Community Wellness team breaks down barriers for rural residents
Delmarva is made up of rural communities, but most of them aren’t quite as rural as Smith Island. Smith Island, Maryland, is surrounded by the waters of the Tangier Sound. The roads through the marshy residential areas are narrow, and visitors are more likely to see a golf cart drive by than a car. Residents can get necessities from markets, but the island has no pharmacy, no bank, no police station and no chain stores.
If residents want to leave one of the island’s three communities — Ewell, Rhodes Point and Tylerton — for the mainland, the boat ride to Crisfield is about 45 minutes.
Accessing healthcare in a rural community can be difficult, but TidalHealth has transformed that reality, bringing high-quality care closer to home for island residents.
From spring through fall, a team of practitioners travel to Smith Island every other Wednesday to provide care to residents.
Tammy Walbert, DNP, CRNP, CP-C, is the clinical supervisor of Community Wellness at TidalHealth and has been traveling to Smith Island to provide care for several years. It’s a tight-knit community, so it was important for the team to come over from the mainland to build relationships with the residents.
“They’ve really welcomed us with open arms and are always looking forward to seeing us, and treat us as part of the community,” said Walbert, a nurse practitioner.
Filling a healthcare gap
Janet Tyler, a TidalHealth medical assistant, lives and works on Smith Island. Her family has lived on the island for 13 generations.
Tyler has worked for TidalHealth for seven years, but outside of this role, she also serves as an emergency medical technician and delivers medications. If a Smith Islander has a medical need, Tyler is the one to contact.
“I’m like a one-stop shop,” she said.
As a medical assistant, she checks patients in, draws blood, does electrocardiograms, and can also attend telehealth appointments with patients.
“Some people, when they first started coming over here seven years ago, hadn’t seen doctors in quite a while,” Tyler said.
With a clinic to go to on the island, people are now receiving healthcare without it being an ordeal or an all-day affair.
The Smith Island clinic is not a primary care office, but it fills a healthcare gap, and residents can have immediate needs addressed. The team can also connect patients to primary care practitioners for follow-up appointments. In addition to the two nurse practitioners, a pharmacist and a physical therapist also make regular visits to the island.
Smith Island is home to about 200 full-time residents, and about 45 percent of the population is age 60 or older, according to U.S. Census data. It can be hard for older residents to get on and off the boat, Tyler said. Plus, the ferry also only runs at certain times.
Lessons learned
Smith Island is a unique place.
“The culture, patients, the scenery — just the whole entire ambiance of the island — is something that I don’t think you can find anywhere else,” said Aaron Sebach, PhD, DNP, MBA, CP-C, CRNP, SFHM, FNAP, FAANP, a nurse practitioner who is part of the TidalHealth team that travels to Smith Island. “It’s such a special place, the residents here are welcoming, and I truly, truly enjoy the privilege to come here to care for Smith Island residents.”
Walbert, Sebach, and Katherine Rodgers, EdD, MPH, director of community health initiatives and population health management for TidalHealth, conducted a qualitative study on Smith Island and talked to residents to learn about the barriers to accessing healthcare.
Sebach said patients must decide whether they can afford the cost to take the ferry to leave the island and whether they can afford to miss a day of work on the water. Weather is also a factor when traveling off the island.
“The lessons learned from the study can also be applied to other rural, isolated communities,” Rodgers said. “It helps us understand that individuals are not neglecting their health by choice — but may need additional support to manage chronic conditions. We, as healthcare providers, can do a better job of coordinating care for our patients by understanding and addressing their barriers.”
Convenient care
The health clinic on Smith Island is in a former Sunday School building that belongs to the nearby church. With wood-paneled walls, it features two exam rooms, a waiting room with plenty of informational brochures on the table, and a pew to sit on in the hallway.
In 2024, upgrades were made to the building and equipment thanks to a grant from the Somerset County Health Department.
Walbert said it depends on the day how many patients they see — it could be two, or it could be nine. Sometimes the team’s visits to the island also include going to a patient’s home.
She shares information with patients about chronic disease management, diet and medications. Patients can also get vaccines at the clinic. They can even get surgical staples, if needed, Tyler said, though that procedure must be done by Walbert or Sebach.
While the types of issues they see in patients may be similar to medical concerns they’d see on the mainland, Sebach said, the practitioners have to think critically — for example, determining which treatment plans are the most cost-effective for the situation and whether it’s crucial to leave the island for a test. Patients also can’t get prescriptions the same day; prescriptions come the next day, by boat.
“There are a lot of care disparities on Smith Island, and I am proud to be part of a team that is employed by TidalHealth to minimize those gaps in care,” Sebach said.
Danielle Linton-Laird, who has lived on Smith Island for several years, said traveling on a boat and then in a car while not feeling well isn’t ideal. Plus, she runs a business, Jack and Pickles Amusements, in the summer, so it’s hard to take the day for an appointment on the mainland. This clinic makes care convenient.
“I really enjoy having a clinic space to come to,” she said.
The regular visits to Smith Island are just one way TidalHealth Community Wellness is meeting patients where they are, considering the whole person instead of only their medical needs, and helping patients meet their health goals, Rodgers said.
“Our efforts on Smith Island and in other communities throughout the region help us bridge gaps and increase access to care,” she said.
Care beyond the waterline
Watch video from a TidalHealth trip to provide care on Smith Island at tidalhealth.org.
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