Learning How Healthcare Could Be

 

 

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For some medical students at Georgetown, there is no better way to understand cura personalis than to work as a physician on one of America’s Indian reservations.

The Jesuit principle of care for the whole person matches closely in spirit to belief among Native Americans that health and community are strongly interwoven. Or so says class of 2010 medical student Rafael Garabis, who volunteered to work with Indian Health Service (IHS) physicians on the Zuni reservation in New Mexico in the winter of 2008. “My experience with the Zuni was a breath of fresh air,” he says. “The physicians at Zuni were role models in their commitment to building a healthy community, spending as much time on prevention as on treatment. They saw the patient as a person, and the person as part of the community, and the community as sacred.”

Garabis says the experience convinced him to become a family physician and a health advocate for his patients.

That happens quite often, says Ranit Mishori, MD, MHS, an assistant professor and director of the family medicine clerkship in the department of family medicine. “Many students who go to Indian reservations end up choosing primary care, including family medicine as future career choices,” she says. “They come back really happy, with a whole new outlook on what health care should be like.”

The opportunity to work with IHS physicians on one of three different reservations (for Zuni, Hopi, and Navajo tribal nations) is an option in the family medicine clerkship, which provides third year students with an overview of the specialty of family medicine, residency training, practice patterns, and common diagnoses seen in the family physician’s office. Students can do the clerkship in the Washington, D.C., area with a family physician or can do so at away sites, which includes rural locations, such as in eastern West Virginia, or on one of the reservations.

Mishori believes the clerkship is the only program of its kind that gives students an opportunity to do an away rotation and says the reservation rotation has been possible for about a decade. Last year 36 students did away rotations, and of those, twelve went to reservations. It was an honor, Garabis says. “Zuni only takes one med student at a time to work with 15 physicians. For a kid from Ohio, it was just remarkable.”

Working as a physician on an Indian reservation is quite a different experience compared to providing health care in most of the rest of the country, says LeManuel Lee Bitsóí, EdD, an assistant professor in the department of human science at the O'Neill Institute for National and Global Health Law, a joint effort between Georgetown University Law Center and Georgetown University School of Nursing & Health Studies.

“Often times the health care system is very sterile. Many times a patient doesn’t even see their physician,” says Bitsóí, who is Navajo and who leads an indigenous genomics project at GUMC. “But IHS members become part of the community. They build trust with the people and therefore their care is much more effective,” he says. “There is the sense that they are involved in healing the entire person. As Native Americans, we believe in being in balance and harmony within ourselves. Thus when something is out of balance in my life, it may have a physical effect on me.”

“We generally practice full-spectrum family medicine, one of the few settings where that is still done,” says Douglas Zang, MD, of the department of family medicine at the Northern Navajo Medical Center in Shiprock, New Mexico. That means physicians take care of patients across the life spectrum, provide both inpatient and outpatient care, including obstetrics and labor and delivery. “IHS also utilizes medical homes, and integrated, multidisciplinary community-based primary care, emphasizing prevention,” he says.

“These concepts are increasingly prominent in the current healthcare debate, but have been the IHS system of delivering care for decades,” Zang says. “It is also a universal system, free to all beneficiaries, and we are able to achieve good outcomes in an extremely cost-effective manner.”

“That is the way to go in health care, in my opinion,” says Mishori.

Georgetown University medical students seem to understand that, and to succeed at offering this kind of care, according to Zang and John Miller, MD, PhD, who works with the IHS hospital on the Zuni reservation in New Mexico.

“Georgetown University students have very strong social skills, relating well to others and adjusting to what is asked of them, and demonstrate interest and caring for the patients and the community,” Miller says.

He cites the example of third year student Michael Rasmussen, who ran a 5K race during his 2008 rotation, “in a very close push to the finish with a Zuni man about his age.

“It wasn’t so much that he won, which was impressive considering the demands of medical school and the fact that he was coming from sea level, but the way he went right to the other man and offered immediate congratulations on a great effort, and an exciting race,” Miller says. “He had that kind of humility and engaging personality.”

Zang also complements the students. “The GUMC students have all been very strong academically, but also very enthusiastic about learning about the community and the Navajo culture,” he says. For example, he says, several years ago Georgetown student Lauren Rebecca Good began a foundation that donates used mountain bikes that can be refurbished for reservation residents, as a way to foster both fitness and bicycle maintenance skills for adolescents in remote communities. “This was an excellent example of addressing medical issues, such as diabetes and obesity, through a community-oriented, public health approach,” he says.

Aaron Laviani, who will do his rotation at the Navajo nation next February, is pursuing a surgical subspecialty but he knows that can change.

“I am actually finding myself more excited than nervous about doing this rotation in such a rural area,” he says. “I really tend to jump at the ability to explore different parts of the world, learning about the different ways of life and the vast array of cultures and customs that our planet offers.

“This has always been something that has fascinated me, and recently it has allowed me to realize that more often than not, there's not a definitive answer to medicine,” Laviani says. “Instead, before formulating a plan it's necessary to truly understand the patient's beliefs and values and what is most important to them. This, to me, is one of the most exciting parts about medicine and I cannot wait for this rotation.”

By Renee Twombly, GUMC Communications