Medical students Randall Waldner, left, and Paul Rozeboom, right, enjoy the reaction of this elementary student at the Pierre, S.D., Indian Learning Center as he examines an X-ray image of a human hand.
Medical students visiting the Pierre Indian Learning Center pose in front of their nutrition poster as they prepare to talk with the students about making healthy food choices.
American Indian children and adolescents who are residents at the Pierre Indian Learning Center gather around visiting medical students for a presentation on personal hygiene.
First-year medical students from the University of South Dakota's Sanford School of Medicine pose for a photo inside the South Dakota Statehouse in Pierre. The annual excursion allows the students to meet with state legislators.
Susan Anderson, M.D., of Canistota, S.D., population 700, describes her state as a "big small town where everybody knows each other and is involved in a lot of things."
South Dakota is largely rural with a frontier feel, says Anderson, a family physician and past president of the South Dakota Academy of Family Physicians (SDAFP). All of that wide open space is interspersed with pockets of underserved populations, all of whom need a source of good primary health care.
In 2013, the U.S. Census Bureau estimated the state's population at about 833,000, with a population density of just 10.9 people per square mile, putting it at 46th out of the 50 states. South Dakota also is home to a large American Indian population -- totaling about 9 percent of the state's total population -- that includes six Indian reservations and three tribal land areas.
- The South Dakota AFP (SDAFP) has accepted the challenge of helping fill the state's physician workforce pipeline to ensure that the state's medically underserved populations have access to good primary health care.
- The SDAFP works closely with the University of South Dakota's Sanford School of Medicine Department of Family Medicine to support a number of programs, including a service trip to a residential school for American Indian students called the Pierre Indian Learning Center.
- The chapter also throws its support -- both financially and in volunteer manpower -- behind South Dakota's Area Health Education Center program and the Health Occupation Students of America program.
Anderson, who in June will take the reins as chair of Department of Family Medicine at the University of South Dakota's Sanford School of Medicine in Sioux Falls, has been collaborating with others around the state to help ensure a workforce pipeline filled with medical students who will see the need and heed the call to train in, and stay in, the state.
Service Learning Project Opens Eyes, Hearts
In 2012, SDAFP Chapter Executive Carletta Hauck wrote a grant to establish funding that ultimately would take Sanford's first-year medical students on a required service learning project to the Pierre Indian Learning Center (PILC)(pilc.k12.sd.us), an academic residential facility for American Indian children from kindergarten through the eighth grade.
The children are voluntarily enrolled at the school by parents, grandparents or guardians and often are in need of medical care. For instance, in the 2011-12 academic year, 83 percent of the student body was documented as homeless. Students were treated for multiple ailments, including strep throat, staph infections, urinary problems, skin sores, rashes and ear infections.
"We take children who have not been successful educationally anywhere else," said PILC Residential Director Robert Hockett. Many of the children come from homes where "learning is secondary," and home life is part of the problem rather than the solution.
At PILC, "students thrive under the structure the school provides," said Hockett, who also serves as the school's social worker. "Here, they have a bed, they have a room and they have a bed time," said Hockett of the 168 students on campus in April 2014.
This past February, a fresh group of medical students disembarked from a long bus ride to spend some special time with children at the school.
"Our medical students don't necessarily know the degree of need there is, even in our own state, as far as health care and primary care, and so we try to expose them to that as much as we can," says Anderson.
"We know there aren't enough health care providers in our rural communities and in reservations in South Dakota," she says. However, "Family medicine is the flagship department of our medical school, and it's part of our mission statement to provide family physicians for the people of this state and, particularly, in underserved areas.
First-year medical student Matt Hustrulid uses a model of a human hand to totally engage two students at the Pierre Indian Learning Center during a small-group presentation on muscles and bones.
"This service trip to Pierre helps to highlight that."
Medical Students Share Experiences
Medical student Ryan Buse was among the medical students who made the now-annual February trip to the school. The students split into groups to present a mini health fair for students, and Buse's group focused on nutrition.
Buse first entertained the children with audience-participation magic tricks and then transitioned into a discussion about making good food choices "During the card tricks, their eyes lit up, and I knew they were ready to listen to the important stuff," he told AAFP News.
Keely Krolikowski was on the same bus trip, but chose an alternative school site option -- St. Joseph's Indian School(www.stjo.org) in Chamberlain, S.D., also a residential facility for Indian students.
Krolikowski told AAFP News that during her visit, the high-school students initially seemed distant. But when Krolikowski revealed her upbringing on South Dakota's Pine Ridge Indian Reservation, the atmosphere changed.
As this first-year medical student began to break down the social barriers, the high-school students seated around her began to see a glimpse of what could be their futures.
"We all started at the same place. You can better yourself," Krolikowski recalls telling the group after supper as she encouraged them to consider health care careers and investigate Indian Health Service scholarship programs. "You've just got to be willing to put in the work and the dedication," she told them.
Looking back, Krolikowski says the trip to Chamberlain solidified her decision to become a family physician and to return to the culture and environment where she was reared. "That's where I fit, and because of my background as a tribal member, maybe I will be able to make a difference," she says.
Facts About the South Dakota AFP
Chapter executive director: Carletta Hauck
Number of chapter members: 576
Year chapter was chartered: 1951
Location of chapter headquarters: Watertown
2015 SDAFP Winter Seminar: Jan 22-24, Deadwood, The Lodge at Deadwood
That kind of outcome is exactly what Anderson likes to hear. "Statistics bear out that often members of diverse populations will go back to serve their population as a health care provider. So we need to engage those young people and get them interested and help them succeed in a health care field," says Anderson.
"And then, if they desire it, they can go back and serve their family and friends."
Organized Programs Gain a Foothold
Getting South Dakota students to think about careers in medicine is an ongoing project on many fronts. For instance, the federally funded Area Health Education Center (AHEC) program(www.usd.edu) now sports two centers in the state.
The idea behind AHECs, a nationwide program that launched in 1971, "is to get kids interested in health care careers and get them trained and into areas of need," says H. Bruce Vogt, M.D., the soon-to-retire chair of Sanford Medical School's Department of Family Medicine and the current program director for the state's AHEC.
In 2012, the South Dakota AHEC launched the state's first Health Occupations Students of America (HOSA) program(www.hosa.org). In just one year with financial support from the SDAFP, the HOSA program -- an outreach initative designed to introduce primarily high-school students to health care career possibilities -- grew from seven chapters and 284 student members to 12 chapters and more than 400 members.
"It's a great thing for our state, and it's all about health occupations," says Vogt.
"The South Dakota Academy provides tremendous organizational support of the medical school and the AHEC and HOSA programs, and is an extremely close partner in all of these activities," Vogt adds.
Looking to the Future
Elizabeth Gravley, M.D., was installed as the SDAFP president in February. She told AAFP News that for nearly 16 years, she has provided clinical, hospital, emergency room and nursing home services for patients in her rural community of Webster, population 1,800.
She feels fortunate to have graduated from the state's short-lived rural training track residency. "The year I graduated from the residency, the rural program was discontinued due to lack of funding," says Gravley. "The program directly contributed to my decision to pursue rural medicine in South Dakota," she adds.
Gravley says she is "acutely aware" of the importance of how South Dakota's aspiring physicians are trained. "Training students and residents in community-based settings and providing access to rural experiences will encourage our future family medicine specialists to practices in rural locations," she says.
According to Gravley, the SDAFP's decision to fund the HOSA program was directly tied to the chapter's ability to share the story of family medicine with high-school students, get involved with those students in their communities and then encourage them to pursue careers within the field of medicine.
After seeing the tremendous success of the high-school HOSA, Gravley would like to see the SDAFP fund a HOSA chapter for college students. But beyond that, she has an even bigger dream. "Much larger future goals for the South Dakota AFP would be to support any and all efforts to reinitiate a rural residency training program in family medicine," says Gravley.