Indian Health Service

I got the opportunity to make house calls with a doctor working with the Indian Health Service (IHS). We went to the reservation of the Kashia tribe, about an hour and a half away from Santa Rosa in the secluded mountains. Doctors visit the tribe about twice a month to check up on patients (especially the older ones) who cannot make it down to the nearest city to see the clinic. In the morning, we loaded up the van with five huge crates of charts (since we could potentially see anyone on the reservation) and two large boxes of medications. We set off for Healdsburg, a really cute town to get some breakfast, and then off to the mountains. It was fun touring the area, passing by several vineyards, Sonoma Lake camping grounds, and the winding deserted mountain roads.

The reservation itself is a really moving experience. It is composed of 20-25 homes and a school for grades 1-8. The nearest town is an hour away. Few teenagers are willing to do the daily commute to go to high school. A lot of the teenagers work at nearby cities or wineries. Much of the food is surplus commodities given to the reservation. The roads are dirt roads. The resources are scant. Unfortunately, the Native American culture has been diluted down by various factors; divides within the tribe due to different religions, arguments over the importance of tradition. Most of the homes were in various degrees of disarray. I was really affected by everything. This is what it means to be in a low socioeconomic underserved population.

We made house calls and all the patients we saw were obese, hypertensive, and diabetic. I really see how difficult it is to change diet, motivate exercise, manage medications. The patients were 200 or 300 lbs struggling to get by the day to day, not even thinking about complications of their diseases down the line. It's easy in an office to expect patients to manage their diseases by changing lifestyles and taking drugs. This made me realize how awfully difficult reality is. The patients, though, were really glad to have me and the doctor come into their homes and talk to them about their lives and functional status.

The sad truth is the Indian Health Service is a well run federal health care provider. The clinic at Santa Rosa is fairly impressive. They send up medications to the tribe every other week. There's health care access despite the poverty. And yet, these chronic diseases exert their toll. How we can change this, I don't know.