Third Year Family Medicine Clerkship student handbook searhc – mt. Edgecumbe hospital

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Third Year Family Medicine Clerkship student handbook

Welcome to Sitka and Mt. Edgecumbe Hospital. We hope that you have a great visit and enjoy learning and practicing family medicine here in Sitka. What follows is an introduction to our hospital, our history, our patients, and an overview of our process. We have also outlined our expectations for you as well. It is important that you take the time to read through this handbook before orientation begins.

  1. History and Organizational Structure

South East Alaska Regional Health Consortium (SEARHC) Mt. Edgecumbe Hospital is a 27- bed general hospital with active inpatient and outpatient services. The hospital serves as a primary source of medical care for Alaska Native people living in the Mt. Edgecumbe hospital service unit and is a referral center for 18 communities throughout Southeast Alaska. The service unit covers all of Southeast Alaska (approx. 35,138 square miles). The hospital exists as a tribal health corporation called SEARHC, which was created out of the Indian Self-Determination act (aka “a 638-pact”). The company is a cooperative of the federal health dollars from all of the distinctive tribal groups within this service unit. The money these tribal groups receive from the federal government to fund their health care is pooled under the auspices of the SEARHC company, and used to operate all of the various activities of the company. The hospital is just one part of the health care system. There are 12 clinics in outlying communities, including a large clinic in Juneau called the Ethel Lund Medical Center (ELMC). There are preventive health services and injury prevention services. There are mental health services as well. The mental health clinic is called Haa Toow’oo N’aakw hit (poorly abbreviated and pronounced by many people as simply “clinic two”). In Sitka and in most outlying communities, SEARHC serves not only the Alaska Native population, but non-native populations as well. This has not always been the case, and you may notice that the health care system in Sitka is somewhat segregated between the native and non-native community. SEARHC is funded in small part by direct payment from the federal government for tribal health care. Tribal health facilities such as SEARHC can also bill private insurance, Medicare, and Medicaid for services, just like any other hospital.

The history of Mt. Edgecumbe Hospital is interesting and complex. Briefly, the hospital was built in the 1940s by the federal government as a response to the military threat posed by the Japanese in the North Pacific. Following the 2nd world war, there were tuberculosis outbreaks throughout Alaska and amongst the Alaska native people. The hospital facilities were transferred from the department of war to the Bureau of Indian Affairs, and the hospital served primarily as a tuberculosis sanitarium throughout the 1950s. It is important to recognize the sadness this time period brought many native people in this part of Alaska, as many died of tuberculosis. Many were brought in to Sitka from their remote villages. Some patients died and were buried here. Others spent many months and even years living in Mt. Edgecumbe Hospital and the surrounding buildings while they recovered from tuberculosis. Many of the older native patients you may care for may have been patients here when they were children during the times of the tuberculosis epidemics. They may be able to tell you some things they remember from those years, but this topic should always be approached with great respect and sensitivity.

Community “village” clinics: Small satellite clinics exist in the number of the surrounding communities, and they are mostly owned and operated by SEARHC. These clinics are staffed by community health aide practitioners (CHAPs), nurse practitioners, physician assistants, and community family service workers. The smallest clinics may only have a CHAP present. A CHAP is a distinct form of medical provider who is a resident of the village where he or she works. They have been given several intensive 6 week training courses in the practical care of common medical problems. The training level can be thought of as something akin to a paramedic with ambulatory care skills. They use the Community Health Aide Manual (CHAM) to help them through their encounters with patients. Spend some time reading through the CHAM, and feel free to reference if during your time in clinic. If you interact with health aides, pay attention! There are some outstanding health aides in this consortium, and you could learn a great deal from them. The larger outlying clinics such as Juneau, Haines, and Prince of Whales Island (Klawok and Craig) have physicians on their staff. The health care providers from these outlying clinics are in contact with physicians at Mt. Edgecumbe hospital on a regular basis to discuss the care of patients and to arrange transport to Sitka via medevac or commercial flight for those needing hospitalization. This aspect of “radio medical traffic” is unique to rural Alaska practice, and requires excellent communication skills, patience, and good triage skills. Try to listen in as your attending physicians in Sitka take calls from the field.

Specific members of the medical staff are assigned to specific villages. For example, Dr. Vega is assigned to Angoon, and Dr. Edwards to Kake. These physicians are responsible for supervising the medical care within that clinic and being a liaison for patients from that clinic to the hospital and the rest of the system. These physicians also travel to their respective clinics for “field health clinics” four times a year.

Hospital Services: There are a wide variety of ancillary services available at MEH. This includes radiology, laboratory, pharmacy, optometry, dental, audiology, and respiratory therapy. In addition to the primary care staff the medical staff also includes a general surgeon, Dr. McPherson and one OB/GYN, Dr. Salinas; and an ENT, Dr. Ainsworth. The ground level of the hospital has business offices, surgery clinics, the ER, respiratory therapy, and the cafeteria. The first floor has primary care clinics, radiology, pharmacy, physical therapy, optometry, and dental clinics. The second floor has labor and delivery, general surgery beds, the operating room, and the 3 bed critical care unit. The third floor has the “acute medical service” or general medical-surgical beds as well as perioperative services. The fourth floor has medical staff offices and business offices.

Role of primary care physicians- the primary care doctors are grouped into 3 “pods”. Within each pods the physicians will cross-cover each other’s patients and share nurse case management support. There are midlevel providers on staff who float between pods and do mostly walk-in care. Each week one of the family physicians is assigned to be the officer of the day, or “OD”. That person covers the inpatient service from 8am-5pm M-F. He or she will also see patients in the ER, and take a large volume of calls from outlying villages. The physicians who are seeing patients in the outpatient clinic may also be on call for obstetrics, inpatient pediatric backup, and be taking calls from his or her outlying village.

  1. Culture

Tlingit (roughly pronounced Khleen-kit) culture: A large number of the patients you’ll be seeing at MEH are Alaska native people – mostly Tlingit. Some of them are Tsimshian and Haida whose home territory is further to the south from Sitka. There are also Native Americans from the lower 48 and indigenous people from Canada. The native people in Sitka take great pride in their culture. The Sitka native people have one of the highest rates of college education of any tribal entity in the country. Many of them own businesses, participate in local government, and hold leadership positions in the school district. Inter-marriage with non-native people is common, and many multi-generational families in Sitka and throughout southeast Alaska have both native and non-native members. (Please be aware of the fact that many of the native people you will interact with will not likely fit any stereotypes you may have had about native people. For example, your patient may not look any different than a patient you may have seen or cared for in the lower 48, but they may have a distinctly different outlook and way of life.)

For many of the Native people in Sitka and for most of the residents of Sitka in general, subsistence activities are an important part of daily living. A recent study looking at Sitka households showed that the average Sitka household consumes more than 600 pounds of food annually, which they collect themselves. For most Native households, this number is probably three to four times higher than that. In spite of the cultural richness which you will see here, it is also true that Native people in Sitka and throughout southeast Alaska have much higher rates of unemployment and face many health challenges at higher rates than the rest of American culture.

You will have a number of extra assignments to complete during your time in Sitka and the 1st of these assignments revolve around issues of cross-cultural communication and Tlingit culture. There are a number of other cultural activities that occur seasonally in Sitka throughout the year and we will do our best to identify those and try and get you involved if you are interested.

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