On Sunday, a second volunteer team departed for South Dakota. The team has 3 components: providing gastroenterology services at Rosebud Indian Health Service (IHS) hospital, holding women’s health & family medicine clinics at the Wanblee IHS Clinic on Pine Ridge, and providing behavioral health training to several partnering organizations on Pine Ridge. This first blog entry is written by volunteer Dr. Scott Rathgaber, gastroenterologist and CEO at Gundersen.
The GI Team (Jenny, Tammy, Beau, Scott) arrived safely on Sunday evening under the able leadership of Dr. Thurman. Great conversation on the ride out as the team got to know each other better. We met Suzanne England who proceeded to get us settled in our housing and gave us a community tour. After the long drive, I must admit that I slept quite well that night.
Up early on Monday morning we arrived for orientation but first were able to sit in on their morning reporting rounds led by Dr. Siemens. Very interesting to see representatives from all disciplines discussing what happened over the weekend, the plan for the current inpatients, and what resources would be needed that day. Very collaborative and an enviable venue for communication across the whole hospital. Reminded me of morning huddles at home. The hardest part is when they have to determine which patients have problems severe enough to warrant referral out to regional health centers for specialty care because there is not enough money in their budget to help all. Chronic issues have to wait otherwise they run out of money by the end of the year and cannot get emergency care completed. By providing care in Rosebud for cases otherwise needing to be referred out (ie the surgeries Dr. Johnson did last week) much money is saved to be used for others. A single medical flight to take a patient to Sioux Falls or Rapid City can cost $30,000. Global Partners is really helping in this regard.
We were then oriented with a cultural video that helped explain some of the trauma of the area residents based upon their history of interaction with the US government. The morning took an unexpected turn when CMS (Centers for Medicare & Medicaid Services) appeared unannounced for their certification survey of the hospital. Yes, this is their version of the Joint Commission. What a week to be here. The staff took the visit in stride and it really did not impact our work at all. The staff had the same anxiety we have at home when the surveyors arrive but also showed the same professionalism in meeting the challenge. (A pause to recognized the surveyors who related that last year they were sent to North Dakota for a survey when the temperature plunged to 50 below zero!)
The GI team started seeing patients at noon. Two colonoscopies on the schedule but a third showed up (prepped) and another arrived for a consult. We gladly saw them all. The afternoon went smoothly as our team worked well with the OR staff. The Rosebud staff were very friendly, happy we were here to help their patients, and were eager to assist us in any way they could. Very enjoyable. We removed 10 polyps in three patients; so, we felt we had provided value.
We ended the day with an informative and inspiring talk by Mr. Hollow Horn Bear. He is a traditional chief of the Lakota people, a university professor in Native American studies, and a Lakota language speaker. He was fascinating as he explained some of the Lakota philosophy and summarized their creation story. His great grandfather was the lone survivor of a massacre by the US military at the age of four. We returned to our housing where we had consumed a couple of pizzas prepared thanks to the expert knowledge of Jenny and Beau and the Euchre games were split 1 to 1.
As I drifted off to sleep, I reflected upon the great opportunity we have been granted to add our skills to this healthcare system. I feel grateful for the willingness of the people to welcome us so warmly. The only anxiety moment for me was when one of the doctors, thinking I was a surgeon, asked if I would be okay doing any emergency surgery that might come in to the ER such as an appendectomy. After initially going pale, I assured him that since I was only a gastroenterologist, I would not be able to do such surgeries. And we like their patients too much to subject them to my non-existent surgical skills. We all had a nice chuckle. Well, off to start our second day.