By Vismaya Gopalan, Dartmouth College, Class of 2027

For the past year and a half I have been fortunate to serve as a Dartmouth Center for Social Impact Class of ‘82 Fellow, working alongside the Public Health Council of the Upper Valley, town leaders, policymakers, and community partners to better understand what rural public health really looks like. As I write this having worked with the PHC for over a year, I am grateful that I can continue collaborating with Alice Ely, the PHC’s Executive Director, over the coming months. Working with her and with the organization has shown me that public health is never just a set of policies or statistics. In rural communities it lives in the everyday. It appears in the driveways that freeze over all winter, in the waiting rooms people never enter because they cannot afford the bill, and in the neighbors who step in when systems fall short.

The stories are countless, and they stay with me long after the meetings or interviews end. Many parts of this region are aging, and that creates layers of vulnerability that do not appear clearly in datasets. I think of older residents who did not know how to book a vaccine appointment online during COVID. The process assumed comfort with technology and broadband access they never had. I think of individuals who distrust vaccines entirely, mistrust that grows not from malice but from isolation, fear, and years of feeling overlooked by the healthcare system.

And I think of the blind veteran in a small New Hampshire town. His story is the one that sits with me most heavily. He lived alone in a mobile home, unable to take out his trash, waiting month after month for a VA appointment that never seemed to come. His social security checks barely covered his needs and slowly his home filled with garbage. Eventually the smell drifted into the road. Neighbors called the town clerk, who then called the town health officer. When they entered the home they found a man barely holding on, furious at a system that had failed him at every turn. His story was not only about one man’s struggles. It revealed how fragile the safety net can be in rural places and how quickly people fall through when there is no one nearby to catch them.

There are other stories too. Families who choose not to vaccinate, not because they do not care, but because they distrust institutions they feel have ignored them. Elderly residents with long, steep driveways who become trapped inside for weeks after winter storms. People who cannot rely on consistent transportation, for whom an appointment thirty miles away might as well be across the country. Residents skip dentist visits until infections spread because insurance does not cover oral health. Others with no insurance at all who must choose between groceries and care.

Then there are the barriers that are harder to name. People of color who feel invisible in a region where diversity is limited and systems are not built with them in mind. New immigrant families trying to navigate unfamiliar services, working through language barriers, or facing subtle forms of exclusion. In a place that prides itself on being close knit, too many still find themselves left outside the circle.

Geography shapes these challenges as well. The Upper Valley straddles Vermont and New Hampshire. This creates opportunities for collaboration, but it also introduces mismatched rules and priorities. Insurance programs, social service structures, and legislative agendas differ across the river. A program that works smoothly in one state may stall in the other. The PHC sits at the center of this tension, helping local leaders piece together a system that is coherent enough to meet real needs across both states.

Yet for all the challenges, I have also seen resilience. I have worked with Town Health Officers who show up at doorsteps not simply to enforce rules but to perform welfare checks. I have met nonprofit staff who stretch every dollar to support food access, addiction recovery, or mobile clinics. I have seen legislators listen closely when local stories are translated into briefs and policy asks. And I have watched neighbors clear each other’s driveways after storms or check in on those who live alone. These quiet acts of care do not erase structural inequities. They do, however, show the humanity that underpins rural public health.

For me, the Upper Valley has become a home not because it is perfect but because I have seen how deeply people care for one another despite imperfection. Public health here is raw and real. It includes the grandmother at the end of a snowy driveway, the farmer who cannot afford to see a doctor, the teenager struggling with addiction, and the family balancing trust and fear around vaccines. It includes the blind veteran left behind by bureaucracy and the immigrant family learning to navigate systems that do not always see them clearly.

My time with the PHC has been an immersion into what rural public health actually looks like. Over the past year I have spoken with Town Health Officers, selectboard members, nonprofit partners, and fire chiefs to understand the realities of housing, sanitation, and community health. I have written blogs and reports that translate those realities into stories and policy recommendations that local residents and legislators can access. I have attended board meetings, written grants to support community health events, and helped shape legislative briefs that connect local experiences to state level decision making. Through it all I have been reminded that public health is not only about systems. It is about showing up where people are and making sure they are heard.

The state of rural health in the Upper Valley is complicated. It is full of inequities, resource gaps, and systemic barriers. It is also full of extraordinary resilience. Working here has reminded me why I care so deeply about this field and why I will carry these lessons with me as I move forward. I owe a special thank you to Alice Ely, whose leadership and mentorship have been a model of how to build trust, create connections, and make rural health more visible and more equitable.

Health is not only a matter of access or policy. It is the measure of how a community cares for its people. And here, even in the midst of struggle, I have witnessed a profound capacity for care.

— Published by the Valley News on February 12, 2026, as “What public health in the Upper Valley has taught me.”

What I Learned Interning at the Public Health Council

By Thomas Hohmann, Dartmouth College, Class of 2026

As a student curious about medicine, particularly in a rural setting, the Public Health Council of the Upper Valley naturally was an attractive opportunity for a summer internship. Surprisingly, I learned that public health is much more complex than I expected, involving a surprising range of professionals from various disciplines. I had previously associated this field primarily with direct community services yet have found the work behind the scenes is just as important in making the greatest positive impact on the community as a whole. This is not to say that the PHC does not touch the lives of its community members – see our flu clinics, for example – but that its impact is far broader.

Over these past few months, it has become clear that PHC’s essential role in the Upper Valley is as a connector and advisor for other organizations working to tackle a variety of public health disparities in our region. In a privatized health system like the U.S., community-based work often falls to nonprofit organizations, which, though doing amazing work individually, often only focus on specific issues or on specific regions. This large number of dedicated groups with slightly different causes creates a confusing public health system for the average community member trying to get the care they need. The same can be said for social services, perhaps even to a greater extent, especially since socioeconomically disadvantaged individuals often look for more than one type of service from more than one organization, government or otherwise.

Given these complexities, leaders like the PHC play a crucial role in connecting the different nodes making up the complex web that is the health and human services sector. In my own internship, this made for an unpredictable, dynamic work environment where each day represented something a little bit different. For example, I started out synthesizing data from a variety of online sources for our website but quickly jumped to creating policy briefs for Community Health Improvement Plan Meetings, interviewing Town Health Officers, organizing outreach for flu clinics in the fall, and taking inventory of emergency preparedness kits for the local Medical Reserve Corps. While some might view this range of tasks as random, it accurately reflects the breadth of the PHC’s work and what is needed in public health right now.

The day-to-day life of our Executive Director, Alice Ely, is a testament to this as well. Over the span of a few hours, she might start with a meeting about housing issues then transition to one about BIPOC representation in the Upper Valley and finish discussing PHC’s new strategic plan. While at first the range of conversations I would hear from her office seemed odd, I have come to appreciate how valuable the broad perspective of the PHC is for the organizations we serve. Everyone needs someone to go to when they have a problem, maybe it’s your parents or friends, and for anyone working in health and human services in the Upper Valley, it seems to be the Public Health Council.

Ultimately, this work toward integration across organizations and focus areas is improving and will continue to improve the efficacy of public health initiatives in the Upper Valley. Though more difficult to measure than caring for community members directly, this work is ultimately making a healthier future possible for our community members.