When I entered pharmacy school, I knew that I wanted to expand my horizons and get experience working with other minority populations in the US. Going out of state to be exposed to pharmacy practice outside of the state of North Carolina was a priority because I knew that there was a chance that I would practice elsewhere. Turns out I'll be pursuing licensure in the state of South Carolina and reciprocating it to the state of Georgia (my pharmacy is located just north of the SC/GA border). However, I wanted to try something completely different. I had heard great things about Indian Health Services (IHS). People spoke of rotations in Alaska, New Mexico, and Arizona. I thought that some of those places were a bit far for one month.
I soon found a UNC graduate who practices in a Warfarin (Coumadin) clinic for the Choctaw Nation in southeast Oklahoma. Her name is Courtney Suggs and she was born and raised in Cary, NC (about 10/15 miles from Durham). I-40 runs from NC to OK so I thought this would be possible and the rest of history. I knew NOTHING with regards to my lodgings, meals, and general feel of the area before arriving on Jan. 31st. Most people would freak out or be worried by that, but I like a sense of adventure and have been through that before (study abroad in Australia and Belize).
For all intensive purposes, I am going to skip the part about the insane amount of snow and ice that fell in this area my first week and a half of living here. It was rare for this part of the state and totally unexpected. I had four full snow days and spent those days watching streaming netflix and reading books/magazines that I brought with me. TALIHINA: a small town of about 1,200 tucked in a valley in Le Flore County, Oklahoma. There is one stop light and a few restaurants that serve VERY VERY unhealthy food. I don't know how Grady would survive here being a vegetarian. The food is free at the hospital for students so I should not complain. There is a post office, two gas stations, and an old fashion/western feel to the 'downtown' area. The Arkansas state line is about 45-60 minutes east of here and the Texas border is about 1 and 1/2-2 hours south of here. All roads have a speed limit ranging from 65-75.
When I think of Oklahoma, I never thought of mountains and pine trees, but that is what this part of the state look likes. The mountains are very low range, but still very pretty. The pine trees remind me of NC. I will say that in my free time it is absolutely boring as hell; but I knew that would be the case.
People of TALIHINA/CHOCTAW NATION: VERY poor, poorly educated, unhealthy (for the most part). That is a general comment not representative of every single person, but it is certainly the case for most. I deal with morbidly obese patients everyday which results in most patients having diabetes and some form of heart disease/lipid disorder. I wonder why these people are like this and it goes back to the same thing everytime: These people were disenfranchised for YEARS by the federal government by being shoved into the old Indian Territory (now Oklahoma). By being forced to assimilate into our society, they emerged poor and unable to 'move-up', per se, in society. Most people around here can't afford much- which puts the purchase of healthy food at a very low priority. Exercise is almost non-existent and when I ask patients if they have had the chance to exercise recently, they tell me that they walked from their car to the clinic or walked their dogs. Not sure how this problem can be resolved, but life here for these people is very different.
I know that the troubles facing the American Indian population are vast with regards to western disease states. I just don't know how the problem will be solved. I am a firm believer in the hospitals that are funded by the federal government to these people and have been impressed by the drug formulary that we have access to for patients. There are multiple drugs in each class to give prescribers options in treating patients: would be a great model for a nationalized system for our country. There are flaws in the system as with ALL systems, but we can always improve.
I LOVE working with this patient population. I think the most work that needs to be done are with these types of patients. Mind you, people in urban areas and with more money to their name need care and management as well. I just get a rush helping the 'underdogs' so to say- optimizing their drug therapy, helping them understand WHY they are prescribed these medicinees and how they will improve their conditions are difficult messages to get across when I am conceptualizing the physiology/pharmacology at my level and I have to convey that information at AT LEAST a fourth an elementary school level without coming across as condescending or that you are making an effort to 'dumb' down the knowledge you are sharing with them. It is a challenge and I love a challenge. It's also an art that I do NOT claim to have mastered- that will only come with time and professional experience. What I do know is that I am learning from these people as well as the other health care professionals I interact with on a daily basis. Pharmaceutical care has the opportunity to take a pivotal and revolutionary role in the rural health setting: if only more of us would seize the opportunity to take it and grow! I hope to develop these skills in my first job at Rite-Aid in Ridgeland, SC. I know it's corporate retail; however, it is the individual delivering the care and represents the face of the profession to that patient. I will strive to deliver this sort of care to this population and can honestly say that this rotation and Indian Health Services is allowing me to grow more and more comfortable at attempting to become proficient in the art of providing care and counseling patients in a rural care setting.
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