Learning the Value of Community With the Indian Health Service

When one thinks of a pharmacist, most people’s first thought may be of the person standing behind the pharmacy counter at a local Walgreens or CVS, or a bustling hospital located in the centers of the biggest metropolitan cities in the world. However, in rural communities—particularly in Native American reservations—the pharmacy environment looks a bit different, and the role of the pharmacist in these communities is heightened in scope.

For Native American reservations, medical services are provided by the Indian Health Service (IHS), which is an operating division within the US Department of Health and Human Services (HHS) and US Public Health Service (USPHS). IHS provides direct medical and public health services to 2.6 million American Indians and Alaska Natives in 37 states.¹

Beyond providing care for indigenous populations in the United States, the USPHS also provides a pathway for students to work within these federal agencies through their Junior Commissioned Officer Student Training and Extern Program (JRCOSTEP).

For the summer of 2021, I had the opportunity to work as a Junior Commissioned Corps Officer at the Crow Service Unit in Crow Agency, Montana. JRCOSTEP students within IHS are those who pursue medical education and work as “seasonal” staff at the service unit. My main duties were to assist in the prescription flow in the outpatient pharmacy by filling, dispensing, restocking, and ordering medications, as well as working in the inpatient pharmacy by restocking the emergency room, inpatient clinics, and assembling crash carts.

As I look toward the start of my first professional pharmacy year, I’ve been thinking about the kind of pharmacist that I want to be in the future and whether I want to specialize in a specific area. Working in a clinical pharmacy has helped show me the varied roles a pharmacist can have, even within 1 hospital.

During my externship, I briefly shadowed Crow’s Pharmacy Informaticist, Kelsey Kroon, PharmD, to learn how drugs were entered into the system for use by providers and verification by other pharmacists. Kroon is responsible for updating the information on what drugs could and could not be accessed on Electronic Health Record (EHR) drug menus, following Pharmaceutical and Therapeutics Committee Meetings with other departments.

When supporting Kroon in this process, I was able to verify the EHR drug menu to see that the antibacterial options were up-to-date with advised first-, second-, and third-line of therapy, and so on. Furthermore, I double checked, revised, and formatted comments in the outpatient formulary excel spreadsheet.

One of the most interesting parts about the externship was working at the satellite clinics in Lodge Grass and Pryor, both located in Montana. Although both locations were hour-long drives from where I was living and located in the most rural parts of the reservation, these clinics are vital to the locals who cannot afford to make the lengthy trip to the Crow Service Unit. Without these satellite clinics, it would be difficult to ensure medication adherence and to monitor the effects and implementation of certain treatments. In emergencies, these clinics can immediately provide the stabilizing care that a patient may need until it is possible to transfer them to a larger service unit.

As part of pharmacy staff, I was able to engage in meaningful discussions with many of the pharmacists, physicians, nurses, dentists, and administration at the Crow Service Unit. Many of the health care workers at IHS are commissioned officers, which was extremely helpful in learning about what the process of working as an officer was like, why they decided to join, and what their experiences were like at other facilities. Dean Goroski, director of pharmacy at Crow Service Unit, has been with the USPHS as a commissioned officer for many years. This wealth of wisdom helped me develop a clearer picture of the types of careers available to pharmacists when working for the federal government.

The relationship between the federal government and Indian tribes was established in 1787, based on Article I, Section 8 of the Constitution of the United States.¹ As the primary federal health care provider for natives, IHS continues to work to raise their health status to the highest level.

The IHS focuses on specific areas, such as encouraging natives to get the COVID-19 vaccine to help decrease overall deaths from COVID-19, as well as helping with the management of diet, nutrition, and exercise to reduce rates of obesity, heart disease, and diabetes on the reservation. The IHS also delivers sex education courses to support a reduction in teenage pregnancies and the spread of sexually transmitted diseases.

The focus on education and support can be seen throughout the clinic on posters and desktop screensavers that display facts about the importance of receiving vaccinations and getting tested for COVID-19, in addition to information on diet and safe food storage.

These educational efforts seem particularly effective as 71% of the IHS employees are Native Americans.² Amber Walks Over Ice, PharmD, deputy chief pharmacist of the outpatient pharmacy at the Crow Service Unit, is originally from the native community in Flathead County, Montana. Most of the pharmacy technicians are native Crows, but some, like Jennifer Lawton, CPhT, are Navajo. As the vaccination rates slowly increase within the Crow reservation, the efforts of the IHS team at the Crow Service Unit become more visible.

Every summer, Crow Agency hosts Native Days, a series of events and festivities where members of the tribe can exhibit their physical and mental skills through competition. The main events include the rodeo, relays, arrow tournaments, and the Ultimate Warrior races, which involve a mile-long canoe race, a 6-mile foot race, and a 6-mile horse relay. There are also prayers, parades, and a powwow.

During my time at the Crow Service Unit, I was fortunate enough to watch the women’s Ultimate Warrior race alongside one of the native pharmacy technicians, Randa Black Eagle, CPhT. As part of the crowd, I could see how Native Days brought everyone together.

The time I’ve spent in Montana as a JRCOSTEP student has been invaluable. Beyond gaining experience in a clinical pharmacy, I have been able to interact with the Crow tribe—whose autonym is Apsáalooke, or Absaroka—both personally and professionally, which is something not many Americans have done. Since the Native American reservations are sovereign states and do not often house outsiders beyond IHS staff, most people have no concept of what it means to be Native American in the 21st century.

Natives’ most frequent media representation features a bow and arrow and a feather, and they’re often depicted as wild or savage—even today, in some Scholastic textbooks. However, the Native American population is not something of the past, and they are not relics of a time long forgotten. They are alive and have survived years of genocide. Today, they are continuing to revive their culture and heritage through language, Native Days, social events, like Crow Fair, and the employment of natives within IHS.

It may sound counterintuitive, but what makes a pharmacist great at their job is not just their understanding of pharmaceuticals, but their ability to show empathy for a patient. For this reason, my time at the Crow Service Unit taught me that truly great pharmacists strive to understand their patients’ way of life, their struggles, and their victories.

The road to becoming the greatest health care provider I can be is not just through school, but through genuine interactions with the humans I serve as well. This is why serving as a JRCOSTEP student at the Crow Service Unit remains instrumental in my understanding of who I want to be in my role as a pharmacist in any community I may work in, in the future.

Had it not been for my participation in the JRCOSTEP program, I would never have encountered the strength and resilience of the Crow tribe. The time I have spent with the USPHS will stick with me for the rest of my career. Despite working in the Crow Service Unit for only 3 months, the time I spent there made me excited for the rest of my journey as a student. One day, as a licensed pharmacist, I will have the opportunity to help make my community healthier, which is a goal I know I can be proud of.

REFERENCES

1. Indian Health Service. July 20, 2021. Accessed August 17, 2021. https://www.ihs.gov/aboutihs/
2. Indian Health Service Fact Sheets. US Department of Health and Human Services-Indian Health Service. March 6, 2008. Accessed August 17, 2021. https://web.archive.org/web/20080423193111/http://info.ihs.gov/Profile08.as