MEXICO, Mo. — When Noble Health closed Audrain Community Hospital and Callaway Community Hospital's doors in March 2022, thousands of residents in mid-Missouri lost nearby access to health care. 

For many, that means an extensive drive to Columbia or another city for emergency or other types of care, leaving many feeling left behind. 

"Once the hospital itself closed, all of the outlying primary care clinics also closed," said Beth Schnitker, co-owner of Schnitker Farms. "People weren't able to get refills on prescriptions, we didn't have access to primary care doctors — it felt like we lived in a health desert." 

Schnitker and her family's farm currently sits over an hour-long drive away from the nearest hospital. She said while the community has since rebuilt the health-related things it lost, there is still one daunting absence: emergency care. 

"There's always this little part of you that's thinking about, 'Oh my gosh, if something happens, will we have all the resources we need?'" Schnitker said. 

Approximately 35% of the Audrain Ambulance District's transports went to the hospital in Mexico before it closed. Now, 100% of transports are going out of town, turning an 86-minute average call time. That spans from the time of call to the time EMS are able to return to service. 

The average call time before the closure was 71 minutes. 

"Taking the time away that they would have before to adequately sit and write reports and to get caught up and to know that their day from this point forward can be fresh again," Audrain Ambulance District Administrator Josh Loyd said. "That's not a thing anymore. So burnout is a huge thing." 

Beth Schnitker's son, Michael Fidler, is also a first responder on top of being a farmer and business owner. He is an assistant chief at the Middletown Community Fire Protection District. He said the increased travel to get patients the care they need directly affects his time on the job. 

"Our response time as a first responder has doubled, if not tripled, in some cases," Fidler said. "And getting ambulances, because they're driving farther, they're going hours now compared to just 30 minutes." 

Fidler said the increased distance makes it harder keep a patient they're transporting alive. 

"When you walk away and somebody's dead, that's heartbreaking," Fidler said. "It really hurts." 

Michael Quinlan has lived in the region his whole life and has practiced as an internal medicine physician in Mexico since 2001. His office was affiliated with the Audrain Community Hospital while it was still open. 

"We knew that other hospitals in Missouri in rural areas had failed, but I think we always thought that couldn't happen here because we'd always had such a strong hospital and such a strong medical community," Quinlan said. "It was a roller coaster." 

After the hospital closed, Quinland's office stayed open to continue providing medicine to patients who it had been providing care for decades, even if it didn't necessarily benefit Quinland's office. 

"We did a lot of free care because nobody ever processed the bills for them," Quinland said. "After they closed, I don't think past April of that year any bills ever made it through the system." 

But the struggle in recent memory is starting to turn into hope.

Boone Health CEO Brady Dubois recently recommitted to a previous pledge to bring more emergency care back to Audrain County at a Mexico City Council meeting, despite some setbacks that stand in the way. 

"Boone Health is again committed to Audrain County," Boone Health spokesperson Christian Basi said. "We know that that's a critical need, and we have every intention of moving forward with this project." 

Basi said that to his understanding, Audrain County will be the one to get the facility up and running while Boone Health will come in and operate it. This could entail utilizing resources from the old hospital or building a completely new facility. 

Once plans are finalized, Boone Health estimates it will take two to three years before the facility is ready to open. 

"I think it gives all of us hope," Schnitker said. "It does. It improves that security blanket and gives us a sense of security that if we do have a crisis, if there is a major health need, that we will really have the opportunity to make a difference in somebody's life."

"Because an hour or an hour-plus is sometimes too long," Schnitker continued. "And 30 minutes gives us such a better opportunity for survival, for better outcomes, for everyone in our community."

But planning for the future doesn't stop with bringing care back to Audrain County. The focus is also on making sure the system is sustainable this time. 

"The partnership that we've had with the elected officials there has been phenomenal," Basi said. "We're continuing to look forward to that partnership as we move forward in this project." 

Many hope the project will help rebuild the broken relationship between rural residents and the health care system. 

"I think we first have to work on building the trust with our citizens," Loyd said. "I do think Audrain County is resilient, and it's not just Audrain County. This has impacted several counties around us." 

Boone Health announced a new clinic building in Glasgow in October as it continues efforts to revive rural health care in mid-Missouri.

'Health desert' in rural mid-Missouri sees hope with commitment from Boone Health to operate emergence center in Audrain County and clinic in Glasgow