I struggled in the suffocating Calcutta heat and humidity to pull together the tattered shirt on an infant, this baby, and place her into a crib as she squirmed and cried.
As her eyes pleaded with me to keep holding her, I thought how all infants want to be held in loving arms, to be fed, and to be lifted toward their dreams of the future.
“Hey Dora, come on!”
My fellow volunteers kept shouting out for me to hurry up.
A few minutes later, I joined them, splashing my feet, puddle hopping in the drenching monsoons, making our way to the volunteer house.
But my mind wandered.
I thought instead of the upcoming winter back in my hometown in Maine, shooshing and gliding down streets on cross-country skis in the quiet of an evening snowstorm.
Now that I was in my early 30s, I also wondered if the streets were still uncrowded enough to ski on them, as they were when I last lived there as a teenager.
A few minutes later, over a dinner of lentils and rice, my fellow volunteers with the Missionaries of Charity shared stories of feeling inspired and wanting to return someday to Calcutta.
But my mind wandered.
I thought instead of returning to Maine and the upcoming conversations over mashed potatoes and corn on the cob, talking with family and friends on everything from state politics to local weather.
After 14 years of living away from Farmington, and several months in Asia, tomorrow was the day I would depart Calcutta to return and start practicing pediatrics in my hometown, in rural western Maine.
However, although my mind was increasingly focused on my new life back in Maine, I also felt very guilty to not feel drawn to staying in Calcutta, where clearly the needs were so dire.
The next day after morning prayers, as was the tradition for departing volunteers, I lined up to pay my respects to Mother Teresa before heading to the airport. I nervously shared with her my feelings of guilt for wanting to leave to return to my home state of Maine.
I’ll never forget her words, as they became a turning point in my life.
She took my hands and said, “If where you are going, you will work with love, and love your work, that is where you are called to go.”
If where you are going, you will work with love, and love your work, that is where you are called to go.
Returning to Maine, practicing pediatrics for four years in Farmington, then directing the state’s public health agency for 15 years, those words have lit my way and helped guide me to focus on those who are underserved in Maine.
The last six years, I’ve been blessed at the University of New England to work with our many health professions students and programs, especially on interprofessional education, or team-based care.
However, recently I’ve been jolted twice, and this has made me rethink things.
First, last summer I received a call from a Bangor Daily News reporter, asking what I thought of Maine’s increasing infant mortality rates.
Now, truthfully, I hadn’t been monitoring the data too closely since leaving state government in 2011, so I was shocked to learn that Maine’s rates are the only ones in the country that are increasing, i.e. worsening.
This is critical, since infant mortality — the rate at which babies die in the first year of life — is the most accurate pulse we have on the health of a society. It reflects not only the health of people at their most vulnerable time of life — that is, infancy — but also of women during and after pregnancy, and of the entire family and community, since, for instance, any environmental toxins contaminating a community often exert their heaviest impact on infants.
I remember in the 1990s when Maine enjoyed the lowest — the best — infant mortality rates in the country, and was even on par with the lowest of any country in the world. So, I was stunned to learn that our rates have increased to the eighth highest in the country.
In digging into the data, I also learned not all of Maine has fared worse over the years. Compared with the 1990s, Maine’s more southern and urban infant mortality rates have stayed about the same, and in some cases even improved. For example, York County has seen a 31 percent improvement.
However, in most of Maine’s rural counties, the rim counties, rates have dramatically worsened. Some of these counties in Maine have infant mortality rates on par with Croatia, Romania, and Botswana. In other words, Maine’s worsening infant mortality rates are mainly due to declining health of babies and families and communities in rural Maine.
At first I thought maybe this decline was due to one or two issues, such as the opioid addiction epidemic.
So, I examined other health data, and compared county trends over the last 20-30 years. I learned that in just about every major category of health indicators, rural Mainers are less well off, and any statewide declines in these issues over the last few years are mainly due to worsening health of people in rural Maine. This is true for cancer, diabetes, drug addiction, heart disease, obesity, and smoking.
As I have been contemplating these data, a second jolt hit me. Over the last few months, I have witnessed a widening cultural divide between rural and urban Maine.
Knowing I’m from rural Maine and spend a lot of time there, my friends in Portland have recently asked me:
“Are people in those areas of Maine racist?”
“Why do people there seem afraid of immigrants?”
“Why do they seem to vote against themselves?”
My short answer is, “No, the people I know in rural Maine are not racist or afraid of immigrants.
“But much of the economy there has faltered, people have moved away, and there are few opportunities for good jobs. When you feel your communities are forgotten, you stand up and listen to those who seem to pay attention and seem to have answers.”
I often give the example of, when I graduated from high school in Franklin County in the late 1970s, most of my classmates found jobs in one of the seven shoe manufacturers in the area or in the wood products industry that made everything from toothpicks to croquet sets.
These were good jobs, enough to raise a family and to enjoy swimming in the lakes in the summer, hunting in the woods in the fall, snowmobiling in the mountains in the winter, and fishing in the streams in the spring.
Now, those jobs and many others are gone, wiped away, offshored or automated. The largest employers are often service industries, such as grocery stores, Walmart, nursing homes, and hospitals.
What I’ve come to realize is that these issues — worsening health outcomes and a widening economic and cultural divide in Maine — are connected.
When much of an economy unravels, more families live in poverty, and in turn, we know poverty is one of the biggest factors negatively impacting health, especially of those who are more vulnerable, such as infants and children.
Additionally, when critical threads that hold together the fabric of a society, such as the economy and health, become tattered and start unraveling, the entire fabric of the community is at risk.
I’ve realized over the last few months that the reason I returned to Maine nearly 25 years ago, was that passion lit inside me for all of Maine — rural and urban. And now, with so many challenges, I need to re-light those passions.
Recently, I’ve decided to accompany UNE medical, nursing, dental, and pharmacy students interested in rural health for immersions there, to light a passion in them for the beauty of rural Maine and its people.
I’ve worked to obtain a major federal grant so we can work more closely with rural clinical sites.
I know all of us hold a passion for Maine. So, I’d like to suggest that each of us living in more urban areas tries to commit to shining a light on rural Maine.
Consider a stay-cation there, with some long walks or skis, and include some stopping and observing as well.
Consider conversing over a meal with people from there, perhaps over mashed potatoes and corn on the cob, and listening.
Consider lifting someone toward their dreams, by perhaps recruiting and hiring someone from rural Maine.
After all, despite the differences, I truly believe we have much more in common — we all want our children to be held, to be fed, to be clothed, to grow healthy.
We all want to dream.
And we all yearn to do something meaningful that we can be passionate about.
After all, if we work with love and love our work, that is what we are called to be doing.
Dr. Dora Anne Mills is vice president for clinical affairs at the University of New England and is Maine’s former state health director. This essay is adapted from a speech Mills gave at Maine Live on March 30 in Portland, an event sponsored by Maine Magazine.