During a recent trip to the Rosebud Reservation in South Dakota, my Stanford classmates and I had the opportunity to meet Ira Salom, MD, and his son. Salom is the chief medical officer of the Indian Health Service serving the Rosebud Sioux Tribe. During our time together he shared his background as an internist from New Jersey; he has a history of working for the government and he came to his post as CMO in Rosebud just this past October. He stressed that the main challenge of this area is it being under-funded and under-resourced.
I loved Salom’s energetic and spunky demeanor, and particularly enjoyed an analogy he drew between squirrels and health care financing: Squirrels spend a lot of time finding and burying nuts that they never remember the location of; however, because all squirrels do this, they’ll find other squirrels’ nuts and benefit from the collective effort. He drew our attention to the more “socialist” notion of paying for healthcare where people’s taxes can be channeled towards those with greatest need; this can be particularly beneficial for communities that are consistently experiencing shortages.
I also appreciated his no-nonsense, straight-forward explanation of his motivation to take on this role and move away from his family on the East Coast. Frankly, the really good salary, lack of state and city income tax, and better pensions and insurance for him and his family were attractive. And I felt somewhat reassured about being able to maintain my connection with the community here when he said that even if health-care providers are not intent on staying out in the countryside for the long term, they can still contribute by volunteering consistently during parts of the year.
For our last night at Rosebud, we enjoyed a farewell dinner with different members of the community, including Doug Lehmann, MD, a pediatric/internal medicine physician from Illinois who decided to move out with his family to South Dakota. His genuineness and passion for his work inspired us greatly. He spoke about the challenges of primary care in these rural settings, where the provider has to take on all types of roles and be able to do a little bit of everything. For instance, he does orthopedics and circumcisions, as well as treat diabetes and rheumatoid arthritis.
Another guest was a Native American physician, Lucy Reifel, MD, who attended UC San Francisco for medical school and is now working on independent health projects in the community. She discussed the possibilities of telemedicine for providers not able to be on-site to offer services to the people here.
The collective comments really motivated me to consider how I could continue my involvement with rural Native American health issues. The two physicians above suggested fourth-year away rotations here to expose students to the value of working in primary, preventative care in rural areas. I’d like to become involved in efforts at Stanford to raise awareness of this possibility and the needs of the Native American people, as well as to expand peers’ ideas about where to do clerkships, and to challenge the common stereotype that primary care is not challenging enough. Perhaps in my career I can even contribute to the telemedicine effort envisoned by Reifel and volunteer some time each year to the people of Rosebud.
Bonnie Chien is a first-year medical student who recently visited the Rosebud reservation in South Dakota as part of her Rural and American Indian Health Disparities class. The goal there was to learn about socioeconomic determinants of health through visits with various Indian Health Centers, community members, and tribal educational institutions. Chien is particularly interested in global health and sees many similarities between the resource shortages abroad and in rural areas like Rosebud.