tumblr_o4wpuqRvYP1vot8d2o1_1280This year, 15 first-year Geisel MD students and 2 TDI students embarked on a journey to Minnesota for spring break. We spent time in Minneapolis with the urban Indian Community and visited four different reservations across northern Minnesota. The trip gave us a glimpse into Indian history, culture, and health. You can read more about our spring break Indian Health Service trip on our blog.

tumblr_o4wpuqRvYP1vot8d2o1_1280This year, 15 first-year Geisel MD students and 2 TDI students embarked on a journey to Minnesota for spring break. We spent time in Minneapolis with the urban Indian Community and visited four different reservations across northern Minnesota. The trip gave us a glimpse into Indian history, culture, and health. You can read more about our spring break Indian Health Service trip on our blog.

Jihan Ryu ('17) lands in Minneapolis to embark on the Indian Health Service Trip, an annual program offered during spring break for first-year Geisel medical students to learn about Native American health issues and serve as volunteers on reservations.

By Jihan Ryu

Over the course of their spring break in March 2014, 10 Geisel medical students took part in an annual trip to Minnesota to volunteer in Native American communities. Read all the entries from their trip here.

Half-awake from a nap, I glanced to my left to catch a glimpse of Minnesota from 10,000 feet above. I was about to land in Minneapolis to embark on the Indian Health Service trip, an annual program offered during spring break for first-year Geisel medical students to learn about Native American health issues and serve as volunteers on reservations. In many ways, my decision to spend a week in Minnesota came at an opportune time, despite the other ways I could have spent a much awaited respite from a long winter in Hanover.

In college, I took a Native American literature course and read about the systemic violence pervasive in Indian communities and how it exhumes historical trauma and manifests in different forms, one being disparities in health. Stories of addiction, depression, and violence told in Native American writers’ voices gave me a conceptual framework to think about the conditions of reservation life but left me wanting an experiential understanding of health issues in Native communities. Dartmouth as an institution has strong historical and educational ties with the Native American community and is well-known for its growing partnership with the Indian Health Service, which provides Geisel medical students with numerous options for their clinical training. So when one of my peers suggested taking part in the Minnesota alternative spring break, I could not pass up the opportunity.

The Indian Health Service Trip team, led by Shawn O’Leary, the director of Multicultural Affairs at Geisel, kicked off the week by participating in community enrichment activities in the Twin Cities. After a warm reception by Geisel alumni and locals in Minneapolis, the 10 students on the trip split into three groups and parted ways to spend time in hospitals and clinics on three different reservations—Red Lake, Cass Lake, and White Earth—in northern Minnesota. I went to Red Lake Hospital, which has a unique administrative structure in the way it serves the reservation population. Funded and run jointly by the tribe of Red Lake Nation and the Indian Health Service, the hospital combines resources of the tribal community and federal health services to address health needs of the reservation in a collaborative and strategic manner.

One impressive feature of the hospital, for instance, was the active deployment of tribal community members as health-care providers. A nurse I shadowed one afternoon, during a home visit at a patient’s house located 10 miles north of the hospital, also happened to be an unofficial local historian with a deep connection to the reservation both in her knowledge and in her relationships with neighbors. Interaction with the patient was more authentic and efficient as a result. Trust built while providing longitudinal care and by strengthening personal relationships sustained a surprisingly delightful and even humorous conversation throughout our home visit, despite the heavy topics we were discussing for this palliative care referral. In fact, a sense of humor, according to a clinical psychologist I met in the hospital, was a theme in many Native Americans’ lives. By giving needed relaxation to mind and body, laughter certainly seemed to play a therapeutic role in alleviating some of the patients' pain.

I learned, however, that having a light-hearted attitude alone isn’t enough. A morning that I spent shadowing the head of the behavioral health program at the Red Lake Hospital showed me the limitations of his department. There was an apparent lack of providers in mental health in the reservation—only one psychiatrist was in charge of all visits and consults in the Bemidji area, to which Red Lake belonged; various initiatives in social work programs were underfunded; and education programs such as prevention of suicide, a rising public health issue that has pressed the community of the reservation in recent years, were largely underdeveloped.

Dr. Paul Ditmanson, a family medicine physician for over 15 years in the reservation and clinical director of Red Lake Hospital, also told me that heroin is making a comeback, afflicting the lives of many in the tribe, and that the epidemic is due in part to systemic poverty and a sense of hopelessness arising from it. Indeed, psychiatric cases I saw in the clinic had a clear association with patients’ social environment, whether it was an abusive relationship with a partner, day-to-day struggles with poverty, or grieving for the loss of a dear friend. My conversations with doctors, psychologists, and nurses were a reminder of the alarming lack of resources in behavioral health and social work. It is a phenomenon that faces the country as a whole but is especially remarkable among minorities and at-risk populations living with historical and emotional traumas.

The last day of the service trip was spent walking around the neighborhood of South Minneapolis, home to a large Native population. While watching Native Americans waiting in the outpatient clinic, sipping coffee in the cafe, or simply strolling on the street, I thought about cultural competency and its value in medical education—a topic that is being increasingly talked about in the Geisel community and beyond. In what manner can cultural competency be best taught to future physicians entering the field, especially as the diversity of patient demographics and cultural values and practices increases?

For me, this alternative spring break was cultural immersion as much as it was shadowing of a health-care system. And I could not have asked for a better way to learn about Native American cultures and communities and about the unique challenges the population faces in health care. Visiting the homes of local Native Americans and interacting with physicians who have worked in the reservation for a long time, I received a vivid education in the practice of primary care in the reservation, the psychosocial context of working with patients, and the room for improvement in minority health.

It was the kind of cultural awareness that I could not have gathered prior by reading public health journal articles or Sherman Alexie’s books. Perhaps to my highest gratification, I left Minnesota feeling like I could actually talk to a Native American patient without feeling like an outsider anymore. That sense of inclusivity was slowly, but assuredly, growing in my heart.

Jihan Ryu ('17) talks about working with Indian Health Service Staff at Red Lake reservation.
Dr. Ditmanson, Alena, Di, Jihan, Cassie, and Dr. Borromeo at the lobby of Red Lake Hospital
Dr. Ditmanson, Alena, Di, Jihan, Cassie, and Dr. Borromeo at the lobby of Red Lake Hospital

By Jihan Ryu

Over the course of their spring break in March 2014, 10 Geisel medical students took part in an annual trip to Minnesota to volunteer in Native American communities. Read all the entries from their trip here.

Today was the last day working with IHS staff at Red Lake reservation. Alena, Jihan, Cassie, and Di spent the slow morning shadowing family nurse practitioner Tammy, Dr. Lotsu, and other nurses in the clinic. A few days of clinical experience in the hospital allowed us to learn about the capabilities and limitations of the in-patient program, as well as hear firsthand accounts of patients as to how they feel are being served. Incomplete resources and underfunded behavioral health and social work programs remained a room for improvement. But, for a small clinic like Red Lake hospital, the accessibility of care, little to no cost of care, and high quality of patient-physician interaction stood out as some of the strengths of the care model that we thought could learn from. We wrapped up our experience by taking a group picture with Dr. Ditmanson, Clinical Director of Red Lake Hospital, and Dr. Borromeo, an internist who made our stay enjoyable and memorable.

Red Lake Team spent a fun afternoon doing blood screening at the Casino Hotel.
Red Lake Team spent a fun afternoon doing blood screening at the Casino Hotel.

The afternoon was spent at Seven Clans Casino Hotel lobby doing blood pressure screening. It was a relaxing hour or two, practicing our blood cuff handling skills and educating people about cardiovascular health issues. We were glad to see that many were attentive to various risks of hypertension and willing to maintain healthy blood pressure. Now we were really done with our schedule at Red Lake. Off to Duluth!

On the second day in Minnesota, members of the Rural Health Scholars visited Red Lake High School to spend an afternoon with Indian youth and their teachers in the reservation.
Seven Clans mural, a student public art project, on the hallway of Red Lake High School.
Seven Clans mural, a student public art project, on the hallway of Red Lake High School.
Di, Cassie, Alena, and Jihan with college-bound senior students and the principal at Red Lake High.
Michael, Di, Cassie, Alena, and Jihan with college-bound senior students and the counselor at Red Lake High.

By Jihan Ryu

Over the course of their spring break in March 2014, 10 Geisel medical students took part in an annual trip to Minnesota to volunteer in Native American communities. Read all the entries from their trip here.

On the second day, Red Lake team visited Red Lake High School to spend an afternoon with Indian youth and their teachers in the reservation. After the school principal gave us a tour of facilities and student art projects on the hallway, we had lunch at the cafeteria. We were all impressed by the nutritionally conscious choices on the menu--our trays were quickly filled with a variety of green vegetables, berries, milk, and not even a splash of ketchup! When the bell rang, we dropped by 9th and 10th graders' classrooms and split ourselves into small groups with students to have one-on-one conversations on homework, hobbies, and dreams. Then, we had a group session with college-bound senior students in the main hall to answer questions about applying for Indian health scholarships among other things. They were both excited and nervous about transitioning out and planning new futures of their own. The guidance counselor told us that one challenge facing high school students in the reservation was lack of role models who can serve as mentors, encouraging them through rough times. Even though it was a short couple of hours, Red Lake team hoped that they left an important message in students' hearts that there are always people waiting to help when they don't give up and keep wearing their winning smiles.

Early in the morning, Jihan Ryu ('17) and other Rural Health Scholars reported to the Indian Health Service Red Lake Hospital and introduced themselves to the staff members.
Jihan, Cassie, and Di in front of the frozen Red Lake.
Jihan, Cassie, and Di in front of the frozen Red Lake.

By Jihan Ryu

Over the course of their spring break in March 2014, 10 Geisel medical students took part in an annual trip to Minnesota to volunteer in Native American communities. Read all the entries from their trip here.

Early in the morning, Jihan, Cassie, and Di reported to the Indian Health Service Red Lake Hospital and introduced themselves to the staff members. We were welcomed by hot bagel and muffins and given a tour of the Red Lake reservation with another nursing student at Bemidji State University by Mary Anne, Director of Nursing at the hospital. An hour of drive north took us to the end point of the road that met beautiful Red Lake. There, we took a photo at the lake and enjoyed a beautiful scenery. After coming back to the hospital, Mary Anne gave us a neat presentation about the history of Red Lake nation, several local traditions, and the names of seven clans that were the symbol of the reservation. We were then greeted by the CEO of Red Lake Hospital, who explained to us the Red Lake's unique health system that combines tribal community health resources and federal management to its full utility.

In the afternoon, Jihan and Cassie accompanied community health nurses on home visits in the area. Cassie's visit entailed checking the growth of newborns and the well-being of the mother. The mothers were then given an opportunity to ask questions and receive information about assistance and education programs, as they moved forward with post-pregnancy. Jihan shadowed a nurse doing a health check-up of a chronically ill patient for referral to palliative care at the hospital. In the meantime, Di shadowed Dr. Ulu and Dr. Jahed in the ER for hours. They walked her through their work-ups for each patient. On top of honing clinical skills, they had a chance to immerse themselves to the social history and culture of reservation through a series of small interactions with local Natives, not only in the clinic, but also those in the post office, food market, and many other places of their daily lives.

Today, four medical students headed out to the Bug O Nay Ge Shig School in Cass Lake. The "Bug School" is a K-12 school operated by the Leech Lake Band of Ojibwe, and serves students enrolled at any one of the nearby tribes (most students are from Cass Lake, Leech Lake, or Red Lake).

Over the course of their spring break in March 2014, 10 Geisel medical students took part in an annual trip to Minnesota to volunteer in Native American communities. Read all the entries from their trip here.

Today, the four of us headed out to the Bug O Nay Ge Shig School in Cass Lake. The "Bug School" is a K-12 school operated by the Leech Lake Band of Ojibwe, and serves students enrolled at any one of the nearby tribes (most students are from Cass Lake, Leech Lake, or Red Lake).

We had a great time with the kids! We gave two presentations—one for middle schoolers, and one for high schoolers—about the different kinds of jobs in medicine, and the various things that students can do to prepare themselves for medical careers. The kids were most engaged during the “skit” portion of our presentation: Liam pretended to be a patient, Chenge narrated, and Adam and I helped the students use stethoscopes, take blood pressures, and look at x-rays.

After answering the students’ questions, we took a tour of the school. Chenge and Adam even helped some of the high schoolers prepare fish for an upcoming event with the tribal elders! The teachers and staff were extremely generous, and gave us each some wild rice, maple sugar, and a birchbark container. We even got to take some of the smoked fish home with us!

Chenge helping to prepare fish
Chenge helping to prepare fish
Adam helping to put fish in the smoker
Adam helping to put fish in the smoker

Megan Laporte ('17) spends the day in a clinic in Cass Lake with a nurse practitioner.

By Megan Laporte

Over the course of their spring break in March 2014, 10 Geisel medical students took part in an annual trip to Minnesota to volunteer in Native American communities. Read all the entries from their trip here.

Chenge, Adam, Liam, and I had a fantastic day shadowing at the Cass Lake Hospital!

I spent the day in the clinic section of the hospital with a nurse practitioner named Joe. He grew up in the Cass Lake area, and came back to work in his hometown after training at Johns Hopkins. Joe and I saw patients with a wide variety of issues. I’m always amazed that primary care docs are able to care for so many medical and social conditions!

It seemed like a typical clinic—friendly and busy nurses, waiting patients, ringing phones—with a noticeably collaborative atmosphere. Many of the staff members have lifelong ties to the community. Some of the nurses were telling me that their children were delivered by the physicians at the Cass Lake Hospital!

Geisel students started their morning at the cozy house of Tommy and Thea Woon, located in a quiet residential alley in Minneapolis still covered with snow from the night before.

By Jihan Ryu (Photo credit: Michael O'Leary and Di Deng)

Over the course of their spring break in March 2014, 10 Geisel medical students took part in an annual trip to Minnesota to volunteer in Native American communities. Read all the entries from their trip here.

March 16th, 2014: Geisel students started their morning at the cozy house of Tommy and Thea Woon, located in a quiet residential alley in Minneapolis still covered with snow from the night before. Welcomed by hot green tea and hearty Korean-Japanese breakfast (jook), medical students gathered in circle and had somatic experiencing led by Tommy Woon. In a beautiful house that filled with words of wisdom, they were able to release tensions that were carried over from the brutal finals week and be mindful as they prepared to start an upcoming week in Minnesota.

In the afternoon, they crossed the Mississippi River and drove to St. Paul Central High School to help out with concessions and admissions at the Pow Wow event. Many neighbors in town came to see students pow-wow dancing and drumming in front of an excited audience. A collection of Indian jewelry and crafts were on display for sale as well. Decked out in blue volunteering t-shits, students had fun time interacting with the local community and eating some tasty Indian fried bread tacos.

Students wound down their day with the dinner at Dr. Angie Erdrich's house in Minneapolis. Native American musicians and writers in the city gathered; a delicious fusion of Indian street food and wild rice showed up. Time flew by as Geisel students mingled with anyone and everyone in the house, talking about medical school, traveling in Midwest, and a lot of others in between. They surely could not think of a better way to solidify the sense of community that was growing in them.