The hospital had lost the last doctor in a succession of those who came to the remote Kansas town and left again. A sole physician assistant kept watch over the 24-bed facility and its adjacent nursing home. It was on the verge of closing.
Then officials at the Ashland Health Center, seeking to reverse the drain of talent symptomatic of what happens across rural America, embraced an unorthodox approach to bring doctors back.
All employees, from maintenance people to physicians, get eight paid weeks off each year that they can use to do missionary work in other countries. The idea: people willing to care for the sick and suffering in developing nations might be content to do the same in a town of 855 people, more than two hours away from the nearest Starbucks.
The public hospital began advertising that benefit _ which employees can use for other volunteer work or any purpose they choose, not just mission work _ in Christian publications and at Catholic-run medical schools. Today, the hospital has a chief medical officer, a medical technologist, a nursing director, a nurse practitioner and other staff drawn by its so-called mission-minded recruiting. It's now looking for nurses, a dentist and a physical therapist.
"I was not surprised by the differences between rural Kansas and rural Zimbabwe. What surprised me were the similarities," said the hospital's 32-year-old administrator, Benjamin Anderson, who has been the catalyst for the program. "I am not saying rural Kansas is the same as a developing country, I am simply saying rural Kansas and rural Zimbabwe struggle with some of the same challenges _ they just look different."
In both places, people have difficulty accessing medical care, face housing problems and can feel isolated.
Situated in the vast prairie of southwestern Kansas, Ashland is a sleepy cattle ranching and oil town filled with modest homes and an aging population. The major employers left are the schools and the hospital. It has a small grocery store, but no gas station. Walking anywhere in town takes 10 minutes.
Anderson, who's gone on missions to Zimbabwe since coming to Ashland in 2009, was convinced the compassionate health care providers he sought could best be found among physicians with a passion for mission work in developing countries.
A few months ago, Dr. Dan Shuman, a 43-year-old family physician, was working at a health care center and a multi-specialist medical group in Georgetown, Texas. Then he heard from a friend about a little hospital in Kansas and the mission opportunities that came with it.
Although Shuman had a comfortable practice caring for well-insured retirees, he missed the medical work he had once done in places like Haiti and Mexico. Shuman and his wife, a social worker, moved in July with their five children to Ashland.
"Everywhere in the country we have problems with health care," Shuman said. "But this was a place that was really seeking to make a difference."
Ashland's recruitment model was developed with faculty at the private Via Christi medical residency program in Wichita, part of the nonprofit Catholic health care system, where students can complete a three-year family medicine residency. It also offers an International Family Medicine Fellowship, a one-year post-residency program geared to providing health care in developing countries.
Dr. Scott Stringfield, its recruiter, has seen more medical students wishing to do mission work, both in developing nations and domestically in inner cities. Last year, 16 percent of applicants indicated interest in such work. This year, it was 33 percent.
Some doctors have taken the initiative in seeking mission-friendly jobs. Four former Via Christi fellows, two of whom were married to other doctors, sent letters to hospital administrators in 25 states offering a package deal: They would move to a town with a hospital in need in exchange for each getting three months off on a rotating basis annually for mission work. All six ended up in New Hampton, Iowa, a town of 3,500.
"If we can use medicine as a tool for us to share the gospel of Christ with people that is really what drives us," Dr. John Epperly said in a phone interview. "We are all going to have bodies that are aging and getting sick and I hope we can prolong that to some extent with medicine. But in the end what is important, I think, is what is eternal and that is what we have been focused on _ whether it is working with farmers in northeastern Iowa or whether it is working in Zimbabwe at a bush hospital."
Among Ashland's new hires are Lacey Mollel and her husband, Enkaiye. As the child of missionaries in Tanzania, she grew up "playing in the bush in the middle of nowhere" with the boy who would become her husband. She came back to the U.S. for college, and Enkaiye, a former Masai warrior, followed later.
The couple left Indianapolis to work at the Ashland hospital _ she as a certified nurse assistant, he as a groundskeeper _ after her uncle, a pastor in Ashland, told them about the opportunity.
Lacey Mollel said they would not have left Indianapolis "unless you feel some calling or purpose in what you are doing."
Clark County Deputy Sheriff Robert Canton used to tell friends if anything ever happened to him not to send him to the local hospital. He lives just a couple of blocks away from the Ashland facility, but thought he couldn't get good care there. Two months ago, he went to the hospital's emergency room with heart problems and came away impressed.
Now, he says, he tells his fellow deputies, "Take me there."