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Lessons from a reservation: South Dakota trip sheds light on a life in rural medicine

Lessons from a reservation: South Dakota trip sheds light on a life in rural medicine

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.

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