There’s rural. Then, there are places like Marquette, Michigan, nestled in the state’s Upper Peninsula and far enough away that finding emergency and health care facilities in a nearby town is a serious challenge. When the region’s only Planned Parenthood facility closed in April, with less than a month’s notice to the community, it wasn’t just an inconvenience.

Emergency physicians in the area saw it as a women’s health care crisis.

Dr. Koskenoja

“There was just nowhere for women to go, even for basic reproductive health services,” said Viktoria Koskenoja, MD, an attending physician in the area and immediate past chair of ACEP’s Rural Emergency Medicine Section. “The nearest Planned Parenthood location was over 280 miles away, and for most people here, that might as well be another country.”

Dr. Koskenoja knew something had to be done to fill this gap, so she and emergency physician Shawn Brown, MD, thought of a plan to add services at an existing urgent care facility. Luckily, Dr. Brown is the owner of Marquette Medical Urgent Care.

“We were already part of the community, already embedded in the care structure here,” Dr. Brown said. “It just made sense to use what we had.”

Hub for Reproductive Health

The idea was to transform an urgent care clinic into a hub for women’s reproductive health, including sexual assault response services and, eventually, medication abortion care. Getting from idea to execution took considerable effort. Dr. Koskenoja took the lead on logistics and staffing, devoting countless hours to grant applications, training protocols, legal research, and care model development.

After wearing out her mobile phone asking for support from local physicians, nurses, physician assistants, community leaders, and anybody else she could think of, they had the shell of what would become a fully staffed facility.

“It wasn’t just about offering services,” she said. “It was about doing it safely, legally, and with compassion.”

One component was to launch a 24-hour, in-clinic sexual assault response program.

The urgent care was a perfect location as it offered a quiet, controlled space. Partnering with The Women’s Center of Marquette—a well-established nonprofit with a 24-hour sexual assault response line and trained Sexual Assault Response Team (SART) advocates—was essential to making this program clinically sound and emotionally safe for patients. Since expanding service to the needs of women and their reproductive care, the clinic has seen a one and a half times increase in reporting for post-assault evaluation. The SART program was actually implemented about eight months before responding to the Planned Parenthood closing.