Karen Whitaker Knapp said, "I always hoped I would leave something better than I had found it."

Knapp made that statement in response to her retiring this month from Oregon Health & Science University where she served as vice provost for rural health and director of the OHSU Center for Rural Health. Knapp is well known throughout Oregon for her work to ensure that dollars flowing from both state and federal coffers improved the quality and availability of health care for rural Oregonians. As vice provost for rural health and director of the OHSU Center for Rural Health, Knapp helped to make sure that Oregonians benefited both from OHSU's current resources and from the Oregon Opportunity, the $500 million statewide public-private partnership. Knapp has also been the director of the Oregon Office of Rural Health until she retired from that position last March.

"Karen Whitaker Knapp has been one of the great resources for OHSU and the state. She has performed exceptionally in all areas for many years. She has made many friends for OHSU and has helped the practice of rural medicine immeasurably. We will greatly miss her," said Peter Kohler, M.D., OHSU president.

Throughout Oregon, many sing her praise: "I have had the pleasure of working with Karen for more than 25 years, both here at OMA and in collaboration with her at the Office of Rural Health. She has been a good friend and a sage adviser and I will truly miss her counsel. Besides, unless it is a very big room, she's the smartest person in it," said Jim Kronenberg, chief operating officer of the Oregon Medical Association.

Lesley Hallick, Ph.D., OHSU provost has worked with Knapp for many years and said: "Karen is the consummate team player. She has the ability to inspire people to want to do the right thing because she leads by example. She is the type of person that you always know will represent you well so you simply don't have to think about it. She has been an effective advocate for rural health programs because she is able to negotiate on their behalf in Salem and in Washington, D.C., and she runs one of the most highly leveraged units at OHSU because of it. That has allowed her to deliver far more services that the state funds - by about four-fold. Karen and her team have literally made the difference between survival and closure for numerous rural health clinics and small hospitals. She just quietly does what needs to be done."

One example of what Knapp has left better than she found it has been the establishment of the Oregon Rural Practice-based Research Network (ORPRN), which links OHSU researchers to clinics around the state in an effort to investigate health care questions specific to rural, community-based medical practices. She also worked closely with the four Area Health Education Centers (AHEC), which are located throughout Oregon. Throughout her years, Knapp has seen changes in the rural health communities she served. For example, there is a lot more federal involvement in rural communities such as the critical access hospital program.

"I have learned that the whole issue and importance of rural health waxes and wanes over time. Luckily, rural health has remained a bipartisan issue. It seems to me that rural communities are becoming more active in health care issues. It always amazes me how small, rural communities can have armies of volunteers that take on an issue until it's resolved," she said.

Some of the issues rural communities face include lack of economic opportunities; inadequate reimbursement from federal programs such as Medicaid; and a shortage of health care practitioners.

"Sometimes I felt like I was running up an escalator that's going down. You have to run like crazy to make any progress," Knapp said.

Knapp said there are still tasks left undone.

"I was really hoping we could get rural emergency medical services funded from the Legislature. Plus, the problem of access to health care insurance is only going to worsen as the number of uninsured people in rural areas especially, is increasing. It's going to be a difficult issue for rural communities. The aging rural population is another challenge. I guess I'm a part of that population now also," she said.

Friday, March 17, is her last day of work at OHSU.

"It is difficult to get my mind around this next part of my life even though I've been planning this for more than a year. I just want to say that I have such boundless admiration for the people I have worked with throughout the state and at OHSU," she said.

Knapp and her husband, Jerry Knapp, who will also be retiring soon, are moving to Puerto Vallarta, Mexico. Scott Ekblad is the deputy director of the OHSU Center for Rural Health and is the director of the Oregon Office of Rural Health.