2018 REHPS John Fanta

Final Thoughts:

As I wrapped up my final week in Philip I spent time reflecting on how important PHS is to healthcare in western South Dakota. I heard many stories of patients traveling up to 100 miles to see the physicians at PHS. This shows me that there are people who place healthcare as a high priority and are willing to go to great lengths to receive their healthcare. I was very impressed with the quality of care at PHS. Each component of the healthcare team, including nurses, lab, pharmacy, imaging and providers worked efficiently to deliver the best health care possible. This experience has shown me how a good health care facility is so vital for maintaining morbidity free life-spans. Yet, it is clear there are still many people who lack appropriate access. This presents a challenge for public health resources to reach into the rural areas of western South Dakota to make healthcare a priority to people who do not have appropriate exposure. Overall, I had a great experience with PHS and hope to go back at some point in my future.

Week 1:

As I traveled across the state on I-90 I wasn’t sure what to expect from a hospital in a town with less than 1,000 people. What kind of healthcare providers would I encounter? Would there even be anyone out in the middle of nowhere to take care of? After a week of working out here my questions have been answered and the facilities, people, and providers have far exceeded my expectations. The first day we arrived started out with some interesting cases including a serious epididymitis case that was sent out my ambulance to Rapid City. Even though we had just arrived, the PA who was working the case willingly brought us into the ER and, after the patient was stabilized, spent time talking us through the case and why it was so important to get him to a larger facility. These real-life cases in my opinion are invaluable learning experiences that are far more memorable then anything I will read in a textbook.

The next few days I spent time in the medical lab, with X-ray and CT, and with physicians. In the medical lab I was able to see the basic lab testing, but more importantly I was able to talk to the lab group about the benefits and challenges of working in a small lab in a rural area. Although they don’t have all of the latest and most technologically advanced equipment they worked hard to get lab results back in a timely manner. I also learned about the process of acquiring X-ray and CT and how to capture the best images. The imaging group was excited to show me around their machines as well as talk about interesting cases that they had seen over the years. As a medical student I think it is important to learn about these departments because both the lab and radiology are such an important part of making a good diagnosis and providing high quality care.

I enjoyed my time with each physician I shadowed because they each had their own “specialties” and were able to provide me with a unique perspective on medicine. Although intimidating, Dr. Klopper was very enjoyable to work with. He was able to effortlessly empathize with each patient earning and maintaining a good relationship with them. Furthermore, he strongly believed in only ordering tests and prescribing drugs that were absolutely necessary, avoiding needless spending.  In addition to learning from his great clinical skills, I was able to talk with him about his broad life experiences of growing up and living in South Africa where 3rd world living conditions were present. These stories have given me a new appreciation for how the basic necessities of life can have such a big impact on healthcare. Dr. Blackham spent time running me through the assessment for the elderly. Although challenging, this helped me realize that guiding patients at the end of life can make a huge difference for them and their families. Finally, I spent time with Dr. Holman who loves to work in pediatrics. We performed a well-baby exam on twins. He spent time explaining everything he was doing and encouraged me to listen, look, and feel along with him. Learning from physicians with so many different life experiences has provided me with the context of what good medicine looks like.

Week 2:

During week two of my time in Philip I was able to continue learning about the challenges of maintaining a rural hospital and the actions that each department must make to keep the hospital running smoothly. I am very impressed with how each hospital employee is willing to do whatever it takes for patient care quality even if it is outside of their area of expertise. For instance, the lack of IT support makes changing medical records system challenging for all departments. Although not formally trained, each department working diligently on figuring out the new computer system by observing other facilities so that they would be ready to make the switch to the new system. This determination has given me a new appreciation for the amount of flexibility that is required by healthcare workers and the challenge of “wearing many hats” in a rural healthcare facility.

Additionally, this week I was able to observe the team-based atmosphere at PHS and how it is so important to rural healthcare. It was easy to tell that there were positive relationships amongst each of the hospital departments. From custodial services to the physicians, there was no sign of supremacy or arrogance but rather a firm commitment to serving the best interest of the patients. I particularly enjoyed the jovial interactions amongst the physicians, nurses and techs. It was easy to see that these interactions made their work less monotonous and of greater satisfaction. Yet, during serious situations they demonstrated the professionalism required by healthcare professionals. This balance of having fun and being professional is a fine-line but I was very impressed with the overall atmosphere at PHS. I hope to be able to emulate these interactions in my practice one day.

Week Three:

As I continued my experience in Philip during week three I continued to see incredible cooperativity amongst the staff at PHS. This cooperativity came out in full force one night I was called to the emergency room. Upon arriving at the hospital, I was informed that a gentleman was coming in with a heart attack. He was in poor condition as the paramedics had to shock him multiple times. Before the ambulance even arrived, everyone was already working together to prepare for what was to come. Everyone knew their role. The nurses had medications prepared and proper equipment in place, the lab tech was there and ready to begin blood studies, and the technicians were ready to collect their EKG’s and perform X-rays of the mans chest. After several minutes the man arrived, and the team was ready to give him the best chance to survive. I was very impressed at everyone’s composure indicating high quality training and lots of prior experience. Lead by the ER physician, the team was able to stabilize the patient and send him to Rapid City for life-saving cardiac catherization procedures. This was my first time experiencing such a serious ER scenario and seeing how everyone came together to save this man has made me excited about becoming a leader of my own healthcare team.

Week Four:

During the last week one of the most interesting thing we did was spend time with the public health nurse. She was very passionate about her job and provided great insights into the rewards and challenges of working in a rural healthcare setting. I realized how important public health authorities are in working with people of low socioeconomic status. She was often their first point of contact and an important entrance for these people into the healthcare system. This experience was a great exposure to public health and has positively influenced my perceptions of the field.