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At first glance, it may appear ironic that Dr. Elia R. Cole, DO, MPH, provides healthcare from her home as part of Northwest Permanente’s virtual healthcare services. After all, much of Cole’s life has been spent on wide-ranging journeys in pursuit of learning and medical opportunities to be in service to others.

Born in the Hudson Valley in upstate New York, Cole’s interest in healthcare was sparked when her mother was diagnosed with stage 3 breast cancer. Cole was just 14 years old but marveled at the all-female medical group that cared for her mother.

“My dad was a social worker and mental health administrator. Through his work, I got a glimpse of what was needed to orchestrate complex service care delivery in rural places and underserved communities. I also got to spend quite a bit of time through my mom’s work as an art therapist at a children’s psychiatric hospital. I was exposed to how institutions deliver healthcare and the impact that changing a patient’s environment can have on overall health outcomes. I think the blend of those three things was the impetus for getting into healthcare.”

Inspired and motivated, Cole wasted little time in pursuing a career. As a pre-med student at Bard College in Annandale-on-Hudson, New York, Cole was an EMT and became Bard’s Director of Emergency Medical Services.

“As a 20-year-old, it was an amazing opportunity to learn on a really small scale about how to deliver healthcare to a community,” Cole said. “Since college, it’s been my area of interest – how does the service of healthcare get delivered to the people who need it?”

Cole learned more when she spent one of her collegiate summers in Lima, Peru, as an intern at a pediatric surgery unit in an urban hospital.

“It was a wonderful character-building experience, but I came back and wanted to shift my learning environment to something that was more local, which focused on the vast medical needs we have in this country.”

That shift led her to Frontier Nursing University’s (FNU) Courier program in Hyden, Kentucky, in the summer of 2009. The Courier Program was started in 1928 by FNU founder Mary Breckinridge, who recruited young people to work in the Kentucky mountains and learn about service to humanity. In the early days, Couriers escorted guests safely through remote terrain, delivered medical supplies to remote outpost clinics, and helped nurse-midwives during home visits and births. Today, the Courier Program Public Health Internship is a service-learning experience that provides an opportunity for students interested in public health, healthcare, or related fields to see what it is like to provide medical care to an underserved population. It was exactly the rural, underserved experience that Cole had been looking for.

“It felt like I was stepping back into history, especially because I was pretty excited to learn in a place where Mary Breckinridge once stood, a place that was part of the history of American Public Health,” said Cole, who was also working on a comparative analysis of wellness as a concept and how it was being perceived in rural, mountainous communities. “I did field site interviews and observations in Hyden and throughout much of Leslie County. I mapped all the community services in Leslie County. Many people invited me into their homes and let me record them and our conversations about this concept of wellness. I compared this area to Greene County in the Catskill Mountains region of New York, which was somewhat less rural but, at the time, comparable on a financial resource level. It was really interesting to think about how resources were being utilized to promote this concept of wellness through diet and exercise. That whole experience was deeply humbling. One man I interviewed offered a response that I carry with me in my thoughts to this day. He said, ‘People just try to survive here. They’re not worried about wellness’.”

Cole’s ties to the Courier Program didn’t end when that summer ended — they were just beginning. Since then, even as her medical career has progressed and she has moved across the country, Cole has stayed connected. She has come back occasionally for opening or closing sessions of the program or to give presentations, has served on the Courier Advisory Committee, and has been a mentor to other Couriers.

“I am the first physician in my family, so it is not lost on me how challenging it can be to come from a rural or underserved background and work your way into this profession. The process of becoming a clinician takes a tremendous amount of effort and resources to be able to finally arrive at the point where you are delivering care to others. I have seen firsthand the power that mentoring relationships can have to facilitate this journey. Any time I have had the chance to speak with Couriers about where they are on their professional paths, it has been a welcomed opportunity,” Cole said.

After her experience as a Courier, Cole continued on to study public health at Boston University and attended medical school at Pacific Northwest University of Health Sciences in Yakima, Washington. As a third- and fourth-year medical student, Cole was assigned clinical rotations based out of Fairbanks, Alaska. There, her rural healthcare experience included traveling to remote villages, where she learned to provide healthcare with limited resources.

“Alaska was an amazing place to be a medical student,” Cole said. “In my third year, I did a rural health rotation in Alaska, which means something different from rural health in the lower 48. This was in a little town called Galena. It was a town of 450 or so people. My supervising physician there held a clinic in town but would also travel to the other nearby villages, sometimes via snowmobile on the Yukon River.”

Further clinical rotations took Cole across the country, including the Midwest and the Navajo Nation. These varied experiences of life in America fueled Cole’s desire to deliver healthcare to rural and underserved populations.

In 2018, Cole began residency with Kaiser Permanente in California. As a resident, she dedicated her research to studying telemedicine. This work focused on teaching medical learners to care for people in the virtual setting safely. After residency, she joined Northwest Permanente, which had been providing virtual care to residents of Washington and Oregon prior to the pandemic. She does a blend of urgent care and primary care, all virtually from her own home.

“In my current practice, I see everything from people who are in the early stages of labor and are not really sure whether they should come into the hospital yet, to family members calling on behalf of people in hospice who transitioned to hospice on a Friday and it’s Saturday afternoon and they can’t get ahold of somebody in the clinic, and they have questions,” Cole said. “I’ve had patients who present with serious acute medical conditions and others who just need treatment for something simple like pink eye.”

Cole recognizes the irony of providing care from home but also sees the connection between the care that telehealth provides and the original purpose of rural health programs like the Courier program.

“Telemedicine is a really interesting way of delivering some types of care,” she said. “In my mind, it’s kind of an extension of Mary Breckinridge’s approach to delivering healthcare in rural areas or in areas where otherwise patients would have limited access to healthcare. This is a way of seeing people in their homes. It’s not through horseback, but it’s a virtual form of horseback, I suppose.”

It is a classic case of studying history to prepare for the future. The mode of delivery has changed from horseback to jeep to computer, but the end goal is the same.

“I constantly think about how to innovate in the physical space of delivering healthcare,” Cole said. “What does the next phase of innovation in American healthcare delivery look like? How can we do better as a country to keep people healthy? This type of thinking is a way to blend my clinical background with public health principles. I am excited to cultivate creative thinking and innovation with the goal of improving our delivery of healthcare.”