, a 2024 UI graduate, said.
Artioli used the program while working on his capstone project to become a certified registered nurse anesthetist. He traveled to Mason City in August 2023 and created scenarios based on what was needed there, including conducting a simulation on a pregnant woman and a toddler
with the flu.
“The idea behind it was, ‘Let’s get you guys to practice something you don’t do frequently but scares
you,’” he said.
UI students can get involved with SIM-IA through graduate programs or by reaching out to the program directly.
“We love to engage with them, give them a chance to kind of see what’s involved with the simulation, and see what exists in their local communities during the semester,” Bunch said.
Bunch said she is grateful SIM-IA received the donation, as for many rural communities, it offers an important service to Iowa citizens.
“We’re very thankful to Wellmark for recognizing the importance of being able to keep this training going in for rural Iowa,” Bunch said. “This doesn’t cover everything that we’re doing and all of the education that we’re providing, but it does provide for that rural coverage over the next five years.”