The corridors of Harvard Medical School might be leading to Native American communities on the Plains. Representatives from the Indian Health Service and Massachusetts General Hospital—the teaching hospital for Harvard Medical School—visited South Dakota Urban Indian Health in Pierre recently to explore the possibility of bringing resident physicians to underserved Native healthcare centers in the state.
Harvard Medical School residents might work in S.D.
The Global Primary Care Program, part of Massachusetts General Hospital, already has partnerships in Chelsea, Mass., and in rural Uganda to reach underserved populations. The Indian Health Service, part of the U.S. Department of Health and Human Services, invited Global Primary Care Program members to look at South Dakota — both for their own medical training and for the services they can bring to the Native communities.
"I think it's a terrific fit," said Dr. Patrick Lee, director and founder of the Global Primary Care Program at Massachusetts General Hospital. He noted not only health care challenges but also cultural richness as factors that could help young physicians make real contributions as they broaden their own understanding.
Lee said the project might involve a rotation of residents who spend two to four weeks in South Dakota serving Native populations. Those populations include South Dakota Urban Indian Health centers in Pierre, Sioux Falls and Aberdeen, as well Indian Health Service agencies on the Pine Ridge and Rosebud reservations.
One resident physician, Dr. Matthew Tobey, is already in the state and will write a description of his experience for other residents who might consider coming after he leaves.
But Lee stressed that it's important to know if the presence of visiting resident physicians is welcome before giving the program a green light.
"That would be crucial," he said.
Tobey, visiting the South Dakota Urban Indian Health recently, will be staying in the state for several weeks. Tobey is a resident physician in internal medicine/global primary care at Massachusetts General Hospital.
"This is a chance to work with communities facing a lot of challenges in their health care," he said.
As for the knowledge his colleagues in Massachusetts currently have about the area, he said: "essentially none."
But Lee and Tobey said they'd seen both problems and unusual courage in tackling those problems during their time here. That sort of challenge, they suggested, could be welcome to young physicians back in Massachusetts.
"They have a lot to teach," said Tobey, speaking of the Native residents he has encountered.
Lee said that if the program does proceed, young physicians would be in a position to learn about a region that's unfamiliar to them—and to consider it as a place to do some of their later work.
"They would be learning a tremendous amount," he said. "We've heard that this may serve as a recruitment opportunity as local providers have a chance to interact with them and share with them what it would be like to come back and serve for a longer term."
Lee said the residents would likely be in their final or second-to-final year of their residency—or "very close to fully trained."
If the program goes forward, Lee said, resident physicians will gather information from the community—including from Native health facilities—as they craft what he called "teaching cases." The teaching case, he said, would be a 15- to 20-page document with graphs or pictures that lets readers understand how care is given and spark discussion about that care.
"There's so much complexity here, and we want to challenge the ideas that one size can fit all, especially as we move toward health reform," Lee said.
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