This is the transcript for episode 461 of the Community Broadband Bits podcast. We're joined by broadband analyst and telehealth advocate, Craig Settles; Dianne Connery, Special Projects Librarian in Pottsboro, Texas; and Adam Echelman, Executive Director of Libraries Without Boarders, to talk about how libraries are the cornerstones of information access for communities across the country. Listen to the podcast here or read the transcript below.
Adam Echelman: Telehealth, when you hear the word you think of like a doctor with an MD over a TV screen telling you about which prescriptions to take, but really it's about using technology, which is part of our everyday life, to navigate your own health information, your health questions. Anyone can do that, they just need the right skills. Librarians are uniquely equipped, but I think there's also an enormous role that librarians can play in equipping community leaders with those same skills.
Ry Marcattilio-McCracken: Welcome to episode 461 of the Community Broadband Bits Podcast. This is Ry Marcattilio-McCracken here at the Institute for Local Self-Reliance. This week on the podcast, we welcome broadband analyst and telehealth advocate, Craig Settles, Diane Connery, the special projects librarian in Pottsboro, Texas, and Adam Echelman, Executive Director of Libraries Without Borders. The group talks about the role of libraries in facilitating more resilient communities and how this new dimension of telehealth is just another among the array of ways that libraries have been and continue to be an access point for information for their communities.
Ry Marcattilio-McCracken: They talk about how trusted and locally-rooted digital navigators have become folded into the fabric of libraries and the part that can play in both treating illness and preventing it. Along the way, Diane shares how these tools have manifested into new options for staff and residents in the town of Pottsboro. Now, here's Christopher talking with Craig, Diane, and Adam.
Chistopher Mitchell: Welcome to another episode of the Community Broadband Bits Podcast. I'm Christopher Mitchell at the Institute for Local Self-Reliance in St. Paul, Minnesota. And today, we have a special show. We have our first ever, I think, cohost, honorary cohost, Craig Settles, a broadband analyst and telehealth advocate and guy who really did the first regular broadband podcast, as far as I can tell. Craig, welcome to the show.
Craig Settles: Thank you. Thank you. It's great to be here. And I guess we have been on each other's show over the years, so this is the [inaudible 00:02:24] of all that. Yes, it's definitely great to be here.
Chistopher Mitchell: Yes. I'm naming you honorary co-host because you have suggested two panelists, two other guests to have on, to talk with about some very interesting synergies between important topics lately. I'm going to introduce Diane Connery, the Special Projects Librarian in Pottsboro, Texas. Welcome to the show.
Dianne Connery: Hi. Thanks for having me.
Chistopher Mitchell: We're also going to bring on Adam Echelman, the Executive Director at Libraries Without Borders.
Adam Echelman: Hey Chris, thanks again for having me too. Great to be here with you, Dianne and Craig.
Chistopher Mitchell: Yes, I'm excited. It's funny because I feel like years ago we were asking what is the role of the library in the digital age? I don't know, maybe now after the show, people will be thinking, "What isn't the role of the library in the digital age?"
Dianne Connery: I'm on a lot of calls weekly that discuss that. Even among libraries, there's a lot of conversation. So yes, I'm happy to talk about it, and in particular, rural libraries as often as I'm invited.
Chistopher Mitchell: Excellent. So Craig, you called me up or emailed me, which is the same thing, and you were talking about the role of the libraries and moving into telehealth. You've been working on telehealth for a while. Why does it make sense to think about libraries with regard to telehealth?
Craig Settles: When you look at the things... They had the movements that the libraries have been involved with, where we look at broadband itself and how that has become the main, one of the main roles of libraries. But if you look at when we went through the transition to digital TV, libraries, we're on the front, on the forefront of helping their patrons understand and to walk through that process.
Craig Settles: When we had the Obamacare and that was passed, all of a sudden, there were lots of people who had lots of questions. Navigators became a part of the library culture, where they provided services and people to help patrons navigate the different aspects of the affordable care act.
Craig Settles: So if you look at that role or the series of roles that they've had, the lot, the telehealth in the library, it's a very valid role because the people who don't have broadband that the libraries have served in those, the rural areas and the urban areas the seniors and so forth are often the people who suffer from healthcare shortcomings.
Craig Settles: So they're already aligned with the people needing telehealth the most. So I would say, and then Diane and Adam can talk from their respective positions Diane in the rural area. And a lot of Adam's projects are in urban areas, but I think that they can talk more about the fitting role that libraries can play when it comes to telehealth.
Chistopher Mitchell: Yeah. Adam, why don't you jump in?
Adam Echelman: Yeah. Happily. And I just want to build on what Craig said. So my team, or Libraries Without Borders, our mission is to promote access to information for folks in need. It's a mission that we share with the American library Association and with public libraries across the country. I think the thing that is often heard is access to information. It sounds like this kind of nebulous, very big, very librarian-esque term, but it's not.
Adam Echelman: Information, and by information today, I'm talking about basic literacy access to books, access to broadband internet, access to computers, digital literacy skills that is healthcare. It's not separate from. It's not part of, you cannot read a prescription. You can not have a telehealth appointment. If you don't have high-speed internet, if you don't have a computer or a functioning device, and if you don't know how to use it.
Adam Echelman: My team over the border is in our partners, which are public library systems across the country. We started doing health literacy and health education work, not as an afterthought, but just kind of naturally and organically. And I think that's often how public libraries end up doing so much.
Adam Echelman: It's not because libraries are wearing so many hats it's because by definition, a library is, it's an information hub. It's a resource. Craig mentioned the affordable care act. For decades, libraries have been the access point for information, whether that's information about whether it's a community gathering space in the 1980s around HIV AIDS, whether it's a gathering space for folks who are dealing with mental health issues and they just need a quiet, safe place where they can feel respected. I mean, I think as we, as a country are like focusing in on COVID-19, we also have to zoom out and look really broadly at health and all the ways that libraries have always been handling health issues.
Chistopher Mitchell: Right? So, to sum that up, it's nothing new. It's something that the libraries have always done. And there's this new dimension part of it. Now that may make it a little bit more interesting, in some regards.
Craig Settles: Oh, I'll have Diane explained their project and some of the hurdles they overcame to, to make this all happen.
Dianne Connery: We are a town in north Texas about an hour and a half north of Dallas, a town of 2,500 people. And there's no newspaper, no TV station, the nearest hospital's 30 minutes away, there are no doctors in town. And when you do the research, people in rural areas actually have lower health outcomes than their peers in suburban and urban areas. People put off going to see a healthcare provider because it takes a long time.
Dianne Connery: Usually nobody wants to go to see a doctor anyway. And when the pandemic started, our area has so many barriers to broadband infrastructure that we, as a library, stayed open because people had to have access to the internet. We started getting some calls, people saying that their healthcare providers wanted to have an appointment with them, but did not want the patient to come into the office. So those people were coming into the library to have an appointment.
Dianne Connery: And one of the things we deal with because the infrastructure is such an issue here, is also those lack of digital skills that Adam mentioned. So there's a lot of us helping people connect, log on, all of that. We're a small town. Our library is an old post office. It was basically one room. So, in terms of privacy, when those people would need to have an appointment, they would come in and I would put them in my office, which was the only private space.
Dianne Connery: We started getting a little more of that. And then some funding came out through the National Library of Medicine, and we were able to apply for a $20,000 grant through COVID funds, to help, with outreach and launch our telehealth program. And I'm sitting right now in a junk room that we made into a private space.
Dianne Connery: It's got great lighting, fast internet connection. And as I consider the library an information utility. Whatever form that information comes in. Library staff here has taken a number of health literacy classes, and we help people walk through the process as much as they need with logging in, and then we'll leave them alone in the private space. And then if they have medical questions afterwards, then we're able to point them to authoritative resources.
Dianne Connery: So if they've been diagnosed with something, they want more information about, we can help get them to Medline Plus, or some other resources where we know that it's good information.
Chistopher Mitchell: When you started that, was it mainly about having a room with privacy and a computer that had like the video chatting software installed on it, or was there more that had to be done?
Dianne Connery: Through a previous grant, an e-sports grant. We were the first public library in the nation to have an e-sports team through that grant. We had...
Chistopher Mitchell: That's cool, I don't mean to interrupt, but that's cool.
Dianne Connery: Thank you. We have for what is, Pottsboro the very fastest internet connection in town. So many people don't have it at home then that led to, we are the community catalyst.
Dianne Connery: We are the leader in digital issues in our community. So yeah, I think having the hardware and then providing a private space, because that is one of the things we've learned along the way, even some people who have internet at home and who have the skills to connect, they still don't have a private space to sit and talk about their healthcare issues.
Chistopher Mitchell: I guess the last question before I let anyone else follow up on this is, do you have a process in which people then have to check it out? I mean, to make sure that you don't have multiple people who have set up their doctor appointments at the same time, on the same day.
Dianne Connery: Exactly. And I have had wonderful partners with this. Because when I conceptualized it, I could wrap my head around the library end of it. And then we were having those kind of one-off appointments I mentioned, but I couldn't figure out how we would get volumes of people without overlapping. we connected with the University of North Texas health science center, and I'm a fly by the seat of my pants person. So luckily being a small library with almost no bureaucracy, if I have an idea, I can implement it that afternoon.
Dianne Connery: Well, that doesn't work for healthcare providers. We had a series of in-person and zoom meetings with different teams, disinfection protocol, marketing, all sorts of different teams. They helped me walk through what this process would be. So Tuesdays and Fridays they've had to have healthcare providers when a person needs an appointment, they call the health science center, not the library. The health science center takes care of payments and appointments. The library, we get an email the afternoon before with no names, no diagnosis, no issue, health issues. It just says library, you will have someone there for an appointment at 11:00 AM tomorrow or 2:00 PM. We're able to keep things private because that's a big deal with librarians is respecting privacy.
Chistopher Mitchell: Wow. That is remarkable. I feel like too many people lack an understanding of how much innovation comes from small towns and folks like yourself that don't have to deal with the bureaucracy.
Dianne Connery: Yes, yes. In that way sometimes rural libraries feel like not quite as good as urban libraries, but I will tell you I'm a believer now. And I've always lived in big cities before this. But because when I started working with the library volunteering, 10 years ago, we had no taxpayer funding. They didn't care what we did, if I could find grants for it and it didn't cost them money, they would say, go for it. And even now, as they kicked in and are giving us significant funding for a small town, they still give us so much freedom. And that innovation is absolutely why I do what I do.
Chistopher Mitchell: Excellent. Adam, is there anything that jumps out to you from your experience with a lot of different libraries and you'd want to add on to it?
Adam Echelman: Well, I think one of the phrases that Diane really mentioned is the innovative work and that's actually where Libraries Without Borders often sits. We are, we're technically an international nonprofit organization with programs in about 30 different countries. But myself, I lead the U S office, which is for all intents and purposes, a pretty small non-profit group.
Adam Echelman: And we have operations in about six different states in the country, as well as Puerto Rico. Our work as fancy as Libraries Without Borders might sound is pretty, it's pretty granular. So we partner with a lot of different library systems across the U.S. to help them think, and then often rethink how to expand outreach activities into their communities. So we're most, well-known in the U.S. for bringing library services, everything from a digital literacy class to free tax prep into laundromats across the U S through a program that we lead called the Wash and Learn initiative.
Adam Echelman: And we also have a program that focuses on getting library services and to trailer parks, more commonly known as manufactured housing communities in rural areas. We work in churches and help them expand access to wifi technology and digital literacy training as well as a lot of work in south Texas. So we're, we're kind of all over, but one of the reasons why Craig and I connected is because of the sheer amount of health literacy programming that we co-lead with libraries, including in St. Paul actually, but also in San Antonio, Texas, and Baltimore, Maryland, and the Pittsburgh Metro area, in Oakland, California.
Adam Echelman: And with those different library systems, we often do we bring library systems and librarians into laundromats, into churches who then offer a... We've done everything from like general how to get online, how to access reliable health information resources, like what Diane mentioned, Medline Plus, and partnerships with organizations like the National Network of Libraries of Medicine.
Adam Echelman: We've also done pretty direct service partnerships. So together with the public library that maybe it was offering a different workshop at a laundromat, we've noticed there was a really big need for direct testing. So we've then convened different local health organizations who will show up at the laundromat once or twice a week to do free testing.
Adam Echelman: We've done HIV and STI testing. We've done blood pressure and like general vitals and just educating folks about that. We've also done workshops around dental health, and we've also done workshops with the local WIC. So every city has been really different because our approach has to change, in the Pittsburgh Metro area, the WIC has a really great partnership with the local library. When the library started doing story time, they reached out to a local WIC office and said, "Hey, would you mind supplementing? We've got a lot of young parents and children here. Do you think you'd be interested in stopping by and talking with parents and caregivers about different WIC benefits?"
Adam Echelman: Same thing in Minnesota. We started off doing a lot of multicultural and multilingual story time and digital literacy programming. And we were reaching a population that a local clinic, Clinic 555, was interested in targeting as well. And they said, "Hey we're already working in this space. Do you guys want to stop by and offer some additional HIV and STI testing?"
Adam Echelman: I think similar to what Diane was mentioning, we often the health literacy component while it's often very innovative. It's also always very organic. It's just kind of figuring out what people are looking for, where people are, what people are interested in and then seeing how we can get the resources to the people where they are.
Craig Settles: Yeah. Yeah. I think that what really will help folks wrap their brain around the idea of telehealth in the library is to understand what is telehealth right.
Craig Settles: We, especially during COVID, people identified telehealth as your video consult with your doctor, but in reality, telehealth is using the internet or intranets to connect patients with doctors. But also I find in the three areas, right? There's a real-time telehealth and that's the idea of I pick up the phone or I pick up my mouse and I dial to my doctor and I interact with them in real time. Right.
Craig Settles: There's also for a stored in, store and forward where if you look at the barbershop idea, that I've been talking about the barber takes the customer's blood pressure and they store that using the telehealth software. And then they basically send all the data with the contact info for the customers to a healthcare provider.
Craig Settles: Right. that's stored and forward. And there's a lot of telehealth applications that rely on that. Right. So it's not real time. The third part of telehealth that people really don't realize it's what I call passive telehealth right. I go to the library after I've gotten a diagnosis from my doctor and I have diabetes.
Craig Settles: So I can go to someone like Diane, right. And say, what do you have? What information do you have that can help me deal with this? Right. I look at Adam's program. I practice the very first thing that attracted me to the, this whole concept of moving libraries into the laundromat was a video that Adam's group has created in St. Paul that has kids using interactive content and games to help them understand health concepts. Right. So that aspect of Diane and other libraries explaining on how to help get information to patrons, right.
Craig Settles: The same way Adam's group pushes content, that's interactive and it's fun for all ages. Right. But that's what telehealth is. And when, so when you look at all three of those, you can look at any library and say somewhere, some aspect of telehealth in that three stages. It makes a lot of sense. I think that, as I said, both, Diane and Adam can talk to more of that. Because I know Diane, you and I have talked about this before, but I like to know, how does that comfort level with I have a serious disease? Can I get some help? Can I get some valuable information?
Chistopher Mitchell: I was curious about that regarding whether librarians are already, so well-versed in providing healthcare related information, that they can just do this off the bat, or if they need any kind of additional resources or training?
Dianne Connery: I would say yes, additional training is necessary for most librarians, especially rural libraries, but it is readily available. I'm working right now with a professor school of information professor at Texas Women's University. And we're surveying that all of the libraries in Texas, what they would need to feel comfortable? What kind of training they do need to be able to do this and promote it.
Adam Echelman: You know, one of the things that my team has found that our partners have found to be at the end of the day, the single most I'd argue the single most important thing. In health literacy, whether it's for libraries or for organizations is trust.
Adam Echelman: Health is ultimately a private issue. And we haven't been particularly successful when we're parachuting into a community to say here's technology and here's all this health information that you should know because this person, or this website told us it was important.
Adam Echelman: The best way to start off in our experience has been to figure out first and foremost, what is the trusted institution who are the trusted leaders in this community and how can we leverage them and equip them with the information and the resources to be strong advocates. And I think to your credit, Diane and your community, it is the library.
Adam Echelman: So you guys have said, "All right, we're trusted. How can we position ourselves to meet the need right now for telehealth." In a lot of communities where libraries are borders works, whether it's in St Paul or our programs in Detroit, or in Baltimore, and San Juan, Puerto Rico, the library is often a very trusted institution, but we're also working in big cities where there's a large swath of the population that isn't frequently going to the library.
Adam Echelman: Maybe because they don't have the transportation to get there, maybe because they're working a couple jobs and they just don't have the time to stop by the library when it's open or lately, because the library has had to be physically closed and because of the stay at home orders. In those cases, we have to be really, really thoughtful about who are the other trusted partners?
Adam Echelman: Is it your aunt? Is it your local business owner? Is it your school teacher? Is it your friend that you catch up with at the local laundromat once a week? And then how can we equip them with the tools to be an advocate? Often I'm thinking about librarianship in a really broader sense about who are the reference specialists in your community and how do we make sure that they have the right information?
Adam Echelman: It gets back to what Craig said as well. The telehealth when you hear the word, you think of like a doctor with an MD over a TV screen telling you about which prescriptions to take, but really it's about using technology, which is part of our everyday life to navigate your own health information, your health questions, and anyone can do that.
Adam Echelman: They just need the right skills. Librarians are uniquely equipped, but I think there's also an enormous role that librarians can play in equipping community leaders with those same skills.
Chistopher Mitchell: We only have a few minutes left. So Craig what are the final points we want to make sure we get out of this?
Craig Settles: Well, I think the big thing right now is money. There seems to be a lot of money and from a lot of sources, the human health, heath and human services, E-Rate and so forth. How do we take advantage of that? And maybe that's the part where you can because obviously Chris, you and I have been dealing with this for a while, but yeah, let's talk more about that.
Dianne Connery: I can jump in there because this is an issue I'm working with this morning. Small library, basically a one person operation here. So when I'm getting all these emails, talking about billions of dollars at stake, and it's a lot for one person to process, it's a lot for multiple people.
Dianne Connery: Partnerships I think are really helping me feel more comfortable. One of the best partners our library has had is a local Wisp. And he's just been so willing any project we've had that come up, he's put up neighborhood access stations for us out in the community. He's just boosted our signal. So working with partners. And then I had mentioned that the healthcare partners, so I am hoping one of the answers to this complex issue of how much money is working together with partners to decide how it can be best spent and what our priorities are.
Adam Echelman: I would just add to that digital literacy is just, I feel like it's the talking point that I have to reinforce again and again, because I see, and I'm excited about the increasing investments in broadband and I am thrilled. But at the same time, we have to make sure that folks have the support to be able to effectively use broadband to access health information or just to go online in general.
Adam Echelman: And I hope that lawmakers are hearing that again and again, because while I think digital literacy and training and education, isn't always the sexiest thing. It's just as important as internet infrastructure and as device access.
Chistopher Mitchell: Craig, any final points.
Craig Settles: The digital navigators that I think has been an under-publicized, but vital role of libraries, how do we even better take advantage of digital navigators? From the library perspective of Diane and Adam?
Dianne Connery: We're working on that now because the idea of telehealth has so many possible directions to go. So I live in an area that's considered a certified retirement community, a lot of older people here who do not have the tech savvy to deal with a lot of the things more and more each day that they need to.
Dianne Connery: So I do think digital navigators at the library to help people negotiate. All of that is, is the area where moving we've started an aging in place series of community conversations. And like, we just did one on how to make your house a smart home. I think there's a lot of room out there that we can grow this whole living, your better life living, where you want to live. And libraries, I think are a great partner in that effort.
Adam Echelman: I'll just add there that a couple of things, one thing I love about the digital navigators program is that it's holistic. It's not just how do you access Comcast internet essentials or connect to a local wireless mesh network. It's also about how you use it and how you pay for it. It's all of the above. And I think that's a model that we can continue to improve on.
Adam Echelman: I think it's one that we should be investing in more and more and I'm looking to states like Maryland which just allocated a substantial budget towards digital navigators. Of course, they have great pilot programs like Salt Lake City. And then the other piece is just about again, community investment.
Adam Echelman: This is not the first time that we've seen smart models come together. I'm thinking about the digital stewards model in Detroit and the role that residents themselves can play in not only sustaining, but also explaining internet to other residents.
Adam Echelman: And I think that when we're thinking about digital navigators. Like of course we want to have, we want to have certified programs. We want certified professionals, but also there should be a world in which anyone, and everyone can be a digital navigator for their aunt, for their brother. And that program can really be democratized.
Adam Echelman: So it's not just folks in some ivory tower who are explaining the internet, explaining digital literacy and how to access health content, but that everybody is equipped with those same skills.
Chistopher Mitchell: Yes, I do think digital navigators is something that a lot of people can offer and in terms of peer to peer support, but the first place to definitely look at it, it's your local libraries. And it's exciting because it's a natural place to continue on in that mission.
Chistopher Mitchell: And I'm excited to learn about what is being innovated in these rural areas in terms of making sure that we're using these wonderful assets, the wonderful people who work there to solve the modern problems that we have, and hopefully help us to, to learn how to better solve them for everyone moving forward. So I want to thank you, Adam, and, and Diane, thank you for both coming on here today.
Dianne Connery: Thanks for having me.
Chistopher Mitchell: And Craig. Thanks for suggesting this. Thanks for making it happen.
Craig Settles: No problem. Thank you very much too, Chris. It has been good to talk about libraries. I think that's going to be a big factor in telehealth being established in the U.S. So I'm ready.
Ry Marcattilio-McCracken: That was Christopher talking with Craig Settles, Diane Connery, and Adam Echelman. We have transcripts for this and other podcasts available at muninetworks.org/broadbandbits. Email us at firstname.lastname@example.org with your ideas for the show.
Ry Marcattilio-McCracken: Follow Chris on Twitter. His handle is @communitynets. Follow muninetworks.org stories on Twitter. The handles @muninetworks. Subscribe to this and other podcasts from ILSR, including building local power, local energy rules, and the composting for community podcast.
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Ry Marcattilio-McCracken: While you're there, please take a moment to donate your support in any amount, keeps us going. Thank you to Arne Huseby for the song, Warm Duck Shuffle licensed through creative commons. This was episode 461 of the Community Broadband Bits Podcast. Thanks for listening.